Experience of a neurology service during the 2016 Olympic and Paralympic Games.

BACKGROUND: We analyzed the utilization of acute neurologic care during the 2016 Olympic and Paralympic Games in Rio de Janeiro. METHODS: We conducted a retrospective analysis of data collected during the games. RESULTS: Sixty-three neurologic evaluations were performed in patients from the Olympic Family (OF), 22 of these involving athletes from 19 countries. Traumatic brain injuries (TBIs) were the most frequent reason for assessment among athletes, some associated with polytrauma. Four patients were admitted to the neurocritical care unit (NICU): 2 acute ischemic strokes, 1 TIA, and 1 polytrauma with moderate TBI. Among nonathletes, evaluation of TBI associated with motor vehicle accidents was surprisingly high, with 10 assessments, none requiring admission. Also, nonathletes with seizures, multiple sclerosis flare, functional deficits, and psychiatric complaints received neurologic evaluation. During the Paralympic Games, 17 neurologic evaluations were performed in patients from the Paralympic Family (PF), 13 involving athletes from 10 countries. Five athletes presented with mild TBI. One PG training coach was admitted to the NICU after receiving alteplase for an acute ischemic stroke. CONCLUSIONS: As expected, many athletes with sports-related injuries were evaluated, but cases of diverse acute neurologic pathologies were observed among nonathlete members of the OF and PF. Olympic Games are large, logistically complex events involving thousands of people. Our observations suggest that a comprehensive and detailed plan for neurologic emergencies should be considered for future games.

Guillain-Barré syndrome and Zika virus outbreaks.

PURPOSE OF REVIEW: Arboviruses have been associated with central and peripheral nervous system injuries, in special the flaviviruses. Guillain-Barré syndrome (GBS), transverse myelitis, meningoencephalitis, ophthalmological manifestations, and other neurological complications have been recently associated to Zika virus (ZIKV) infection. In this review, we aim to analyze the epidemiological aspects, possible pathophysiology, and what we have learned about the clinical and laboratory findings, as well as treatment of patients with ZIKV-associated neurological complications. RECENT FINDINGS: In the last decades, case series have suggested a possible link between flaviviruses and development of GBS. Recently, large outbreaks of ZIKV infection in Asia and the Americas have led to an increased incidence of GBS in these territories. Rapidly, several case reports and case series have reported an increase of all clinical forms and electrophysiological patterns of GBS, also including cases with associated central nervous system involvement. Finally, cases suggestive of acute transient polyneuritis, as well as acute and progressive postinfectious neuropathies associated to ZIKV infection have been reported, questioning the usually implicated mechanisms of neuronal injury. SUMMARY: The recent ZIKV outbreaks have triggered the occurrence of a myriad of neurological manifestations likely associated to this arbovirosis, in special GBS and its variants.

Effect of Age on Transcranial Doppler Velocities in Patients with Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND: It is not well understood whether age impacts transcranial Doppler (TCD) mean flow velocities (MFVs) in patients with aneurysmal subarachnoid hemorrhage (SAH) with or without delayed cerebral ischemia (DCI). The aim of our study was to analyze the behavior of TCD MFV during the first 7 days after SAH in patients of different ages and correlate them with the occurrence of DCI. METHODS: This study is a databank analysis of patients with SAH admitted between 2010 and 2012 in a single center. We analyzed mean MFV of bilateral middle cerebral arteries (MCAs) in all patients enrolled in the study on days 1, 3 and 7. The correlation between age and TCD MFV was analyzed using a univariate linear regression model. RESULTS: Fifty-five patients were studied. Starting on the third day after the bleeding, increasing age was associated with slower MFVs. This trend was not affected by the interrogation of the right or left MCA. After correction to include only patients who developed DCI, the same findings persisted on days 3 and 7. CONCLUSION: Older age was correlated with a significant decrease on TCD velocities in patients with SAH, even after correction for patients who developed DCI.

Formation of a Ternary Complex for Selenocysteine Biosynthesis in Bacteria.

The synthesis of selenocysteine-containing proteins (selenoproteins) involves the interaction of selenocysteine synthase (SelA), tRNA (tRNA(Sec)), selenophosphate synthetase (SelD, SPS), a specific elongation factor (SelB), and a specific mRNA sequence known as selenocysteine insertion sequence (SECIS). Because selenium compounds are highly toxic in the cellular environment, the association of selenium with proteins throughout its metabolism is essential for cell survival. In this study, we demonstrate the interaction of SPS with the SelA-tRNA(Sec) complex, resulting in a 1.3-MDa ternary complex of 27.0 ± 0.5 nm in diameter and 4.02 ± 0.05 nm in height. To assemble the ternary complex, SPS undergoes a conformational change. We demonstrated that the glycine-rich N-terminal region of SPS is crucial for the SelA-tRNA(Sec)-SPS interaction and selenoprotein biosynthesis, as revealed by functional complementation experiments. Taken together, our results provide new insights into selenoprotein biosynthesis, demonstrating for the first time the formation of the functional ternary SelA-tRNA(Sec)-SPS complex. We propose that this complex is necessary for proper selenocysteine synthesis and may be involved in avoiding the cellular toxicity of selenium compounds.