Neurology Commons^™

Plasma Soluble Human Elastin Fragments As An Intra-Aneurysmal Localized Biomarker For Ruptured Intracranial Aneurysm, Daichi Nakagawa, Mario Zanaty, Joseph Hudson, Nahom Teferi, Daizo Ishii, Lauren Allan, Pascal Jabbour, Santiago Ortega-Gutierrez, Edgar A. Samaniego, David M. Hasan

Department of Neurosurgery Faculty Papers

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of …

Neurological Complications In Patients With Plasmodium Vivax Malaria From Karachi, Pakistan, Mohammad Asim Beg, A Akhlaq, Najia Karim Ghanchi, B Usmani, R Shahzad, A Rahim, Mohammad Wasay

Department of Pathology and Laboratory Medicine

Background: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide.
Method: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan.
Results: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral …

Evaluation Of Quality Of Warfarin Therapy By Assessing Patient's Time In Therapeutic Range At A Tertiary Care Hospital In Pakistan, Haris Hakeem, Ammar Zaman Khan, Kashif Aziz, Ayesha Abbasi, Anam Haider, Bushra Moiz, Mohammad Wasay

Section of Neurology

Objective: To assess the time in therapeutic range in patients on warfarin anti-coagulation therapy.

Methods: The retrospective chart review was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients having undergone anti-coagulation with warfarin from January 2013 to April 2015. To determine the mean time in therapeutic range, Rosendaal method was used. Association of time in therapeutic range with the composite outcome, bleeding and thromboembolic events was also assessed. Percentage of patients with time in therapeutic range <60% was calculated.

Results: There were 92 patients whose median time in therapeutic range was 34.9% (interquartile range: 20.0- 55.7). Overall, 71(77.2%) …

Impact Of Airborne Pollutants On Stroke, Adeel Khoja, Fizzah Kazim

Section of Neurology

No abstract provided.

Suprasellar Epidermoid Cyst Originating From The Infundibulum: Case Report And Literature Review., Erin P Mccormack, Justin M Cappuzzo, Zachary Litvack, M Isabel Almira-Suarez, Jonathan S Sherman

Articles, Abstracts, and Reports

Epidermoid cysts account for a small fraction of intracranial brain tumors, most commonly found in the cerebellopontine angle and parasellar cisterns. Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The patient's pre-operative evaluation was significant for pseudotumor cerebri, hyponatremia, obesity, and a history of smoking; post-operative course was significant for neurogenic diabetes insipidus.

Hypoglycemic, Hypolipidemic And Antioxidant Effects Of Iridoid Glycosides Extracted From: Corni Fructus: Possible Involvement Of The Pi3k-Akt/Pkb Signaling Pathway, Jiefang Kang, Chen Guo, Rodolfo Thome, Ning Yang, Yuan Zhang, Xing Li, Xiaoyan Cao

Department of Neurology Faculty Papers

Iridoid glycosides (CIG) are the major component of Corni fructus. In this work, we researched the antioxidative, hypoglycemic and lowering blood lipids effects of CIG on diabetic mice induced by a high-fat diet (HFD) and streptozotocin (STZ). Furthermore, to investigate the molecular mechanism of action, the phosphorylation and protein expression of phosphoinositide 3-kinase (PI3K) and its downstream proteins, such as insulin receptor (INSR), protein kinase B (Akt/PKB) and glucose transporter 4 (GLUT4) have been detected. The results showed that CIG significantly improved oral glucose tolerance in diabetic mice. Biochemical indices also revealed that CIG had a positive effect on lipid …

Congenital Zika Virus Infection In Immunocompetent Mice Causes Postnatal Growth Impediment And Neurobehavioral Deficits, Amber M. Paul, Dhiraj Acharya, Biswas Neupane, E. Ashley Thompson, Gabriel Gonzalez-Fernandez, Katherine M. Copeland

Publications

A small percentage of babies born to Zika virus (ZIKV)-infected mothers' manifest severe defects at birth, including microcephaly. Among those who appeared healthy at birth, there are increasing reports of postnatal growth or developmental defects. However, the impact of congenital ZIKV infection in postnatal development is poorly understood. Here, we report that a mild congenital ZIKV-infection in pups born to immunocompetent pregnant mice did not display apparent defects at birth, but manifested postnatal growth impediments and neurobehavioral deficits, which include reduced locomotor and cognitive deficits that persisted into adulthood. We found that the brains of these pups were smaller, had …

Does The Venus De Milo Have A Spinal Deformity?, Kevlian Andrew, Joe Iwanaga, Marios Loukas, Jens Chapman, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The Venus de Milo, an ancient Greek statue, has been viewed as one of the most celebrated pieces of art in Western culture. It was sculpted during the Hellenistic period between 150 and 50 BC and is believed to be the work of Alexandros of Antioch. The sculpture is thought to depict Aphrodite, the Greek goddess of love and beauty. When assembled, the two halves of the sculpture meet in an almost horizontal line that is purposefully obscured by a roll of garment around the hips. It has been noted that the midline of the statue's face is displaced slightly. …

Chronically Implanted Intracranial Electrodes: Tissue Reaction And Electrical Changes., Andrew Campbell, Chengyuan Wu

Department of Neurosurgery Faculty Papers

The brain-electrode interface is arguably one of the most important areas of study in neuroscience today. A stronger foundation in this topic will allow us to probe the architecture of the brain in unprecedented functional detail and augment our ability to intervene in disease states. Over many years, significant progress has been made in this field, but some obstacles have remained elusive-notably preventing glial encapsulation and electrode degradation. In this review, we discuss the tissue response to electrode implantation on acute and chronic timescales, the electrical changes that occur in electrode systems over time, and strategies that are being investigated …

Variant Of The Anconeus Epitrochlearis Muscle: A Case Report., Chrissie Massrey, Joe Iwanaga, Basem Ishak, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The anconeus epitrochlearis is a muscle variant sometimes present at the elbow. It is present in up to 34% of individuals and has been implicated in some cases of cubital tunnel syndrome. We report an unusual variant of this muscle with additional proximal attachments in the arm. We will review and discuss the background and the clinical relevance of such a muscle.

Depression Following A Traumatic Brain Injury: Uncovering Cytokine Dysregulation As A Pathogenic Mechanism, Colleen N. Bodnar, Josh M. Morganti, Adam D. Bachstetter

Spinal Cord and Brain Injury Research Center Faculty Publications

A substantial number of individuals have long-lasting adverse effects from a traumatic brain injury (TBI). Depression is one of these long-term complications that influences many aspects of life. Depression can limit the ability to return to work, and even worsen cognitive function and contribute to dementia. The mechanistic cause for the increased depression risk associated with a TBI remains to be defined. As TBI results in chronic neuroinflammation, and priming of glia to a secondary challenge, the inflammatory theory of depression provides a promising framework for investigating the cause of depression following a TBI. Increases in cytokines similar to those …

Bifid Xiphoid Process: Case Report And Review., Seif Eid, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The xiphoid process is a bony process that comprises part of the sternum. This anatomical structure exhibits several morphological variations, which may complicate diagnostic examinations and invasive thoracic procedures. Variations include bifurcated or trifurcated, deflected, and curved processes. This report discusses a case of a bifid xiphoid process during cadaveric dissection and compares similar findings in the literature. The aim is to improve our knowledge of anatomical variations in an effort to reduce complications and improve patient care.

Implementation Of Aset Skin Safety Guideline By Lehigh Valley Health Network Committee Improves Extended Eeg Related Skin Breakdown, Jo Ann Coryell R. Eeg T, Cnim, Alexis Gerber R. Eeg T. Cltm, Sameh Morkous Md, Faan

Department of Medicine

No abstract provided.

Comparison Of Decompression Alone Versus Decompression With Fusion For Stenotic Lumbar Spine: A Systematic Review And Meta-Analysis, Syed Ijlal Ahmed, Gohar Javed, Syeda Beenish Bareeqa, Ali Shah, Maha Zubair, Rabbia Faisal Avedia, Noor Rahman, Syeda Sana Samar, Kashif Aziz

Section of Neurosurgery

The first line of treatment for lumbar spinal stenosis (with or without lumbar degenerative spondylolisthesis) involves conservative options such as anti-inflammatory drugs and analgesics. Approximately, 10%-15% of patients require surgery. Surgical treatment aims to decompress the spinal canal and dural sac from degenerative bony and ligamentous overgrowth. Different studies have given conflicting results. The aim of our study is to clear the confusion by comparing two surgical techniques. This meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted of the Ovid Embase, Scopus, Pubmed, Ovid Medline, Google …

Intelligence Quotient In Patients With Myelomeningocele: A Review., Yusuf Alimi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

It has been proposed that hydrocephalus in children with myelomeningocele (MMC) can indicate a low intelligence quotient (IQ). Others have argued that it is not the mere presence of hydrocephalus but the superimposition of cerebrospinal fluid (CSF) infections, multiple shunt procedures, and other CNS complications that lead to the lowering of IQ in these patients. In this paper, we review the literature to clarify the information about IQ in patients with MMC and whether it changes after infections and shunt procedures. We have also considered the other factors that could be involved in the IQ development of these patients and …

Carnosol Modulates Th17 Cell Differentiation And Microglial Switch In Experimental Autoimmune Encephalomyelitis, Xing Li, Li Zhao, Juan-Juan Han, Fei Zhang, Shuai Liu, Lin Zhu, Zhe-Zhi Wang, Guang-Xian Zhang, Yuan Zhang

Department of Neurology Faculty Papers

Medicinal plants as a rich pool for developing novel small molecule therapeutic medicine have been used for thousands of years. Carnosol as a bioactive diterpene compound originated from Rosmarinus officinalis (Rosemary) and Salvia officinalis, herbs extensively applied in traditional medicine for the treatment of multiple autoimmune diseases (1). In this study, we investigated the therapeutic effects and molecule mechanism of carnosol in experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS). Carnosol treatment significantly alleviated clinical development in the myelin oligodendrocyte glycoprotein (MOG35–55) peptide-induced EAE model, markedly decreased inflammatory cell infiltration into the central nervous system and reduced …

Additional Attachment Of The Semitendinosus And Gracilis Muscles To The Crural Fascia: A Review And Case Illustration., Asad Rizvi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The semitendinosus and gracilis muscles insert primarily onto the superior medial aspect of the tibia. These tendons can be harvested for anterior cruciate ligament reconstruction, and knowledge of their accessory attachments is important for the success of such harvesting procedures. Here, we present a case illustration and review of the attachment of these muscles into the crural fascia (deep fascia of the leg), which is often an underappreciated insertion site.

Wormian Bone Of The Orbit: A Case Report., Asad Rizvi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Wormian bones are formed due to abnormal ossification centers in various locations in the skull. Genetic and/or environmental factors have been proposed to explain their formation. These bones can be normal anatomical variants or associated with a number of pathological conditions. The literature reports the most common locations of these bones as the cranial sutures, and reports of the presence of these bones in the orbit are rare. Clinically, these bones in the orbit can simulate fractures on imaging or can dislodge during surgery causing injury to the surrounding structures. Herein, we report a case of wormian bones of the …

Anatomical Study Of The Lingual Nerve And Inferior Alveolar Nerve In The Pterygomandibular Space: Complications Of The Inferior Alveolar Nerve Block., Joe Iwanaga, Paul J Choi, Marc Vetter, Mayank Patel, Shogo Kikuta, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The inferior alveolar nerve block (IANB) procedure delivers anesthetics to the pterygomandibular space through which the lingual nerve (LN) and inferior alveolar nerve (IAN) travel. Injury to the LN has been reported more often than injury to the IAN. However, the number of anatomical studies of LN injury is limited. We aimed to establish evidence by investigating LN and IAN anatomy at the level of the mandibular foramen (MF). Forty-four sides from 22 Caucasian cadaveric heads (16 fresh-frozen and six formalin-fixed cadavers) were used in this study. The LN and IAN were laterally dissected, and the diameter and the distance …

A Cadaveric Case Of A Circular Torcular Herophili., Sasha Lake, Juan J Altafulla, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The torcular Herophili is formed by the joining of the straight sinus, superior sagittal sinus, and transverse sinus. The anatomic configuration of the torcular Herophili is highly variable. In the current literature, classification systems define up to nine subtypes of the torcular Herophili. The frequency of prevalence of these anatomical variants is also variable. Herein is a case report of a circularly-shaped torcular Herophili found during cadaveric dissection.