Encephalitis Induced by Durvalumab During Treatment of Metastatic Small-Cell Lung Cancer: Illustrative Case and Review of the Literature.

The immune checkpoint inhibitors have improved the standards of care in cancer treatment and have dramatically improved patient prognoses. These new antibodies turned to be an integral part of the standard of care for metastatic small-cell lung cancer. Platinum-based chemotherapy combined with checkpoint inhibitors, resulted in statistically significant improvement of progression free survival and overall survival. Immune checkpoint inhibitors immune-related adverse events have been observed and reported as a consequence of administering these innovative treatment drugs. Neurological immune-related adverse events are rare complications; however, they can be potentially fatal, particularly encephalitis. This report describes a 66-year-old female who received Durvalumab for metastatic small-cell lung cancer. Following 3 cycles of treatment, she developed encephalitis.

Stroke identification using a portable EEG device - A pilot study.

OBJECTIVE: Changes in EEG patterns during stroke are almost immediate; however, a full EEG test takes time and requires highly qualified staff. In this study, we examined whether a short recording using a portable EEG device can differentiate between a stroke and control group. METHODS: EEG samples were collected from patients with an acute ischemic stroke event. The control group comprised healthy volunteers. EEG recordings were recorded using a portable brain wave sensor device. The Revised Brain Symmetry Index (rsBSI) was used to quantify the symmetry of spectral power between the two hemispheres. RESULTS: The investigation group included 33 patients (ages 46-96, mean age 72 years, 66% male) who were diagnosed with ischemic stroke. The control group included 25 healthy individuals. Scores for the rsBSI of non-stroke patients (M=0.1686, SD=0.10) differed significantly from those of ischemic stroke patients (P<0.05, M=0.363, SD=0.25). CONCLUSIONS: A statistically significant difference was observed between a group of stroke patients and a matched group of healthy controls with a short recording using a portable EEG device.

Levofloxacin-induced delirium.

An 83-year-old man was admitted for right lower lobe pneumonia which did not improve after a 5-day outpatient treatment with amoxicillin/clavulinate and clarithromycin. An empiric treatment with levofloxacin was started with a significant improvement after 24 h of this treatment. On the third day of hospitalization, delirium developed, while the patient was afebrile and with normal blood oxygenation. Treatment with levofloxacin was stopped, and a complete resolution of the patient's delirium was observed 2 days later. To the best of our knowledge, this is the third case of levofloxacin-induced delirium described in the medical literature.

Nonpainful remote electrical stimulation alleviates episodic migraine pain.

OBJECTIVE: To evaluate the efficacy of remote nonpainful electrical upper arm skin stimulation in reducing migraine attack pain. METHODS: This is a prospective, double-blinded, randomized, crossover, sham-controlled trial. Migraineurs applied skin electrodes to the upper arm soon after attack onset for 20 minutes, at various pulse widths, and refrained from medications for 2 hours. Patients were asked to use the device for up to 20 attacks. RESULTS: In 71 patients (299 treatments) with evaluable data, 50% pain reduction was obtained for 64% of participants based on best of 200-µs, 150-µs, and 100-µs pulse width stimuli per individual vs 26% for sham stimuli. Greater pain reduction was found for active stimulation vs placebo; for those starting at severe or moderate pain, reduction (1) to mild or no pain occurred in 58% (25/43) of participants (66/134 treatments) for the 200-µs stimulation protocol and 24% (4/17; 8/29 treatments) for placebo (p = 0.02), and (2) to no pain occurred in 30% (13/43) of participants (37/134 treatments) and 6% (1/17; 5/29 treatments), respectively (p = 0.004). Earlier application of the treatment, within 20 minutes of attack onset, yielded better results: 46.7% pain reduction as opposed to 24.9% reduction when started later (p = 0.02). CONCLUSION: Nonpainful remote skin stimulation can significantly reduce migraine pain, especially when applied early in an attack. This is presumably by activating descending inhibition pathways via the conditioned pain modulation effect. This treatment may be proposed as an attractive nonpharmacologic, easy to use, adverse event free, and inexpensive tool to reduce migraine pain. CLINICALTRIALSGOV IDENTIFIER: NCT02453399. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with an acute migraine headache, remote nonpainful electrical stimulation on the upper arm skin reduces migraine pain.

Neurological manifestations of an acute abdomen in children.

The acute abdomen in the pediatric age group is not infrequently fraught with diagnostic pitfalls. The younger the patient, the more problematic the presentation can be. Among the more unusual manifestations of an acute abdomen is an apparent encephalopathic picture. We present 2 cases which serve to illustrate the diagnostic difficulties encountered.

The relationship between heart rate variability and epileptiform activity among children--a controlled study.

Autonomic symptoms frequently occur during epileptic seizures. Attention has been mainly devoted to cardiovascular changes. We studied the relationship between heart rate variability (HRV) and epileptiform activity in children with epilepsy.Simultaneous electroencephalograms and electrocardiograms were recorded in 36 children diagnosed with epilepsy and in 36 children with unrelated conditions who served as a comparison group. Heart rate variability was evaluated by time-domain analysis, before, after, and during an epileptiform event, a benign abnormal event and baseline activity.An age-related change in the HRV associated with an epileptiform event was noted in the study group but not in the comparison group. No other significant differences in HRV were noted between the two groups or between true and benign abnormal events.Age seems to be a significant covariate in the analysis of HRV in children with epilepsy. Epileptiform activity is not associated with a significant change in HRV in children.

Carotid endarterectomy with a polyurethane patch versus primary closure: a prospective randomized study.

INTRODUCTION: The use of synthetic patch angioplasty during carotid endarterectomy (CEA) has been advocated to reduce restenosis, stroke, and death, but the type of material used is still being debated. This study compared rate of restenosis, neurologic events, and perioperative death in patients undergoing CEA with primary closure versus polyester urethane patch closure. PATIENTS AND METHODS: In a prospective randomized study, we compared patch angioplasty with polyester urethane (Vascular-patch, B. Braun Medical AG, Tuttlingen, Germany) to primary closure between February 1999 and March 2002 in 404 operations. Early (30-day) stroke and mortality rate, long-term restenosis, and neurologic events were compared in the two groups during 2.5 to 5 years of follow-up (median follow-up, 2 years). RESULTS: Primary closure was used in 216 operations, and patch angioplasty was used in 206. Clamping time was significantly shorter in the primary closure group ( P < .001). Perioperative mortality and neurologic events were similar in both groups (1.9% vs 3.9%, P = .21, odds ratio [OR], 2.1; 95% confidence interval [CI], 0.56 to 9.85). The rate of residual stenosis (> or =50%) at 0 or 3-month follow-up was significantly lower in the patch group (2 operations, 1.1%) compared with the primary closure group (17 operations, 8.9%) ( P = .001, OR, 0.114; 95% CI, 0.026 to 0.5). Multivariable logistic regression showed that only primacy closure was found to influence residual stenosis. Restenosis of 70% was significantly less in the patch angioplasty group (2.2% vs 8.6%) ( P = . 01, hazard ratio, 0.246; 95% CI, 0.08 to 0.75). No correlation was found between restenosis and gender, preoperative symptoms, or risk factors. CONCLUSIONS: Patch angioplasty with polyester urethane significantly reduced the restenosis rate ( P = . 01) compared with primary closure. Even though clamping time was longer, patching was not associated with more perioperative complications.