Brain atrophy in acute ischaemic stroke patients treated with reperfusion therapy: a systematic review

Background Brain atrophy (BA) may have a role in acute ischemic stroke (AIS) in mediating outcomes after reperfusion therapy. The extent of this association is not well understood. Purpose : To examine the impact of pre-existing BA on functional outcome, survival, symptomatic intracerebral hemorrhage (sICH), and early neurological change in patients with AIS treated with intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT). Material and Methods PubMed, EMBASE, and the Cochrane library were searched for studies on BA in AIS receiving reperfusion therapy. Studies were included if: (i) patients were aged ≥18 years; (ii) patients had been diagnosed with AIS; (iii) patients received IVT and/or EVT; (iv) studies reported on BA; (v) studies reported on post-reperfusion outcomes; and (vi) studies had a sample size of >25 patients. Results A total of 4444 patients from eight studies were included. Four out of seven studies reporting on 90-day functional outcome found pre-existing BA to be significantly associated with poor functional outcome. Moreover, two out of four studies found BA to be a significant predictor of 90-day mortality. None of the included studies reported a significant association of BA with sICH or early neurological deterioration. Conclusion This systematic review indicates a potential prognostic role of BA in AIS. Quantitative analysis of association of BA with outcomes in AIS is not possible given the heterogeneity in BA assessment and reporting across studies. Future studies using standardized BA assessment are warranted to clarify its association with clinical and safety outcomes in AIS.

The role of Dopamine in the Sensitised Locomotor Activating Effects of Methylenedioxymethamphetamine (MDMA) in Rats

<p>Under certain regimens of repeated pre-exposure, psychostimulant drugs show an increase in locomotor activity across days of testing and, after abstinence from the drug, a greater responsiveness to a subsequent challenge dose of the drug. This phenomenon, termed behavioural sensitisation, is thought to underlie certain aspects of drug addiction such as drug seeking and relapse. Repeated administration of +/-3, 4-Methylenedioxymethamphetamine (MDMA, ecstasy) produced sensitised hyperactivity in rats suggesting a lasting neurological change. The present studies sought to evaluate some of the parameters around both the induction and expression of behavioural sensitisation to MDMA and to evaluate if the sensitivity of the dopamine (DA) D1 and D2 receptors had altered under the current pre-exposure regimen of MDMA. Further, following MDMA pre-exposure that results n behavioural sensitisation, changes in potency to the reinforcing effects of MDMA were investigated through the self administration paradigm. Finally, high performance liquid chromatography (HPLC) was used to evaluate changes in brain amine levels following sensitisation to MDMA locomotor activating effects. Rats received a pre-treatment regimen consisting of 5 daily injections of MDMA (0.0, 5.0 or 10mg/kg i.p). MDMA-produced locomotor activity was measured after 2, 9 or 28 days of withdrawal. In other groups, hyperactivity following administration the DA D1 agonist SKF81297 (0.0, 0.5, 1.0, 2.0, 4.0 or 8.0 mg/kg), or the D2-like DA agonist apomorphine (0.0, 0.5, 1.0, 2.0 or 4.0 mg/kg) was measured in groups that received pre-exposure to MDMA (10.0 4mg/kg) or vehicle. The effects of the D1 antagonist SCH23390 (0.0, 0.01, 0.02, or 0.04 mg/kg), the D2 antagonist eticlopride (0.03, 0.01, 0.003, 0.05, 0.1, or 0.2 mg/kg) or the 5-HT2C antagonist RS102221 (0.0, 0.25, 0.5, or 1.0 mg/kg) on MDMA-produced hyperactivity in MDMA or vehicle pre-treated rats was also measured. In Experiment 3, effects of MDMA or vehicle pre-treatment on latency to acquisition of MDMA (0.5 or 1.0 mg/kg/infusion) selfadministration was measured. In Experiment 4 effects of pre-treatment on brain tissue levels of DA, its metabolite homovanillic acid (HVA), serotonin (5-HT) and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA) were determined. The regimen of 5 daily treatments of 10.0mg/kg produced persistent behavioural sensitisation and cross-sensitisation to hyperactivity produced by DA receptor agonists. These effects were not, however, reflected in sensitised responses to the ability of the antagonists to attenuate MDMA-produced hyperactivity. Pre-treatment with MDMA did not decrease latency to acquisition of self-administration. Rather, there was an increased latency to acquisition of self-administration in the MDMA pre-treated rats. MDMA pretreatment decreased levels of the serotonin metabolite 5-HIAA in the frontal cortex and hippocampus. Following the current pre-treatment regimen, MDMA produced behavioural sensitisation is mediated by neuroadaptations in central dopaminergic substrates. The persistent locomotor sensitisation is similar to that produced by other amphetamine-like stimulants and might underlie use and abuse of this compound.</p>

The role of Dopamine in the Sensitised Locomotor Activating Effects of Methylenedioxymethamphetamine (MDMA) in Rats

<p>Under certain regimens of repeated pre-exposure, psychostimulant drugs show an increase in locomotor activity across days of testing and, after abstinence from the drug, a greater responsiveness to a subsequent challenge dose of the drug. This phenomenon, termed behavioural sensitisation, is thought to underlie certain aspects of drug addiction such as drug seeking and relapse. Repeated administration of +/-3, 4-Methylenedioxymethamphetamine (MDMA, ecstasy) produced sensitised hyperactivity in rats suggesting a lasting neurological change. The present studies sought to evaluate some of the parameters around both the induction and expression of behavioural sensitisation to MDMA and to evaluate if the sensitivity of the dopamine (DA) D1 and D2 receptors had altered under the current pre-exposure regimen of MDMA. Further, following MDMA pre-exposure that results n behavioural sensitisation, changes in potency to the reinforcing effects of MDMA were investigated through the self administration paradigm. Finally, high performance liquid chromatography (HPLC) was used to evaluate changes in brain amine levels following sensitisation to MDMA locomotor activating effects. Rats received a pre-treatment regimen consisting of 5 daily injections of MDMA (0.0, 5.0 or 10mg/kg i.p). MDMA-produced locomotor activity was measured after 2, 9 or 28 days of withdrawal. In other groups, hyperactivity following administration the DA D1 agonist SKF81297 (0.0, 0.5, 1.0, 2.0, 4.0 or 8.0 mg/kg), or the D2-like DA agonist apomorphine (0.0, 0.5, 1.0, 2.0 or 4.0 mg/kg) was measured in groups that received pre-exposure to MDMA (10.0 4mg/kg) or vehicle. The effects of the D1 antagonist SCH23390 (0.0, 0.01, 0.02, or 0.04 mg/kg), the D2 antagonist eticlopride (0.03, 0.01, 0.003, 0.05, 0.1, or 0.2 mg/kg) or the 5-HT2C antagonist RS102221 (0.0, 0.25, 0.5, or 1.0 mg/kg) on MDMA-produced hyperactivity in MDMA or vehicle pre-treated rats was also measured. In Experiment 3, effects of MDMA or vehicle pre-treatment on latency to acquisition of MDMA (0.5 or 1.0 mg/kg/infusion) selfadministration was measured. In Experiment 4 effects of pre-treatment on brain tissue levels of DA, its metabolite homovanillic acid (HVA), serotonin (5-HT) and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA) were determined. The regimen of 5 daily treatments of 10.0mg/kg produced persistent behavioural sensitisation and cross-sensitisation to hyperactivity produced by DA receptor agonists. These effects were not, however, reflected in sensitised responses to the ability of the antagonists to attenuate MDMA-produced hyperactivity. Pre-treatment with MDMA did not decrease latency to acquisition of self-administration. Rather, there was an increased latency to acquisition of self-administration in the MDMA pre-treated rats. MDMA pretreatment decreased levels of the serotonin metabolite 5-HIAA in the frontal cortex and hippocampus. Following the current pre-treatment regimen, MDMA produced behavioural sensitisation is mediated by neuroadaptations in central dopaminergic substrates. The persistent locomotor sensitisation is similar to that produced by other amphetamine-like stimulants and might underlie use and abuse of this compound.</p>

NONSPECIFIC SPONDYLODISCITIS IN ADULTS: RETROSPECTIVE STUDY

ABSTRACT Objective To describe the epidemiological and clinical characteristics of patients with pyogenic spondylodiscitis treated in a Brazilian hospital. Methods This is a retrospective study of patients diagnosed with nonspecific spondylodiscitis. Patients of both sexes, above 18 years of age with a minimum follow-up time of 6 months were included. Epidemiological, laboratory, and clinical data were analyzed. Results Nine patients were included. The mean age was 64 years, with seven men (77.7%) and two women (22.2%). All patients evaluated had back pain. The most affected location was the lumbar spine (44.4%). Only three patients (33.3%) had fever and five (55%) had constitutional symptoms. The mean duration of symptoms before diagnosis was 2.5 (± 1.5) weeks. Only four patients (44.4%) had positive cultures. As for neurological status, five patients (55.5%) presented neurological change. At the end of treatment, two patients improved one level in the Frankel score and two patients improved two levels. The main indication for surgery was neurological deficit (55.5%). Two of the patients evaluated died as a result of an infectious condition. Conclusions Less than half of the patients with pyogenic spondylodiscitis had fever or constitutional symptoms. Back pain was present in all cases. In less than half of the patients it was possible to isolate the responsible microorganism. Most patients underwent surgical treatment, although not all improved from the neurological deficit. Level of evidence II; Retrospective study.

Experiencing dementia: How does assessment of cognition and language relate to daily life?

This Swedish study investigates how persons living with dementia report their experiences of cognitive and linguistic testing, as well as their perspectives on the communicative resources and barriers they experience in daily interactions. Eight dyads were included in this qualitative exploratory study; eight persons with dementia and eight family members with whom they interact with daily. Semi-structured interviews, with questions focusing on experiences of diagnostic pathways as well as communicative and cognitive function in daily life, were carried out together with standard clinical testing. The data were analysed using qualitative content analysis. The results shed light on the experiences of uncertainty during the dementia assessment process related to the assessment tasks, the consequences of the assessment and receiving a diagnosis. We interpret this as a result of the unfamiliar clinical focus on function as measured in decontextualised tasks, compared to the participants’ view based on their abilities in everyday life. The study also reveals that adjustments in daily life that are necessitated by the consequences of neurological change are often developed in collaboration between the person with dementia and their conversation partners. There are, however, reports of conflicting feelings by the persons diagnosed with dementia, and by their families, as well as their views on how to best handle change, while maintaining a sense of being a competent person through the progression of disease.

Efektifitas Intervensi Self-Management pada Pasien Stroke

Background: Stroke is a neurological change that occurs quickly caused by disruption of blood supply to parts of the brain. Stroke has a complex impact which includes bio-psycho-social and spiritual. Various complexities of problems encountered in stroke patients so that self-management is needed as a form of adaptation to new conditions after stroke. Self-management interventions are useful for improving self-management skills and behavior in stroke patients. Purpose this study is to analize effectiveness of self-management interventions in stroke patients. Methods : Narrative literature review, research analyzes published in the online databases of ProQuest, Google scholar and Scopus. The study was selected using the criteria and keywords for the 2015-2019 period. Seven studies were analyzed using the literature review process. Results: To improve self-management stroke patients self-management interventions are needed. Self-management interventions can be applied in hospitals when post acute patients are hospitalized, preparation for discharge, return and after discharge home and can be combined with rehabilitation programs in the community. Self-management interventions can improve self-efficacy, self-management behavior, activity daily living (ADL) ability, decreased re-hospitalisation and patient readiness to return to the community. Conclusion: Self-management interventions can be applied in Indonesia, with a note that among others prepared human resources, costs, supporting facilities and policies from the manager.

Depression and obesity: can the cycle be broken?

SUMMARYObesity and depression are conditions that have been linked through a great number of interesting mechanisms. To fully understand the implications of treatment choices it is necessary to continue to investigate the physiology of these two conditions. By examining the background of these problems and considering factors such as stress response, neurological change and systemic inflammation, we propose a cycle linking depression and obesity. With reference to this cycle, we discuss management options, focusing particularly on prescribing choices and current guidelines. An assessment of the medication options is provided demonstrating that prescribing choices can have a significant impact on ongoing physical health. The aim of this discussion is to raise awareness of current research and progress and to see whether the cycle of depression and obesity can be broken.LEARNING OBJECTIVES•Update knowledge of the mechanisms linking depression and obesity•Understand the impact of medication on the cycle linking the two•Consider how we can improve outcomes for patients with depression and/or obesityDECLARATION OF INTERESTNone.

A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting

OBJECTIVESelecting the appropriate patients undergoing craniotomy who can safely forgo postoperative intensive care unit (ICU) monitoring remains a source of debate. Through a multidisciplinary work group, the authors redefined their institutional care process for postoperative monitoring of patients undergoing elective craniotomy to include transfer from the postanesthesia care unit (PACU) to the neurosurgical floor. The hypothesis was that an appropriately selected group of patients undergoing craniotomy could be safely managed outside the ICU in the postoperative period.METHODSThe work group developed and implemented a protocol for transfer of patients to the neurosurgical floor after 4-hour recovery in the PACU following elective craniotomy for supratentorial tumor. Criteria included hemodynamically stable adults without significant new postoperative neurological impairment. Data were prospectively collected including patient demographics, clinical characteristics, surgical details, postoperative complications, and events surrounding transfer to a higher level of care.RESULTSOf the first 200 consecutive patients admitted to the floor, 5 underwent escalation of care in the first 48 hours. Three of these escalations were for agitation, 1 for seizure, and 1 for neurological change. Ninety-eight percent of patients meeting criteria for transfer to the floor were managed without incident. No patient experienced a major complication or any permanent morbidity or mortality following this care pathway.CONCLUSIONSCare of patients undergoing uneventful elective supratentorial craniotomy for tumor on a neurosurgical floor after 4 hours of PACU monitoring appears to be a safe practice in this patient population. This tailored practice safely optimized hospital resources, is financially responsible, and is a strong tool for improving health care value.

Social Cognition Deficits: Current Position and Future Directions for Neuropsychological Interventions in Cerebrovascular Disease

Neuropsychological assessments of cognitive dysfunction in cerebrovascular illness commonly target basic cognitive functions involving aspects of memory, attention, language, praxis, and number processing. Here, I highlight the clinical importance of often-neglected social cognition functions. These functions recruit a widely distributed neural network, making them vulnerable in most cerebrovascular diseases. Sociocognitive deficits underlie most of the problematic social conduct observed in patients and are associated with more negative clinical outcomes (compared to nonsocial cognitive deficits). In clinical settings, social cognition deficits are normally gleaned from collateral information from caregivers or from indirect inferences made from patients’ performance on standard nonsocial cognitive tests. Information from these sources is however inadequate. I discuss key social cognition functions, focusing initially on deficits in emotion perception and theory of mind, two areas that have gained sizeable attention in neuroscientific research, and then extend the discussion into relatively new, less covered but crucial functions involving empathic behaviour, social awareness, social judgements, and social decision making. These functions are frequently impaired following neurological change. At present, a wide range of psychometrically robust social cognition tests is available, and this review also makes the case for their inclusion in neuropsychological assessments.

Progressive Gait Dysfunction

Spinal vascular malformations are rare, with dural arteriovenous fistulas (AVFs) accounting for the majority of the pathology. Unlike spinal arteriovenous malformations, which cause abrupt neurological change as a result of hemorrhage, spinal dural AVFs tend to result in a progressive myelopathy through venous congestion and cord edema. If diagnosed and treated early with endovascular embolization or microsurgery, some deficits may be reversible.