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1.
Gina Ancora Silvia Soffritti Raffaele Lodi Caterina Tonon Sara Grandi Chiara Locatelli Laura Nardi Nicoletta Bisacchi Claudia Testa Giovanni Tani Paolo Ambrosetto Giacomo Faldella 《Brain & development》2010
Objectives
Brain damage following a perinatal hypoxic–ischemic (HI) insult has been documented by different diagnostic techniques. The aim of the present study was to relate a-EEG time course during the first 24 h of life to brain metabolic changes detected by proton MR spectroscopy (1H-MRS) at 7–10 days of life and to evaluate their correlation with outcome.Methods
Thirty-two patients with any grade HI encephalopathy were studied. Thirty-one out of 32 patients survived and underwent 1H-MRS examination at 7–10 days of life; a-EEG was recorded during the first 24 h of life in 27/32 newborns; 26 patients underwent both examinations. Griffiths test, evaluation of motor skills, visual and hearing function were performed at regular intervals until the age of 2 years.Results
a-EEG at 6, 12 and 24 h of life showed a significant correlation with outcome. N-acetyl-aspartate/creatine (Cr), Lactate/Cr and myo-inositol differed significantly between patients with normal or poor outcome. a-EEG time course during the first 24 h of life showed improvement in newborns with normal 1H-MRS and good outcome and a deterioration in those with abnormal 1H-MRS and poor outcome.Conclusions
a-EEG time course may be able to document the severity and the evolution of the cerebral damage following an HI event. a-EEG is related to the severity of cerebral injury as defined by 1H-MRS and both examinations showed a good correlation with outcome. These data, obtained in non-cooled infants, may represent reference data for future investigations in cooled infants. 相似文献2.
Jill L. Ostrem Nicholas B. Galifianakis Leslie C. Markun Jamie K. Grace Alastair J. Martin Philip A. Starr Paul S. Larson 《Clinical neurology and neurosurgery》2013
Objective
Recently, an iMRI-guided technique for implanting DBS electrodes without MER was developed at our center. Here we report the clinical outcomes of PD patients undergoing STN DBS surgery using this surgical approach.Methods
Consecutive PD patients undergoing bilateral STN DBS using this method were prospectively studied. Severity of PD was determined using the UPDRS scores, Hoehn and Yahr staging score, stand-sit-walk testing, and the dyskinesia rating scale. The primary outcome measure was the change in UPDRS III off medication score at 6 months. DBS stimulation parameters, adverse events, levodopa equivalent daily dose (LEDD), and DBS lead locations were also recorded. Seventeen advanced PD patients (9M/8F) were enrolled from 2007 to 2009.Results
The mean UPDRS III off medication score improved from 44.5 to 22.5 (49.4%) at 6 months (p = 0.001). Other secondary outcome measures (UPDRS II, III on medication, and IV) significantly improved as well (p < 0.01). LEDD decreased by an average of 24.7% (p = 0.003). Average stimulation parameters were: 2.9 V, 66.4 μs, 154 Hz.Conclusion
This pilot study demonstrates that STN DBS leads placed using the iMRI-guided method results in significantly improved outcomes in PD symptoms, and these outcomes are similar to what has been reported using traditional frame-based, MER-guided stereotactic methods. 相似文献3.
Chernov MF Kasuya H Nakaya K Kato K Ono Y Yoshida S Muragaki Y Suzuki T Iseki H Kubo O Hori T Okada Y Takakura K 《Clinical neurology and neurosurgery》2011,113(3):202-212
Objective
The main goal of the present study was evaluation of proton magnetic resonance spectroscopy (1H-MRS) in diagnosis of histopathologically aggressive intracranial meningiomas.Methods
Single-voxel 1H-MRS of 100 intracranial meningiomas was performed before their surgical resection. Investigated metabolites included mobile lipids, lactate, alanine, N-acetylaspartate (NAA), and choline-containing compounds (Cho). According to criteria of World Health Organization (WHO) 82 meningiomas were assigned histopathological grade I, 11 grade II, and 7 grade III. The MIB-1 index varied from 0% to 27.3% (median, 1.6%). In 43 cases tight adhesion of the tumor to the pia mater or brain tissue was macroscopically identified at surgery. The consistency of 49 meningiomas was characterized as soft, 26 as hard, and 25 as mixed.Results
No one metabolic parameter had statistically significant association with histopathological grade and subtype, invasive growth, and consistency of meningioma. Univariate statistical analysis revealed greater 1H-MRS-detected Cho content (P = 0.0444) and lower normalized NAA/Cho ratio (P = 0.0203) in tumors with MIB-1 index 5% and more. However, both parameters lost their statistical significance during evaluation in the multivariate model along with other clinical and radiological variables. It was revealed that non-benign histopathology of meningioma (WHO grade II/III) is mainly predicted by irregular shape (P = 0.0076) and large size (P = 0.0316), increased proliferative activity by irregular shape (P = 0.0056), and macroscopically invasive growth by prominent peritumoral edema (P = 0.0021).Conclusion
While 1H-MRS may be potentially used for the identification of meningiomas with high proliferative activity, it, seemingly, could not add substantial diagnostic information to other radiological predictors of malignancy in these tumors. 相似文献4.
José L. Fernández-Torre Miguel A. Hernández-Hernández Cristina Muñoz-Esteban 《Clinical neurophysiology》2013,124(12):2362-2367
Objective
To describe the causes and outcome of adult patients with preserved electroencephalographic activity despite clinical findings suggesting brain death (BD), and its impact on organ donation.Methods
Retrospective study of the clinical and electroencephalography (EEG) data of all adult patients admitted to our hospital between January 2001 and December 2011 in whom a comprehensive clinical diagnosis of BD was reached following absence of brainstem reflexes and confirmatory apnea tests, were obtained. All patients with clinical findings suggesting BD and an EEG showing brain activity were selected for the analysis. We calculated the brain death interval (BDI) as the time between the first complete clinical examination and confirmatory ancillary test, or the time between the first and second complete clinical examination for BD, in order to analyze the impact on family consent for organ donation.Results
A complete clinical examination and EEG were diagnostic in 289 patients. In 279 (96.5%), the first EEG showed electrocerebral inactivity corroborating the clinical findings of BD. The mean BDI in this group was 4.2 ± 5.8 h (median; 1.8[1.0–3.5]). This value was significantly lower than in the group in which only two full clinical evaluations were performed (p < 0.0001). In 10 out 289 (3.5%), the first EEG showed at least some brain activity. The mean BDI in this group was 27.2 ± 13.8 h (median; 22.9 [19.1−31.2]). In two cases, a third EEG was necessary before obtaining electrocerebral inactivity. A BDI > 6 h, was positively associated with a family refusal for organ donation (p = 0.02).Conclusions
The rate of EEGs with electrocerebral activity despite clinical findings suggesting BD was only 3.5%. It occurred most frequently with severe brainstem damage. Although in this small percentage of patients, BD diagnosis was notably delayed, in the great majority of cases the use of EEG shortened the BDI. In our series, a BD diagnosis delay >6 h negatively affected consent for organ donation.Significance
The use of EEG can decrease the time interval for brain death diagnosis. 相似文献5.
Introduction and objectivesThis study aims at presenting our experience of the MRI-guided frame-based stereotactic brainstem biopsy method, and evaluating the outcomes of the procedure.Patients and methodsThe current study involved 18 cases that underwent MRI-guided frame-based stereotactic biopsy for brainstem lesions between 2011 and 2018 in our clinic. The relevant data regarding the technique of the biopsy procedure, morbidity, histopathological diagnosis it yields and diagnostic accuracy was retrospectively analyzed.ResultsStereotactic biopsy procedure was performed on 18 patients, including 16 adults and two children. MRI was used as guidance for the biopsy procedure in all patients. The adult patients had the biopsy under local anesthesia; as for the pediatric patients local anesthesia plus sedation was used. All patients received diagnosis based on the histopathological examination of their biopsy samples. No equivocal or negative results, and no major morbidity or mortality was seen in the patients after the procedure.ConclusionsMRI-guided frame-based stereotactic biopsy can be considered as a safe and efficient diagnostic method for brainstem lesions when its diagnostic yield and its morbidity and/or mortality rates are evaluated. Choosing the best trajectory for each lesion, using MRI as guidance for targeting, taking a limited number of biopsy samples are valuable criteria for the decreased morbidity rates in stereotactic brainstem biopsy procedures. 相似文献
6.
Sven Rupprecht Björn Walther Hilmar Gudziol Jörg Steenbeck Martin Freesmeyer Otto W. Witte Albrecht Günther Matthias Schwab 《Sleep medicine》2013,14(11):1064-1070
Background
Rapid eye movement sleep behavior disorder (RBD) is an early feature in α synucleinopathies and may precede other clinical manifestations of disease for several years. Olfactory dysfunction and mild motor abnormalities (MMAs) are highly prevalent in prodromal α synucleinopathies such as RBD and are suspected to be predictive neurodegenerative markers. Because both markers also are highly prevalent in the healthy elderly population, the discriminative value to detect an early neurodegenerative process is unclear.Methods
We examined 28 patients with idiopathic RBD (iRBD) without manifest neurodegenerative disease to determine diagnostic accuracy of MMAs and olfactory dysfunction in identifying patients with early nigrostriatal degeneration in transcranial sonography (TCS) and 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane single-photon emission computed tomography (123I-FP-CIT-SPECT).Results
Sixty-three percent of our participants showed MMAs which were strongly associated with abnormal TCS and 123I-FP-CIT-SPECT findings. The discriminative value in detecting participants with early nigrostriatal degeneration was excellent (area under the receiver operating characteristic [ROC] curve, 0.84 [P ? .003] for TCS and 0.79 [P ? .066] for 123I-FP-CIT-SPECT). Olfactory dysfunction was present in 78% of iRBD participants, but it was not linked with neuroimaging abnormalities or MMAs. Olfactory dysfunction did not discriminate participants with early nigrostriatal degeneration (area under the ROC curve, 0.54 [P ? .747] for TCS and 0.31 [P ? .225] for 123I-FP-CIT-SPECT). Early RBD manifestation but no demographic (e.g., age, gender) or clinical characteristics of RBD (e.g., duration, severity of RBD) were associated with neuroimaging abnormalities in TCS and 123I-FP-CIT-SPECT.Conclusions
Unlike olfactory dysfunction, MMAs discriminate patients with early nigrostriatal degeneration in iRBD. Early RBD manifestation seems to be an additional risk factor which aggravates neurodegenerative risk. 相似文献7.
Duong Anh Vuong Dirk Rades Albertus T.C. van Eck Gerhard A. Horstmann Reinhard Busse 《Clinical neurology and neurosurgery》2013
Objectives
This study aims to identify the cost-effectiveness of two brain metastatic treatment modalities, stereotactic radiosurgery (SRS) versus surgical resection (SR), from the perspective of Germany's Statutory Health Insurance (SHI) System.Methods
Retrospectively reviewing 373 patients with brain metastases (BMs) who underwent SR (n = 113) and SRS (n = 260). Propensity score matching was used to adjust for selection bias (n = 98 each); means of survival time and survival curves were defined by the Kaplan–Meier estimator; and medical costs of follow-up treatment were calculated by the Direct (Lin) method. The bootstrap resampling technique was used to assess the impact of uncertainty.Results
Survival time means of SR and SRS were 13.0, 18.4 months, respectively (P = 0.000). Medians of free brain tumor time were 10.4 months for SR and 13.8 months for SRS (P = 0.003). Number of repeated SRS treatments significantly influenced the survival time of SRS (R2 = 0.249; P = 0.006). SRS had a lower average cost per patient (€9964 – SD: 1047; Skewness: 7273) than SR (€11647 – SD: 1594; Skewness: 0.465), leading to an incremental cost effectiveness ratio of €−3740 per life year saved (LYS), meaning that using SRS costs €1683 less than SR per targeted patient, but increases LYS by 0.45 years.Conclusion
SRS is more cost-effective than SR in the treatment of brain metastasis (BM) from the SHI perspective. When the clinical conditions allow it, early intervention with SRS in new BM cases and frequent SRS repetition in new BM recurrent cases should be advised. 相似文献8.
Background
Although amyotrophic lateral sclerosis (ALS) is a relentlessly progressive disorder, early diagnosis allows a prompt start with the specific drug riluzole and an accurate palliative care planning. ALS at onset may however mimic several disorders, some of them treatable (e.g., multifocal motor neuropathy) or epidemiologically more frequent (e.g., cervical myelopathy).Objective
To study the delay from onset to diagnosis in a cohort of ALS patients and to the variables that may affect it.Methods
We performed a retrospective analysis of the diagnostic delays in a cohort of 260 patients affected by ALS (M/F = 1.32) followed at our tertiary referral ALS Center between 2000 and 2007.Results
The median time from onset to diagnosis was 11 months (range: 6–21) for the whole ALS cohort, 10 months (range: 6–15) in bulbar-onset (n = 65) and 12 months (range: 7–23) in spinal-onset (n = 195) patients (p = 0.3). 31.1% of patients received other diagnoses before ALS and this led to a significant delay of the correct diagnosis in this group (other diagnoses before ALS, n = 81: median delay, 15 months [9.75–24.25] vs ALS, n = 179, median delay, 9 months [6–15.25], p < 0.001).Conclusions
The diagnostic delay in ALS is about one year, besides the growing number of tertiary centres and the spread of information about the disease through media and internet. Cognitive errors based on an incorrect use of heuristics might represent an important contributing factor. Furthermore, the length of the differential diagnosis from other disorders and delays in referral to the neurologist seems to be positively associated with the delay in diagnosis. 相似文献9.
Myung Hun Jung Min Jung Huh Do-Hyung Kang Jung-Seok Choi Wi Hoon Jung Joon Hwan Jang Ji-Young Park Ji Yeon Han Chi-Hoon Choi Jun Soo Kwon 《Progress in neuro-psychopharmacology & biological psychiatry》2009
Objective
Obsessive–compulsive symptoms are induced or aggravated by stress, and the pituitary is a key component of the hypothalamic-pituitary-adrenal axis. We examined pituitary volume in drug-naïve and medicated male patients with obsessive–compulsive disorder (OCD).Methods
Volumetric magnetic resonance imaging studies were conducted on 62 male control subjects, medicated male patients (N = 50) and drug-naïve male patients (N = 12) with OCD.Results
Pituitary volume was significantly smaller in drug-naïve patients with OCD (464.97 ± 55.82 mm3) compared to medicated patients (577.84 ± 129.11 mm3, P = 0.004) and control subjects (543.04 ±113.70 mm3, P = 0.027), and no difference between control subjects and medicated patients (P = 0.174).Conclusion
The results indicate that drug-naïve male patients with OCD exhibit decreased pituitary volume. This finding suggests that dysregulation of the HPA axis in OCD may influence pituitary volume. In addition, the increased pituitary volume in medicated patients may reflect the effect of drugs on the pituitary. 相似文献10.
Luis Patricio Maskin Federico Capparelli Andrea Mora Alejandro Hlavnicka Nora Orellana Maria Fernanda Díaz Néstor Wainsztein Marcelo Del Castillo 《Clinical neurology and neurosurgery》2013
Background
Differential diagnosis between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker.Objective
To evaluate the diagnostic accuracy of CSF lactate as a PNBM marker in patients hospitalized after a neurosurgical procedure.Methods
Between July 2005 and June 2009, a prospective clinical study, in which all patients with clinical suspicion of PNBM were enrolled, was conducted at our neurosurgical Intensive Care Unit. PNBM diagnosis was categorized as proven, probable or negative before the analysis.Results
Seventy-nine patients, 51 males with a mean age of 50 years (range 32–68 years) were included. Surgery was elective in 76% patients, mostly for brain tumors (57%); thirty PNBM episodes were identified. CSF parameters were significantly different in glucose concentration (27 mg% vs. 73 mg%, p < 0.001), lactate (8 mmol/L vs. 2.8 mmol/L, p < 0.001), CSF neutrophil pleocytosis (850 mm–3 vs. 10 mm–3, p < 0.001), and protein levels (449 mg% vs. 98 mg%) between the PNBM and non-PNBM groups. The ROC curve that best fits PNBM diagnosis is lactate.Conclusion
Increased CSF lactate is a useful PNBM marker, with better predictive value than CSF hypoglycorrhachia or pleocytosis. Lactate levels ≥4 mmol/L showed 97% sensitivity and 78% specificity, with a 97% negative predictive value. 相似文献11.
Objective
To determine the value of non-stereotactic brain biopsies in patients with severe neurologic disease of unknown etiology and indeterminate brain imaging.Methods
We reviewed 42 consecutive patients who underwent non-stereotactic brain biopsy at a single institution for evaluation of severe neurologic disease of unknown etiology. All patients had indeterminate or normal imaging results. Seventy-nine percent had been symptomatic for less than a year. Exclusion criteria were immunocompromise or a preoperative diagnosis of intracranial neoplasm. Diagnostic yield and surgical complication rate were calculated. We performed exploratory univariate analysis aimed at identifying clinical features possibly predictive of diagnostic biopsies.Results
A histologic diagnosis was achieved in 12 of 42 biopsies (29%). Three patients experienced minor transient complications from the procedure (7%). There were no permanent deficits or deaths. Treatment was altered based on biopsy result in five patients (12%). A more precise prognosis was obtained in eight patients (19%). In total, 11 different patients (26%) benefited from biopsy. Exploratory univariate analysis showed a possible inverse relationship between age and the likelihood of a diagnostic biopsy (OR = 0.929; 95% CI = 0.864–0.998).Conclusions
Our data suggest that the value of non-stereotactic brain biopsy is sufficiently high and the morbidity sufficiently low to justify its use in carefully selected patients with severe neurologic disease that remains undiagnosed despite thorough less invasive evaluation. 相似文献12.
Enzo Emanuele Marianna BosoNatascia Brondino Stefania PietraFrancesco Barale Stefania Ucelli di NemiPierluigi Politi 《Progress in neuro-psychopharmacology & biological psychiatry》2010
Background
High mobility group box 1 (HMGB1) is a highly conserved, ubiquitous protein that functions as an activator for inducing the immune response and can be released from neurons after glutamate excitotoxicity. The objective of the present study was to measure serum levels of HMGB1 in patients with autistic disorder and to study their relationship with clinical characteristics.Methods
We enrolled 22 adult patients with autistic disorder (mean age: 28.1 ± 7.7 years) and 28 age- and gender-matched healthy controls (mean age: 28.7 ± 8.1 years). Serum levels of HMGB1 were measured by enzyme-linked immunosorbent assay (ELISA).Results
Compared with healthy subjects, serum levels of HMGB1 were significantly higher in patients with autistic disorder (10.8 ± 2.6 ng/mL versus 5.6 ± 2.5 ng/mL, respectively, P < 0.001). After adjustment for potential confounders, serum HMGB1 levels were independently associated with their domain A scores in the Autism Diagnostic Interview-Revised, which reflects their impairments in social interaction.Conclusions
These results suggest that HMGB1 levels may be affected in autistic disorder. Increased HMGB1 may be a biological correlate of the impaired reciprocal social interactions in this neurodevelopmental disorder. 相似文献13.
Zhibo Xia Nu Zhang Huawei Jin Zhenhua Yu Guixing Xu Zhongsong Huang 《Clinical neurology and neurosurgery》2010
Objective
To investigate the expression of astrocyte elevated gene-1 (AEG-1) in human oligodendrogliomas and the association between AEG-1 expression and progression of oligodendrogliomas.Methods
The expression of AEG-1 in normal human oligodendroglial cells, oligodendroglioma cell line, and four pairs of matched oligodendroglioma tissues and their adjacent normal brain tissues was detected by quantitative RT-PCR and western blotting. In addition, AEG-1 protein expression was examined in 75 cases of histologically characterized oligodendrogliomas by immunohistochemistry. Statistical analyses were applied to test for prognostic and diagnostic associations.Results
Western blotting and RT-PCR showed that AEG-1 mRNA and protein were elevated in the oligodendroglioma cell line and significantly upregulated in primary oligodendrogliomas compared with the adjacent non-cancerous brain tissues. Immunohistochemical analysis showed that 51 of 75 (68.0%) paraffin-embedded archival oligodendroglioma samples exhibited high expression of AEG-1. Statistical analysis suggested that upregulation of AEG-1 was significantly correlated with the histological grade of oligodendroglioma (p = 0.000) and that patients with high AEG-1 level exhibited shorter survival time (p = 0.000). Multivariate analysis revealed that AEG-1 upregulation might be an independent prognostic indicator for the survival of patients with oligodendroglioma.Conclusions
AEG-1 might represent a novel, useful diagnostic and prognostic marker for oligodendroglioma and play a role during the development and progression of the disease. 相似文献14.
Caroline Dubertret Claire Bardel Nicolas Ramoz Pierre-Marie Martin Jean-Charles Deybach Jean Adès Philip Gorwood Laurent Gouya 《Progress in neuro-psychopharmacology & biological psychiatry》2010
Background
The gene coding for the D2 dopamine receptor (DRD2) is considered to be one of the most pertinent candidate genes in schizophrenia. However, genetic studies have yielded conflicting results whereas the promising TaqIA variant/rs1800497 has been mapped in a novel gene, ANKK1.Methods
We investigated eleven single nucleotide polymorphisms (SNPs) spanning the DRD2 and ANKK1 genes, using both a case–control association study comparing 144 independent patients to 142 matched healthy subjects, and a transmission disequilibrium test in 108 trios. This classical genetic study was coupled with a cladistic phylogeny-based association test of human variants, and with an interspecies evolution study of ANKK1.Results
Case–control study, followed by a 108 trios family-based association analysis for replication, revealed an association between schizophrenia and the ANKK1 rs1800497 (p = 0.01, Odds Ratio = 1.5, 95% Confidence Interval = 1.1–2.2), and the intergenic rs2242592 (p = 2 · 10− 4, OR = 1.8, 95%CI = 1.3–2.5). A significant SNP–SNP interaction was also found (p < 10− 5, OR = 2.0, 95%CI = 1.6–2.5). The phylogeny-based association test also identified an association between both these polymorphisms and schizophrenia. Finally, interspecies comparison of the sequences from chimpanzee, orangutan, rhesus macaque and human species suggested specific involvement of ANKK1 in the human lineage.Conclusions
Intergenic rs2242592 appears to be involved in the genetic vulnerability to schizophrenia, whereas the ANKK1 rs1800497 appears to have a modifying rather than causative effect. Finally, ANKK1 may be a specific human lineage-trait involved in a specific human disease, schizophrenia. 相似文献15.
C. Shyam babu P. Satishchandra A. Mahadevan V. Pillai Shibu S. Ravishankar N. Sidappa R. Udaykumar V. Ravi S.K. Shankar 《Clinical neurology and neurosurgery》2013
Background
Focal brain lesions (FBL) in HIV/AIDS frequently pose a diagnostic dilemma as the etiology varies from infective (tuberculoma, toxoplasmosis and tuberculous abscesses) to neoplastic lesions like lymphoma. For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities. Stereotactic biopsy (STB) of the lesions is reserved for lesions unresponsive to appropriate therapy.Objective and methods
In this study, the diagnostic yield of neuroimaging [cranial CT (n = 25), MRI (n = 24), and Th201/99Tc SPECT scan (n = 18)] is compared with histopathological diagnosis obtained by STB (n = 21) or autopsy (n = 4) in 25 HIV-1 subtype C seropositive individuals with FBL identified by neuroimaging with special reference to cerebral toxoplasmosis in an eighteen month study period (2006–2007).Results and conclusion
Cerebral toxoplasmosis was the most frequent cause of FBL (21/25, 84%), followed by one case each of tuberculoma, progressive multifocal leukoencephalopathy (PML), primary central nervous system lymphoma (PCNSL) and measles inclusion body encephalitis (MIBE), the last two diagnosed at autopsy. Of the 21 cases of cerebral toxoplasmosis, definitive diagnosis with histopathological confirmation was available in 14/21 (66.6%), with indirect evidence suggesting probable toxoplasmosis in seven, all of whom responded to antitoxoplasma therapy. CT and MRI had comparable specificities (75%), while MRI had marginally higher sensitivity (85% versus 80.9%) in detecting multiple lesions. The positive predictive value of both CT and MRI was identical (94.4%), suggesting that CT maybe a cost effective screening tool in resource restricted settings, for evaluating FBL. Sensitivity of 99Tc SPECT scan for diagnosing inflammatory lesions was 75% but failed to differentiate PCNSL from toxoplasmosis. This study is the first of its kind from India analyzing FBL with specific focus on cerebral toxoplasmosis in the setting of HIV-1 subtype C. 相似文献16.
Rishi V.A. Sheorajpanday Guy Nagels Arie J.T.M. Weeren Didier De Surgeloose Peter P. De Deyn 《Clinical neurophysiology》2010,121(10):1719-1725
Objective
The clinical course of acute stroke can be highly variable and for effective management outcome prediction needs to be refined. We investigated whether EEG parameters are of additional diagnostic and prognostic value in the early phase of acute ischemic anterior circulation stroke.Methods
Ninety-four patients presenting with acute anterior circulation syndrome (ACS) of presumed ischemic origin were incrementally included. Clinical characteristics were correlated with volume of ischemia and EEG parameters. Predictive values for definite stroke, early neurological deterioration, spontaneous early neurological improvement and death within 1 week after ACS were calculated using ROC curves and logistic regression modelling.Results
In patients with normal or near normal NIHSS score of 0 or 1, the pairwise derived brain symmetry index (pdBSI) was an independent predictor for definite stroke displaying an overall accuracy of 80%. Early neurological deterioration was independently predicted by pdBSI with a correct classification rate of 95%. In ROC analysis, death was predicted by pdBSI with overall accuracy of 97%. Spontaneous neurological improvement was independently predicted by the delta + theta/alpha + beta – ratio with overall accuracy of 75%. Small-vessel stroke was independently predicted by pdBSI with a correct classification rate of 92%.Conclusions
EEG may be of prognostic value for spontaneous neurological improvement, early neurological deterioration and death in the acute setting of acute anterior circulation syndrome of presumed ischemic origin.Significance
These findings may have an impact on stroke care. 相似文献17.
Makoto Uchino Satoshi Yamashita Katsuhisa Uchino Akira Mori Akio Hara Tomohiro Suga Tomoo Hirahara Tatsuya Koide En Kimura Taro Yamashita Akihiko Ueda Ryoichi Kurisaki Junko Suzuki Shoji Honda Yasushi Maeda Teruyuki Hirano Yukio Ando 《Clinical neurology and neurosurgery》2013
Objective
The characteristic pathological muscular findings of polymyositis (PM) and dermatomyositis (DM) have been shown to reflect their different pathogeneses. Here, we characterized the muscle biopsy findings of PM and DM patients with or without malignancy.Methods
We evaluated the muscle biopsy findings of 215 consecutive PM and DM patients admitted to our hospital between 1970 and 2009. Pathology of the lesion biopsy sections was classified into 3 types: endomysial infiltration-type, perivascular infiltration-type, and rare-infiltrative-type.Results
There was no difference between the muscle pathology of PM patients with and without malignancy. However, the incidence of rare-infiltrative type muscle pathology in DM patients with malignancy was significantly higher than in those without such tumors (p = 0.0345).Conclusion
The incidence of rare-infiltrative type muscle pathology may be a predictive marker of DM with malignancy. 相似文献18.
Pia Zeinoun Souha Bawab Mia Atwi Nayla Hariz Lucy Tavitian Mounir Khani Ziad Nahas Fadi T. Maalouf 《Comprehensive psychiatry》2013
Background
Countries in the Arab region lack a valid Arabic psychiatric diagnostic interview for children and adolescents. We set out to establish the diagnostic validity of the Arabic version of the Development and Well Being Assessment (DAWBA-Arabic), a multi-informant structured interview for predicting DSM-IV-TR diagnoses.Methods
The DAWBA was translated, updated, and administered to 45 participants (child and adolescent psychiatric outpatients and their parents) as part of a clinic registry. Two clinicians, blinded to their respective diagnoses, formulated the DAWBA diagnoses. Participants also underwent a clinical evaluation by a child and adolescent psychiatrist who generated clinical diagnoses according to the DSM-IV-TR.Results
Inter-rater reliabilities were .93, .82, and .72 for disruptive disorders, mood disorders and anxiety disorders respectively. Agreement between DAWBA and clinical diagnoses was substantial for disruptive disorders (κ = .0.82) and mood disorders (κ = 0.74), and moderate for anxiety disorders (κ = 0.46).Conclusion
The DAWBA-Arabic could serve as a valid and reliable clinical tool for assessing psychiatric disorders among children and adolescents in the Arab region. 相似文献19.
George A. Alexiou Spyridon Tsiouris George Vartholomatos George Fotakopoulos Athanasios Papadopoulos Athanasios P. Kyritsis Spyridon Voulgaris Andreas D. Fotopoulos 《Clinical neurology and neurosurgery》2009
Objectives
Brain single-photon emission computed tomography (SPECT) has been proposed as a potentially useful modality for the metabolic assessment of various brain tumors.Material and methods
In a 10-patient prospective pilot study we evaluated whether 99mTc-Tetrofosmin (99mTc-TF) uptake correlates with glioma proliferative activity assessed by flow cytometric analysis. 99mTc-TF brain SPECT was performed shortly before surgical tumor excision.Results
Eight patients were diagnosed with glioblastoma multiform and 2 with anaplastic astrocytoma. All tumors were aneuploid. We found a significant positive linear correlation between 99mTc-TF uptake and percentage of tumor cells on the S-phase of the cell cycle (r = 0.92, P = 0.001).Conclusion
Initial evidence suggests that 99mTc-TF could provide a non-invasive indicator of glioma proliferative activity. 相似文献20.
Najiba Fekih-Mrissa Sarra Klai Jamel Zaouali Nasreddine Gritli Ridha Mrissa 《Clinical neurology and neurosurgery》2013