SARS-CoV2 evokes structural brain changes resulting in declined executive function.

BACKGROUND: Several research has underlined the multi-system character of COVID-19. Though effects on the Central Nervous System are mainly discussed as disease-specific affections due to the virus' neurotropism, no comprehensive disease model of COVID-19 exists on a neurofunctional base by now. We aimed to investigate neuroplastic grey- and white matter changes related to COVID-19 and to link these changes to neurocognitive testings leading towards a multi-dimensional disease model. METHODS: Groups of acutely ill COVID-19 patients (n = 16), recovered COVID-19 patients (n = 21) and healthy controls (n = 13) were prospectively included into this study. MR-imaging included T1-weighted sequences for analysis of grey matter using voxel-based morphometry and diffusion-weighted sequences to investigate white matter tracts using probabilistic tractography. Comprehensive neurocognitive testing for verbal and non-verbal domains was performed. RESULTS: Alterations strongly focused on grey matter of the frontal-basal ganglia-thalamus network and temporal areas, as well as fiber tracts connecting these areas. In acute COVID-19 patients, a decline of grey matter volume was found with an accompanying diminution of white matter tracts. A decline in executive function and especially verbal fluency was found in acute patients, partially persisting in recovered. CONCLUSION: Changes in gray matter volume and white matter tracts included mainly areas involved in networks of executive control and language. Deeper understanding of these alterations is necessary especially with respect to long-term impairments, often referred to as 'Post-COVID'.

Symptom burden and surgical outcome in non-skull base meningiomas.

Purpose: Non-skull base meningiomas (NSBM) are a distinct entity and frequently present with focal neurological deficits. This study was designed to analyze functional and oncological outcome following microsurgical tumor resection in patients with NSBM. Patients and methods: An analysis of 300 patients that underwent NSBM resection between 2003 and 2013 was performed. Assessment measures for functional outcome were Karnofsky Performance Scale (KPS), Medical Research Council - Neurological Performance Scale (MRC-NPS), and improvement rates of focal deficits and seizures. The extent of resection; recurrence-free survival (RFS) and tumor-specific survival (TSS) were also determined. Results: Impaired KPS and MRC-NPS were present in 73.3% and 45.7%, respectively. Focal neurological deficits were recorded in 123 patients (41.0%), with hemiparesis (21.7%) and aphasia (9.3%) the most prevalent form of impairment. Most meningiomas were localized at the convexity (64.0%), followed by falcine tumors (20.3%). Both KPI and MRC-NPS scores were significantly improved by surgical resection. Postoperative improvement rates of 96.6%, 89.3%, 72.3%, 57.9%, and 27.3% were observed for aphasia, epilepsy, hemiparesis, cranial nerve, and visual field deficits, respectively. Long-term improvement was achieved in 83.2%, 89.3%, 80.0%, 68.4% and 54.6% of patients, respectively. Gross total resection (GTR) over subtotal resection (STR) significantly improved preoperative seizures and visual field deficits and correlated with reduced risk of new postoperative hemiparesis. Poor Simpson grade was the only significant prognostic factor in multivariate analysis for long-term functional deficit, which occurred in 7.3%. Median RFS was 45.9 months (6.0 - 151.5 months), while median TSS was 53.7 months (3.1 - 153.2 months). Both WHO grade (p= 0.001) and Simpson classification (p= 0.014 and p= 0.031) were independent significant prognostic factors for decreased RFS and TSS by multivariate analysis, respectively. Furthermore, tumor diameter > 50 mm (p= 0.039) significantly correlated with decreased TSS in multivariate analysis. Conclusion: Surgical resection significantly and stably improves neurological deficits in patients with NSBM.

[Injuries and influencing factors on accidents in paragliding]. / Verletzungen und das Unfallgeschehen beeinflussende Faktoren im Paragleitsport.

Approximately 100 000 pilots worldwide practice the sport of paragliding. Most studies performed to date have been conducted retrospectively, using data from hospitals or emergency rescue organisations and focusing on injury patterns. Reasons for accidents and possible influencing factors have hardly been investigated. Therefore, the aim of this study was to analyse paragliding accidents in the Alps and to identify possible influencing factors. The data were taken from the "Flash-News" magazine (issues no. 149-160) covering the years 2015 to 2017. Only accidents occurring in Austria, Germany, Switzerland and Italy were considered. All in all, 487 accidents met the inclusion criteria of using a conventional paraglider and were analysed in this study. 88.5 % of the pilots involved were male and the average age was 42.9 ±â€Š13.7 years. Most accidents happened in summer and during the afternoon hours. The majority of incidents happened during the flight phase, but the comparison of tandem and solo pilots showed that tandem pilots had significantly more accidents during the take-off phase, whereas solo pilots had more accidents during the landing phase. Mistakes by pilots were identified as the main reason for accidents, followed by accidents caused by wind. In 71 of 487 (14,6 %) accidents, the pilots were not injured. If they were injured during the accident, the lower limbs were injured most frequently (35.5 %). In 45 of 487 accidents, the pilots died during the accident (9,2 %). The fact that more flights were executed during the summer months, combined with the more demanding flight conditions in summer (wind, weather, thermal conditions) may have led to the increased number of incidents in the period from April to August. Mistakes by pilots were identified as the major causes of accidents; therefore, training to handle difficult situations and the equipment are suggested. In general, the documentation of paragliding accidents is insufficient and inconsistent. The implementation of a harmonised, transnational form to document paragliding accidents is recommended to get unified and comparable data.