Neurology Commons^™

Neurohospitalist Core Competencies, Jana J Wold, Jetter Robertson, Jerome A Jeevarajan, Molly G Knox, Prateek Thatikunta, Guillermo E Solorzano, Kristin Galetta, Shefali Dujari, Tarini Goyal, Matthew E Ehrlich, Jonathan P Donnelly, Elizabeth Marriott, Vishal A Mandge, Roshni S Dhoot, Matthew W Luedke, Matthew B Maas, Margaret Y Yu, Michel Toledano, Rafid Mustafa, Jamie L Palaganas, Kathryn Kvam, Rachelle Dugue, Ethan Meltzer, Lahoud Touma, Maulik P Shah, Vanja C Douglas, Karen Orjuela, Brian J Scott, Joshua P Klein, David J Likosky, Jennifer R Simpson, Megan B Richie, Carolin Dohle, Jane G Morris, Carl A Gold

Faculty, Staff and Student Publications

The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each …

Using High-Frequency Oscillations From Brief Intraoperative Neural Recordings To Predict The Seizure Onset Zone, Behrang Fazli Besheli, Zhiyi Sha, Jay R Gavvala, Sacit Karamursel, Michael Quach, Chandra Prakash Swamy, Amir Hossein Ayyoubi, Alica M Goldman, Daniel J Curry, Sameer A Sheth, David Darrow, Kai J Miller, David J Francis, Gregory A Worrell, Thomas R Henry, Nuri F Ince

Faculty, Staff and Students Publications

BACKGROUND: While high-frequency oscillations (HFOs) and their stereotyped clusters (sHFOs) have emerged as potential neuro-biomarkers for the rapid localization of the seizure onset zone (SOZ) in epilepsy, their clinical application is hindered by the challenge of automated elimination of pseudo-HFOs originating from artifacts in heavily corrupted intraoperative neural recordings. This limitation has led to a reliance on semi-automated detectors, coupled with manual visual artifact rejection, impeding the translation of findings into clinical practice.

METHODS: In response, we have developed a computational framework that integrates sparse signal processing and ensemble learning to automatically detect genuine HFOs of intracranial EEG data. This …

Medial Prefrontal Cortex To Nucleus Reuniens Circuit Is Critical For Performance In An Operant Delayed Nonmatch To Position Task, Evan J Ciacciarelli, Scott D Dunn, Taqdees Gohar, T Joseph Sloand, Mark Niedringhaus, Elizabeth A West

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Working memory refers to the temporary retention of a small amount of information used in the execution of a cognitive task. The prefrontal cortex and its connections with thalamic subregions are thought to mediate specific aspects of working memory, including engaging with the hippocampus to mediate memory retrieval. We used an operant delayed-non match to position task, which does not require the hippocampus, to determine roles of the rodent medial prefrontal cortex (mPFC), the nucleus reuniens thalamic region (RE), and their connection. We found that transient inactivation of the mPFC and RE using the GABA-A agonist muscimol led to a …

Increased Neuroinflammation And Compromised Blood Brain Barrier In A Mouse Model Of Autism, Amani S. Ikram, Rekha Jagadapillai, Idil Tuncali, Gregory N. Barnes, Evelyne Gozal

The Cardinal Edge

No abstract provided.

Plasmodium Berghei Liver Stage Parasites Exploit Host Gabarap Proteins For Tfeb Activation, Jacqueline Schmuckli-Maurer, Annina F Bindschedler, Rahel Wacker, Oliver M Würgler, Ruth Rehmann, Timothy Lehmberg, Leon O Murphy, Thanh N Nguyen, Michael Lazarou, Jlenia Monfregola, Andrea Ballabio, Volker T Heussler

Duncan NRI Faculty and Staff Publications

Plasmodium, the causative agent of malaria, infects hepatocytes prior to establishing a symptomatic blood stage infection. During this liver stage development, parasites reside in a parasitophorous vacuole (PV), whose membrane acts as the critical interface between the parasite and the host cell. It is well-established that host cell autophagy-related processes significantly impact the development of Plasmodium liver stages. Expression of genes related to autophagy and lysosomal biogenesis is orchestrated by transcription factor EB (TFEB). In this study, we explored the activation of host cell TFEB in Plasmodium berghei-infected cells during the liver stage of the parasite. Our results …

Firearm Access, Carriage And Use In An Ethnically Diverse Sample Of Young Adults In Texas, Usa, Yu Lu, Elizabeth Baumler, Annalyn Saludares Demello, Leila Wood, Hillary Mcguire, Jeff R Temple

Faculty, Staff and Student Publications

Background Despite the high rates of firearm ownership and firearm-related injuries and mortalities in Southern US states, understandings on the factors contributing to these are lacking.

Methods Using wave 10 (2021) data from a longitudinal study, we examined firearm-related experiences among 636 ethnically diverse young adults (mean age=26 years; 62% female) in Texas, USA.

Results Just over half of participants had ready access to firearms, with 22.3% having carried a firearm outside of their home, 4.9% having been threatened with a firearm by a romantic partner and 4.4% by a non-romantic partner. More firearm access and carriage were reported in …

Il-37 Suppresses Cns Autoimmunity By Increasing The Frequency Of Treg Cells And Reducing Cd4 + T Cell-Derived Il-10 Production, Reza Yazdani, Hamed Naziri, Gholamreza Azizi, Bogoljub Ciric, Mozhde Askari, Amir Moghadam-Ahmadi, Jaya Aseervatham, Guang-Xian Zhang, Mohamad Rostami

Department of Neurology Faculty Papers

BACKGROUND: Interleukin-37 (IL-37) has anti-inflammatory properties in innate and adaptive immunity. Patients with multiple sclerosis (MS), an autoimmune inflammatory demyelinating disease of the central nervous system (CNS), have increased serum levels of IL-37. However, it is unknown whether IL-37 has an inhibitory effect on ongoing autoimmune neuroinflammation, thus offering a potential MS therapy.

AIM: Here, we examined the effect of IL-37 in an experimental autoimmune encephalomyelitis (EAE) model after disease onset to determine if it was protective.

FINDINGS: IL-37-treated mice developed a less severe disease than control mice, with reduced demyelination as determined by increased expression of myelin basic protein. …

Endovascular Treatment Of Patients With Acute Ischemic Stroke With Tandem Lesions Presenting With Low Alberta Stroke Program Early Computed Tomography Score, Milagros Galecio-Castillo, Mudassir Farooqui, Waldo R Guerrero, Marc Ribo, Ameer E Hassan, Mouhammad A Jumaa, Afshin A Divani, Michael G Abraham, Nils H Petersen, Johanna T Fifi, Amer Malik, James E Siegler, Thanh N Nguyen, Sunil A Sheth, Guillermo Linares, Nazli Janjua, Jazba Soomro, Darko Quispe-Orozco, Marta Olivé-Gadea, Wondewossen G Tekle, Syed F Zaidi, Sara Y Sabbagh, Tiffany Barkley, Ayush Prasad, Reade A De Leacy, Mohamad Abdalkader, Sergio Salazar-Marioni, Weston Gordon, Charoskhon Turabova, Aaron Rodriguez-Calienes, Mahmoud Dibas, Maxim Mokin, Dileep R Yavagal, Albert J Yoo, Amrou Sarraj, Tudor G Jovin, Santiago Ortega-Gutierrez

Faculty, Staff and Student Publications

Background: Recent trials confirmed the efficacy and safety of endovascular thrombectomy in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS); however, evidence in tandem lesions is limited. This study evaluates endovascular thrombectomy safety and efficacy in patients with acute large-vessel occlusion with tandem lesions, stratified by baseline ASPECTS.

Methods and results: We conducted a retrospective analysis of data from 16 centers. Inclusion criteria included the following: age ≥18 years, anterior circulation tandem lesions, endovascular thrombectomy < 24 hours of symptom onset, and ≥70% internal carotid artery stenosis/occlusion. Patients were categorized into low (0-5) and high (6-10) ASPECTS. Inverse probability of treatment weighting matching was used to balance the groups. Primary outcomes included the following: 90-day modified Rankin Scale (mRS) score 0 to 2 and symptomatic intracranial hemorrhage. Secondary outcomes included the following: ordinal mRS, mRS 0 to 3, modified Thrombolysis in Cerebral Infarction ≥2b and 2c-3, petechial hemorrhage, parenchymal hematoma (1/2), early neurologic improvement, and mortality. Of 691 patients, 44 had ASPECTS 0 to 5 and 505 had ASPECTS 6 to 10. Patients with low ASPECTS had lower odds of 90-day mRS 0 to 2 (adjusted odds ratio [OR], 0.48; P=0.036) and higher odds of symptomatic intracranial hemorrhage (adjusted OR, 3.78; P=0.014). Additional significant differences were found in mRS shift, …

The Pipeline Embolization Device For The Treatment Of Intracranial Aneurysms In Pediatric Patients With Tuberous Sclerosis Complex: Illustrative Cases, Eveline Teresa Hidalgo, Eric A Grin, Omar Tanweer, Cordelia Orillac, Jason K Chu, Peter Kan, Howard L Weiner

Faculty, Staff and Students Publications

BACKGROUND: Tuberous sclerosis complex (TSC) is a neurocutaneous disorder characterized by the multisystem development of benign tumors. Patients with TSC are also at an increased risk of developing intracranial aneurysms early in life. While aneurysms have historically been treated with open surgical clipping, endovascular approaches are increasingly being used in both pediatric and adult populations.

OBSERVATIONS: In this case series, the authors report the endovascular treatment of three young patients with TSC and fusiform intracranial aneurysms using the Pipeline embolization device (PED) for flow diversion of the affected artery. In all cases, complete aneurysm occlusion was observed, with good parent …

Long-Term Outcomes Following Posterior Fossa Decompression In Pediatric Patients With Chiari Malformation Type 1, A Population-Based Cohort Study, Victor Gabriel El-Hajj, Erik Öhlén, Ulrika Sandvik, Jenny Pettersson-Segerlind, Elias Atallah, Pascal Jabbour, Mohamad Bydon, David J. Daniels, Adrian Elmi-Terander, Erik Edström

Department of Neurosurgery Faculty Papers

OBJECTIVE: Posterior fossa decompression for Chiari malformation type I (Chiari 1) is effective and associated with a low risk of complication. However, up to 20% of patients may experience continued deficits or recurring symptoms after surgical intervention. For pediatric patients, there are no established tools to predict outcomes, and the risk factors for unfavorable postoperative outcomes are poorly understood. Hence, our aim was to investigate baseline data and early postoperative predictors of poor outcomes as determined by the Chicago Chiari outcome scale (CCOS).

METHODS: All pediatric patients (< 18 years) receiving a posterior fossa decompression for Chiari 1 between the years of 2005 and 2020 at the study center were eligible for inclusion. Patients with congenital anomalies were excluded.

RESULTS: Seventy-one pediatric patients with a median age of 9 years were …

Real-World Effectiveness Of Cgrp Antagonists In Patients With Migraine And Cluster Headache: A Study Protocol, Suraj Malhan, Do/Ms, Areeba Nisar, Md, Shreya Ghosh, Bs, Victor Wang, Md, Nicole Spare, Do, Michael Marmura, Md, Hsiangkuo Yuan, Md, Phd

Department of Jefferson Headache Center Papers and Presentations

Background

Scientific Gap

Despite FDA approval of CGRP antagonists (gepant) in 2019, their realworld effectiveness and utilization patterns remain underexplored.

Study Objectives

- Evaluate the real-world usage and effectiveness of gepants for headache treatment based on survey responses.

- Assess patient-reported outcomes regarding acute and preventative average monthly use of gepants among current and past users.

• Preventative: Average monthly reduction in headache days, intensity, and daily functioning (>50% significant, <50% moderate, or no change).
• Acute: Consistency scaled as "never" to "always" of pain reduction, pain freedom, and function restoration at 2 hours; pain freedom at 24 hours.

- Identify any adverse effects with gepant …

Observing The Impacts Of Different Diets On Clinical Outcomes In Patients With Alzheimer's Disease: A Scoping Review, Erjola Toska, Alessandra Ottley, Quinn Jackson, Rachel Fricker, Alexa Carleo, Gabriella Cutrali, Olivia D’Alessio, Raquel Rossman, Samuel Kruchakov, Abraham Edelstein, Lubov Nathanson

HCA-NSU MD Research Day

Observing the Impacts of Different Diets on Clinical Outcomes in patients with Alzheimer's disease: A Scoping Review Authors: Quinn Jackson, OMS-III; Rachel Fricker,OMS-III; Erjola Toska, OMS-III; Alessandra Ottley,OMS-III; Alexa Carleo,OMS-III; Gabriella Cutrali, OMS-III; Olivia D’Alessio, OMS-III; Raquel Rossman, OMS-III; Samuel Kruchakov, OMS-III; Abraham Edelstein,OMS-III; Lubov Nathanson, Ph.D. Program: Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Florida Objectives: This study aimed to assess the literature published from 2013 to 2023 on the impact of diet on Alzheimer’s Disease (AD). Background: AD is primarily marked by β-amyloid plaques and neurofibrillary tangles, which impair neuronal synapses, leading to memory …

Gulf War Illness: Risk Of Cognitive Decline And Dementia, Nidhi Patel, Fabian Mantilla, Mayur Parmar Phd

HCA-NSU MD Research Day

Gulf War Illness: Risk of Cognitive Decline and Dementia 1Nidhi Patel, 1Fabian Mantilla, 2Mayur S. Parmar, PhD 1Class of 2026, Dr. Kiran C. Patel College of Osteopathic Medicine 2Assistant Professor, Pharmacology. Dr. Kiran C. Patel College of Osteopathic Medicine Objective. This review highlights the current understanding of neurological dysfunction associated with Gulf War Illness (GWI), specifically focusing on cognitive impairment and dementia as key complications. Background. GWI is a chronic multi-system disorder affecting a significant portion of veterans who served in the 1990-1991 Gulf War. Methods. This review synthesizes evidence from human and preclinical primary peer-reviewed studies evaluating the cognitive …

Lifestyle Effects On An Unusual Presentation Of Syncope: A Case Report, Rishma Gattu, Nisarg Shah, Ramya Ravulapalli, Vania Rodriguez, Gary Merlino

HCA-NSU MD Research Day

Introduction: This case study explores a unique presentation of syncope with a multifactorial etiology and discusses the impact of lifestyle behaviors on syncope exacerbation. Scant literature exists on behavioral modifications affecting cardiogenic responses. Case Presentation: We present a 53 year old Hispanic male with a past history of palpitations and chronic marijuana use coming to the emergency department (ED) with three episodes of sudden loss of consciousness that occurred after starting his job as a night shift worker, which led to severe chronic sleep deprivation. These episodes lacked prodromal (chest pain, shortness of breath, palpitations, diaphoresis) and postictal (drowsiness, nausea, …

Modeling Antisense Oligonucleotide Therapy In Mecp2 Duplication Syndrome Human Ipsc-Derived Neurons Reveals Gene Expression Programs Responsive To Mecp2 Levels, Sameer S Bajikar, Yehezkel Sztainberg, Alexander J Trostle, Harini P Tirumala, Ying-Wooi Wan, Caroline L Harrop, Jesse D Bengtsson, Claudia M B Carvalho, Davut Pehlivan, Bernhard Suter, Jeffrey L Neul, Zhandong Liu, Paymaan Jafar-Nejad, Frank Rigo, Huda Y Zoghbi

Faculty, Staff and Students Publications

Genomic copy-number variations (CNVs) that can cause neurodevelopmental disorders often encompass many genes, which complicates our understanding of how individual genes within a CNV contribute to pathology. MECP2 duplication syndrome (MDS or MRXSL in OMIM; OMIM#300260) is one such CNV disorder caused by duplications spanning methyl CpG-binding protein 2 (MECP2) and other genes on Xq28. Using an antisense oligonucleotide (ASO) to normalize MECP2 dosage is sufficient to rescue abnormal neurological phenotypes in mouse models overexpressing MECP2 alone, implicating the importance of increased MECP2 dosage within CNVs of Xq28. However, because MDS CNVs span MECP2 and additional genes, we generated human …

Endovascular Treatment Of Patients With Acute Ischemic Stroke With Tandem Lesions Presenting With Low Alberta Stroke Program Early Computed Tomography Score, Milagros Galecio-Castillo, Mudassir Farooqui, Waldo R. Guerrero, Marc Ribo, Ameer E. Hassan, Mouhammad A. Jumaa, Afshin A. Divani, Michael G. Abraham, Nils Petersen, Johanna T. Fifi

School of Medicine Publications

Background: Recent trials confirmed the efficacy and safety of endovascular thrombectomy in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS); however, evidence in tandem lesions is limited. This study evaluates endovascular thrombectomy safety and efficacy in patients with acute large-vessel occlusion with tandem lesions, stratified by baseline ASPECTS.

Methods and results: We conducted a retrospective analysis of data from 16 centers. Inclusion criteria included the following: age ≥18 years, anterior circulation tandem lesions, endovascular thrombectomy onset, and ≥70% internal carotid artery stenosis/occlusion. Patients were categorized into low (0-5) and high (6-10) ASPECTS. Inverse probability of treatment weighting …

Genetic Risk Factors Underlying White Matter Hyperintensities And Cortical Atrophy, Yash Patel, Jean Shin, Eeva Sliz, Ariana Tang, Aniket Mishra, Rui Xia, Edith Hofer, Hema Sekhar Reddy Rajula, Ruiqi Wang, Frauke Beyer, Katrin Horn, Max Riedl, Jing Yu, Henry Völzke, Robin Bülow, Uwe Völker, Stefan Frenzel, Katharina Wittfeld, Sandra Van Der Auwera, Thomas H Mosley, Vincent Bouteloup, Jean-Charles Lambert, Geneviève Chêne, Carole Dufouil, Christophe Tzourio, Jean-François Mangin, Rebecca F Gottesman, Myriam Fornage, Reinhold Schmidt, Qiong Yang, Veronica Witte, Markus Scholz, Markus Loeffler, Gennady V Roshchupkin, M Arfan Ikram, Hans J Grabe, Sudha Seshadri, Stephanie Debette, Tomas Paus, Zdenka Pausova

Faculty, Staff and Student Publications

White matter hyperintensities index structural abnormalities in the cerebral white matter, including axonal damage. The latter may promote atrophy of the cerebral cortex, a key feature of dementia. Here, we report a study of 51,065 individuals from 10 cohorts demonstrating that higher white matter hyperintensity volume associates with lower cortical thickness. The meta-GWAS of white matter hyperintensities-associated cortical 'atrophy' identifies 20 genome-wide significant loci, and enrichment in genes specific to vascular cell types, astrocytes, and oligodendrocytes. White matter hyperintensities-associated cortical 'atrophy' showed positive genetic correlations with vascular-risk traits and plasma biomarkers of neurodegeneration, and negative genetic correlations with cognitive functioning. …

Psychosis And Personality Changes Following Traumatic Brain Injury, David Hanna, Sonya Priven, Nathan Carroll, Heba Ekladios, Adriana Fitzsimmons

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Psychotic disorders following traumatic brain injury (TBI) are a significant concern in psychiatry, with chronic sequelae often overlooked. The pathophysiology of post-TBI psychosis involves neuroplasticity and neuronal remodeling, potentially exacerbating vulnerabilities to chronic psychotic disorders. Differentiating post-TBI psychosis from primary schizophrenia and other psychotic conditions is crucial for appropriate treatment. This case report discusses a 63-year-old male with a history of TBI from a gunshot wound sustained in adolescence, who later developed schizophrenia. The report explores the patient's psychiatric symptoms, cognitive dysfunction, personality changes, and imaging findings. The report examined the complex relationship between TBI and psychotic symptoms, considering genetic, …

Enlarged Perivascular Space Burden Predicts Declines In Cognitive And Functional Performance, Timothy Justin Libecap, Colleen A. Pappas, Christopher E. Bauer, Valentinos Zachariou, Flavius D. Raslau, Brian T. Gold

Neurology Faculty Publications

Introduction: We evaluated the relationship between baseline enlarged perivascular space (ePVS) burden and later cognitive decline.

Methods: 83 community-dwelling, older adults (aged 56–86) completed three annual cognitive assessments that included the Clinical Dementia Rating (CDR®) Dementia Staging Instrument Sum of Boxes (CDR-SB) and composite measures of executive function and episodic memory. An MRI scan at baseline was used to count ePVS in the basal ganglia and centrum semiovale. Mixed effects models were run with ePVS as the predictor variable and cognitive measures as the dependent variable. Covariates included age, sex, education, cerebral small vessel disease (cSVD) risk factors, and cSVD …

An Expansion Of The Phenotype In Individuals With Syncrip-Related Neurodevelopmental Disorder, Tooba Shafiq, Joanna Feng, Lindsay Phillips, Kara Murias, Marcia Ferguson, Kristin Baranano, Alaina Acchione, Patricia Kipkemoi, Collins Kipkoech, Amina Abubakar

Institute for Human Development, East Africa

Disruption of genes within the HNRNP gene family has been observed in neurodevelopmental and neurodegenerative diseases. The HNRNP-Related Neurodevelopmental Disorders (HNRNP-RNDDs), while each unique, have been recently described with similar clinical and molecular features across variation in several genes. However, the phenotypic information on these patients is still lacking. In this case series we aim to describe the phenotypes that are associated with SYNCRIP-Related Neurodevelopmental Disorder (SYNCRIP-RNDD). We describe in depth ten novel individuals and one previously published individual with mostly de novo and predicted damaging variants in SYNCRIP, consistent with a diagnosis of SYNCRIP-RNDD. We also describe previously published …