Nervous System Diseases Commons^™

Tiny But Mighty, An Exploration Of Microbes And Plants As Sources Of Small Novel Bioactive Compounds Against Invasive Mycoses., Hannah Mai Peacock, James Anthony O'Connor

SURE Journal: Science Undergraduate Research Experience Journal

Despite the high mortality rate involved with invasive cerebral mycoses, there is a relative lack of research available around antifungals capable of crossing the blood brain barrier.

In this study the metabolites of four plants (Crocus vernus, Miniature Narcissus (daffodil), Osmanthus delavayi and Taraxacum officinale (common dandelion)) and two bacteria (Lacticaseibacillus paracasei and Staphylococcus epidermidis) were extracted and assayed for antifungal activity against Candida albicans and Saccharomyces cerevisiae. Thin layer chromatography and bioautography were then employed to assess the activity of the constituent components of sources showing antifungal activity.

Metabolites of S.epidermidis, and extracts …

Arachnoid Webs With Spinal Cord Compression: Insights From Three Cases, Kaleb Derouen, Kierany B. Shelvin, Tayler Payton, George A. Crabill, John M. Wilson, Gabriel Tender

School of Medicine Faculty Publications

Spinal arachnoid webs are intradural bands of abnormally formed arachnoid tissue, located within the subarachnoid space and causing compression of the dorsal aspect of the spinal cord. Arachnoid webs are uncommon and can be difficult to treat. We report 3 patients presenting with a spinal arachnoid web within a 6-month period. All of them exhibited signs of thoracic myelopathy and the MRI showed the pathognomonic 'scalpel sign'. Two of the patients underwent surgery for removal of their spinal arachnoid web, whereas the third patient case is currently being managed conservatively. We also present our 2D intraoperative video for arachnoid web …

Differential Diagnostic Considerations In A Patient With New Onset Apathy: A Case Study On Frontal Lobe Glioblastoma Multiforme, Joy Zarandy, Sarah Yoon, Sharnikha Saravanan, Sanjana Das, Sarah Thomas

The Journal of Integrated Primary Care

This case study involves a 50 year-old previously healthy female presenting with a two-week history of clinically significant apathy. The patient and her family assume her symptoms are due to a potential underlying psychiatric condition; however, neurologic and systemic disorders should also be considered when evaluating a patient with sudden personality change. After a thorough history and physical exam, further evaluation with neuroimaging is performed due to suspicion of neurological etiology. A sizable ring-enhancing lesion in the frontal lobe is noted on MRI, and a diagnosis of glioblastoma multiforme (GBM) is confirmed with biopsy. GBM, or grade 4 astrocytoma, is …

Cytomegalovirus And Varicella Zoster Virus Coinfection-Associated Central Hypoventilation Syndrome (Ondine's Curse), Marine Isakadze, Benjamin Zwain, Alan J. Velander, Jesus Lovera

School of Medicine Faculty Publications

Central hypoventilation syndrome (CHS) is a rare condition resulting from damage to the respiratory centers in the central nervous system (CNS). It can be congenital or acquired and can cause hypoventilation, inadequate gas exchange, and respiratory failure, often during sleep but sometimes even while awake. CHS can lead to respiratory failure and life-threatening complications if not identified promptly. In this report, we present a rare case of a patient with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), who developed CHS likely due to an opportunistic infection by cytomegalovirus (CMV) and varicella zoster virus (VZV), manifesting as a lesion in the …

Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sánchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Trisha M. Keshar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background

Objectives

Methods

Using Digital Assessment Technology To Detect Neuropsychological Problems In Primary Care Settings, David J Libon, Emily Frances Matusz, Stephanie Cosentino, Catherine C Price, Rod Swenson, Meagan Vermeulen, Terrie Beth Ginsberg, Adaora Obiageli Okoli-Umeweni, Leonard Powell, Robert Nagele, Sean Tobyne, Joyce Rios Gomes-Osman, Alvaro Pascual-Leone

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

INTRODUCTION: Screening for neurocognitive impairment and psychological distress in ambulatory primary and specialty care medical settings is an increasing necessity. The Core Cognitive Evaluation™ (CCE) is administered/scored using an iPad, requires approximately 8 min, assesses 3- word free recall and clock drawing to command and copy, asks questions about lifestyle and health, and queries for psychological distress. This information is linked with patients' self- reported concerns about memory and their cardiovascular risks.

METHODS: A total of 199 ambulatory patients were screened with the CCE as part of their routine medical care. The CCE provides several summary indices, and scores on …

Falling Into Action, Kent Hoffman

The Goose

Kent Hoffman explores human movement, his own mobility, and how it influences the way he moves on land. This personal essay, told through the lens of disability and accessibility, outlines his experience of living with Becker muscular dystrophy. Hoffman's approach to walking and mobility is heavily influenced by a fear of falling. As his mobility is changing, he's adapting and seeking out new ways to move on land. Different modes of mobility determine the way we experience personal movement, but accessibility determines who is welcome in spaces in the first place. Accessibility in the form of providing equal access is …

Erythrocyte–Brain Endothelial Interactions Induce Microglial Responses And Cerebral Microhemorrhages In Vivo, Hai Zhang, Rachita K. Sumbria, Rudy Chang, Jiahong Sun, David H. Cribbs, Todd C. Holmes, Mark J. Fisher, Xiangmin Xu

Pharmacy Faculty Articles and Research

Background

Cerebral microhemorrhages (CMH) are associated with stroke, cognitive decline, and normal aging. Our previous study shows that the interaction between oxidatively stressed red blood cells (RBC) and cerebral endothelium may underlie CMH development. However, the real-time examination of altered RBC–brain endothelial interactions in vivo, and their relationship with clearance of stalled RBC, microglial responses, and CMH development, has not been reported.

Methods

RBC were oxidatively stressed using tert-butylhydroperoxide (t-BHP), fluorescently labeled and injected into adult Tie2-GFP mice. In vivo two-photon imaging and ex vivo confocal microscopy were used to evaluate the temporal profile of RBC–brain endothelial interactions associated with …

From Covid-19 To Long Covid; The Forms Of The Neurological Manifestations, Sana Ahuja, Sufian Zaheer

Journal of Mind and Medical Sciences

Ever since the SARS-CoV-2 infection was declared a global pandemic in 2020, numerous multisystemic manifestations have been discovered. The COVID-19 is known to cause a wide spectrum of neurological symptoms like fatigue, headache, brain fog, stroke, smell and taste disorders, encephalopathy and neurodegenerative disorders. The neurological manifestations are more prevalent in the post-COVID syndrome or long COVID. The National Institute for Health and Care Excellence and WHO defined Ongoing Symptomatic COVID as 4-12 weeks post infection and post COVID-19 syndrome as persistence of symptoms beyond 12 weeks. So far there are limited data available regarding the pathophysiology of neurological symptoms …

Ciprofloxacin-Induced Peripheral Neuropathy: A Case Report, Alexander Refaeian, Eric L. Vest, Michael Schmidt, Jorge D. Guerra, Mohd N. Refaei, Michael Refaeian, Ryan A. Floresca, Manouchehr Refaeian

HCA Healthcare Journal of Medicine

Introduction

Fluoroquinolones, a class of antibiotics, are commonly employed in the treatment of a wide array of bacterial infections. Recognized for their effectiveness against a broad spectrum of pathogens, fluoroquinolones have played a pivotal role in managing conditions like urinary tract infections and respiratory diseases. Nevertheless, their usage is not without contention due to their association with a variety of adverse effects, including tendon rupture and the less frequently reported issue of peripheral neuropathy.

Case Presentation

We present the case of a 42-year-old male who developed peripheral neuropathy several days after completing a 10-day course of ciprofloxacin for gastroenteritis. The …

Pituitary Adenoma Hidden By Comorbid Cataract, Len Koh Od, Megan E. Mcchesney Od, Chad E. Gosnell Od

Optometric Clinical Practice

Background: A pituitary adenoma is an abnormal growth in the pituitary gland. Pituitary adenomas are the most common cause of sellar masses accounting for approximately 10% of all intracranial neoplasms. Early visual symptom of pituitary adenoma can be hidden by comorbid cataract in elderly patients. Case Report: A 74 y.o. male presented to the eye clinic with blurry vision at all distances and has trouble with glare from lights. His best corrected visual acuity (BCVA) was 20/20^-1 OD, 20/25^-2 OS, but subjectively of poor quality. Slit lamp exam confirmed mild nuclear sclerotic cataract OU and normal fundus exam. …

Sagging Eye Syndrome--An Overlooked Diagnosis, Zachary Tlumak Od, Theresa Zerilli-Zavgorodni Od, Nancy Shenouda-Awad Od

Optometric Clinical Practice

Abstract

Background: Sagging Eye Syndrome (SES) is a relatively unknown cause for binocular distance diplopia. SES presents with an acquired comitant or non-comitant small angle esotropia and/or hypotropia commonly occurring in the elderly population. Inferior displacement of the lateral rectus secondary to age-related degeneration of orbital connective tissue and extraocular muscles appears to be responsible for the ocular misalignment. SES patients often present with new onset or progressively worsening distance diplopia, typically warranting neuroimaging. However, through understanding SES, eye care practitioners may identify these cases, avoiding unnecessary imaging studies. Case Report: A 90-year-old male presented with complaints of intermittent horizontal …

Autosomal Dominant Optic Atrophy Plus Syndrome, Aaron W. Case Od, Lovelee E. Sayomac Od, Matthew J. Anderson Od

Optometric Clinical Practice

Background: Dominant optic atrophy (DOA) is the most commonly encountered hereditary optic neuropathy in clinical practice and is the result of a mutation in the OPA1 or OPA3 genes encoding mitochondrial membrane proteins. The resultant mitochondrial dysfunction causes a distinct set of ophthalmic findings and may progress to extra-ocular systems known as OPA plus syndrome. We present a case of late-onset OPA plus syndrome encompassing both typical ophthalmic findings and the rarer extra-ocular findings. Case Report: A 41 year-old Caucasian male presents for a second opinion regarding a previously diagnosed traumatic optic neuropathy. Examination revealed decreased best-corrected acuities, …

Advances In Molecular Pathology, Diagnosis, And Treatment Of Amyotrophic Lateral Sclerosis., Hristelina Ilieva, Mithila Vullaganti, Justin Kwan

Farber Institute for Neuroscience Faculty Papers

Although the past two decades have produced exciting discoveries in the genetics and pathology of amyotrophic lateral sclerosis (ALS), progress in developing an effective therapy remains slow. This review summarizes the critical discoveries and outlines the advances in disease characterization, diagnosis, imaging, and biomarkers, along with the current status of approaches to ALS care and treatment. Additional knowledge of the factors driving disease progression and heterogeneity will hopefully soon transform the care for patients with ALS into an individualized, multi-prong approach able to prevent disease progression sufficiently to allow for a dignified life with limited disability.

Tolfenamic Acid Derivatives: A New Class Of Transcriptional Modulators With Potential Therapeutic Applications For Alzheimer’S Disease And Related Disorders, Juanetta Hill, Karim E. Shalaby, Syed W. Bihaqi, Bothaina H. Alansi, Benjamin Barlock, Keykavous Parang, Richard Thompson, Khalid Ourarhni, Nasser H. Zawia

Pharmacy Faculty Articles and Research

The field of Alzheimer’s disease (AD) has witnessed recent breakthroughs in the development of disease-modifying biologics and diagnostic markers. While immunotherapeutic interventions have provided much-awaited solutions, nucleic acid-based tools represent other avenues of intervention; however, these approaches are costly and invasive, and they have serious side effects. Previously, we have shown in AD animal models that tolfenamic acid (TA) can lower the expression of AD-related genes and their products and subsequently reduce pathological burden and improve cognition. Using TA as a scaffold and the zinc finger domain of SP1 as a pharmacophore, we developed safer and more potent brain-penetrating analogs …

Normal Values Of Nerve Conduction Studies In Children Aged 7 Days To 14 Years Referred To Electrodiagnosis Clinic Of Iranian Children’S Medical Center, Masood Ghahvechi Akbari, Fazel Mahmoodpoor, Mahmoodreza Ashrafi, Elahe Rezaee, Sahar Ghorbanpour, Seyede Zahra Emami Razavi, Mohaddeseh Azadvari, Reza Shervin Badv, Gholamreza Zamani, Ali Reza Tavasoli, Morteza Heidari, Zahra Rezaei, Setareh Rohani, Mahmoud Mohammadi

Jefferson Institute of Molecular Medicine Papers and Presentations

Background: The normal values of nerve conduction studies (NCS) are different in children compared to adults. Moreover, racial and geographical factors can affect these values.

Objectives: The present study aimed to investigate the normal NCS values in children of different ages.

Methods: The present cross-sectional study included children referred to the Electrodiagnosis Clinic of the Children’s Medical Center in Iran, who had normal NCS results based on the references and had no exclusion criteria. The patients were divided into 8 age groups (7 days to one month, 1 - 3 months, 3 - 6 months, 6 - 12 months, 1 …

Insulin In Combination With N-Acetylcysteine Protects Hypoxia-Induced Toxicity In 661w Cells, Lili M. Guerra, Laura Valdez, Benxu Cheng, Andrew Tsin

Research Colloquium

Background: Proliferative diabetic retinopathy (PDR) is the leading cause of blindness among working-age adults. Photoreceptors are the most numerous and metabolically demanding cells in the retina thus oxygen is essential for retinal function. It has been reported that photoreceptors found in rat retina are specifically vulnerable to hypoxia. Hypoxia-induced metabolic stress leads to photoreceptor atrophy and retinopathy. Furthermore, photoreceptor cell death is known to occur mainly through apoptosis. However, the protection of hypoxia-induced-cytotoxicity in cone photoreceptor cells has not been investigated extensively. The aim of this study was to determine whether co-treatment of insulin and the N-Acetyl-L-Cysteine (NAC) (a free …

Subacute Combined Degeneration Due To Nitrous Oxide-Induced Vitamin B-12 Deficiency, Jorge Nadal, Daniela Hernandez, Brandon Cantazaro

Research Colloquium

Background: Nitrous oxide also known as “laughing gas” is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, recreational use is on the rise.1 Here, I will present a case of subacute combined degeneration in the setting of nitrous oxide induced vitamin B-12 deficiency.

Case presentation: 23-year-old right-handed gentleman with no past medical history presented to the ED complaining of 1 week of bilateral lower extremity …

Developing An Assay For Easy And Rapid Detection Of Als Biomarker(S): A Hypothesis, Swati Dhasmana, Anupam Dhasmana, Meena Jaggi, Murali M. Yallapu, Subhash C. Chauhan

Research Symposium

Background: Death of motor neurons is the key pathology underlying neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS). Biomarkers are chemical changes in the biological fluids. Biomarkers serving as a diagnostic tool should be specific to the concerned disease. Biomarkers indicating disease progression should be very sensitive to demonstrate changes during the disease process as well as therapeutics development. Biomarkers proposed for ALS include poly (GP) repeats in C9orf72, neurofilaments, miRNAs, glutathione and 4HNE in CSF, SOD1/TDP43 protein, poly (GP) repeats in C9orf72, neurofilaments, T regulatory cells, CRP, chitotriosidase, creatinine, creatinine kinase, miRNAs, glutamate, albumin, uric acid, glutathione, ferritin, …

A Moyamoya Case Report On A Patient With Slurred Speech And Right-Hand Weakness, Priyasha Suri, Mery Bartl, Don Rajan, Natalia Pinto, Daniela Hernandez

Research Symposium

Background: Moyamoya angiopathy (MMA) is a cerebrovascular disease affecting about one in a million people. It is characterized by progressive stenosis of the terminal portion of the internal carotid arteries leading to cerebral hypo-perfusion which in turn induces neo-angiogenesis in the deep parts of the brain. Patients are predisposed to ischemic and hemorrhagic strokes. Diagnosis is usually made with magnetic resonance imaging (MRI) and a magnetic resonance angiogram (MRA) to evaluate the brain and its blood vessels. Symptomatic patients should undergo surgical interventions. A few studies have shown that the superficial temporal artery to middle cerebral artery bypass combined with …

Without A Rash! A Diagnostic Dilemma For Vzv Vasculopathy, Paulina Vega Enriquez, Jose E. Campo Maldonado

Research Symposium

Varicella zoster virus vasculopathy is a condition that can classically present with a dermatomal zoster rash followed by a neurological deficit. The possible neurological manifestations and disease range are extensive. Diagnosis becomes more challenging in patients whose presentation does not include a rash, often causing cognitive errors and delay in treatment. We present a case of an 85-year-old patient, who developed stroke-like symptoms, initially with normal MRI, to later progress to multiple evolving enhancing lesions seen in subsequent MRIs. This case also represents the anchoring, that we as physicians can have when a patient with risk factors for stroke or …

Alzheimer’S Disease Studies In The Tex-Mex Border: Dissecting A Complex Multifactorial Problem, Ney Alliey-Rodriguez, Rosa V. Pirela, Alvaro Diaz-Badillo, Karla Lopez Lorenzo, Noe Garza, Frank Gilliam, Eron G. Manusov, Gladys E. Maestre

Research Symposium

Purpose: Alzheimer’s Disease (ALZ) is the leading cause of dementia in the aging population, and Latinos have >3 times higher risk to develop dementia than the overall US population. Although several studies have examined for possible causes of this increased risk, lack of comprehensive information plus a reduced number of Latino samples available in each study have hindered the answers.

Description: The University of Texas Rio Grande Valley has joined two large studies looking for multiple biomarkers associated with ALZ: The South Texas Alzheimer’s Center Clinical Data Repository and Biobank (STAC) and the Texas Alzheimer’s Research and Care Consortium (TARCC). …

Understanding The Resources, Barriers, Facilitators And Interests About Aging And Dementia Research Of Community Members From The Rio Grande Valley, Karla Daniela Lopez Lorenzo, Rosa V. Pirela Mavarez, Gabriela Osuna, Kendra Stine, Nahalie Chacon De Alvarez, Noe Garza, Gladys E. Maestre

Research Symposium

Background: One of ten people aged 65 develops Alzheimer’s Disease and it is one of the sixth-leading cause of death in the United States. The Rio Grande Valley (RGV) is mostly constituted by Hispanic/Latinos (93%), a population that has a 1.5X increased risk of AD onset. Nevertheless, there are not enough resources to support people living with dementia and their care partners. This study will leverage research efforts deployed by the RGV Alzheimer’s Disease Resource Center for Minority Aging Research to understand the social representations about the resources, barriers, facilitators, and interests of the RGV community about dementia and Alzheimer’s …

A Case Report Of A Primary Cerebral Abscess Due To Nocardia Asteroides In An Immunocompetent Patient, Ileana Elita Mendez, Nicole Marie Barreto, Alan Lanurias, Luis Alberto Rosas

Research Symposium

Background: Brain abscesses caused by Nocardia are rarely reported and have high mortality. It usually affects patients who are immunocompromised and initiates as a lung infection that disseminates hematogenously, though it can also affect those immunocompetent. Cerebral nocardiosis imitates brain tumors, which can delay the initiation of the appropriate antibiotic therapy.

Case Description: We present a case of a 64-year-old immunocompetent male with multiple cerebral abscesses who presented with headaches, left-sided weakness, and ataxia. Upon imaging, multiple brain lesions were revealed. The patient underwent craniotomy and drainage of the mass. He was initially empirically treated, though cultures later grew Nocardia …

Using Cartesian Coordinate Systems To Create, Classify, And Retrieve Biomedical Time-Series: Applications To 24-Hour Ambulatory Blood Pressure Monitoring, Antonio Garcia, Gladys E. Maestre, John Blangero, Jesus D. Melgarejo, Julio Facelli

Research Symposium

Background: Ambulatory Blood Pressure Measurement (ABPM) allows physicians to monitor blood pressure variability under everyday living conditions and predicts clinical outcomes better than conventional blood-pressure measurement. ABPM can demonstrate mean arterial pressure (MAP) behavior over 24 hours relevant to clinical practice, such as nocturnal hypertension or increased blood pressure variability. We hypothesized that individuals with the same cardiovascular health status would have the same MAP signal (MAPs) waveform.

Methods: This study reutilizes a data subset from the IDACO Consortium to create 24-hour MAPs. We assigned all the MAPs to data matrix X, performed principal components analysis (PCA) to X, and …

Integrated Inflammatory Signaling Landscape Response After Delivering Elovanoid Free-Fatty-Acid Precursors Leading To Experimental Stroke Neuroprotection, Madigan M. Reid, Ludmila Belayev, Larissa Khoutorova, Pranab K. Mukherjee, Andre Obenaus, Kierany Shelvin, Stacey Knowles, Sung Ha Hong, Nicolas G. Bazan

School of Graduate Studies Faculty Publications

Despite efforts to identify modulatory neuroprotective mechanisms of damaging ischemic stroke cascade signaling, a void remains on an effective potential therapeutic. The present study defines neuroprotection by very long-chain polyunsaturated fatty acid (VLC-PUFA) Elovanoid (ELV) precursors C-32:6 and C-34:6 delivered intranasally following experimental ischemic stroke. We demonstrate that these precursors improved neurological deficit, decreased T2WI lesion volume, and increased SMI-71 positive blood vessels and NeuN positive neurons, indicating blood–brain barrier (BBB) protection and neurogenesis modulated by the free fatty acids (FFAs) C-32:6 and C-34:6. Gene expression revealed increased anti-inflammatory and pro-homeostatic genes and decreases in expression of pro-inflammatory genes in …

Objectivity, Practicality, And Significance Of Practice Guidelines For The Practicing Neurologists: What We Learnt From Consensus Criteria In Cidp, Myasthenia Gravis And Inflammatory Myopathies, Marinos C. Dalakas

Department of Neurology Faculty Papers

The value of practice guidelines in the three most common autoimmune neuromuscular disorders, namely Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Myasthenia Gravis (MG) and Autoimmune Inflammatory Myopathies (AIM), has been extensively debated regarding their usefulness in clinical practice, objectivity and universal value considering that guidelines are also established regionally in certain countries. This commentary highlights common concerns on how guidelines are presently generated, pointing out: (a) non-sufficient diversity among Task-Force members to identify and address not only routine clinical and electrophysiology issues but also immunology, imaging, pathology, biomarkers, epidemiology or treatment economics; (b) Task-Force being often comprised by the same or …

Exploring The Experience Of Sexuality And Gender During The Healthcare Transition Of The Youth With Cerebral Palsy, Umma Salma

Electronic Thesis and Dissertation Repository

Background: Transition from the pediatric to adult health care system is an important phase of healthcare for youth with cerebral palsy (CP). Sexuality and gender are two very important components of health that are mostly ignored in the healthcare transition process. It is possible that health care providers only see a client’s disability, and therefore, key aspects of sexuality and gender diversity may be ignored, or deemed irrelevant as a result of their disability status. Therefore, the purpose of our study is to explore how gender and sexuality may influence the experience of health care transition for youth with cerebral …

Stiff Person Syndrome: A Rare Presentation Of A Rare Disorder, Muhammad Hammad Sharif, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Stiff Person Syndrome (SPS) is a rare autoimmune disease that is caused by the lack of inhibition to excitatory neurotransmitters in the central nervous system (CNS) which then leads to inappropriate and excessive motor unit firing causing stiffness, a characteristic feature of the disease. SPS has an incidence of one case in a million and occurs in the middle-aged population with a female predominance. SPS mostly occurs in the background of autoimmune disorders like type 1 diabetes, thyroid disorders, pernicious anemia, and less often, vitiligo. The pathophysiology is not completely understood; however, there is a strong correlation between high …

Referral Patterns For Pediatric Sports-Related Concussion In One New England Health Care System, Joseph Benert, Amy Haskins Phd, Christina T. Holt, Krystian Bigosinski

Journal of Maine Medical Center

Introduction: Patients with concussion may benefit from care provided by professionals from multiple disciplines based on the constellation of symptoms being reported. This study analyzed referral patterns from primary care and sports medicine clinicians for pediatric patients with sports-related concussion in one health care system.

Methods: A retrospective chart review identified referrals placed to physical therapy, occupational therapy, speech pathology, optometry, psychology, neuropsychology, audiology, neurology, ophthalmology, otolaryngology, psychiatry, and sports medicine for pediatric patients with sports-related concussion. These patients were evaluated at MaineHealth family medicine, internal medicine/pediatrics, pediatrics, and sports medicine clinics in southern Maine between February 2019 and June …