Neurology Commons^™

Stroke In Hfref Without Atrial Fibrillation And Concurrent Protein S Deficiency: What Is The Best Treatment?, Rohan Umrani, Trinava Roy, Bhavana Kadiyala, Yvette Wang

Rowan-Virtua Research Day

Hypercoagulable disorders are often the culprit for repeated strokes in young patients, with or without other comorbidities

Medications typically used for stroke prophylaxis:

• Warfarin
• Aspirin
• Direct Oral Anticoagulants (DOACs)

Warfarin is the preferred method of anticoagulation for stroke prophylaxis in patients with hypercoagulable disorders

A deficiency of protein S increases the risk of pro coagulation due to a relative deficiency of anticoagulants.

Patients with protein S deficiency tend to have recurrent venous thromboses and pulmonary emboli

A Case Of Intracranial Empyema After Bacterial Sinusitis, Eric Doane, Bhumi Shah, Robert Belfer

Rowan-Virtua Research Day

Acute sinusitis in the pediatric population is a common presentation in the emergency department. Most cases are viral and can be managed conservatively and will resolve spontaneously in 7-10 days. Even in cases of bacterial sinusitis, patients can typically be discharged with oral antibiotics and close follow up with the pediatrician.

There is however a small subset of patients who will develop a rare lethal complication, an intracranial empyema. While the incidence in the developed world has decreased as antibiotics become more available, it is still estimated to occur in up to 5% of severe cases requiring hospitalization (1) . …

A Preliminary Report: The Hippocampus And Surrounding Temporal Cortex Of Patients With Schizophrenia Have Impaired Blood-Brain Barrier, Eric L. Goldwaser, Randel L. Swanson, Edgardo J. Arroyo, Venkat Venkataraman, Mary C. Kosciuk, Robert G. Nagele, L. Elliot Hong, Nimish K. Acharya

Rowan-Virtua Research Day

Schizophrenia (SZ) is one of the most severe forms of mental illness, yet mechanisms remain unclear. A widely established brain finding in SZ is hippocampal atrophy, and a coherent explanation similarly is lacking. Epidemiological evidence suggests increased cerebrovascular and cardiovascular complications in SZ independent of lifestyle and medication, pointing to disease-specific pathology. Endothelial cell contributions to blood-brain barrier (BBB) compromise may influence neurovascular unit and peripheral vascular function, and we hypothesize that downstream functional and structural abnormalities may be explained by impaired BBB.

Case Report: Glioblastoma Tumor Presenting With Mild Changes In Memory, Samuel Thalathoti, Nicholas Palladino, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 66-year-old female who presented to the ED with generalized headache and mild confusion, who was diagnosed with high-grade glial neoplasm. The differential diagnosis of headache is vast, but without red flags or symptoms is generally from a benign cause and easily treatable. However, even in the context of a normal neurologic physical exam, symptoms such as confusion, forgetfulness, and behavioral changes should merit imaging in the workup. Glioblastoma is the most common brain tumor, accounting for 47.7% of all cases, with an incidence of 3.21 per 100,000 population. Median age of diagnosis is 64 …

Distinguishing Multiple System Atrophy Vs Parkinson’S Disease In An African American Woman, Mahoua Kane, Rebecca Smith, Venkat Venkataraman

Rowan-Virtua Research Day

An 87-year-old African American woman with a past medical history of atrial fibrillation on warfarin and peripheral neuropathy with a family history of myasthenia gravis presented to the Emergency Department. The primary reason was loss of consciousness upon standing. The patient was given the diagnosis of hypertension, cervical spinal stenosis, and Parkinson’s Disease. There is little improvement with medications for any of these conditions. Currently, patient has episodes of worsening BP, blackouts, dysphagia, snoring, decreasing voice pitch with trismus. In addition, the patient is positive for dizziness, mild resting tremor in left hand with rigidity, constipation, multiple UTIs and postural …

Charles Bonnet Syndrome: A Case Report, Christian Scouarnec, Martin M. Forsberg

Rowan-Virtua Research Day

Charles Bonnet syndrome (CBS) involves nonthreatening hallucinations in patients who have no neurological and no psychological abnormalities but with significant visual impairment secondary to ocular disease, such as macular degeneration, cataracts and diabetic retinopathy. When a patient loses vision, their visual system doesn’t process new images. Without data coming through the eyes, the brain fills the void and makes up images or recalls stored images for you to see and this is what causes the hallucinations in CBS.

Many physicians are unaware of CBS and its prevalence, and with proper detection, physicians can help treat their patients with a frequently …

Helicopter Ems And Its Outcomes In Stroke Patients During Transport From Rural Ed To Comprehensive Stroke Center, Asim Shafique, Jillian Baker

Rowan-Virtua Research Day

The theory that will be examined in this review pertains to creating an algorithm based upon whether patients suffering from a stroke with a large vessel occlusion should be taken to a stroke center from rural emergency departments for a mechanical thrombectomy via helicopter EMS (HEMS) or ambulance transport. Such an algorithm does not exist in healthcare, so this literature review will have the potential to be clinically applicable. This review will aim to identify the proper method of transportation during an ischemic stroke with the goal of reducing mortality rates and improving outcomes. Most rural communities are over an …

Improvement Of Memory Loss Through Dietary Intervention In The Assisted Living And Rehabilitative Settings, Alexander Swartz, Martin Forsberg

Rowan-Virtua Research Day

• The ketogenic diet is a popular, controversial diet that fuels the brain through beta-oxidation of fatty acids and production of ketone bodies, the most populous of which is betahydroxybutyrate (BHB).

• The ketogenic diet consists of 70-80% fats, 20-25% protein, and 5-10% carbohydrates.

• Medically, the ketogenic diet is utilized in patients with epilepsy and recommended by some physicians to improve general health through weight loss and insulin sensitivity.

• Key factors of neurodegeneration include glucose hypometabolism, oxidative damage, and neuroinflammation.

• Studies have shown that with ingestion of exogenous ketones alone, or endogenous ketonemia through a ketogenic diet, there is: …

Plasmalogen Deficiency: A Risk Factor For Dementias And Potential Treatment Target, Mitchel A. Kling, Mallika Mendu, Rima F. Kaddurah-Daouk, Sheldon Jordan, Dayan B. Goodenowe

Rowan-Virtua Research Day

Altered lipid metabolism is implicated in the risk of sporadic Alzheimer’s disease (AD) and related dementias (ADRD); however, the precise mechanisms accounting for findings from observational studies remains to be fully elucidated.

Plasmalogens are a subclass of integral membrane phospholipids with unique properties that appear to play important roles relevant to the pathophysiology of AD and ADRD, including vesicle fusion necessary for synaptic neurotransmitter release, modulation of membrane fluidity and microdomain dynamics, membrane antioxidant functions, and neuroprotection. Like the more familiar phosphatides, plasmalogens are synthesized on a 3-carbon glycerol backbone; however, they differ from phosphatides by the presence of a …

A Case Of Acute Disseminated Encephalomyelitis In An Adult Male With Bipolar Disorder, Jinisha Patwa, Tracey Harris

Rowan-Virtua Research Day

Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disease characterized by inflammation of the brain and spinal cord. The rapidly progressive inflammation in the central nervous system is known to occur in response to a prior infection or immunization.

The clinical signs of ADEM may manifest up to 60 days post illness or vaccination. Some develop encephalopathy and neurologic symptoms which include confusion, psychosis, and tetraparesis. Paresthesia of the limbs and muscular atrophy indicate a worse prognosis and higher risk of relapse as opposed to those with only CNS involvement. A predominantly psychiatric presentation is also possible.

Risk factors include …

A Case Of Akinetic Mutism In Patient With Unilateral Anterior Communicating Artery Stroke, David Ho, Or Shachar, James Espinosa, Alan Lucerna, James Lee

Rowan-Virtua Research Day

Akinetic mutism, a rare neurological condition involving sensory, motor, language, behavior, and emotional changes, mimicking locked-in syndrome, should be considered in acute stroke patients presenting with speech deficits. This condition, although debilitating initially, does have prospects for recovery. In this case report, we present the case of a patient presenting to the ER for altered mental status, found to be in DKA, NSTEMI, suspected narcotic overdose, and unilateral acute ischemic stroke of the left anterior communicating artery (ACA), who was found to have Akinetic Mutism. In stroke patients presenting with aphasia and dysarthria, it is worth considering akinetic mutism in …

Neurosyphilis: A Monkey Among Men, Cameron Rowe Do, Nathan Buckley Do, Bhaskar Chhetri Md, Suresh Paudel Md

Journal of Community Hospital Internal Medicine Perspectives

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous system at any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called “The Great Pretender” or “The monkey among diseases” (12). This is a case report of an 83-year-old female with a history of multiple …

Cross-Species Genetic Screens Identify Transglutaminase 5 As A Regulator Of Polyglutamine-Expanded Ataxin-1, Won-Seok Lee, Ismael Al-Ramahi, Hyun-Hwan Jeong, Youjin Jang, Tao Lin, Carolyn J Adamski, Laura A Lavery, Smruti Rath, Ronald Richman, Vitaliy V Bondar, Elizabeth Alcala, Jean-Pierre Revelli, Harry T Orr, Zhandong Liu, Juan Botas, Huda Y Zoghbi

Duncan NRI Faculty and Staff Publications

Many neurodegenerative disorders are caused by abnormal accumulation of misfolded proteins. In spinocerebellar ataxia type 1 (SCA1), accumulation of polyglutamine-expanded (polyQ-expanded) ataxin-1 (ATXN1) causes neuronal toxicity. Lowering total ATXN1, especially the polyQ-expanded form, alleviates disease phenotypes in mice, but the molecular mechanism by which the mutant ATXN1 is specifically modulated is not understood. Here, we identified 22 mutant ATXN1 regulators by performing a cross-species screen of 7787 and 2144 genes in human cells and Drosophila eyes, respectively. Among them, transglutaminase 5 (TG5) preferentially regulated mutant ATXN1 over the WT protein. TG enzymes catalyzed cross-linking of ATXN1 in a polyQ-length–dependent manner, …

Effective Therapies And Nursing Approaches: Improving Cognition In Older Adult Stroke Patients, Selyna Baltazar

Nursing | Senior Theses

Background

Ischemic stroke occurs in thousands of older adults throughout the year. Due to the lack of oxygen entering the brain, many patients experience a decline in cognitive function due to ischemic stroke. Cognition is the ability to understand, learn, and remember information which is needed for completing daily tasks. Modern technology has allowed for patients to survive ischemic strokes but has yet to provide proper screening tools and methods for stroke-related cognitive impairment.

Objective

To investigate the best practices for identifying, treating, and caring for patients with a cognitive injury related to a stroke. A review of the research …

Safety Measures In The Epilepsy Monitoring Unit: An Organizational Assessment, Tina Yates

Doctor of Nursing Practice Scholarly Projects

Long-term video-electroencephalography (EEG) monitoring in the epilepsy monitoring unit (EMU) is an elective procedure and generally safe. Clinical experts determined the EMU protocols at a level-4 comprehensive epilepsy center were not followed correctly. The project is a retrospective chart audit incorporating Ray’s Bureaucratic Caring theoretical framework with Donabedian’s conceptual model. The project objective is to evaluate if safety measures protocols are implemented appropriately in the EMU and determine whether a need exists for quality improvements.

The project reviewed patients admitted to the EMU from September 2021 through November 2021 who developed a generalized tonic clonic (GTCs) seizure with electrographic epileptiform …

Identifying Motivators, Facilitators, And Barriers To Engaging In An Online Fine Motor Exercise Program, Kristine Ricossa, Kyndra Menefee, Lauren Rally, Mia Do, Charis Chan

Occupational Therapy | MSOT Capstone Projects

Purpose: The aim of this qualitative study was to examine the impact of the motivators, facilitators and barriers for individuals with Parkinson’s Disease (PD) in engaging in a fine motor exercise program given online. Methods: Using a phenomenological design, a purposive sample of 6 individuals with PD were recruited. Data were collected through semi-structured interviews via zoom with follow up member checks. Data were analyzed through an inductive approach by developing generalizations from themes based on the interview data. Results: Three common themes were developed, ‘integrating and forming habits’, ‘acknowledging participation in exercise can fight the disease’, ‘recognizing improvement in …

The Impact Of Volume Of Tissue Activation On Cortical-Striatal Networks And Verbal Fluency Declines In Post-Deep Brain Stimulation Parkinson's Disease Patients., Alexander Luke Alley

Electronic Theses and Dissertations

This study investigated the cortical-striatal networks of verbal fluency declines in 6-month, post-operative, deep brain stimulation Parkinson’s Disease patients. Nine Parkinson’s disease participants with implanted STN or GPi DBS systems were recruited for this study. Verbal fluency data was obtained from each patient preoperatively and 6- months post implantation. The stimulation-based volume of tissue activated area (VTA) of each target site (STN or GPi) was analyzed using Lead-DBS and Lead-Group. The white matter tracks intersecting each patient’s VTA, terminating in the pre-SMA, SMA, caudate nucleus, and anterior cingulate were investigated and correlated with verbal fluency declines. We found statistically significant …

Modeling Of Cns Cancer With A Focus On The Immune Component, Daniel Zamler

Dissertations and Theses (Open Access)

The knowledge surrounding cancers of the central nervous system remains poorly developed, in particular with regard to the immune component. The works contained in this thesis look at craniopharyngioma, glioblastoma, and several forms of brain metastasis. While some attention is given to the tumor cells themselves, as well as the patient setting which these studies model, the immune component of disease progression and treatment plays a strong role in each and is the primary focus of the works contained.

Craniopharyngioma is a relatively rare tumor in adults. Although histologically benign, it can be locally aggressive and may require additional therapeutic …

“Translation Of Hdac6 Pet Imaging Using [18f]Ekz-001 – Cgmp Production And Measurement Of Hdac6 Target Occupancy In Nhps” – A Review, Dania Rahal

Chemistry & Biochemistry Undergraduate Honors Theses

The inhibition of histone deacetylase 6 (HDAC6) has been reported to alleviate the effects of neurodegenerative diseases such as Alzheimer’s disease. The brain-penetrant PET radioligand [¹⁸F]EKZ-001 has high affinity and selectivity towards HDAC6 and therefore suggests great promise in therapeutic treatment studies and development for neurodegenerative diseases. “Translation of HDAC6 PET imaging using [¹⁸F]EKZ-001 – cGMP production and measurement of HDAC6 target occupancy in NHPs” has achieved an effective, fully automated method of producing [¹⁸F]EKZ-001 in compliance with current good manufacturing practices (cGMP) to support the translation of [¹⁸F]EKZ-001 PET for …

Peripheral Neuropathy Evaluations Of Patients With Prolonged Long Covid., Anne Louise Oaklander, Alexander J Mills, Mary Kelley, Lisa S Toran, Bryan Smith, Marinos Dalakas, Avindra Nath

Department of Neurology Faculty Papers

Background and objectives: Recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears exponential, leaving a tail of patients reporting various long COVID symptoms including unexplained fatigue/exertional intolerance and dysautonomic and sensory concerns. Indirect evidence links long COVID to incident polyneuropathy affecting the small-fiber (sensory/autonomic) axons.

Methods: We analyzed cross-sectional and longitudinal data from patients with World Health Organization (WHO)-defined long COVID without prior neuropathy history or risks who were referred for peripheral neuropathy evaluations. We captured standardized symptoms, examinations, objective neurodiagnostic test results, and outcomes, tracking participants for 1.4 years on average.

Results: Among 17 patients (mean age …

Providing Effective Assessment Feedback To Patients: Lessons Learned From Feedback After A Severe Injury, Kelsie Mcquinn

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

This paper seeks to articulate lessons learned from feedback received after a severe injury in order to help guide neuropsychologists provide effective feedback to patients. Given that there is no agreed upon conceptual framework for providing neuropsychological assessment feedback, parallels are drawn from what works in clinical psychology – the working alliance. I use personal examples to highlight how the working alliance, as well as other psychological principles, can help inform neuropsychologists provide the most effective feedback to patients.

Author Correction: Short Amylin Receptor Antagonist Peptides Improve Memory Deficits In Alzheimer’S Disease Mouse Model, Rania Soudy, Ryoichi Kimura, Aarti Patel, Wen Fu, Kamaljit Kaur, David Westaway, Jing Yang, Jack Jhamandas

Pharmacy Faculty Articles and Research

Correction to: Scientific Reports https://doi.org/10.1038/s41598-019-47255-9, published online 29 July 2019

The original Article contained an error in Figure 1A where the control trace for both the HEK-AMY3 and HEKWT cells was duplicated...

The original Article has been corrected.

The Rey Auditory Verbal Learning Test: Cross-Validation Of Mayo Normative Studies (Mns) Demographically Corrected Norms With Confidence Interval Estimates, David W. Loring, Jessica L. Saurman, Samantha E. John, Stephen C. Bowden, James J. Lah, Felicia C. Goldstein

Brain Health Faculty Research

Objective: The Mayo Normative Studies (MNS) represents a robust dataset that provides demographically corrected norms for the Rey Auditory Verbal Learning Test. We report MNS application to an independent cohort to evaluate whether MNS norms accurately adjust for age, sex, and education differences in subjects from a different geographic region of the country. As secondary goals, we examined item-level patterns, recognition benefit compared to delayed free recall, and derived Auditory Verbal Learning Test (AVLT) confidence intervals (CIs) to facilitate clinical performance characterization. Method: Participants from the Emory Healthy Brain Study (463 women, 200 men) who were administered the AVL were …

Patient Involvement In The Development Of Proms Within The Ms Field: A Systematic Review, Signe Baattrup Reitzel, Melinda Magyari, Lasse Skovgaard, Maria Kristiansen

Patient Experience Journal

This review reports on the development of patient-reported outcome measures (PROMs), published within the past ten years, for people with multiple sclerosis (PwMS). Moreover, this review evaluates the extent to which patient participation was integrated in the development of the PROMs. A systematic review was conducted, and four relevant articles were extracted, from which nine PROMs were identified. Patient involvement in the development phase was identified in three PROMs. The results emphasize the need for more patient involvement in the development of new MS-specific PROMs to ensure that the measures reflect the needs and priorities of PwMS.

Experience Framework

This …

Role Of Atogepant In The Treatment Of Episodic Migraines: Clinical Perspectives And Considerations, Fred Cohen, Hsiangkuo Yuan

Department of Neurology Faculty Papers

Advances in molecular biology and neuroscience have led to the discovery of calcitonin gene-related peptide (CGRP), a 37 amino-acid neuropeptide that plays a critical role in the pathogenesis of migraine. CGRP receptor antagonist, also known as gepant, is an oral medication that inhibits the CGRP-related nociceptive signaling pathway. To date, three gepants are approved by the FDA for migraine treatment. Atogepant is a 2nd-generation gepant that non-competitively antagonizes CGRP receptors inhibiting neurogenic inflammation and pain sensitization. With its long half-life and minimal cardiovascular or liver toxicity, it is the first in its class approved primarily for migraine prevention. This article …

Tolerability And Feasibility Of At-Home Remotely Supervised Transcranial Direct Current Stimulation (Rs-Tdcs): Single-Center Evidence From 6,779 Sessions, Giuseppina Pilloni, Amy Vogel-Eyny, Matthew Lustberg, Pamela Best, Martin Malik, Lillian Walton-Masters, Allan George, Ibraheem Mirza, Lana Zhovtis, Abhishek Datta, Marom Bikson, Lauren Krupp, Leigh Charvet

Department of Medicine Faculty Papers

Introduction: The ability to deploy transcranial direct current stimulation (tDCS) at home is a key usability advantage to support scaling for pivotal clinical trials. We have established a home-based tDCS protocol for use in clinical trials termed remotely supervised (RS)-tDCS.

Objective: To report the tolerability and feasibility of tDCS sessions completed to date using RS-tDCS in clinical trials.

Methods: We analyzed tolerability (i.e., adverse events, AEs) reported in six Class I/II/III trials using RS-tDCS to study symptom outcomes over 10 to 60 daily applications. Across the six clinical trials, 308 participants (18-78 years old) completed an average of 23 sessions …

Reduction Of Mutant Atxn1 Rescues Premature Death In A Conditional Sca1 Mouse Model, James P Orengo, Larissa Nitschke, Meike E Van Der Heijden, Nicholas A Ciaburri, Harry T Orr, Huda Y Zoghbi

Duncan NRI Faculty and Staff Publications

Spinocerebellar ataxia type 1 (SCA1) is an adult-onset neurodegenerative disorder. As disease progresses, motor neurons are affected, and their dysfunction contributes toward the inability to maintain proper respiratory function, a major driving force for premature death in SCA1. To investigate the isolated role of motor neurons in SCA1, we created a conditional SCA1 (cSCA1) mouse model. This model suppresses expression of the pathogenic SCA1 allele with a floxed stop cassette. cSCA1 mice crossed to a ubiquitous Cre line recapitulate all the major features of the original SCA1 mouse model; however, they took twice as long to develop. We found that …

A Combined Conduit-Bioactive Hydrogel Approach For Regeneration Of Transected Sciatic Nerves, Cheuk Sun Edwin Lai, Viridiana Leyva-Aranda, Victoria H Kong, Tania L Lopez-Silva, Adam C Farsheed, Carlo D Cristobal, Joseph W R Swain, Hyun Kyoung Lee, Jeffrey D Hartgerink

Duncan NRI Faculty and Staff Publications

Transected peripheral nerve injury (PNI) affects the quality of life of patients, which leads to socioeconomic burden. Despite the existence of autografts and commercially available nerve guidance conduits (NGCs), the complexity of peripheral nerve regeneration requires further research in bioengineered NGCs to improve surgical outcomes. In this work, we introduce multidomain peptide (MDP) hydrogels, as intraluminal fillers, into electrospun poly(ε-caprolactone) (PCL) conduits to bridge 10 mm rat sciatic nerve defects. The efficacy of treatment groups was evaluated by electromyography and gait analysis to determine their electrical and motor recovery. We then studied the samples' histomorphometry with immunofluorescence staining and automatic …

Clinical Diagnosis Of Metabolic Disorders Using Untargeted Metabolomic Profiling And Disease-Specific Networks Learned From Profiling Data, Lillian R Thistlethwaite, Xiqi Li, Lindsay C Burrage, Kevin Riehle, Joseph G Hacia, Nancy Braverman, Michael F Wangler, Marcus J Miller, Sarah H Elsea, Aleksandar Milosavljevic

Duncan NRI Faculty and Staff Publications

Untargeted metabolomics is a global molecular profiling technology that can be used to screen for inborn errors of metabolism (IEMs). Metabolite perturbations are evaluated based on current knowledge of specific metabolic pathway deficiencies, a manual diagnostic process that is qualitative, has limited scalability, and is not equipped to learn from accumulating clinical data. Our purpose was to improve upon manual diagnosis of IEMs in the clinic by developing novel computational methods for analyzing untargeted metabolomics data. We employed CTD, an automated computational diagnostic method that "connects the dots" between metabolite perturbations observed in individual metabolomics profiling data and modules identified …

The Effects Of Paclitaxel On Cellular Migration And The Cytoskeleton, Ashley Salguero-Gonzalez

Thinking Matters Symposium

In a clinical setting, some patients are exposed to an anti-cancer chemotherapy agent, paclitaxel. Cancerous cells undergo rapid, continuous cell division without control. Chemotherapy treatments try to slow and stop the uncontrollable cell division cycles and eliminate cancerous cells in the process. Paclitaxel serves as a treatment for some types of cancers, including lung, melanoma, bladder, and esophageal. Because it targets the cytoskeleton, paclitaxel can also influence cell migration. This project utilizes a cellular migration assay and an immunohistochemistry assay to analyze the effects of paclitaxel on the movement of cells and on the cytoskeleton of neuroglia rat cells with …