Neurology Commons^™

Hypoxic Preconditioning Of Embryonic Stem Cells: A Novel Transplantation Strategy To Improve Recovery After Stroke, Michelle Hedrick Theus

MUSC Theses and Dissertations

Embryonic stem (ES) cell transplantation therapy offers a novel therapeutic alternative for ameliorating the pathologic consequences of cerebral ischemia. The success of ES cell transplantation therapy relies not only on initial survival in the post-ischemic brain but also on whether or not these cells will reliably differentiate into the appropriate neuronal phenotypes required for cerebral repair. To address both issues, the present study investigates the neural differentiation of retinoic acid treated ES cells and how activating signaling pathways common in response to hypoxia can impact their usefulness as graft material intended to repair, replace and restore function after stroke. These …

Pharmacological Studies Of Nicotine And Galantamine Effects On Age Associated Memory Impairment And The Neurotrophic System In Aged Female Rats, Kristen L. French

MUSC Theses and Dissertations

Nicotine and Galantamine were studied for their pharmacological effects on age associated memory impairment (AAMI) and the neurotrophin system in the aged female F344 rat. Nicotine was found to have dose dependent effects on cognition in the 24 month old rat. A low dose of nicotine improved both working and reference memory (WM, RM) performance on the water radial arm maze and also improved the ability of aged rats to handle an increasing WM load. A high dose did not improve WM and caused deficits in RM, and high cotinine levels in these subjects correlated with worse performance. Nicotine treatment …

Limb-Shaking Transient Ischemic Attacks: Case Report And Review Of Literature, Saad Ali, Muhib Alam Khan, Bhojo Khealani

Section of Neurology

Background: Limb shaking Transient Ischemic Attack is a rare manifestation of carotid-occlusive disease. The symptoms usually point towards a seizure like activity and misdiagnosed as focal seizures. On careful history the rhythmic seizure like activity reveals no Jacksonian march mainly precipitated by maneuvers which lead to carotid compression. We here present a case of an elderly gentleman who was initially worked up as suffering from epileptic discharge and then later on found to have carotid occlusion.CASE PRESENTATION: Elderly gentleman presented with symptoms of rhythmic jerky movements of the left arm and both the lower limbs. Clinical suspicion of focal epilepsy …

Functional Redistribution Of Hippocampal Cannabinoid Cb1 Receptors In The Rat Pilocarpine Model Of Acquired Epilepsy, Katherine Winslow Falenski

Theses and Dissertations

Cannabinoids, such as the marijuana derivative Δ9-THC, are known to have CBl receptor-mediated anticonvulsant effects in several animal models of seizures and epilepsy, including the rat pilocarpine model of acquired epilepsy. However, the distribution of CBl receptor expression and function in brains of epileptic rats has not been characterized. Therefore, this dissertation was initiated to evaluate the effect of epileptogenesis on the distribution and function of the endogenous CBI receptor system in the rat pilocarpine model, a well-established model of acquired temporal lobe epilepsy. Using immunohistochemistry, we demonstrated that chronically epileptic rats exhibit a unique, long-term, and specific redistribution of …

Neuroleptic Malignant Syndrome: Need For Early Diagnosis And Therapy, Humaira M. Khan, Nadir A. Syed, Mughis Sheerani, Bhojo Khealani, Ayeesha Kamal, Mohammad Wasay

Department of Medicine

Background: Neuroleptic Malignant Syndrome (NMS) is a medical entity that has received little attention in the clinical settings in Pakistan. The aim of our study was to review the predisposing factors, outcomes and characteristics of in-patients diagnosed with NMS.

Methods: We performed a retrospective chart review of all cases (age > 15 years) at a tertiary care center in Karachi between January 01, 1990 and November 30, 2001, diagnosed using ICD 10 coding. Data was collected using a standardized data entry form and statistical analysis was performed using Epi Info 6, Version 6.02.

Results: There were a total of 20 patients …

Comparison Of Two Surveys Of Head Injured Patients Presenting During A Calendar Year To An Urban Medical Centre 32 Years Apart, Rashid Jooma, Shahid Ahmed, Abdul Malik Zarden

Section of Neurosurgery

Objective: To study the patients presenting with head injuries to a tertiary hospital in Karachi during the year 2003.
Methods: During the calendar year 2003, a cross-sectional study was conducted of all patients presenting to the casualty department of Jinnah Postgraduate Medical Centre (JPMC) with head injury. Personal information was collected from the patient's attendants at presentation or later if the patient had been brought in by the emergency services as an unknown person. The circumstances of the injury were similarly established and the clinical features documented.
Results: During the year 2003, a total of 3008 patients reported to the …

Continuous Asl Perfusion Fmri Investigation Of Higher Cognition: Quantification Of Tonic Cbf Changes During Sustained Attention And Working Memory Tasks, Junghoon Kim, John Whyte, Jiongjiong Wang, Hengyi Rao, Kathy Z. Tang, John A. Detre

Department of Rehabilitation Medicine Faculty Papers

Arterial spin labeling (ASL) perfusion fMRI is an emerging method in clinical neuroimaging. Its non-invasiveness, absence of low frequency noise, and ability to quantify the absolute level of cerebral blood flow (CBF) make the method ideal for longitudinal designs or low frequency paradigms. Despite the usefulness in the study of cognitive dysfunctions in clinical populations, perfusion activation studies to date have been conducted for simple sensorimotor paradigms or with single-slice acquisition, mainly due to technical challenges. Using our recently developed amplitude-modulated continuous ASL (CASL) perfusion fMRI protocol, we assessed the feasibility of a higher level cognitive activation study in twelve …

Dural Metastases Presenting As An Extradural Hematoma: A Rare Presentation, Muhammad Shahzad Shamim, Muhammad Ehsan Bari, S. Ather Enam

Department of Surgery Docs

Abstract

We report a case of an elderly man who presented with hemiparesis and plain CT scan findings highly suggestive of an extradural hematoma as the underlying cause. This patient was later found to have dural metastases secondary to bronchogenic carcinoma. Dural metastases are rare, usually presenting as dural mass, but may also present as chronic subdural or extradural hematoma on non contrast CT scan, leading to an erroneous diagnosis in the unsuspecting.

Encephalopathy Caused By Bartonella Henselae Following Cat Scratch, Joseph L. Yozviak Do, Facp, John Margraf Md, Marcelo Gareca Md

Department of Medicine

No abstract provided.

Brain Neprilysin Activity And Susceptibility To Transgene-Induced Alzheimer Amyloids, Troy L. Carter, Steve Pedrini, Jorge Ghiso, Michelle E. Ehrlich, Sam Gandy

Department of Neurology Faculty Papers

Neprilysin (NEP) is a zinc metalloproteinase that degrades enkephalins, endothelins, and the Alzheimer’s disease amyloid ß (Aß) peptides. NEP-deficient mice possess increased levels of brain Aß^1-40 and Aß^1-42. The objective of this study was to determine whether tissue NEP specific activity differs according to age and/or across mouse strains, especially those strains predisposed toward formation of Aß-amyloid plaques following overexpression of the human Alzheimer amyloid precursor protein (APP). The C57Bl/6J mouse strain appears to be relatively susceptible to cerebral amyloidosis, whereas the Swiss Webster (SW) strain appears more resistant. We investigated whether NEP specific activity in brain …

Prognostic Indicators In Patients With Primary Intraventricular Haemorrhage, Bilal Hameed, Bhojo A. Khealani, Tahseen Mozzafar, Mohammad Wasay

Department of Medicine

Objectives: Primary intraventricular haemorrhage (PIVH) is a rare clinical entity. We sought to evaluate risk factors, clinical and radiological features, and outcome of patients with PIVH.

Materials and Methods: Cases of PIVH were identified from cohort of patients with non traumatic intracerebral haemorrhage (ICH) by reviewing the radiological data. Their charts were reviewed and demographic, clinical, radiological and laboratory data was recorded and analyzed. Chi square and t test were used to determine predictors of poor outcome.

Results: Fifteen of 677 (2%) patients with ICH had PIVH. Nine (60%) were men. Median age was 56 years. Predisposing factors included hypertension …

Organization And Signal Processing Of The Descending Tracts In The Cervical Spinal Cord, Yanmei Tie

Doctoral Dissertations

This dissertation addresses the research for the development of spinal cord-computer interface (SCCI). The main objective of SCCI is to generate voluntary motor control signals for individuals with spinal cord injury (SCI).

In the neuroscience aspect, organization of the fibers in the descending tracts of the dorsolateral funiculus of the cervical spinal cord was investigated in cats. The spinal cord was penetrated with silicon substrate microelectrodes at 400 μm intervals in the medio-lateral direction at the C5/C6 and C6/C7 segmental borders. The stimulus consisted of a 20 ms train of charge-balanced biphasic pulses at 330 Hz. The evoked activities from …

Rapidly Developing Optic Neuritis Secondary To Ethambutol: Possible Mechanism Of Injury, Sajjad Ali, Uzma Usman, Mohammad Wasay

Department of Medicine

Optic neuritis has been described among the toxic effects of Ethambutol. This side effect is dose related. The mean duration of Ethambutol induced optic neuritis (EON) is three months. We report a case of EON after few days of exposure to Ethambutol and the symptoms resolved after discontinuation of Ethambutol. This most likely represents an idiosyncratic reaction which is different as compared to dose related optic neuritis.

The Cns Role Of Toll-Like Receptor 4 In Innate Neuroimmunity And Painful Neuropathy, Flobert Y. Tanga, Nancy Nutile-Mcmenemy, Joyce A. Deleo

Dartmouth Scholarship

Neuropathic pain remains a prevalent and persistent clinical problem because of our incomplete understanding of its pathogenesis. This study demonstrates for the first time, to our knowledge, a critical role for CNS innate immunity by means of microglial Toll-like receptor 4 (TLR4) in the induction phase of behavioral hypersensitivity in a mouse and rat model of neuropathy. We hypothesized that after L5 nerve transection, CNS neuroimmune activation and subsequent cytokine expression are triggered by the stimulation of microglial membrane-bound TLR4. To test this hypothesis, experiments were undertaken to assess tactile and thermal hypersensitivity in genetically altered (i.e., TLR4 knockout and …

The Effects Of Greater Occipital Nerve Block And Trigger Point Injection On Brush Allodynia And Pain In Migraine, Avi Ashkenazi, William B. Young

Department of Neurology Faculty Papers

Objective: To evaluate the effect of GONB, with or without trigger point injection (TPI), on dynamical mechanical (brush) allodynia (BA) and on head pain in migraine.

Background: Patients with migraine often have cutaneous allodynia, which is related to sensitization of central pain neurons. Greater occipital nerve block (GONB) is an effective treatment for migraine headache, however its effect on cutaneous allodynia in migraine is unknown.

Methods: We studied patients with migraine and BA who were treated with GONB with or without TPI. Demographic data, migraine history and headache features were documented. Allodynia was evaluated using a structured …

Gas-Producing Brain Abscess, Arshad A. Siddiqui, Khalid N. Chishti

Section of Neurosurgery

A case of a known psychiatric patient who presented with rapid neurological deterioration is reported. Neuroimaging revealed a gas-producing brain abscess in left parietal lobe with a contiguous focus of infection in the adjacent bone and scalp initiated by obsessive scalp scratching. On complete surgical excision of abscess, followed by culture-based antibiotic therapy, a good neurological recovery was achieved with minimal residual deficits at follow-up.

Involvement Of Beta-Chemokines In The Development Of Inflammatory Demyelination., Ileana Banisor, Thomas P Leist, Bernadette Kalman

Department of Neurology Faculty Papers

The importance of beta-chemokines (or CC chemokine ligands - CCL) in the development of inflammatory lesions in the central nervous system of patients with multiple sclerosis and rodents with experimental allergic encephalomyelitis is strongly supported by descriptive studies and experimental models. Our recent genetic scans in families identified haplotypes in the genes of CCL2, CCL3 and CCL11-CCL8-CCL13 which showed association with multiple sclerosis. Complementing the genetic associations, we also detected a distinct regional expression regulation for CCL2, CCL7 and CCL8 in correlation with chronic inflammation in multiple sclerosis brains. These observations are in consensus with previous studies, and add new …

Characterization Of The Zona Incerta, Heather Joyce Green

Theses and Dissertations

Parkinson's Disease affects more than 1 million people in the United States with 60,000 new cases being diagnosed each year. Currently, there is no cure for Parkinson's Disease, but there are several treatment options available. Currently the most popular surgical option is Deep Brain Stimulation. Microelectrode recording helps identify nuclei as the microelectrode passes through them. While the firing frequencies of the target nuclei are well defined, other nuclei are not. This study will attempt to characterize the Zona Incerta, which is the structure directly above the Subthalamic Nucleus, a target nucleus. Characterization of the firing frequency of the Zona …

Referred Cutaneous Allodynia In A Migraine Patient Without Simultaneous Headache, Avi Ashkenazi, Carla Lopinto, William B. Young

Department of Neurology Faculty Papers

Cutaneous allodynia is defined as the perception of pain when a non-noxious stimulus is applied to normal skin. This phenomenon has been demonstrated in migraine patients during an acute attack. It is thought to result from central sensitization of neurons in the trigemino-vascular system and may spread to areas beyond that of the referred head pain.

In a recent study, migraine patients demonstrated increased temporal summation to painful mechanical stimuli in their referred head pain area between attacks. This suggests that changes in physiologic properties of nociceptive neurons may occur in migraine patients between attacks.

We describe a migraine patient …

The Long Shadow Of Cerebral Localization, Saad Shafqat

Section of Neurology

In 1995, during my first week as a neurology resident at Massachusetts General Hospital, I had the privilege of meeting the late Raymond Adams. He was an established octogenarian by then, but the years had made no difference to his air of professionalism and academic authority. His reputation was made in the 1950s and 1960s, when he developed Boston as a major centre of clinical neurology. Among other things, he is immortalized through a famous textbook that has appeared in multiple editions. Our meeting took place at a clinical conference in which I was required to present a case. He …

Development Of A Comprehensive Epilepsy Surgery Programme In Pakistan, Mughis Sheerani

Section of Neurology

No abstract provided.

Epileptogenesis Causes Long-Term Plasticity Changes In Calbindin D-28k In The Rat Pilocarpine Model Of Acquired Epilepsy, Anne Johnston Harrison

Theses and Dissertations

Epilepsy is one of the most common neurological disorders, affecting more than 2% of children and 1% of adults in the U.S. Emerging research has demonstrated that calcium, as a major second messenger system, underlies many of these injury-induced plasticity changes associated with the development of epilepsy. Recent evidence has suggested that long term elevations in neuronal resting calcium levels play a role in initiating and maintaining epileptogenesis (the development of epilepsy). Collaborations between our lab and others have produced microarray data that suggests that a major calcium-binding protein, calbindin D-28k, mRNA levels are decreased in epileptic rats even up …

Childhood Traumatic Brain Injury: Recovery Of Working Memory Function And Behavioral Adjustment, Gayle L. Crahen

All-Inclusive List of Electronic Theses and Dissertations

Children and adolescents with a traumatic brain injury (TBI) were the focus of this investigation using an extant data set. The 3 7 participants were between the ages of 5 and 15 years at the time of injury, and the majority had a severe TBI. Participants were evaluated soon after injury for a Baseline description of functioning on measures of cognition and memory and re-evaluated at one and/or two year return appointments. Parents provided estimates of adaptive, internalizing, and externalizing behaviors at Baseline and at follow-up appointments on the V ABS and CBCL. It was expected that parents' descriptions of …

Preventing Neural Tube Defects By Folic Acid Fortification Of Flour, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Periodic Autonomic Dysfunction Without Pain In A Patient With Cluster Headache, Avi Ashkenazi, Stephen Silberstein

Department of Neurology Faculty Papers

Cluster headache (CH) is characterized by episodes of severe unilateral headache accompanied by symptoms of cranial parasympathetic hyperactivity and sympathetic dysfunction that occur in cluster periods. Positron emission tomography (PET) studies have demonstrated evidence of a central generator of CH attacks located in the posterior-inferior hypothalamus. It has been suggested that the autonomic symptoms in CH result from reflex activation of the superior salivatory nucleus secondary to activation of the trigeminal nucleus caudalis (TNC). However, several cases of CH-like symptoms with no head pain have been documented.

We describe a patient who had suffered from typical episodic CH for two …

Dynamic Mechanical (Brush) Allodynia In Cluster Headache, Avi Ashkenazi, William B. Young

Department of Neurology Faculty Papers

Cutaneous allodynia is the perception of pain when a non-noxious stimulus is applied to normal skin. It has been described in patients with migraine. Cutaneous allodynia is caused by sensitization of central nervous system neurons that receive convergent sensory input from both skin and intracranial structures. This phenomenon has not been previously described in patients with cluster headache. Although migraine and cluster headache (CH) may share some clinical features, the pathogenesis of these two primary headaches is different. The aim of this study was to examine the occurrence of dynamic mechanical (brush) allodynia (BA) in patients with CH.

Patterns Of Tuberculosis In The Central Nervous System, Soobia Raza, Aliyah Sadaf, Faisal Fecto, Rushna Pervez Ali, Muhammad Ehsan Bari, Ather Enam

Medical College Documents

Tuberculous involvement of central nervous system (CNS), although not very frequent, results in severe morbidity. Tuberculosis (TB) is endemic in developing countries but even in developed countries, after an initial decline up until 1980’s, incidence of TB is on the rise. The AIDS epidemic, emergence of multi-drug resistant strains and immigration of people from endemic areas are some of the factors significantly contributing to this increase. Consequently, the burden of central nervous system tuberculosis has increased significantly worldwide.

Occipital Nerve Block Rapidly Eliminates Allodynia Far From The Site Of Headache: A Case Report, William B. Young, Valentin Mateos, Avi Ashkenazi

Department of Neurology Faculty Papers

Seventy to 80% of persons with migraine develop allodynia during the course of a severe attack. During a migraine attack, allodynia spreads topographically to extratrigeminal territory. Dynamic mechanical allodynia, otherwise known as brush allodynia (BA), is a subtype of allodynia that is easily tested. Ashkenazi & Young recently reported on the immediate benefits of greater occipital nerve (GON) block on brush allodynia and pain in migraine and in cluster headache. In these studies, testing was performed at fixed sites in the trigeminal and cervical distributions. Allodynia in thoracic dermatomes was not studied.

Headache Management For The Pain Specialist, Avi Ashkenazi, Stephen Silberstein

Department of Neurology Faculty Papers

Headache is a common symptom caused by a wide variety of diseases. Primary headaches include migraine, cluster headache, tension-type headache and other less common diseases. It is important to differentiate these headaches from secondary headaches caused by vascular, neoplastic, infectious, metabolic and toxic disorders. Most primary headaches have a genetic basis, with environmental factors acting as triggers. Recent advances in basic research resulted in the development of more specific and effective therapies. Medication overuse headache is a very common cause of chronic daily headache. Detoxification from the offending drug is essential for headache improvement. Cervicogenic headache is common and needs …

Similar Promotion Of Abeta1-42 Fibrillogenesis By Native Apolipoprotein E Epsilon3 And Epsilon4 Isoforms., David Sweeney, Ralph Martins, Harry Levine, Jonathan D Smith, Sam Gandy

Farber Institute for Neuroscience Faculty Papers

The apolipoprotein E epsilon4 allele contributes to the genetic susceptibility underlying a large proportion (~40-60%) of typical, sporadic Alzheimer disease. Apolipoprotein E deficient mice made transgenic for human apolipoprotein E epsilon4 accumulate excess cerebral amyloid when compared to similarly prepared mice expressing human apolipoprotein E epsilon3. Therefore, it is important to search for relevant interactions(s) between apolipoprotein E epsilon4 and Abeta in order to clarify the biological role for apolipoprotein E epsilon4 in Alzheimer disease. Using a thioflavine T (ThT)-based assay, we have investigated the effects of native human apolipoprotein E isoforms on the kinetics of Abeta fibrillogenesis. No obvious …