Neurology Commons^™

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 …

Primary Cardiac Sarcoma: A Rare, Aggressive Malignancy With A High Propensity For Brain Metastases., Brittany L Siontis, Lili Zhao, Monika Leja, Jonathan B Mchugh, Maryann M Shango, Laurence H Baker, Scott M Schuetze, Rashmi Chugh

Articles, Abstracts, and Reports

Introduction: Primary cardiac sarcoma (PCS) has a poor prognosis compared to other sarcomas due to late presentation, challenging resection, incidence of metastases, and limited efficacy of systemic therapies.

Methods: A medical record search engine was queried to identify patients diagnosed with PCS from 1992 to 2017 at the University of Michigan.

Results: Thirty-nine patients with PCS had a median age of 41 years (range 2-77). Common histologies were angiosarcoma (AS, 14), high-grade undifferentiated pleomorphic sarcoma (UPS, 10), and leiomyosarcoma (LMS, 5). Sites of origin were left atrium (18), right atrium (16), and pericardium (5). AS was the most common right-sided …

Postoperative Intracranial Migration Of A C2 Odontoid Screw: A Case Report And Literature Review., Ankush Chandra, Seong-Jin Moon, Blake Walker, Emre Yilmaz, Marc Moisi, Robert Johnson

Articles, Abstracts, and Reports

Background: Intracranial migration of odontoid screws is a rare but serious complication of anterior odontoid screw fixation not often reported in literature by neurosurgeons. Here, we describe the second case in literature of intracranial migration of an odontoid screw.

Case Description: A 64-year-old neurologically intact patient with a type II odontoid fracture secondary to trauma underwent anterior odontoid screw fixation without any intraoperative complications. He tolerated the procedure well, and postoperative imaging demonstrated near anatomic correction of the fracture with satisfactory placement of the lag screw. Unfortunately, the patient was subsequently lost to follow up and he presented 7 months …

Precision Sensorimotor Control In Aging Fmr1 Gene Premutation Carriers., Walker S Mckinney, Zheng Wang, Shannon Kelly, Pravin Khemani, Su Lui, Stormi P White, Matthew W Mosconi

Articles, Abstracts, and Reports

Background: Individuals with premutation alleles of the

Materials and Methods: 26

Results: Relative to controls, premutation carriers showed reduced rates of initial force generation during rapid motor actions and longer durations of their initial pressing with their dominant hand. During sustained force, premutation carriers demonstrated reduced force complexity, though this effect was specific to younger premutation carries during dominant hand pressing and was more severe for younger relative to older premutation carriers at low and medium force levels. Increased reaction time and lower sustained force complexity each were associated with greater CGG repeat length for premutation carriers. Increased reaction time …

A Case Report Of Thalamic Infarction After Lumbar Drain: A Unique Cause Of Perioperative Stroke?, Daniel N Kianpour, Thomas M Nguyen, Arthur M Lam

Articles, Abstracts, and Reports

In the case presented, a patient has an unexplained episode of hypertension during aneurysm clipping. Following the procedure, the patient was discovered to have bilateral thalamic infarctions unrelated to the vascular location of the aneurysm. After a review of the case, it becomes apparent that intracranial hypotension caused by lumbar over drainage of cerebrospinal fluid (CSF) is the likely cause of both the episode of intraoperative hypertension and the thalamic infarcts. It is often presumed that having an open dura protects against intracranial hypotension and subsequent herniation. We present this case to suggest that opening the dura might not be …

Focused Transcranial Ultrasound For Treatment Of Neurodegenerative Dementia., Natalie Eleanor Nicodemus, Sergio Becerra, Taylor P Kuhn, Hannah R Packham, John Duncan, Kennedy Mahdavi, Jessica Iovine, Santosh Kesari, Scott Pereles, Mike Whitney, Michael Mamoun, Daniel Franc, Alexander Bystritsky, Sheldon Jordan

Articles, Abstracts, and Reports

Introduction: Preclinical studies support investigation of focused ultrasound for breakdown of cerebral pathologies in neurodegenerative conditions including Alzheimer's disease (AD) and Parkinson's disease (PD).

Methods: A focused transcranial Doppler device with probes (2 MHz, 520 mW/cm

Results: Of all, 62.5% of patients had one or more improved cognitive scores without data incongruence, 87% had stable or improved fine motor scores, and 87.5% had stable or improved gross motor scores. No adverse events were reported.

Discussion: The safety of focused transcranial Doppler and possible enhancement in patient functioning were suggested by outcome data.

Epigenetic Classifiers For Precision Diagnosis Of Brain Tumors., Javier I Orozco, Ayla O Manughian-Peter, Matthew P Salomon, Diego M Marzese

Articles, Abstracts, and Reports

DNA methylation profiling has proven to be a powerful analytical tool, which can accurately identify the tissue of origin of a wide range of benign and malignant neoplasms. Using microarray-based profiling and supervised machine learning algorithms, we and other groups have recently unraveled DNA methylation signatures capable of aiding the histomolecular diagnosis of different tumor types. We have explored the methylomes of metastatic brain tumors from patients with lung cancer, breast cancer, and cutaneous melanoma and primary brain neoplasms to build epigenetic classifiers. Our brain metastasis methylation (BrainMETH) classifier has the ability to determine the type of brain tumor, the …

Altered Domain Functional Network Connectivity Strength And Randomness In Schizophrenia., Victor M Vergara, Eswar Damaraju, Jessica A Turner, Godfrey Pearlson, Aysenil Belger, Daniel H Mathalon, Steven G Potkin, Adrian Preda, Jatin G Vaidya, Theo G M Van Erp, Sarah C Mcewen, Vince D Calhoun

Articles, Abstracts, and Reports

Functional connectivity is one of the most widely used tools for investigating brain changes due to schizophrenia. Previous studies have identified abnormal functional connectivity in schizophrenia patients at the resting state brain network level. This study tests the existence of functional connectivity effects at whole brain and domain levels. Domain level refers to the integration of data from several brain networks grouped by their functional relationship. Data integration provides more consistent and accurate information compared to an individual brain network. This work considers two domain level measures: functional connectivity strength and randomness. The first measure is simply an average of …

The Current Understanding Of Microrna's Therapeutic, Diagnostic, And Prognostic Role In Chordomas: A Review Of The Literature., Paul J Choi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Chordomas are primary low-grade bone tumors derived from the embryonic notochord that make up less than 5% of all osseous malignancies and commonly affect the spine at its vertebral body and at its two ends i.e., skull base and the sacrum. Although histologically defined to be low-grade, chordoma is locally destructive, metastatic, and has a serious recurrence rate, which all contribute to the dismal median survival rate of six years. Its locally destructive nature places the adjacent vital neurovascular structures at risk, making an en-bloc resection a challenge. This tumor is also known to show high resistance to currently available …

The Sin Of Missing Data: Is All Forgiven By Way Of Imputation?, Joseph R Dettori, Daniel C Norvell, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Bilateral Sternocleidomastoid Variant With Six Distinct Insertions Along The Superior Nuchal Line., Graham Dupont, Joe Iwanaga, Juan J Altafulla, Stefan Lachkar, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Anatomical variations of the sternocleidomastoid muscle (SCM) have been observed to occupy multiple origins and insertion points and have supernumerary heads, sometimes varying in thickness. During routine dissection, a SCM was observed to have six distinct insertions that interface with the course of the superior nuchal line, ending at the midline, bilaterally. This variation was also seen to receive innervation from the accessory nerve as well as the great auricular nerve. To our knowledge, this variant of supernumerary insertions and nerve innervations has not yet been reported. These variants may pose as problematic during surgical approaches to the upper neck …

Cost-Utility Of Revisions For Cervical Deformity Correction Warrants Minimization Of Reoperations., Samantha R Horn, Peter G Passias, Aaron Hockley, Renaud Lafage, Virginie Lafage, Hamid Hassanzadeh, Jason A Horowitz, Cole A Bortz, Frank A Segreto, Avery E Brown, Justin S Smith, Daniel M Sciubba, Gregory M Mundis, Michael P Kelley, Alan H Daniels, Douglas C Burton, Robert A Hart, Frank J Schwab, Shay Bess, Christopher I Shaffrey, Richard A Hostin, Christopher P Ames

Articles, Abstracts, and Reports

Background: Cervical deformity (CD) surgery has become increasingly more common and complex, which has also led to reoperations for complications such as distal junctional kyphosis (DJK). Cost-utility analysis has yet to be used to analyze CD revision surgery in relation to the cost-utility of primary CD surgeries. The aim of this study was to determine the cost-utility of revision surgery for CD correction.

Methods: Retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin-brow vertical angle (CBVA) …

The Ratio Of Observed To Expected: How Much Of It Is Unexpected?, Jens R Chapman, Karsten Wiechert, Jeffrey C Wang

Articles, Abstracts, and Reports

No abstract provided.

Wound Closure After Posterior Multi-Level Lumbar Spine Surgery: An Anatomical Cadaver Study And Technical Note., Emre Yilmaz, Tamir Tawfik, Thomas M O'Lynnger, Joe Iwanaga, Ronen Blecher, Amir Abdul-Jabbar, R Shane Tubbs, Cameron K Schmidt, Rod J Oskouian, Jens R Chapman

Articles, Abstracts, and Reports

Meticulous attention to wound closure in posterior lumbar spine surgery is an important principle in reducing surgical site infections. We detail standardized wound closure used for posterior lumbar spine surgery at a tertiary care referral center and illustrate this as a step-by-step cadaveric dissection. The lumbar spine of a cadaveric specimen (male, 73 years at death) was used for dissection. Standardizing wound closure in posterior lumbar spine surgery may help limit wound complications and infection. Some key points of our technique, as demonstrated on a cadaveric specimen, include separating fascial compartments, avoiding suture abscesses, and creating a tension-free wound.

Epigenetic Profiling For The Molecular Classification Of Metastatic Brain Tumors., Javier I Orozco, Theo A Knijnenburg, Ayla O Manughian-Peter, Matthew P Salomon, Garni Barkhoudarian, John R Jalas, James S Wilmott, Parvinder Hothi, Xiaowen Wang, Yuki Takasumi, Michael E Buckland, John F Thompson, Georgina V Long, Charles S Cobbs, Ilya Shmulevich, Daniel F Kelly, Richard A Scolyer, Dave S B Hoon, Diego M Marzese

Articles, Abstracts, and Reports

Optimal treatment of brain metastases is often hindered by limitations in diagnostic capabilities. To meet this challenge, here we profile DNA methylomes of the three most frequent types of brain metastases: melanoma, breast, and lung cancers (n = 96). Using supervised machine learning and integration of DNA methylomes from normal, primary, and metastatic tumor specimens (n = 1860), we unravel epigenetic signatures specific to each type of metastatic brain tumor and constructed a three-step DNA methylation-based classifier (BrainMETH) that categorizes brain metastases according to the tissue of origin and therapeutically relevant subtypes. BrainMETH predictions are supported by routine histopathologic evaluation. …

Brain Metastasis Dna Methylomes, A Novel Resource For The Identification Of Biological And Clinical Features., Matthew P Salomon, Javier I J Orozco, James S Wilmott, Parvinder Hothi, Ayla O Manughian-Peter, C Cobbs, Richard A Scolyer, Dave S B Hoon, Diego M Marzese

Articles, Abstracts, and Reports

Brain metastases (BM) are one the most lethal and poorly managed clinical complications in cancer patients. These secondary tumors represent the most common intracranial neoplasm in adults, most frequently originating from lung cancer, breast cancer, and cutaneous melanoma. In primary brain tumors, such as gliomas, recent advances in DNA methylation profiling have allowed for a comprehensive molecular classification. Such data provide prognostic information, in addition to helping predict patient response to specific systemic therapies. However, epigenetic alterations of metastatic brain tumors with specific biological and translational relevance still require much further exploration. Using the widely employed Illumina Infinium HumanMethylation 450K …

Basic Considerations For The Use Of Monoclonal Antibodies In Migraine., Morris Levin, Stephen D Silberstein, Robert Gilbert, Sylvia Lucas, Leanne Munsie, Alyssa Garrelts, Kate Kennedy, Nicole Everman, Eric Pearlman

Articles, Abstracts, and Reports

BACKGROUND: Migraine impacts more than 36 million people in the United States and 1 billion people worldwide. Despite the increasing availability of acute and preventive therapies, there is still tremendous unmet need. Potential treatments in development include monoclonal antibodies (mAbs). Appropriate use of these “biologic” treatments will necessitate an understanding of the aspects that distinguish them from traditional medications.

AIM: Many drug classes are prescribed for migraine treatment, but all have limitations. Recently, calcitonin gene-related peptide (CGRP) activity has shown a significant promise as a target for preventive therapy. In this review, we provide an overview of the potential role …

Differences Between Stance And Foot Preference Evident In Osprey (Pandion Haliaetus) Fish Holding During Movement., Laura L Allen, Katie L Morrison, Wesley A E Scott, Steve Shinn, Alan M Haltiner, Michael J Doherty

Articles, Abstracts, and Reports

BACKGROUND: Skateboarders, snowboarders, and surfers all show stance preferences for which foot is forward while moving. We are unaware of other animals than humans with a stance preference, perhaps excepting Osprey, who fly their caught fish beneath them in a foot-forward stance. We hypothesize there should be no difference between left foot forward, right foot back (conventional) versus right foot forward left foot back (goofy) stances or for fish holding with unilateral left or right foot. Online, publicly available, convenience images of Osprey catching fish were accessed and assessed by five independent reviewers using different Internet search engines or online …

The Global Dilemma: Standardization Of Nonoperative Treatment., Karsten Wiechert, Jeffrey C Wang, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

A Real-World Comparison Of Relapse Rates, Healthcare Costs And Resource Use Among Patients With Multiple Sclerosis Newly Initiating Subcutaneous Interferon Beta-1a Versus Oral Disease-Modifying Drugs., James D Bowen, Chris M Kozma, Megan M Grosso, Amy L Phillips

Articles, Abstracts, and Reports

Background: Administrative-claims data enable comparative effectiveness assessment using large numbers of patients treated in real-world settings.

Objective: To evaluate real-world relapses, healthcare costs and resource use in patients with MS newly initiating subcutaneous interferon beta-1a (sc IFNβ-1a) v. oral disease-modifying drugs (DMDs: dimethyl fumarate, fingolimod, teriflunomide).

Methods: Patients from an administrative claims database (1 Jan 2012-31 Dec 2015) were selected if they: were 18-63 years old; had an MS diagnosis; had newly initiated sc IFNβ-1a, dimethyl fumarate, fingolimod, or teriflunomide (first claim = index); had no evidence of DMD 12-months pre-index; and had 12-month eligibility pre- and post-index. Relapse was …

Comprehensive Review Of Spinal Neurenteric Cysts With A Focus On Histopathological Findings., Woong Kee Baek, Stefan Lachkar, Joe Iwanaga, Rod J Oskouian, Marios Loukas, W Jerry Oakes, R Shane Tubbs

Articles, Abstracts, and Reports

Among the occult spinal dysraphisms, neurenteric cysts (NECs) are rare and are thought to arise due to a failure of the separation of the primitive endoderm and ectoderm. Patients experience various neurological symptoms depending on the location of the lesion. As the epithelial morphology of NECs share similarities with other intracranial and intraspinal cystic growths, the definitive diagnosis of NEC can be made after a histochemical analysis with endodermal markers. Complete resection is associated with the lowest disease recurrence rate.

Sparse Recurrent Excitatory Connectivity In The Microcircuit Of The Adult Mouse And Human Cortex., Stephanie C Seeman, Luke Campagnola, Pasha A Davoudian, Alex Hoggarth, Travis A Hage, Alice Bosma-Moody, Christopher A Baker, Jung Hoon Lee, Stefan Mihalas, Corinne Teeter, Andrew L Ko, Jeffrey G Ojemann, Ryder P Gwinn, Daniel L Silbergeld, Charles Cobbs, John Phillips, Ed Lein, Gabe Murphy, Christof Koch, Hongkui Zeng, Tim Jarsky

Articles, Abstracts, and Reports

Generating a comprehensive description of cortical networks requires a large-scale, systematic approach. To that end, we have begun a pipeline project using multipatch electrophysiology, supplemented with two-photon optogenetics, to characterize connectivity and synaptic signaling between classes of neurons in adult mouse primary visual cortex (V1) and human cortex. We focus on producing results detailed enough for the generation of computational models and enabling comparison with future studies. Here, we report our examination of intralaminar connectivity within each of several classes of excitatory neurons. We find that connections are sparse but present among all excitatory cell classes and layers we sampled, …

A Median Artery Of The Corpus Callosum., Juan J Altafulla, Emily A Simonds, Graham Dupont, Stefan Lachkar, Zachary Litvack, Joe Iwanaga, R Shane Tubbs

Articles, Abstracts, and Reports

The anterior communicating artery is one of the main components of the vascular network that delivers blood to the brain. Therefore, a good understanding of the normal anatomy and its variations is important to neurologists, neurosurgeons, and other health care providers dealing with the central nervous system. Here, we present a case of a median artery of the corpus callosum found in a cadaver, with consideration of cerebral hemodynamics implications.

Bilateral Displacement Of The Common Carotid Arteries By A Large Goiter., Lexian J Mcbain, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Large goiters are less common in the developing world due to the use of iodized salt. However, these are seen occasionally. Herein, we report a case of very large goiter identified in a cadaver. This case is also of interest due to the significant lateral displacement of the common carotid arteries (CCA) and the midline shift of the trachea. This case and the salient literature addressing this topic have been discussed.

Variations Of The Transverse Sinus: Review With An Unusual Case Report., Chrissie Massrey, Juan J Altafulla, Joe Iwanaga, Zachary Litvack, Basem Ishak, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The dural venous sinuses are venous channels in the cranium that drain blood and cerebrospinal fluid circulating from the brain into the vascular system via the internal jugular veins. The transverse sinus is a dural venous sinus present in the posterior aspect of the cranium. We report an unusual variant of this sinus with the presence of a fenestration at its proximal segment. We will review and discuss the background and the potential clinical relevance of this anatomical variation.

Parametric And Nonparametric Tests In Spine Research: Why Do They Matter?, Sarah Hopkins, Joseph R Dettori, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Distinctive Structural And Molecular Features Of Myelinated Inhibitory Axons In Human Neocortex., Kristina D Micheva, Edward F Chang, Alissa L Nana, William W Seeley, Jonathan T Ting, Charles Cobbs, Ed Lein, Stephen J Smith, Richard J Weinberg, Daniel V Madison

Articles, Abstracts, and Reports

Numerous types of inhibitory neurons sculpt the performance of human neocortical circuits, with each type exhibiting a constellation of subcellular phenotypic features in support of its specialized functions. Axonal myelination has been absent among the characteristics used to distinguish inhibitory neuron types; in fact, very little is known about myelinated inhibitory axons in human neocortex. Here, using array tomography to analyze samples of neurosurgically excised human neocortex, we show that inhibitory myelinated axons originate predominantly from parvalbumin-containing interneurons. Compared to myelinated excitatory axons, they have higher neurofilament and lower microtubule content, shorter nodes of Ranvier, and more myelin basic protein …