How do the clinical features of brain tumours in childhood progress before diagnosis?

Objectives

To investigate the progression of the clinical features from symptom onset to diagnosis in children with brain tumours. Design: Retrospective case note review. Patients: Sixty children with brain tumours: 27 patients from Nagoya University Hospital diagnosed between February 2004 and April 2008, and 33 patients from Anjo Kosei Hospital diagnosed between April 1995 and December 2008. Results: Various symptoms and signs were observed. The most common initial symptoms or signs were vomiting (24.1%), headache (17.2%), unsteadiness (10.3%), and paresis (10.3%). Sixteen patients were diagnosed based on the initial symptom or sign alone; six, at routine medical check-ups or had perinatal diagnosis; and the remaining 38, based on one or more additional features following the initial symptom. Nine of the 10 patients with headache as the initial symptom subsequently developed either vomiting (in seven) or unsteadiness with cranial nerve palsies (in two). Twelve of the 14 patients with vomiting as the initial symptom subsequently developed headache (in three), unsteadiness (in five), or other manifestations of increased intracranial pressure (in four). The remaining 14 had varied initial symptoms and combinations of symptoms and signs associated with the tumour location. The median pre-diagnosis symptomatic interval was 20.5 days. There was no significant difference in the median symptomatic interval between patients with headache or vomiting as the initial symptom and those with any neurological sign. Conclusion: Paediatric brain tumours present with various initial symptoms and signs. Many are diagnosed as additional symptoms or signs develop. The clinical features exhibit several patterns of progression, which are related to the tumour location.     

Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK)

Background

Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study.

Methods

Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99); N?=?13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45).

Results

Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r?=?0.016, p?=?0.032).

Conclusions

The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.     

Pain after whiplash: a prospective controlled inception cohort study

OBJECTIVES: In Lithuania, there is little awareness of the notion that chronic symptoms may result from rear end collisions via the so-called whiplash injury. After most such collisions no contact with the health service is established. An opportunity therefore exists to study post-traumatic pain without the confounding factors present in western societies. METHODS: In a prospective, controlled inception cohort study, 210 victims of a rear end collision were consecutively identified from the daily records of the Kaunas traffic police. Neck pain and headache were evaluated by mailed questionnaires shortly after the accident, after 2 months, and after 1 year. As controls, 210 sex and age matched subjects were randomly taken from the population register of the same geographical area and evaluated for the same symptoms immediately after their identification and after 1 year. RESULTS: Initial pain was reported by 47% of accident victims; 10% had neck pain alone, 18% had neck pain together with headache, and 19% had headache alone. The median duration of the initial neck pain was 3 days and maximal duration 17 days. The median duration of headache was 4.5 hours and the maximum duration was 20 days. After 1 year, there were no significant differences between the accident victims and the control group concerning frequency and intensity of these symptoms. CONCLUSIONS: In a country were there is no preconceived notion of chronic pain arising from rear end collisions, and thus no fear of long term disability, and usually no involvement of the therapeutic community, insurance companies, or litigation, symptoms after an acute whiplash injury are self limiting, brief, and do not seem to evolve to the so-called late whiplash syndrome.     

EEG in whiplash: a reappraisal

Sixty-eight patients with symptomatic cervical whiplash injuries, who did not receive head trauma, had standard electroencephalograms performed with a time span of 1 day to 2 years after the occurrence of the accident. Minimal EEG abnormalities were found in a small number of patients. Plain x-rays, computerized tomography or radionuclide brain scans failed to demonstrate associated structural abnormalities. Twenty-five of the group had 24-hour EEG cassette recordings; 15 of the latter reported specific symptoms of their post-traumatic syndrome during the test but no abnormal EEG correlates were established. Sixteen patients had long-term follow-up studies and no example was encountered of early or late onset post-traumatic epilepsy. These findings contradict previous reports of the greater incidence and severity of EEG abnormalities in patients that have sustained whiplash neck injuries in isolation (no head trauma).     

Clinical assessment of prognostic factors for long‐term pain and handicap after whiplash injury: a 1‐year prospective study

Background and purpose: Physical mechanisms are the possible factors involved in the development and maintenance of long‐term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra‐cervical pains, as well as non‐painful complaints after a whiplash injury as predictors for subsequent handicap. Methods: Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high‐ or a low‐risk group by an algorithm based on pain intensity, number of non‐painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high‐risk patients and 230 low‐risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high‐risk patients (n = 458) and 41 consecutive low‐risk patients at median 11, 109, 380 days after injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability. Results: The relative risk for a 1‐year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced CROM and by four times with multiple non‐painful complaints. Conclusion: Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non‐painful complaints are the important prognostic factors for a 1‐year handicap after acute whiplash.     

Disturbed Eye Movements after Whiplash Due to Injuries to the Posture Control System

Abstract

Self-reports after whiplash often indicate associations with vertigo and reading problems. Neuropsychological and otoneurological tests were applied to a group of whiplash patients (n =26) and to a carefully matched control group. The whiplash group deviated from the control group on measures of eye movements during reading, on smooth pursuit eye movements with the head in normal position, and with the body turned to the left or to the right. Clinical, caloric, and neurophysiological tests showed no injury to the vestibular system or to the CNS. Test results suggest that injuries to the neck due to whiplash can cause distortion of the posture control system as a result of disorganized neck proprioceptive activity.     

Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea

Background and PurposeTo investigate the incidence and characteristics of neurological manifestations associated with coronavirus disease 2019 (COVID-19).MethodsWe reviewed the medical records of the consecutive patients with COVID-19 who were admitted to the central infectious diseases hospital designated for the treatment of COVID-19 in South Korea between March 2020 and September 2020. Newly developed neurological manifestations associated with COVID-19 were investigated. The frequency and clinical features of the neurological manifestations were analyzed according to disease severity, which was classified according to World Health Organization interim guidance.ResultsOf the 306 symptomatic patients, 186 (60.8%) developed at least one neurological manifestation during hospitalization. The most common neurological symptom was headache (n=102, 33.3%), followed by myalgia (n=96, 31.4%) and anosmia/ageusia (n=54, 17.6%). Acute stroke (all ischemic stroke) occurred in three (1.0%) patients, and new-onset seizures occurred in two (0.7%). Neurological manifestation was a presenting symptom of COVID-19 in 72 (23.5%) patients, and was the only symptom of COVID-19 in 12 (3.9%). Stroke, seizure, and impaired consciousness were significantly associated with severe to critical COVID-19, whereas headache and anosmia/ageusia were frequently found in patients with mild to moderate disease.ConclusionsNeurological manifestations were commonly observed in patients with COVID-19. During the current pandemic, when patients present with new-onset neurological symptoms, COVID-19 may be considered as part of the differential diagnosis. Attention to severe neurological complications is needed, especially in patients with severe or critical COVID-19.     

Percutaneous transluminal angioplasty and stenting of post-irradiation stenosis of the vertebral artery

BackgroundThe outcomes of percutaneous transluminal angioplasty and stenting (PTAS) in patients with medically refractory post-irradiation stenosis of the vertebral artery (PISVA) have not been clarified.AimThis retrospective study evaluated the safety and outcomes of PTAS in patients with severe PISVA compared with their radiation-naïve counterparts (non-RT group).MethodsPatients with medically refractory severe symptomatic vertebral artery stenosis and undergoing PTAS between 2000 and 2021 were classified as the PISVA group or the non-RT group. The periprocedural neurological complications, periprocedural brain magnetic resonance imaging, the extent of symptom relief, and long-term stent patency were compared.ResultsAs compared with the non-RT group (22 cases, 24 lesions), the PISVA group (10 cases, 10 lesions) was younger (62.0 ± 8.6 vs 72.4 ± 9.7 years, P = 0.006) and less frequently had hypertension (40.0% vs 86.4%, P = 0.013) and diabetes mellitus (10.0% vs 54.6%, P = 0.024). Periprocedural embolic infarction was not significantly different between the non-RT group and the PISVA group (37.5% vs 35.7%, P = 1.000). At a mean follow-up of 72.1 ± 58.7 (3–244) months, there was no significant between-group differences in the symptom recurrence rate (0.00% vs 4.55%, P = 1.000) and in-stent restenosis rate (10.0% vs 12.5%, P = 1.000).ConclusionPTAS of severe medically refractory PISVA is effective in the management of vertebrobasilar ischemic symptoms in head and neck cancer patients. Technical safety and outcome of the procedure were like those features in radiation-naïve patients.     

Prospective follow-up of neuropsychological deficits after cervicocephalic acceleration trauma]

30 patients with acute cervico-cephalic syndrome following whiplash injury (neck and head pain, vegetative symptoms and subjective complaints of impaired mental functions) without neurological deficits were investigated in a prospective follow-up of 3 months with neuropsychological examination in the acute phase (x = 5.7 days) and again 6 and 12 weeks after the accident. Attention, concentration, cognition and verbal and visual memory functions were quantified by neuropsychological tests, and changes over the observation period were analysed. In the acute phase all neuropsychological functions were below the individual's normal level. Deficits in attention and concentration recovered within the first 6 weeks. Further recovery within the following 6 weeks were observed in visual memory, imagination and analytic capacity. The capability of verbal memory and abstraction, cognitive selectivity and information processing speed was impaired for a longer time and first recovered after 12 weeks. In conclusion, intraindividual neuropsychological deficits following whiplash injury can be quantified and monitored to show the time course of recovery. Thus in clinical and forensic practice the diagnosis of a pseudoneurasthenic or even "neurotic" syndrome in acute whiplash injury should be made with caution.     

Common disorders in the neurological emergency room – experience at a tertiary care hospital

Background: The profile of patients with neurological diseases referred to specialized emergency rooms (ER) has not been reported and it is unknown whether a setting of decentralized ERs is associated with a high number of referrals because of inappropriate admissions. Methods: In this prospective study, consecutive patients of a specialized neurological ER were enrolled. Data encompassed time from symptom onset to admission, discharge diagnoses, data on hospitalization and on transfers to and from other ERs. Results: Thousand seven hundred and forty‐three patients were enrolled. Most common diagnoses were cerebrovascular events (26.5%), headache disorders (13%) and seizures (12.7%). Time since onset of symptoms depended on who referred the patient (P < 0.001); seizure patients presented earlier than other patients (P < 0.001) and 30.5% of patients with cerebrovascular events presented within 3 h after symptom onset but did not present sooner than patients with other diagnoses. In 18%, diagnoses did not match neurological disorders, 4.5% of patients suffered from cardiovascular events. Referrals to and from other ERs rarely occurred (10.3% vs. 5.9%). Only 20 patients with acute cerebrovascular events were referred via other ERs (1.1%). Conclusion: A system of a specialized neurological ER can quickly clear up uncertainties in interpreting neurological symptoms. Owing to the rising number of neurological patients in ERs, more studies are urgently needed comparing the different organizational forms for emergency services.     

When and how to investigate the patient with headache

The very common symptom of headache most often has a benign cause and can usually be diagnosed following a thorough history and neurologic and focused general physical examinations. Because the potential etiologies can threaten life and neurological function, headaches provoke understandable concern on the part of the patient and health care provider. Thoughtful testing can exclude the worrisome underlying causes. This article reviews the neurological and general symptoms and signs that should prompt diagnostic testing and the specific diagnostic studies that are recommended. The worrisome factors include recent head or neck injury; a new, worse, worsening, or abrupt-onset headache; headache brought on by exertion or Valsalva maneuver/cough; new headache in the patient over the age of 50; neurological symptoms and/or abnormal signs; systemic symptoms and/or signs; and secondary risk factors such as a history of cancer or human immunodeficiency virus infection. Less worrisome are headaches that wake the patient from sleep at night, side-locked headaches, and prominent effect of change in posture on the pain. The diagnostic investigations include neuroimaging, cerebrospinal fluid examination, and blood testing in specific situations.     

The clinical utility of MRI in patients with neurodevelopmental disorders of unknown origin

Introduction: Neuroimaging of the brain in the diagnostic work‐up of patients with neurodevelopmental disorders is a matter of continuing debate. Recommendations range from performing brain imaging in all patients with neurodevelopmental disorders to performing an MRI only in those with indication on clinical examinations. Important indications for neuroimaging are head size abnormalities and focal neurological findings. Methods: Patients with neurodevelopmental disorders of unknown origin (n = 410), referred to a specialized tertiary diagnostic center for neurodevelopmental disorders were included in a retrospective analysis. A 1‐day work‐up, including an MRI of the brain was performed. Studied were the: (i) yield of MRI scans of the brain and (ii ) associations of specific clinical symptoms/signs with abnormal and diagnostic MRI scans. Results: (i) In 30.7% of the 410 patients with neurodevelopmental disorders (n = 126), abnormal MRI scans were observed, leading to an etiological diagnosis in 5.4% of the patients (n = 22). (ii) Pyramidal disorders (P = 0.001), epilepsy (P = 0.04) and an abnormal head circumference (P = 0.02) were associated with an abnormal MRI scan. The presence of one of the following neurological symptoms/signs: movement disorders, pyramidal disorders, epilepsy, or an abnormal head circumference was associated with a diagnostic MRI scan (P < 0.001) (diagnostic MRI % in neurological versus no neurological symptoms/signs, 13.0% versus 1.9%). Conclusion: Neuroimaging of the brain in a tertiary care center for patients with neurodevelopmental disorders of unknown origin is useful, especially in case of neurological symptoms/signs.     

Social class of origin and cardinal symptoms of schizophrenic disorders over the early illness course

  Background: This study describes the relationship of social class of origin to cardinal symptoms of schizophrenic disorders over the early illness course. Method: The sample of subjects was drawn from the Suffolk County Mental Health Project, a longitudinal epidemiologic study of first-hospitalized subjects with psychotic disorders; the present study focused on patients with schizophrenic disorders. At baseline, subjects were dichotomized into upper/middle and lower social class of origin groups, based on occupation of the head of the household of origin. The patients in both groups were assessed for the major symptoms of schizophrenic disorders using standard structured instruments at both baseline and 6-month follow-up. The 6-month symptom severity levels were compared between the groups, controlling for baseline symptom status and potential confounders. Results: At 6-month follow-up, the upper/middle social class of origin group, as compared to the lower social class of origin group, had lower symptom levels for hallucinations (adjusted OR = 4.88, χ² = 8.49, P = 0.004) and delusions (adjusted OR = 2.46, χ² = 4.16, P = 0.04). There were no notable group differences for any of the negative or thought disorganization symptoms. Conclusions: Social class of origin is associated with positive symptoms of schizophrenia over the early illness course. Accepted: 10 November 1999     

Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases

Objective  Symptom recurrence remains a problem for some patients after surgical decompression for Chiari I malformation. We set out to identify variables at presentation that could identify subgroups most likely to experience incomplete symptom relief after hindbrain decompression for Chiari I malformation. Materials and methods  We retrospectively reviewed the records of all pediatric patients undergoing first-time suboccipital decompression for Chiari I malformation over a 10-year period. Measured outcomes included (1) persistence or recurrence of symptoms regardless of severity and (2) need for revision decompression. Results  Two hundred fifty-six children (10 5years old) underwent surgery for Chiari I malformation and were followed up for a mean of 27months. Presenting symptoms included headache in 192 (75%) patients and brainstem or cranial nerve symptoms in 68 (27%) patients. Fifty-seven (22%) patients experienced mild to moderate symptom recurrence. Nineteen (7%) patients required revision decompression for significant symptom recurrence. Headache was 70% more likely to persist or recur versus cranial nerve or brainstem symptoms (relative risk 1.70, p < 0.05). Vertigo and frontal headache independently increased the odds of symptom recurrence 2.9- and 1.5-fold, respectively. Each increasing year of preoperative headache duration was independently associated with 15% increase in likelihood of symptom persistence (p < 0.05). Severe tonsilar ectopia (caudal to C2 lamina) was twice as likely to require revision decompression (14% versus 6%). Conclusion  In our experience, recurrence of mild symptomatology not severe enough to justify revision surgery may occur in nearly a fifth of patients after surgery. Headache was more likely to recur than objective cranial nerve or brainstem symptoms. Increasing duration of headaches, frontal headaches, and vertigo may be more refractory symptoms of Chiari I malformation.     

fMRI response during visual motion stimulation in patients with late whiplash syndrome

After whiplash trauma, up to one fourth of patients develop chronic symptoms including head and neck pain and cognitive disturbances. Resting perfusion single-photon-emission computed tomography (SPECT) found decreased temporoparietooccipital tracer uptake among these long-term symptomatic patients with late whiplash syndrome. As MT/MST (V5/V5a) are located in that area, this study addressed the question whether these patients show impairments in visual motion perception. We examined five symptomatic patients with late whiplash syndrome, five asymptomatic patients after whiplash trauma, and a control group of seven volunteers without the history of trauma. Tests for visual motion perception and functional magnetic resonance imaging (fMRI) measurements during visual motion stimulation were performed. Symptomatic patients showed a significant reduction in their ability to perceive coherent visual motion compared with controls, whereas the asymptomatic patients did not show this effect. fMRI activation was similar during random dot motion in all three groups, but was significantly decreased during coherent dot motion in the symptomatic patients compared with the other two groups. Reduced psychophysical motion performance and reduced fMRI responses in symptomatic patients with late whiplash syndrome both point to a functional impairment in cortical areas sensitive to coherent motion. Larger studies are needed to confirm these clinical and functional imaging results to provide a possible additional diagnostic criterion for the evaluation of patients with late whiplash syndrome.     

Duration of attenuated positive and negative symptoms in individuals at clinical high risk: Associations with risk of conversion to psychosis and functional outcome

Research in individuals at clinical high-risk (CHR) for psychosis has focused on subjects with no more than 12 months of present or worsened attenuated positive symptoms. However, the impact of long duration attenuated positive and/or negative prodromal symptoms on outcomes is unclear. Seventy-six CHR subjects with attenuated positive symptoms and at least moderate severity level negative symptoms rated on the Scale of Prodromal Symptoms (SOPS) were prospectively followed for a mean of 3.0 ± 1.6 years. Social and Role functioning was assessed with the Global Functioning: Social and Role scales. Correlations between attenuated positive and negative symptom duration and severity and conversion to psychosis and functional outcomes were analyzed. The average onset of SOPS rated negative symptoms (M = 53.24 months, SD = 48.90, median = 37.27) was approximately twelve months prior to the emergence of attenuated positive symptom (M = 40.15 months, SD = 40.33, median = 24.77, P < 0.05). More severe positive symptoms (P = 0.004), but not longer duration of positive (P = 0.412) or negative (P = 0.754) symptoms, predicted conversion to psychosis. Neither positive symptom duration (P = 0.181) nor severity (P = 0.469) predicted role or social functioning at study endpoint. Conversely, longer negative symptom duration predicted poor social functioning (P = 0.004). Overall, our findings suggest that the severity of attenuated positive symptoms at baseline may be more important than symptom duration for determining individuals at increased risk of developing psychosis. In contrast, long-standing negative symptoms may be associated with persistent social difficulties and therefore have an important position in the treatment of disability.     

Neurological abnormalities in localized scleroderma of the face and head: a case series study for evaluation of imaging findings and clinical course

Introduction: Localized scleroderma (LoS) of the face and head is often associated with neurological manifestations and/or imaging abnormalities in the central nervous system (CNS). Case series: We present an analysis of 20 cases of LoS affecting the face and head. The CNS symptoms and/or abnormalities in high-resolution computed tomography (HRCT) and/or magnetic resonance imaging (MRI) were observed in 12 patients (60%). In addition to the mild and unspecific disorders (e.g. headaches), serious neurological complications probably in the course of vasculitis were revealed: epilepsy (in two patients), epilepsy and pyramidal sings (in one patient). Neurological disorders and LoS occurred at the same time (in three patients) or at the course of the disease (nine patients) and no later than 29 years since the onset of the disease. No link between neurological disorders and the LoS clinical morphology, immunological and other laboratory parameters has been established. Conclusions: CNS involvement is not correlated with the clinical course of the facial and head LoS and may occur years after the disease initial symptomatology. Imaging follow-up is not required if there is not any emerging neurological symptom. In some cases, however, both HRCT and MRI are useful for monitoring disease evolution and addressing therapeutic choices.     

以眩晕为首发症状脑梗死19例临床分析

目的探讨以眩晕为首发症状脑梗死的临床及影像学特点。方法收集2011年1月至2012年10月我院神经内科收治的以眩晕为首发症状脑梗死的临床资料,与同时期无眩晕症状脑梗死对照,前者称眩晕组,后者为对照组,比较两组人口统计学、血管危险因素、临床和影像学特征。结果眩晕组脑梗死患者年龄、性别、血管危险因素与无眩晕组脑梗死差异无统计学意义(P>0.05)。眩晕组脑梗死部位多位于后循环,常伴随多种神经受损的症状和体征(P<0.05)。结论以眩晕颅首发症状的脑梗死多为后循环脑梗死,常伴随多种神经受损的症状和体征,单纯眩晕患者应早期完善头颅MRI或DSA检查。     

Course of attention and memory after common whiplash: a two-years prospective study with age, education and gender pair-matched patients

Attentional functioning and memory of common whiplash patients were evaluated during the first two years after experiencing injury. The study was based on a non-selected sample of 117 whiplash patients referred from primary care and recruited according to a strict injury definition. All patients had a similar socioeconomic background, all being injured in automobile accidents and fully covered by insurance plans. Two years following initial trauma, 21 patients remained symptomatic. For each of these 21 patients, a counterpart matched by age, educational attainment and gender was selected from the group of patients who had fully recovered during the follow-up period. Symptomatic patients and matched controls were compared with regard to baseline, six-months and two-years findings. Examinations included testing of different aspects of attention (i.e. Digit Span, Corsi Block-Tapping Test, Trail Making Test, Number Connection Test, Paced Auditory Serial Addition Task) and memory functioning (California Verbal Learning Test). Cognitive functioning was assessed in conjunction with self-ratings of cognitive abilities (Cognitive Failures Questionnaire), well-being (Well-being Scale), headache and neckpain intensity, utilized medication and subjective complaints. Results show no impairment of memory in symptomatic patients. In attentional functioning, different levels of improvement were found for symptomatic patients and matched counterparts, with the former showing difficulty at follow-up with tasks of divided attention. Utilized medication and pain intensity could not explain this difference in recovery of attentional functioning between the groups. These findings suggest problems in selective aspects of attentional functioning after common whiplash, which under real life circumstances may explain these patients' cognitive complaints and cause adaptational problems in daily life.     

Symptom resolution in infiltrating WHO grade II-IV glioma patients undergoing surgical resection

Past studies of morbidity in patients with infiltrating gliomas have focused on the impact of surgery on quality of life. Surprisingly, little attention has been given to the rate at which the presenting symptoms improve after surgery, even though this is often the patient’s first concern. This study is an initial effort to provide useful information about symptom resolution and factors predicting persistence of symptoms in glioma patients who undergo surgery. We conducted a retrospective analysis on patients who underwent surgery for World Health Organization (WHO) grade II-IV astrocytoma/oligodendroglioma/oligoastrocytoma at our institution. All patients were seen 2–4 months postoperatively, and asked about the persistence of symptoms they experienced preoperatively. Symptoms reported in clinic were assessed against symptoms reported prior to surgery. Our study includes 56 consecutive patients undergoing surgery for gliomas. Of patients who experienced symptoms initially, headache resolved in 18/27 postoperatively, weakness resolved in 8/14 postoperatively, altered mental status resolved in 8/12 postoperatively, vision problems resolved in 7/11 postoperatively, nausea resolved in 5/7 postoperatively, and ataxia resolved in 4/5 postoperatively. Headache was more likely to resolve in patients with frontal or temporal tumors (p = 0.02). Preoperative Karnofsky Performance Scale (KPS) of 70 or less was associated with longer postsurgical hospital stay (p < 0.01). Younger patients were more likely to experience a resolution of altered mental status (p = 0.04). Our analysis provides data regarding the rate at which surgery alleviates patient symptoms and considers variables predicting likelihood of symptom resolution. Some patients will experience symptom resolution following resection of WHO grade II-IV gliomas in the months following surgery.