Neurology Commons^™

Clippers (Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive To Steroids)–Case Report With Neuroimaging, Abdul Salam, Farah Sana, Rashed Nazir, M. Azhar Saeed, Yasir Iqbal, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Background: CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory disease process primarily involving the pons and adjacent structures. Clinically, the patient may present with cerebellar signs such as dysarthria, gait ataxia and with cranial nerve palsies. It shows good response to steroids / immunosuppressive therapy. Pathologically, there is infiltration of T lymphocytes into the perivascular spaces of brainstem. The disease follows a relapsing and a remitting course and the earlier the treatment is started with high dose steroids and the more prolonged it is, the better the clinical outcome will be.

Sporadic Cjd And Retinitis Punctata Albescansa Case Report And Literature Review, Quratulain Khan, Yusra Hanif Khan

Pakistan Journal of Neurological Sciences (PJNS)

Introduction Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common form of CJD causing 85% of all cases. Various phenotypes of sCJD have been identified including Heidenhain variant which has early and predominant visual symptoms with most pronounced neuropathological changes in occipital lobe. Methodology. We are reporting a case of sCJD with Retinitis Punctata Albescens (RPA), a variant of Retinitis Pigmentosa (RP), which to our knowledge has not been reported before. A 51 year old, married, right handed, Pakistani woman presented with dementia and gait problems for 3 months and visual hallucinations for 2 months. Ophthalmological examination 3 years prior to …

Endovascular Treatment Of Intracranial Aneurysms Using Balloon Remodeling Technique, Wasey Jilani, Tanveer Ul Haq

Pakistan Journal of Neurological Sciences (PJNS)

Endovascular treatment with coils is widely used in the management of intracranial aneurysms. However, this type of treatment can be technically challenging for anatomic reasons, particularly when the neck of the aneurysm is wide or when the dome-to-neck ratio is not favorable. Previous studies described the remodeling technique for extending the indications and feasibility of the endovascular treatment to wide-neck intracranial aneurysms. In remodeling technique, a non-detachable balloon is temporarily inflated in front of the neck of the aneurysm during each coil placement. At the end of the procedure, the remodeling balloon is removed and no device is left in …

Autism- Towards Comprehensive Assessment And Management, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Autism is a pervasive, neurodevelopmental disorder characterized by stereotyped movements and impairment in social skills and communication patterns. Prevalence patterns show an increasing burden of about 1 in 150 children affected by the disorder. Most affected individuals have symptoms that interfere greatly with quality of life. Although a burgeoning concern, research on the prevalence, etiological factors and presentation patterns is limited in LAMI countries, leading to a minimal understanding of the disorder at individual, professional and societal level. There is an urgent need to enhance awareness and education to decrease stigma that maybe associated with autism.

Psychiatric Disorders In Neurology, Rizwan Taj, Mamoona Manzoor

Pakistan Journal of Neurological Sciences (PJNS)

Psychiatric disorders (PDs) are very frequent in neurological illnesses. Depression, anxiety and cognitive impairment are frequently seen in many neurological disorders such as stroke, Parkinson disease (PD), epilepsy and multiple sclerosis (MS). In addition, hallucinations, delusions, obsessive-compulsive disorder, sleep disorders, Impulse control disorders (ICDs), somatization, bipolar disorder, behavior problems and psychological problem are also seen. Depression in stroke and epilepsy has bidirectional relationship. Lesion location affects both frequency and severity of depression in stroke patients.

Il-4 Signaling Drives A Unique Arginase+/Il-1Β+ Microglia Phenotype And Recruits Macrophages To The Inflammatory Cns: Consequences Of Age-Related Deficits In Il-4rα After Traumatic Spinal Cord Injury, Ashley M. Fenn, Jodie C.E. Hall, John C. Gensel, Phillip G. Popovich, Jonathan P. Godbout

Spinal Cord and Brain Injury Research Center Faculty Publications

Alternative activation of microglia/macrophages (M2a) by interleukin (IL)-4 is purported to support intrinsic growth and repair processes after CNS injury. Nonetheless, alternative activation of microglia is poorly understood in vivo, particularly in the context of inflammation, injury, and aging. Here, we show that aged mice (18-19 months) had reduced functional recovery after spinal cord injury (SCI) associated with impaired induction of IL-4 receptor α (IL-4Rα) on microglia. The failure to successfully promote an IL-4/IL-4Rα response in aged mice resulted in attenuated arginase (M2a associated), IL-1β, and chemokine ligand 2 (CCL2) expression, and diminished recruitment of IL-4Rα⁺ macrophages to …

Immunomodulatory Activity Of Interferon-Beta, Lloyd H. Kasper, Anthony T. Reder

Dartmouth Scholarship

Multiple sclerosis (MS) is a complex disorder of the central nervous system that appears to be driven by a shift in immune functioning toward excess inflammation that results in demyelination and axonal loss. Beta interferons were the first class of disease-modifying therapies to be approved for patients with MS after treatment with this type I interferon improved the course of MS on both clinical and radiological measures in clinical trials. The mechanism of action of interferon-beta appears to be driven by influencing the immune system at many levels, including antigen-presenting cells, T cells, and B cells. One effect of these …

Advances In Neurovascular Treatments., Robert M Starke, Stephen J Monteith, Nohra Chalouhi, Dale Ding, Ricky Medel, David Hasan, Aaron S Dumont

Department of Neurosurgery Faculty Papers

No abstract provided.

Vulnerability Of The Ventral Language Network In Children With Focal Epilepsy, Louise J. Croft, Torsten Baldeweg, Leigh Sepeta, Lauren Zimmaro, Madison M. Berl, William D. Gaillard

Neurology Faculty Publications

Children with focal epilepsy are at increased risk of language impairment, yet the neural substrate of this dysfunction is not yet known. Using functional magnetic resonance imaging we investigated the impact of focal epilepsy on the developing language system using measures of network topology (spatial organization of activation) and synchrony (functional connectivity). We studied healthy children (n = 48, 4–12 years, 24 females) and children with focal epilepsy (n = 21, 5–12 years, nine females) with left hemisphere language dominance. Participants performed an age-adjusted auditory description decision task during functional magnetic resonance imaging, to identify perisylvian language regions. …

Pilot Study To Assess Benefit Of Virtual Reality Game System, Wii, On Balance And Gait In Persons With Parkinson's Disease, Peter J. Barbour Md, Amy L. Kerstetter Pt, Allyn Danni Pt, Ncs, Atp, Mscs, Jolene Hammer Pt, Michael J. Weiss Mph, Sandra M. Tremblay Pt, Ms, Cws, Mscs

Department of Medicine

No abstract provided.

Letter To Alliance For Headache Disorders Advocacy, William B. Young, Md

Department of Jefferson Headache Center Papers and Presentations

Several years ago the Centers for Medicare and Medicare Services (CMS) decided it would not pay for oxygen for the treatment of cluster headache. This is a serious hardship for many people with cluster headache. The American Headache Society and the Alliance for Headache Disorders Advocacy appealed to CMS to reverse this decision but they refused.

In February, we went to Congress, asking them to encourage CMS to reconsider this appeal. As a result of these efforts, Nebraska Senator Johanns and Delaware Senator Coons are circulating a letter for all Senators to sign urging CMS to re-evaluate this situation. To …

Alzheimer’S Disease Cooperative Study (Adcs) Prevention Instrument Project Assessing Resource Use And Volunteer And Paid Work Among Healthy Elders, A Longitudinal Study, Peter J. Whitehouse

Faculty Scholarship

No abstract provided.

Kyphotic Progression After Thoracolumbar Burst Fractures Treated Conservatively, With Mis, Or Via Open Approach, Mark Rivkin, Howard Eisenbrock

Research Day

Management of thoracolumbar burst fractures (AO A3) without neurological deficit is subject to debate in the literature. While TLICS provides guidance for injuries necessitating intervention, it makes little mention of best surgical approaches. Furthermore, intact patients with suspected posterior ligamentous complex injury (TLICS 4) compose an additional level of management uncertainty. Present study examined outcomes for TL burst fractures in neurologically intact patients with suspected disruption of the PLC treated with bracing, MIS, or open fixation and fusion.

Medial Temporal Lobe Roles In Human Path Integration, Naohide Yamamoto, John W. Philbeck, Adam J. Woods, Daniel A. Gajewski, Joeanna C. Arthur, Samuel J. Potolicchio, Lucien M. Levy, Anthony J. Caputy

Neurological Surgery Faculty Publications

Path integration is a process in which observers derive their location by integrating self-motion signals along their locomotion trajectory. Although the medial temporal lobe (MTL) is thought to take part in path integration, the scope of its role for path integration remains unclear. To address this issue, we administered a variety of tasks involving path integration and other related processes to a group of neurosurgical patients whose MTL was unilaterally resected as therapy for epilepsy. These patients were unimpaired relative to neurologically intact controls in many tasks that required integration of various kinds of sensory self-motion information. However, the same …

Reduction In Post-Botulinum Toxin Flu-Like Symptoms After Injection With Incobotulinum Toxin, Edwin George, Natalya Shneyder

Neurology Faculty Publications

OBJECTIVE: To determine if patients reporting flu-like symptoms (FLS) after botulinum toxin (BoNT) injections are less susceptible to this reaction after incobotulinum toxin.

BACKGROUND: Approximately 10% of patients injected with BoNT in our clinic complain of FLS, primarily malaise, myalgias and rhinorrhea, beginning a few days to one week after injection and lasting one week or less. A review by Baizabal-Carvallo et al. (Toxicon, 2011, 58:1-7) found rates of FLS between 1.7 and 20% in patients after various preparations of botulinum toxin A, and a subsequent study showed increased cytokines in patients with FLS (Neurotoxicity Research, …

A Refresher On Tourette Syndrome., James R. Batterson, Shayla Sullivant, Jean-Baptist Lepichon, Christy Kleinsorge, Sandy Price, Stephanie Andrews

Manuscripts, Articles, Book Chapters and Other Papers

Tourette Syndrome (TS) is recognized as a more common neurodevelopmental disorder than once thought. In this article we present an update on TS including the DSM-5 revised criteria, new findings in the genetics of TS, treatment advances such as new medications for tics and the use of new tools including Cognitive Behavioral Intervention for Tics (CBIT). We also explore supportive services for the ongoing care of patients using nursing education and family therapy.

Use Of Antiepileptic Drugs And Lipid-Lowering Agents In The United States., Scott Mintzer, Vittorio Maio, Kathleen Foley

Department of Neurology Faculty Papers

INTRODUCTION: The extent to which enzyme-inducing antiepileptic drugs (EIAEDs) are used as first-line treatment in the United States remains unknown. Studies suggest that EIAEDs produce elevation of serum lipids, which could require additional treatment. We assessed the current use of EIAED in monotherapy for epilepsy in the U.S., as well as the correlation between the use of EIAEDs and subsequent new prescriptions for HMG-CoA reductase inhibitors ("statins") for hyperlipidemia.

METHODS: We queried the MarketScan® databases between July 2009 and January 2013, covering 66million patients with commercial or supplemental Medicare insurance. We identified individuals who had a diagnosis of seizures, continuous …

Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series, Muhammad Babar Khan, Rajesh Kumar, Ather Enam

Section of Neurosurgery

Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia.
Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) …

Critical Role Of Tnf-Α In Cerebral Aneurysm Formation And Progression To Rupture., Robert M Starke, Nohra Chalouhi, Md, Pascal Jabbour Md, Stavropoula Tjoumakaris, L. Fernando Gonzalez, Robert H. Rosenwasswer Md, Kosuke Wada, Kenji Shimada, David M Hasan, Nigel H Greig, Gary K Owens, Aaron Dumont

Department of Neurosurgery Faculty Papers

BACKGROUND: Alterations in TNF-α expression have been associated with cerebral aneurysms, but a direct role in formation, progression, and rupture has not been established.

METHODS: Cerebral aneurysms were induced through hypertension and a single stereotactic injection of elastase into the basal cistern in mice. To test the role of TNF-α in aneurysm formation, aneurysms were induced in TNF-α knockout mice and mice pretreated with the synthesized TNF-α inhibitor 3,6'dithiothalidomide (DTH). To assess the role of TNF-α in aneurysm progression and rupture, DTH was started 6 days after aneurysm induction. TNF-α expression was assessed through real-time PCR and immunofluorescence staining.

RESULTS: …

The End Of Alzheimer's Disease - From Biochemical Pharmacology To Ecopsychosociology: A Personal Perspective, Peter J. Whitehouse

Faculty Scholarship

The future of the Alzheimer's disease (AD) field involves a more complete understanding not only the state of current scientific approaches, but also the linguistic and cultural context of preclinical and clinical research and policy activities. The challenges surrounding dementia are large and growing but are only part of broader social and health concerns. In this latter context, the current state of research in the AD area is reviewed together with necessary priorities in moving forward. Creating a more optimistic future will depend less on genetic and reductionist approaches and more on environmental and intergenerative approaches that will aid in …