Neurology Commons^™

Report Of An Inferior Rectal Nerve Variant Arising From The S3 Ventral Ramus., Graham Dupont, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

In surgical approaches to the perineum in general and anal region specifically, considering the possible variations of the inferior rectal nerve is important for the surgeon. Normally, the inferior rectal nerve originates as a branch of the pudendal nerve. However, during routine dissection, a variant of the inferior rectal nerve was found where it arose directly from the third sacral nerve ventral ramus (S3). Many cases have described the inferior rectal nerve arising independently from the sacral plexus, most commonly from the fourth sacral nerve root (S4); however, few cases have reported the inferior rectal nerve arising from S3. Herein, …

Variant Anatomy Of The Buccal Nerve., Mayank Patel, Joe Iwanaga, Shogo Kikuta, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Knowledge of the anatomy and variations of the nerves of the oral cavity is important to surgeons who operate this region. Herein, we report a rare case of a buccal nerve with two distinct roots. The anatomy of this case and its clinical applications is discussed.

Neck Movement During Cervical Transforaminal Epidural Injections And The Position Of The Vertebral Artery: An Anatomical Study., Juan J Altafulla, Emre Yilmaz, Stefan Lachkar, Joe Iwanaga, Jacob Peacock, Zachary Litvack, R Shane Tubbs

Articles, Abstracts, and Reports

Background: Cervical transforaminal epidural steroid injections (CTFESIs) are sometimes performed in patients with cervical radiculopathy secondary to nerve-root compression. Neck movements for patient positioning may include rotation, flexion, and extension. As physicians performing such procedures do not move the neck for fear of injuring the vertebral artery, we performed fluoroscopy and cadaveric dissection to analyze any movement of the vertebral artery during head movement and its relation to the foramina in the setting of CTFESI.

Purpose: To determine cervical rotational positioning for optimized vertebral artery location in the setting of cervical transforaminal epidural steroid injections.

Material and Methods: Four sides …

Ectopic Pituitary Adenoma Presenting As A Clival Mass., Juan J Altafulla, Joshua Prickett, Graham Dupont, R Shane Tubbs, Zachary Litvack

Articles, Abstracts, and Reports

Pituitary adenomas are well described in the literature and are frequently observed and treated in clinical practice by neurosurgeons. On the other hand, ectopic adenomas are a diagnostic enigma; a good understanding of anatomy and radiological characteristics is crucial for the successful management of such pathologies. In this paper, we describe the case of a 77-year-old woman who presented with a clival mass invading the left cavernous sinus; we also discuss the associated diagnostic techniques, approaches, imaging options, and characteristics.

A Propensity-Matched Analysis Of Outcomes For Patients With M2 Branch Occlusions At Endovascular Stroke Centers, R. Ovando, L. Lucas, Elizabeth Baraban, Jason Tarpley

Articles, Abstracts, and Reports

Introduction: Endovascular therapy (EVT) for Emergent Large Vessel Occlusion (ELVO) is recommended for patients with acute proximal MCA (M1 segment) occlusions (Class I, level A evidence), but the benefits of EVT are uncertain in patients with M2 and more distal occlusions. The purpose of this study was to compare the efficacy and outcomes of EVT-treated M2 ELVOs with EVT-treated M1 ELVOs, and to examine the outcomes of EVT-treated M2 ELVO patients with those whose M2 ELVOs were not treated.

Methods: Data were obtained from a multi-hospital system of patients from January 2014 and May 2018. Two propensity score (PS)-based nearest-neighbor …

Outcomes And Characteristics Of Large Vessel Occlusion Patients In A Multi-Hospital System With National Institute Of Health Stroke Scale (Nihss) ≤ 5 Treated With Endovascular Thrombectomy Vs Medical Management, Steven Augustine, Lindsay Lucas, Elizabeth Baraban, Jason Tarpley

Books, Presentations, Posters, Etc.

No abstract provided.

Contact Sports As A Risk Factor For Amyotrophic Lateral Sclerosis: A Systematic Review., Ronen Blecher, Michael A Elliott, Emre Yilmaz, Joseph R Dettori, Rod J Oskouian, Akil P Patel, Andrew Clarke, Mike Hutton, Robert Mcguire, Robert Dunn, John Devine, Bruce Twaddle, Jens R Chapman

Articles, Abstracts, and Reports

Study Design: Systematic review.

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, ultimately resulting in paralysis and death. The condition is considered to be caused by a complex interaction between environmental and genetic factors. Although vast genetic research has deciphered many of the molecular factors in ALS pathogenesis, the environmental factors have remained largely unknown. Recent evidence suggests that participation in certain types of sporting activities are associated with increased risk for ALS.

Objective: To test the hypothesis that competitive sports at the highest level that involve repetitive concussive head and cervical spinal trauma result in an increased …

Editorial., Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Managing Severe Tbi In The Icu Setting Using A Three Tier Approach, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Assess the effects of injury to the brain in the neurologic injured patient and implement a tiered approach to manage severe TBI
• Evaluate TBI patients using multimodality monitoring
• Apply interventions to manage brain injury & integrate the complex multi-system issues and manage these patients using an actual case study.

Implementation Of Coordinated Telestroke Program In An Urban Setting Improves Acute Stroke Care, John Zurasky, Leslie Corless, Lindsay Lucas, Elizabeth Baraban

Books, Presentations, Posters, Etc.

Purpose: Telestroke has been shown to improve acute ischemic stroke (AIS) care in rural settings, but few studies have examined the impact of telestroke in an urban setting. In an urban area, there was a planned transition from an outpatient-based acute stroke provider pool to a centralized telehealth team of neurovascular and neurocritical care providers. This study assessed the impact of this change by comparing patient outcomes during three time periods: pre-initiation (PRE), transition after initiation (TRAN) and post-transition (POST).

Methods: Data for AIS patients 18 and older from five urban hospitals were used. Outcomes were hospital length of stay …

Impact Of Early Mobilization On 90-Day Outcomes In Thrombectomy Patients, Tamela Stuchiner, Diane Clark, Lindsay Lucas, John Robinson, Lisa Yanase

Books, Presentations, Posters, Etc.

Introduction: Early mobilization of ischemic stroke patients receiving IV alteplase (tPA) did not worsen 90-day outcome at two urban stroke centers in a prior study, but there are no studies evaluating outcomes of early mobilization after thrombectomy. The mobility protocol used in the previous study was also utilized to mobilize stroke patients receiving thrombectomy treatment at these two centers, once minimum number of hours for groin precautions was complete and the groin puncture site was stable. The objective of this study was to determine for post-thrombectomy patients mobilized within 24 hours, whether earlier mobilization worsened outcomes.

Methods: Medical records of …

Temperature Management: All Shook Up! Managing Shivering In Normothermia, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Identify key factors related to maintaining normothermia
• Describe the use of the Bedside Shivering Assessment Scale
• Provide interventions to manage shivering in the Neuro patient population

Cost Analysis Of Implementing Standardized Stroke Patient Education Materials In A Large Five State Health System, Natalie Swearingen, Leslie Corless, Jessica Swann, Kailey Cox, Diane Lada, Elizabeth Baraban

Books, Presentations, Posters, Etc.

No abstract provided.

Regional Stroke Program Coordinator Nurses Standardize Ems Feedback Utilizing Kurt Lewin’S Change Model, Molly Archer, Megan Fuller, Kailey Cox, Natalie Swearingen

Books, Presentations, Posters, Etc.

No abstract provided.

Complications From Iv Alteplase In Mild Stroke Patients In A Multi-State Health System, Lisa R. Yanase, Lindsay Lucas, Leslie Corless, Elizabeth Baraban

Books, Presentations, Posters, Etc.

No abstract provided.

Standardized Code Stroke Inpatient Activation Process Resulted In Consistent Acute Stroke Evaluation Times Regardless Of Primary Problem Or Patient Location, Kailey Cox, Brandon Sheets, Alyx Lesko, Lindsay Lucas, Elizabeth Baraban, Ronda Chandler, Diane Clark

Books, Presentations, Posters, Etc.

Introduction: Inpatient strokes have a higher mortality risk and longer length of stay compared to community-onset strokes. The inpatient stroke population is often not included in national registries. This study examines a hospital-wide standardized process for acute triage of Code Stroke Inpatient Activations (CSIAs) at a Comprehensive Stroke Center.

Methods: CSIA data collected between September 2016-July 2018 from the Stroke and Rapid Response Team pager were used. False CSIAs were excluded. Outcomes included percentage of CSIAs by patient location (PL), primary problem (PP), and final discharge diagnosis (FDD), as well as percentage treated with IV-alteplase (tPA) and thrombectomy. Evaluation times …

Large Five State Health System Standardizes Stroke Patient Education While Significantly Improving Health Literacy, Natalie Swearingen, Leslie Corless, Jessica Swann, Kailey Cox, Diane Lada, Elizabeth Baraban

Books, Presentations, Posters, Etc.

No abstract provided.

Fast And Furious: Stroke Update 2019, Mary Kay Bader

Books, Presentations, Posters, Etc.

This lecture focuses on the AHA guidelines and how the Acute Stroke Team focuses the efforts in the first few hours after presentation. Audience will be made up of physicians, nurses and EMT/EMS personnel. The aims of the event include providing a couple ‘cutting edge’ key note speakers with varying expertise from different parts of the acute stroke care continuum.

Increase In Video Evaluations But Not Complications Over Time In A Large Stroke Network, Archit Bhatt, Elizabeth Baraban, Leslie Corless, Lindsay Lucas

Books, Presentations, Posters, Etc.

Introduction: Telestroke technology allows evaluation of stroke patients remotely. We sought to determine if there was any change in the standard of care and evaluation of stroke patients over time and whether there were differences in complication rates between those who were evaluated using telestroke technology and those who were not.

Methods: Data from April 2010 to May 2018 from a large stroke network were used. Acute ischemic stroke patients who presented to the emergency departments (ED) with last-known-well-to-door less than 4.5 hours and were treated with IV-alteplase were included. The number of facilities ranged from 7 in 2010 to …

Static And Dynamic Postural Control Deficits In Aging Fragile X Mental Retardation 1 (Fmr1) Gene Premutation Carriers., Zheng Wang, Pravin Khemani, Lauren M Schmitt, Su Lui, Matthew W Mosconi

Articles, Abstracts, and Reports

BACKGROUND: Individuals with premutation alleles of the fragile X mental retardation 1 (FMR1) gene are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS) during aging. Characterization of motor issues associated with aging in FMR1 premutation carriers is needed to determine neurodegenerative processes and establish new biobehavioral indicators to help identify individuals at greatest risk of developing FXTAS.

METHODS: We examined postural stability in 18 premutation carriers ages 46-77 years and 14 age-matched healthy controls. Participants completed a test of static stance and two tests of dynamic postural sway on a force platform to quantify postural variability and complexity. CGG …

The Carotid Sinus Nerve And The First English Translation Of Hering's Original Research On This Nerve., Mohammadali M Shoja, Rabjot Rai, Stefan Lachkar, Seleipiri Iboroma Akobo, Emre Yilmaz, Marios Loukas, Emanuela Binello, Mehrnoush Gorjaian, Christoph J Griessenauer, Joe Iwanaga, R Shane Tubbs

Articles, Abstracts, and Reports

This paper provides a brief depiction of the life and achievements of the most iconic experiments of Heinrich Ewald Hering. The authors herein have presented a translation of his paper on the carotid sinus nerve in English; the original paper by Heinrich Ewald Hering, titled "Ueber die Wand des Sinus caroticus als Reizempfänger und den Sinusnerv als zentripetale Bahn für die Sinusreflexe" (1924), provides a detailed account of his experimental process and findings. He recognized that the sinus reflexes are mediated by a branch of the glossopharyngeal nerve (CN IX).

Single-Cell Glia And Neuron Gene Expression In The Central Amygdala In Opioid Withdrawal Suggests Inflammation With Correlated Gut Dysbiosis., Sean J O'Sullivan, Evangelia Malahias, James Park, Ankita Srivastava, Beverly A S Reyes, Jon Gorky, Rajanikanth Vadigepalli, Elisabeth J Van Bockstaele, James S Schwaber

Articles, Abstracts, and Reports

Drug-seeking in opioid dependence is due in part to the severe negative emotion associated with the withdrawal syndrome. It is well-established that negative emotional states emerge from activity in the amygdala. More recently, gut microflora have been shown to contribute substantially to such emotions. We measured gene expression in single glia and neurons gathered from the amygdala using laser capture microdissection and simultaneously measured gut microflora in morphine-dependent and withdrawn rats to investigate drivers of negative emotion in opioid withdrawal. We found that neuroinflammatory genes, notably

Characterizing Whole Brain Temporal Variation Of Functional Connectivity Via Zero And First Order Derivatives Of Sliding Window Correlations., Flor A Espinoza, Victor M Vergara, Eswar Damaraju, Kyle G Henke, Ashkan Faghiri, Jessica A Turner, Aysenil A Belger, Judith M Ford, Sarah C Mcewen, Daniel H Mathalon, Bryon A Mueller, Steven G Potkin, Adrian Preda, Jatin G Vaidya, Theo G M Van Erp, Vince D Calhoun

Articles, Abstracts, and Reports

Brain functional connectivity has been shown to change over time during resting state fMRI experiments. Close examination of temporal changes have revealed a small set of whole-brain connectivity patterns called dynamic states. Dynamic functional network connectivity (dFNC) studies have demonstrated that it is possible to replicate the dynamic states across several resting state experiments. However, estimation of states and their temporal dynamicity still suffers from noisy and imperfect estimations. In regular dFNC implementations, states are estimated by comparing connectivity patterns through the data without considering time, in other words only zero order changes are examined. In this work we propose …

Are There Mortality Risks For Patients With Epilepsy Who Use Cannabis Treatments As Monotherapy?, Devon M Kollmyer, Kyla E Wright, Nicole M Warner, Michael J Doherty

Articles, Abstracts, and Reports

Mortality associated with cannabis used for treatment of epilepsy is not well documented. We discuss two fatalities in the setting of epilepsy and self-determined therapy with cannabis (SDTC). One patient had probable sudden unexpected death in epilepsy, the second death was due to seizure-associated drowning. Both directed SDTC over conventional anti-seizure medications. Where recreational cannabis is legal, decisions to use cannabis are often self-directed and independent of physician advice of cannabis risks, in part because physicians may not be aware of the risk of SDTC. Further study of morbidity and mortality of SDTC in patients with epilepsy is needed.

How Might Tissue Glucose Influence Responsive Neurostimulation Detection?, Kyla E Wright, Devon M Kollmyer, Nicole M Warner, Alan M Haltiner, Ryder P Gwinn, Michael J Doherty

Articles, Abstracts, and Reports

No abstract provided.

An Inflammatory Landscape For Preoperative Neurologic Deficits In Glioblastoma., Amal Katrib, Hyun-Hwan Jeong, Nina L Fransen, Kristin S Henzel, Jeremy A Miller

Articles, Abstracts, and Reports

No abstract provided.

Difficult Conversations., Alison Christy

Articles, Abstracts, and Reports

No abstract provided.

Down Syndrome Associated Moyamoya May Worsen Epilepsy Control And Can Benefit From Surgical Revascularization., Sarah R Garson, Stephen J Monteith, Sheila D Smith, Bart P Keogh, Ryder P Gwinn, Michael J Doherty

Articles, Abstracts, and Reports

Objectives: To examine outcome of bilateral extracranial to intracranial (EC-IC) bypass surgeries for a Down syndrome patient with hard-to-treat epilepsy and moyamoya.

Materials and methods: Superficial temporal arteries were anastamosed using an indirect bypass technique to middle cerebral arteries bilaterally to help limit perfusion deficits and seizure controls.

Results: Two superficial temporal to middle cerebral artery indirect bypass surgeries were performed within 3 months. Post-revascularization improvements included seizure control, gait, perfusion, wakefulness, language and quality of life.

Conclusion: In patients with Down syndrome and moyamoya, improvements in seizure control and quality of life may occur with EC-IC bypass procedures.

Regeneration Enhances Metastasis: A Novel Role For Neurovascular Signaling In Promoting Melanoma Brain Metastasis., Roshini Prakash, Sivan Izraely, Nikita S Thareja, Rex H Lee, Maya Rappaport, Riki Kawaguchi, Orit Sagi-Assif, Shlomit Ben-Menachem, Tsipi Meshel, Michal Machnicki, Shuichi Ohe, Dave S B Hoon, Giovanni Coppola, Isaac P Witz, S Thomas Carmichael

Articles, Abstracts, and Reports

Neural repair after stroke involves initiation of a cellular proliferative program in the form of angiogenesis, neurogenesis, and molecular growth signals in the surrounding tissue elements. This cellular environment constitutes a niche in which regeneration of new blood vessels and new neurons leads to partial tissue repair after stroke. Cancer metastasis has similar proliferative cellular events in the brain and other organs. Do cancer and CNS tissue repair share similar cellular processes? In this study, we identify a novel role of the regenerative neurovascular niche induced by stroke in promoting brain melanoma metastasis through enhancing cellular interactions with surrounding niche …

Glioblastoma Mimicking Viral Encephalitis Responds To Acyclovir: A Case Series And Literature Review., Keenan J Piper, Haidn Foster, Brandon Gabel, Burt Nabors, Charles Cobbs

Articles, Abstracts, and Reports

Viral encephalitis and glioblastoma are both relatively rare conditions with poor prognoses. While the clinical and radiographic presentations of these diseases are often distinctly different, viral encephalitis can sometimes masquerade as glioblastoma. Rarely, glioblastoma can also be misdiagnosed as viral encephalitis. In some cases where a high-grade glioma was initially diagnosed as viral encephalitis, antiviral administration has proven effective for relieving early symptoms. We present three cases in which patients presented with symptoms and radiographic findings suggestive of viral encephalitis and experienced dramatic clinical improvement following treatment with acyclovir, only to later be diagnosed with glioblastoma in the region of …