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Cureus Jan 2023Intravenous tissue plasminogen activator (tPA) is a mainstay of therapy in acute ischemic stroke but transient neurologic changes related to reperfusion have not been...
Intravenous tissue plasminogen activator (tPA) is a mainstay of therapy in acute ischemic stroke but transient neurologic changes related to reperfusion have not been well described. One of the authors (ISN) experienced a cardioembolic stroke due to apical hypertrophic cardiomyopathy with a left ventricular apical aneurysm. He received tPA and we describe his unusual cognitive symptoms during the infusion. The patient's presenting neurologic deficit improved with tPA, suggesting reperfusion. His subsequent restlessness, disorientation, and déjà vu lasted about 10 minutes and resolved spontaneously. Imaging studies confirmed an ischemic infarction in the left posterior cerebral artery (PCA) distribution. Cardiac events, including arrhythmias related to coronary reperfusion after myocardial infarction, are well described. Neurologic events due to reperfusion have not been previously described in patients with stroke. We describe a case of transient neurologic symptoms during revascularization of an embolic stroke.
PubMed: 36751231
DOI: 10.7759/cureus.33360 -
Neurology Mar 2023Foster Kennedy syndrome refers to a finding of optic atrophy in one eye from direct compression of the optic nerve by a mass lesion and contralateral papilledema in the...
Foster Kennedy syndrome refers to a finding of optic atrophy in one eye from direct compression of the optic nerve by a mass lesion and contralateral papilledema in the nonatrophic optic nerve caused by an increased intracranial pressure. When the fundoscopy finding is not due to a direct compressive mass, the term pseudo-Foster Kennedy syndrome is used; this can be caused by any process or processes that result in optic atrophy in one eye and optic disc edema in the other. Identifying Foster Kennedy syndrome in a patient calls for expedient neuroimaging looking for an intracranial mass lesion. In this article, we present the case of a patient presenting with vision loss and Foster Kennedy syndrome who was found to have a large trigeminal cystic schwannoma. While several other accompanying symptoms were not evident from the patient complaint, a careful history and physical examination revealed additional localizing clues: unilateral sensory changes in the face and pterygoid and masseter atrophy, unilateral cranial nerve VI palsy, and episodes of intense déjà vu sensation, which were presumed to represent temporal lobe-onset focal aware seizures. Trigeminal schwannomas are a rare entity, and they are even more rarely cystic. This case highlights an unusual scenario where a slow expansion of the tumor ultimately resulted in vision loss and presentation of the patient to medical attention.
Topics: Humans; Optic Nerve Diseases; Papilledema; Optic Atrophy; Meningeal Neoplasms; Abducens Nerve Diseases; Vision Disorders; Cranial Nerve Neoplasms; Neurilemmoma; Seizures
PubMed: 36535773
DOI: 10.1212/WNL.0000000000201700 -
Journal of Vascular Surgery Dec 2022
Topics: Humans; Plaque, Atherosclerotic
PubMed: 36410846
DOI: 10.1016/j.jvs.2022.07.186 -
The Lancet. Infectious Diseases Feb 20235 months into the monkeypox epidemic, there are no proven therapies and no comparative safety and efficacy data in the treatment of affected individuals. The question... (Review)
Review
5 months into the monkeypox epidemic, there are no proven therapies and no comparative safety and efficacy data in the treatment of affected individuals. The question remains whether we, as a scientific and medical community, will apply the lessons learned from the past decade of outbreaks that well conducted randomised controlled trials can be ethically, safely, and efficiently performed to guide clinical decision making so that the right drug is used for the right patient at the right time. Furthermore, the robust level of evidence from randomised controlled trials is highly relevant to advocating for equitable access to new treatments in low-income and middle-income countries. As with COVID-19, we need to pair optimal supportive care with rigorously designed double-blind randomised controlled trials to elucidate safe and effective therapies for monkeypox. The need remains for the funding and development of predesigned, adaptive trial protocols for diseases with epidemic or pandemic potential that can be timely pulled off the shelf and launched early in an outbreak, leveraging ready clinical trial networks and infrastructure for rapid discovery and implementation of new treatments.
Topics: Humans; COVID-19; Mpox (monkeypox); Double-Blind Method; Pandemics; Disease Outbreaks; Randomized Controlled Trials as Topic
PubMed: 36400066
DOI: 10.1016/S1473-3099(22)00722-8 -
Neurology(R) Neuroimmunology &... Nov 2022To assess seizure characteristics in antibody (ab)-associated autoimmune encephalitis (ab + AE) with the 3 most prevalent abs against N-methyl-d-aspartate receptor...
BACKGROUND AND OBJECTIVES
To assess seizure characteristics in antibody (ab)-associated autoimmune encephalitis (ab + AE) with the 3 most prevalent abs against N-methyl-d-aspartate receptor (NMDAR), leucine-rich glioma-inactivated protein 1 (LGI1), and glutamic acid decarboxylase (GAD).
METHODS
Multicenter nationwide prospective cohort study of the German Network for Research in Autoimmune Encephalitis.
RESULTS
Three hundred twenty patients with ab + AE were eligible for analysis: 190 NMDAR+, 89 LGI1+, and 41 GAD+. Seizures were present in 113 (60%) NMDAR+, 69 (78%) LGI1+, and 26 (65%) GAD+ patients and as leading symptoms for diagnosis in 53 (28%) NMDAR+, 47 (53%) LGI+, and 20 (49%) GAD+ patients. Bilateral tonic-clonic seizures occurred with almost equal frequency in NMDAR+ (38/51, 75%) and GAD+ (14/20, 70%) patients, while being less common in LGI1+ patients (27/59, 46%). Focal seizures occurred less frequently in NMDAR+ (67/113; 59%) than in LGI1+ (54/69, 78%) or in GAD+ patients (23/26; 88%). An aura with déjà-vu phenomenon was nearly specific in GAD+ patients (16/20, 80%). Faciobrachial dystonic seizures (FBDS) were uniquely observed in LGI1+ patients (17/59, 29%). Status epilepticus was reported in one-third of NMDAR+ patients, but only rarely in the 2 other groups. The occurrence of seizures was associated with higher disease severity only in NMDAR+ patients.
DISCUSSION
Seizures are a frequent and diagnostically relevant symptom of ab + AE. Whereas NMDAR+ patients had few localizing semiological features, semiology in LGI1+ and GAD+ patients pointed toward a predominant temporal seizure onset. FBDS are pathognomonic for LGI1 + AE. Status epilepticus seems to be more frequent in NMDAR + AE.
Topics: Humans; Glutamate Decarboxylase; Receptors, N-Methyl-D-Aspartate; Prospective Studies; Leucine; Intracellular Signaling Peptides and Proteins; Seizures; Encephalitis; Autoantibodies; Status Epilepticus
PubMed: 36266054
DOI: 10.1212/NXI.0000000000200034 -
Empirical Software Engineering 2022The paper introduces a fundamental technological problem with collecting high-speed eye tracking data while studying software engineering tasks in an integrated...
Deja Vu: semantics-aware recording and replay of high-speed eye tracking and interaction data to support cognitive studies of software engineering tasks-methodology and analyses.
The paper introduces a fundamental technological problem with collecting high-speed eye tracking data while studying software engineering tasks in an integrated development environment. The use of eye trackers is quickly becoming an important means to study software developers and how they comprehend source code and locate bugs. High quality eye trackers can record upwards of 120 to 300 gaze points per second. However, it is not always possible to map each of these points to a line and column position in a source code file (in the presence of scrolling and file switching) in real time at data rates over 60 gaze points per second without data loss. Unfortunately, higher data rates are more desirable as they allow for finer granularity and more accurate study analyses. To alleviate this technological problem, a novel method for eye tracking data collection is presented. Instead of performing gaze analysis in real time, all telemetry (keystrokes, mouse movements, and eye tracker output) data during a study is recorded as it happens. Sessions are then replayed at a much slower speed allowing for ample time to map gaze point positions to the appropriate file, line, and column to perform additional analysis. A description of the method and corresponding tool, Deja Vu, is presented. An evaluation of the method and tool is conducted using three different eye trackers running at four different speeds (60 Hz, 120 Hz, 150 Hz, and 300 Hz). This timing evaluation is performed in Visual Studio, Eclipse, and Atom IDEs. Results show that Deja Vu can playback 100% of the data recordings, correctly mapping the gaze to corresponding elements, making it a well-founded and suitable post processing step for future eye tracking studies in software engineering. Finally, a proof of concept replication analysis of four tasks from two previous studies is performed. Due to using the Deja Vu approach, this replication resulted in richer collected data and improved on the number of distinct syntactic categories that gaze was mapped on in the code.
PubMed: 36159896
DOI: 10.1007/s10664-022-10209-3 -
Frontiers in Psychology 2022Previous research has contrasted fleeting erroneous experiences of familiarity with equally convincing, and often more stubborn erroneous experiences of remembering....
Previous research has contrasted fleeting erroneous experiences of familiarity with equally convincing, and often more stubborn erroneous experiences of remembering. While a subset of the former category may present as nonpathological "déjà vu," the latter, termed "déjà vécu" can categorize a delusion-like confabulatory phenomenon first described in elderly dementia patients. Leading explanations for this experience include the dual process view, in which erroneous familiarity and erroneous recollection are elicited by inappropriate activation of the parahippocampal cortex and the hippocampus, respectively, and the more popular encoding-as-retrieval explanation in which normal memory encoding processes are falsely flagged and interpreted as memory retrieval. This paper presents a novel understanding of this recollective confabulation that builds on the encoding-as-retrieval hypothesis but more adequately accounts for the co-occurrence of persistent déjà vécu with both perceptual novelty and memory impairment, the latter of which occurs not only in progressive dementia but also in transient epileptic amnesia (TEA) and psychosis. It makes use of the growing interdisciplinary understanding of the fluidity of time and posits that the functioning of memory and the perception of novelty, long known to influence the subjective experience of time, may have a more fundamental effect on the flow of time.
PubMed: 35967717
DOI: 10.3389/fpsyg.2022.794683 -
Journal of Urban Health : Bulletin of... Aug 2022
Topics: Humans; Mpox (monkeypox)
PubMed: 35916973
DOI: 10.1007/s11524-022-00671-1 -
Neuron May 2022Genetic and environmental factors during development are involved in autism, and in this issue of Neuron Krüttner et al. (2022) find environment may play a more acute...
Genetic and environmental factors during development are involved in autism, and in this issue of Neuron Krüttner et al. (2022) find environment may play a more acute role in modulating autism behavior in a Shank3 exon 21 deletion mutant mouse (Shank3). The authors explore the underlying circuit mechanisms in detail.
Topics: Animals; Autism Spectrum Disorder; Autistic Disorder; Disease Models, Animal; Mice; Microfilament Proteins; Nerve Tissue Proteins
PubMed: 35512633
DOI: 10.1016/j.neuron.2022.04.007 -
Andes Pediatrica : Revista Chilena de... Feb 2022The birth of intensive care was a process that took place in Copenhagen, Denmark, during and after the polio epidemic of 1952-1953. The fact that marks its beginning was...
The birth of intensive care was a process that took place in Copenhagen, Denmark, during and after the polio epidemic of 1952-1953. The fact that marks its beginning was that anesthesiologist Björn Ibsen was asked to help and "came out of the operating room", not without some controversy. Ib sen proposed and advocated the use of tracheostomy, suctioning and ventilation. Given the lack of positive pressure ventilators, this task was carried out by students who contributed 165,000 hours of manual ventilation. Few years later, in Gothenburg, Sweden, the anesthesiologist Göran Haglund, motivated by the case of a four years old boy with complicated appendicitis, created the first multi disciplinary pediatric intensive care unit in the world (1955). In Chile, during the 1950s, the concept of pediatric intensive care began to develop under the direction of physicians with a solid vision of the future. Given that the planet is experiencing a pandemic, it seems an appropriate moment to review the role of the polio epidemic in the development of positive pressure ventilation, the birth of intensive care medicine and intensive care units, in order to assess the role of the various tasks and innovations carried out.
Topics: Child; Child, Preschool; Critical Care; Humans; Intensive Care Units, Pediatric; Poliomyelitis; Respiration, Artificial; Ventilators, Mechanical
PubMed: 35506786
DOI: 10.32641/andespediatr.v93i1.3977