Neurology Commons^™

Improved Inter-Rater Reliability For Sah Ct Grading Scales Through Application Of A Formal Definition Of Clot Thickness, William Mcbride, Md, Valerie Dechant, Md, Michael Moussouttas, Md

Department of Neurology Faculty Papers

Various scales have been devised for the prediction of vasospasm following aneurysmal rupture.

Especially prominent in these scales is their reliance upon a subjective assessment of clot thickness which introduces variability in grading across raters.

The current study seeks to compare the inter-rater reliability of the traditional Fisher and newer "Frontera" scale (Modified Fisher) when a rigid definition of thick clot is employed.

Sonography Of The Neonatal Brain, Traci B. Fox

Department of Radiologic Sciences Faculty Papers

Neurosonography is a critical part of the care of the sick newborn. Sonography is superior to other modalities in imaging of the brain because it can be performed at the bedside, is easily reproducible, and does not require ionizing radiation or sedation. This article refreshes the sonographer in the normal anatomy and appear- ance of the neonatal brain using sonography, as well as some of the more common pathologic conditions that may be encountered.

Traumatic Thoracic Asia A Examinations And Potential For Clinical Trials, James S. Harrop, Md, Mitchell G. Maltenfort, Phd, Fred H. Geisler, Md, Phd, William Coleman, Phd, Linda A.T. Jones, Pt, Ms, Edward Wirth, Md, Alexander Vaccaro, Md, Phd

Department of Neurosurgery Faculty Papers

Study Design: Retrospective review of prospective database

Objectives: To define the variability of neurologic examination and recovery after non-penetrating complete thoracic spinal cord injuries (ASIA A).

Background Data: Neurologic examinations after SCI can be difficult and inconsistent. Unlike cervical SCI patients, alterations in thoracic (below T1) complete SCI (ASIA A – based on the ASIA Impairment Scale [AIS]) patients’ exams are based only on sensory testing, thus changes in the neurological level (NL) are determined only by sensory changes.

Methods: A retrospective review of the placebo control patients in a multicenter prospective database utilized for the pharmacologic trial of Sygen. …

The Production Of Antibody By Invading B Cells Is Required For The Clearance Of Rabies Virus From The Central Nervous System., D Craig Hooper, Timothy W Phares, Marzena J Fabis, Anirban Roy

Department of Cancer Biology Faculty Papers

BACKGROUND: The pathogenesis of rabies is associated with the inability to deliver immune effectors across the blood-brain barrier and to clear virulent rabies virus from CNS tissues. However, the mechanisms that facilitate immune effector entry into CNS tissues are induced by infection with attenuated rabies virus.

METHODOLOGY/PRINCIPAL FINDINGS: Infection of normal mice with attenuated rabies virus but not immunization with killed virus can promote the clearance of pathogenic rabies virus from the CNS. T cell activity in B cell-deficient mice can control the replication of attenuated virus in the CNS, but viral mRNA persists. Low levels of passively administered rabies …

Utilization Of Dantrolene In Stiff-Person Syndrome: A Case Report, John M. Vasudevan, Md, S. Kamal Fetouh, Md,, Nethra S. Ankam, Md, Adam L. Schreiber, Do, Ma

Department of Rehabilitation Medicine Faculty Papers

Setting: University hospital-based acute rehabilitation.

Patient: 75-year-old woman with Stiff-Person Syndrome (SPS) with a recent fall and Colles fracture.

Case Description: Four months prior to admission, the patient was diagnosed with SPS, negative for anti-GAD antibodies. Diagnosis was based on a 3-year history of progressive rigidity leading to frequent falls and fractures. Anxiety and fear of falling limited her mobility, and she sustained a sacral pressure ulcer during acute hospitalization. On admission, history was remarkable for unsteady gait and muscle cramps exacerbated when startled or excited. Examination was remarkable for rigidity in her axial and limb muscles. She presented …

Human Amniotic Fluid Stem Cells Do Not Differentiate Into Dopamine Neurons In Vitro Or After Transplantation In Vivo., Angela E Donaldson, Jingli Cai, Ming Yang, Lorraine Iacovitti

Farber Institute for Neuroscience Faculty Papers

Although embryonic stem (ES) cells can generate dopamine (DA) neurons that are potentially useful as a cell replacement therapy in Parkinson's disease (PD), associated ethical and practical concerns remain major stumbling blocks to their eventual use in humans. In this study, we examined human amniotic fluid stem (hAFS) cells derived from routine amniocenteses for their potential to give rise to DA neurons in vitro and following transplantation into the 6-hydroxydopamine-lesioned rat brain. We show that undifferentiated hAFS cells constitutively expressed mRNAs and proteins typical of stem cells but also cell derivatives of all three germ layers, including neural progenitors/neurons (nestin, …

Early And Late Treatment Of Migraine With Dhe Ns (Migranal®), Meryl Latsko, Md, Mph, Stephen D. Silberstein, Md

Department of Jefferson Headache Center Papers and Presentations

To examine the use of DHE NS (Migranal®) in the early and late treatment of migraine in subjects with a history of cutaneous allodynia.

Transverse Myelitis In Pregnancy: A Case Report, Brian P. Mcdonald, Do, Nethra S. Ankam, Md

Department of Rehabilitation Medicine Faculty Papers

Objective: Describe the clinical course and treatment of a patient with paraplegia secondary to transverse myelitis during her pregnancy.

Setting: Acute Inpatient Rehabilitation Unit, University Hospital.

Participant: 36 year old Caucasian woman at 18 weeks gestation.

Interventions: Provided education and training on basic childcare tasks at a wheelchair level, and on how to obtain wheelchair accessible baby furniture. Provided availability of a peer who sustained a spinal cord injury prior to pregnancy. Maintained a close working relationship with maternal fetal health department regarding management of nausea and pain management, and educated team members about the possibility of autonomic …

Frovatriptan As Preemptive Treatment For Fasting-Induced Migraine, Meryl Latsko, Md, Mph, Stephen D. Silberstein, Md

Department of Jefferson Headache Center Papers and Presentations

To examine frovatriptan's efficacy as preemptive treatment for fasting-induced migraine.

Mechanisms Of Primary Axonal Damage In A Viral Model Of Multiple Sclerosis., Jayasri Das Sarma, Lawrence C. Kenyon, Susan T. Hingley, Kenneth S. Shindler

Department of Neurology Faculty Papers

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS. Recent studies have demonstrated that significant axonal injury also occurs in MS patients and correlates with neurological dysfunction, but it is not known whether this neuronal damage is a primary disease process, or occurs only secondary to demyelination. In the current studies, neurotropic strains of mouse hepatitis virus (MHV) that induce meningitis, encephalitis, and demyelination in the CNS, an animal model of MS, were used to evaluate mechanisms of axonal injury. The pathogenic properties of genetically engineered isogenic spike protein recombinant demyelinating and nondemyelinating strains of MHV were compared. …

Dynamic Mechanical (Brush) Allodynia In Cluster Headache: A Prevalence Study In A Tertiary Headache Clinic., Michael J Marmura, Muhammad Abbas, Avi Ashkenazi

Department of Jefferson Headache Center Papers and Presentations

Cutaneous allodynia (CA) has been described in migraine and has been related to treatment failure. There are little data about the incidence of CA in other primary headache syndromes such as cluster headache (CH). The objectives of this study are to evaluate the prevalence of dynamic mechanical (brush) allodynia (BA) in CH patients attending a tertiary headache clinic, and to assess its relation to disease characteristics. Adult patients with episodic or chronic CH were recruited. We obtained demographic data and data on disease characteristics through a structured questionnaire, and tested the patients for brush allodynia BA by applying a 4 …

Intravenous Inoculation Of A Bat-Associated Rabies Virus Causes Lethal Encephalopathy In Mice Through Invasion Of The Brain Via Neurosecretory Hypothalamic Fibers., Mirjam A R Preuss, Marie-Luise Faber, Gene S Tan, Michael Bette, Bernhard Dietzschold, Eberhard Weihe, Matthias J Schnell

Department of Microbiology and Immunology Faculty Papers

The majority of rabies virus (RV) infections are caused by bites or scratches from rabid carnivores or bats. Usually, RV utilizes the retrograde transport within the neuronal network to spread from the infection site to the central nervous system (CNS) where it replicates in neuronal somata and infects other neurons via trans-synaptic spread. We speculate that in addition to the neuronal transport of the virus, hematogenous spread from the site of infection directly to the brain after accidental spill over into the vascular system might represent an alternative way for RV to invade the CNS. So far, it is unknown …

Near Fatal Posterior Reversible Encephalopathy Syndrome Complicating Chronic Liver Failure And Treated By Induced Hypothermia And Dialysis: A Case Report., Rashmi Chawla, Daniel Smith, Paul E Marik

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

INTRODUCTION: Posterior reversible encephalopathy syndrome is a clinico-neuroradiological entity characterized by headache, vomiting, altered mental status, blurred vision and seizures with neuroimaging studies demonstrating white-gray matter edema involving predominantly the posterior region of the brain. CASE PRESENTATION: We report a 47-year-old Caucasian man with liver cirrhosis who developed posterior reversible encephalopathy syndrome following an upper gastrointestinal hemorrhage and who was managed with induced hypothermia for control of intracranial hypertension and continuous veno-venous hemodiafiltration for severe hyperammonemia. CONCLUSION: We believe this is the first documented case report of posterior reversible encephalopathy syndrome associated with cirrhosis as well as the first report …

The Efficacy Of Surgical Decompression Before 24 Hours Versus 24 To 72 Hours In Patients With Spinal Cord Injury From T1 To L1--With Specific Consideration On Ethics: A Randomized Controlled Trial., Vafa Rahimi-Movaghar, Soheil Saadat, Alexander R Vaccaro, Seyed Mohammad Ghodsi, Mohammad Samadian, Arya Sheykhmozaffari, Seyed Mohammad Safdari, Bahram Keshmirian

Department of Neurosurgery Faculty Papers

BACKGROUND: There is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome. Such information must be obtained from randomized controlled trials (RCTs). To date no large scale RCT has been performed evaluating the timing of surgical decompression in the setting of thoracolumbar spinal cord injury. A concern for many is the ethical dilemma that a delay in surgery may adversely effect neurologic recovery although this has never been conclusively proven. The purpose of this study is to compare the efficacy of early (before 24 hours) verse late (24-72 hours) surgical decompression in terms of neurological …

Combined Effects Of Hyperglycemic Conditions And Hiv-1 Nef: A Potential Model For Induced Hiv Neuropathogenesis., Edward A Acheampong, Cassandra Roschel, Muhammad Mukhtar, Alagarsamy Srinivasan, Mohammad Rafi, Roger J Pomerantz, Zahida Parveen

Department of Neurology Faculty Papers

Hyperglycemic conditions associated with diabetes mellitus (DM) or with the use of antiretroviral therapy may increase the risk of central nervous system (CNS) disorders in HIV-1 infected patients. In support of this hypothesis, we investigated the combined effects of hyperglycemic conditions and HIV-1 accessory protein Nef on the CNS using both in vitro and in vivo models. Astrocytes, the most abundant glial cell type required for normal synaptic transmission and other functions were selected for our in vitro study. The results show that in vitro hyperglycemic conditions enhance the expression of proinflammatory cytokines including caspase-3, complement factor 3 (C3), and …

Functional Interleukin-17 Receptor A Is Expressed In Central Nervous System Glia And Upregulated In Experimental Autoimmune Encephalomyelitis., Jayasri Das Sarma, Bogoljub Ciric, Ryan Marek, Sanjoy Sadhukhan, Michael L. Caruso, Jasmine Shafagh, Denise C. Fitzgerald, Kenneth S. Shindler, Am Rostami

Department of Neurology Faculty Papers

BACKGROUND: Interleukin-17A (IL-17A) is the founding member of a novel family of inflammatory cytokines that plays a critical role in the pathogenesis of many autoimmune diseases, including multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE). IL-17A signals through its receptor, IL-17RA, which is expressed in many peripheral tissues; however, expression of IL-17RA in the central nervous system (CNS) and its role in CNS inflammation are not well understood.

METHODS: EAE was induced in C57Bl/6 mice by immunization with myelin oligodendroglial glycoprotein. IL-17RA expression in the CNS was compared between control and EAE mice using RT-PCR, in situ …

Intramedullary Spinal Cord Metastases And Radiation Therapy: A Case Report, Daniel Ikeda, James S. Harrop Md

JHN Journal

Intramedullary spinal cord metastases (ISCM) are a clinically rare, although devastating, complication of disseminated cancer. These lesions have been reported to originate from many types of solid tumors, although primary lung carcinoma, particularly small cell, is the most common etiology. These metastases, which can occur anywhere along the spinal cord, often represent the end-stage of the disease process with limited survival outcomes.

Patients with ISCM may develop a variety of neurological deficits with treatment goals aimed at palliation. Different modalities of treatment have been found to preserve or restore ambulation and neurological function. The options for therapeutic intervention include surgical, …

Cervical Intramedullary Ganglioma, Harminder Singh Md, Ashwini Sharan Md, John K. Ratliff Md

JHN Journal

A 48 year male presented to the ER with severe headaches which were episodic in nature and which had been present for several weeks. Patient had a history of traumatic head injury (TBI) several years prior. Otherwise, he was in good health with no significant past medical or surgical history.

On physical exam, patient was oriented x 3 with an intact cranial nerve exam. He had significant upper and lower extremity spasticity with mild hand intrinsic weakness. His motor exam was otherwise unremarkable. His gait was very spastic. He had sustained lower extremity clonus, upgoing toes, and increased tone in …

Surgeon Opinions On Use Of Epidural Steroids In Treatment Of Lumbar Disk Disease: Results Of An Online Survey, John K. Ratliff Md, Mitchell Maltenfort Phd, Bryan Lebude

JHN Journal

“Standard of care” can vary along regional and specialty lines; it is common to discover that a local “standard” can be different somewhere else. Opinions may differ between pain management specialists, primary care physicians, and spine surgeons with regard to use of conservative treatment modalities.

Opinion within a given group of practitioners, however, should converge. Local differences between hospitals may exist, but conferences, professional journals, and national boards for certification are mechanisms that should act to maintain homogeneity within a professional group. It could be expected that commonly utilized treatment approaches within a well defined group of sub-specialists should converge. …

Case Report: Intramedullary Cervical Spinal Cord Hemangioblastoma With An Evaluation Of Von Hippel-Lindau Disease, Steven Falowski Md, Ashwini Sharan Md, James S. Harrop Md, John K. Ratliff Md

JHN Journal

History of Present Illness

MO is a 49 year old male with a history of multiple sclerosis who presents with a one year history of progressive numbness in his shoulders bilateral and upper back. The patient describes occasional sharp pains that radiate to his first three fingers on his right hand. He denies weakness, clumsiness, difficulty walking, or bladder/bowel dysfunction. He describes no problems with handwriting, or fine motor skills.

Jhn Journal (Download The Full Pdf Of This Issue), Robert H. Rosenwasser Md

JHN Journal

Complete December 2008 issue of JHN Journal

Spinal Cord Stimulators: An Introduction, Steven Falowski Md

JHN Journal

Pain can be divided into two broad categories, nociceptive pain and neuropathic pain. Nociceptive pain is a dull, throbbing pain which results from irritated nerves after physical tissue injury. This is seen commonly in cancer or after a fracture. Nociceptive pain is amenable to treatment with pain medications such as opioids and/or anti-inflammatories. Neuropathic pain is described as burning, shooting, or shocking pain. This type of pain results from nerve damage or abnormal nerve conduction such as pain exhibited with failed back syndrome, post surgical pain, neuromas, shingles, and complex regional pain syndrome (previously called RSD or causalgia). Neuropathic pain …

Minimally Invasive Surgery For Skull Base Tumors, James J. Evans Md, Marc R. Rosen Md

JHN Journal

The Jefferson Center for Minimally Invasive Cranial Base Surgery and Endoscopic Neurosurgery reflects three of the current evolutions in neurological surgery. The first of these is reflected in the name of the Center itself. Surgical Procedures, Minimally Invasive, a Medline Subject Heading since 1998, is defined as:

Procedures that avoid use of open invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. With the reduced trauma associated with minimally invasive surgery, long hospital stays may …

Clinical Guidelines Written By Residents, David W. Andrews Md

JHN Journal

“Variation” is an innocent word that that can represent many levels of frustration to the clinician. Variation among patients is the least of these; the physician expects patients and their individual problems to be as diverse as the human race itself. Variation within a practice should be due to matching the specific needs of the specific patient. Other variations can mean trouble if they represent differences in understanding of the problem among clinicians and other allied health practitioners. These differences could be between institutions or even between shifts within one institution.

Young Woman With Chronic Conversion Disorder With Dramatic Improvement In Upper Motor Neuron Type Syndromes Through The Use Of Electromyography (Emg) Triggered Biofeedback, Bruce H. Hsu, Md, Nethra S. Ankam, Md, Ralph J. Marino

Department of Rehabilitation Medicine Faculty Papers

Patient: 31 year old woman chronic flexion contracture of hand, prior history seizure disorder, chronic conversion disorder.

Program Description: Patient presented initially to neurology service with chronic right hand flexion contracture in the context of 3 days of weakness and numbness in lower extremities after exertion. MRI/MRA Brain, Head CT, CT of entire spine were all unrevealing. Patient was transferred to the rehabilitation unit 8 days after initial admission. On rehabilitation admission patient exam was noted to have right hand markedly flexed with pain to passive ranging out of extreme flexion, chronic in nature. Patient initially had her hand ranged …

Sensitivity Of The Human Circadian System To Short Wavelength (420 Nm) Light, George C. Brainard, David Silney, John P. Hanifin, Gena Glickman, Brenda Byrne, Jeffrey M. Greeson, Samar Jasser, Edward Gerner, Mark D. Rollag

Department of Neurology Faculty Papers

The circadian and neurobehavioral effects of light are primarily mediated by a retinal ganglion cell photoreceptor in the mammalian eye containing the photopigment, melanopsin. Nine action spectrum studies using rodents, monkeys, and human for these responses indicate peak sensitivities in the blue region of the visible spectrum ranging from 459 nm to 484 nm, with some disagreement in short wavelength sensitivity of the spectrum. The aim of this work was to quantify the sensitivity of human volunteers to monochromatic 420 nm light for plasma melatonin suppression. Adult female (N=14) and male (N=12) subjects participated in two studies, each employing a …

Experimental Optic Neuritis Induced By A Demyelinating Strain Of Mouse Hepatitis Virus., Kenneth S. Shindler, Lawrence C. Kenyon, Mahasweta Dutt, Susan T. Hingley, Jayasri Das Sarma

Department of Neurology Faculty Papers

Optic neuritis (ON), an inflammatory demyelinating optic nerve disease, occurs in multiple sclerosis (MS). Pathological mechanisms and potential treatments for ON have been studied via experimental autoimmune MS models. However, evidence suggests that virus-induced inflammation is a likely etiology triggering MS and ON; experimental virus-induced ON models are therefore required. We demonstrate that MHV-A59, a mouse hepatitis virus (MHV) strain that causes brain and spinal cord inflammation and demyelination, induces ON by promoting mixed inflammatory cell infiltration. In contrast, MHV-2, a nondemyelinating MHV strain, does not induce ON. Results reveal a reproducible virus-induced ON model important for the evaluation of …

Multi-Scale Modeling Of Angiotensin Ii Induced Neuronal Regulatory Mechanisms In The Brain, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Poster Presentation.

Spinal Cord Stimulation For Control Of Pain, Stephen Falowski Md

JHN Journal

Spinal cord stimulation (SCS) is an adjustable, non-destructive procedure which delivers therapeutic doses of electrical current to the spinal cord for the management of neuropathic pain. The most common indications include post-laminectomy (“failed back surgery”) syndrome, complex regional pain syndrome (CRPS), ischemic limb pain, and angina. Other reported applications include visceral/abdominal pain, cervical neuritis pain, spinal cord injury pain, post-herpetic neuralgia, and neurogenic thoracic outlet syndrome.

Case Report: Signal Drop On Mra Imaging Of The Internal Carotid Artery After Neuroform Stent Placement, Aditya S. Pandey Md, Meryl A. Severson Iii Md, Robert H. Rosenwasser Md

JHN Journal

Magnetic resonance angiography (MRA) is an important tool in evaluating the patency of vessels which have previously been stented. Neuroform stents (Boston Scientific, Natick, MA, U.S.A.) are utilized to provide a scaffold across the neck of an aneurysm. These stents are synthesized from Nitinol (nickel and titanium) and thus cause minimal distortion upon imaging with MRA. Patients who have undergone Neuroform stent assisted coiling of aneurysms are routinely followed with MRA to delineate stenosis of the stented segment of vessel as well as recurrence of the aneurysms. While numerous reports show that Neuroform stents do not lead to MRA imaging …