Large vessel occlusion detection by non-contrast CT using artificial intelligence.

INTRODUCTION: Computer vision models have been used to diagnose some disorders using computer tomography (CT) and magnetic resonance (MR) images. In this work, our objective is to detect large and small brain vessel occlusion using a deep feature engineering model in acute of ischemic stroke. METHODS: We use our dataset. which contains 324 patient's CT images with two classes; these classes are large and small brain vessel occlusion. We divided the collected image into horizontal and vertical patches. Then, pretrained AlexNet was utilized to extract deep features. Here, fc6 and fc7 (sixth and seventh fully connected layers) layers have been used to extract deep features from the created patches. The generated features from patches have been concatenated/merged to generate the final feature vector. In order to select the best combination from the generated final feature vector, an iterative selector (iterative neighborhood component analysis-INCA) has been used, and this selector has chosen 43 features. These 43 features have been used for classification. In the last phase, we used a kNN classifier with tenfold cross-validation. RESULTS: By using 43 features and a kNN classifier, our AlexNet-based deep feature engineering model surprisingly attained 100% classification accuracy. CONCLUSION: The obtained perfect classification performance clearly demonstrated that our proposal could separate large and small brain vessel occlusion detection in non-contrast CT images. In this aspect, this model can assist neurology experts with the early recanalization chance.

Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE).

BACKGROUND: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. METHODS: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients' database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. RESULTS: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. DISCUSSION: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs.

[A Histopathologically Diagnosed Neurocysticercosis Case from Türkiye]. / Türkiye'de Histopatolojik Olarak Tanisi Konulmus Bir Nörosistiserkoz Olgusu.

Cysticercosis is a parasitic tissue infection caused by larval cysts of Taenia solium. Although the disease affects many tissues, it primarily affects the brain and muscles. The most common form is neurocysticercosis, a term used for human central nervous system involvement with T.solium cysts. Neurocysticercosis is an important public health problem in many parts of the world. Its prevalence is particularly high in places where T.solium tapeworms are common, such as Mexico, Central America, South America, Southeast Asia, Africa, China, India, and Nepal. Its incidence has been increasing rapidly in recent years in non-endemic countries, due to both import and local cases, while in some highly endemic areas, numbers appear to have decreased, possibly due to better sanitation and increased public awareness. It is extremely rare in Türkiye. Cysticercosis is usually caused by drinking water or eating food containing tapeworm eggs. Clinical manifestations can range from completely asymptomatic infection to severe illness or death. Although the infection can involve any part of the central nervous system, symptomatic patients mostly have spinal cord involvement, intracerebral lesion, intraventricular cyst or subarachnoid lesion. An intraparenchymal cerebral cyst typically grows slowly and causes minimal symptoms for years or decades after the onset of infection. The site of involvement and the symptoms experienced determine the diagnosis and treatment method. The current general consensus supports antihelmintic and corticosteroid therapy for viable parenchymal lesions. In this report, a neurocysticercosis case with a single brain lesion that was surgically removed and histologically examined was presented. The patient had complaints of lisp in the tongue, numbness in the lips and left face. The patient had no concomitant chronic disease. The patient did not have a travel history or a history of eating pork but had a history of contact with a dead pig two months ago. Upon detection of a central mass in the brain computed tomography examination, surgical procedure was performed on the patient. Based on the identification of a larval stage of T.solium in biopsy material neurocysticercosis was diagnosed. However, histopathologically demonstration of the parasite is not possible in most cases. The patient received an antiparasitic treatment with albendazole 1000 mg/d in combination with dexamethasone. The patient was successfully treated and is still being followed up by calling for controls.

Evaluation of neurological disorders that develop concurrently with COVID-19 pneumonia: a retrospective analysis.

BACKGROUND: During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. OBJECTIVE: To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. METHODS: Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. RESULTS: The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. CONCLUSION: The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.

Evaluation of neurological disorders that develop concurrently with COVID-19 pneumonia: a retrospective analysis / Avaliação de transtornos neurológicos concomitantes à pneumonia por COVID-19: análise retrospectiva

ABSTRACT Background: During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. Objective: To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. Methods: Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. Results: The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. Conclusion: The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.

RESUMO Antecedentes: Durante a pandemia, muitos sintomas neurológicos foram avaliados como complicações da pneumonia por COVID-19. Objetivo: Investigar a frequência e as características dos achados neurológicos e seus efeitos no prognóstico de pacientes com pneumonia por COVID-19 que consultaram o departamento de Neurologia. Métodos: Foram analisados os dados de 2.329 pacientes internados com diagnóstico de pneumonia por COVID-19 em nosso hospital. Os achados clínicos, laboratoriais e radiológicos relativos ao tratamento de 154 pacientes que necessitaram de consulta neurológica foram avaliados retrospectivamente por meio da revisão das anotações clínicas. Resultados: O número de pacientes com pneumonia por COVID-19 que necessitaram de consultas neurológicas enquanto internados na UTI foi de 94 (61,0%). O sintoma mais comum entre esses pacientes foi o delírio hiperativo. A média de idade, os níveis de ferritina e os valores de PCR daqueles apresentando delírios foram maiores, enquanto a porcentagem média de linfócitos foi menor do que em pacientes sem delírios. Crises epilépticas foram observadas em oito pacientes sem diagnóstico de epilepsia. Dois pacientes foram diagnosticados com SGB e um paciente com neuropatia na UTI. Os níveis de dímero D de pacientes com DCV hemorrágica aguda e os níveis de trombócitos de pacientes com DCV isquêmica aguda foram maiores do que em pacientes sem DCV isquêmica aguda. Conclusão: A proporção de pacientes que necessitaram consultas neurológicas foi maior nas UTIs. Observamos sintomas neurológicos com mais frequência em pacientes de faixa etária avançada. Não houve aumentos significativos na incidência de outras condições neurológicas, exceto delírio, em pacientes com COVID-19. Acreditamos que mais estudos são necessários para apoiar nossos dados.

Long-term clinical course and prognosis of hot water epilepsy: 15-Year follow-up.

OBJECTIVE: Hot water epilepsy (HWE) is a type of reflex epilepsy triggered by bathing with hot water. Hot water epilepsy is generally considered as a self-limiting benign disease although its long-term course and prognosis remains unknown. In this study, we aimed to determine the long-term clinical course and prognosis of hot water epilepsy and possible factors affecting them. METHODS: The diagnosis of HWE was made based on the clinical history obtained from patients and their first degree relatives witnessing to the seizures and video recordings of seizures if available; then, the type of seizure was identified. Good prognosis was defined as patients whose seizures were controlled with or without preventive measures and who did not require antiepileptic treatment. The poor prognosis was defined as patients whose seizures continued despite preventive measures and required antiepileptic treatment. RESULTS: The study included 50 (31 male and 19 female) patients with a mean follow-up of 17.63 ±â€¯10.46 (median, 15.0) years. The age at onset of seizure was 14.52 ±â€¯12.71 (median: 10.0) years. There were 38 (76%) patients in the good prognosis group. 18 (36%) of them achieved complete remission, who did not require preventive measures. In the remaining 20 (40%) patients, seizures could be controlled with only preventive measures. Seizures could be controlled with antiepileptic treatment in only 1 (2%) of 12 (24%) patients in the poor prognosis group. A significant relationship was found between the frequency of hot water seizures (HWSs) and poor prognosis (p = 0.019), as well as the presence of spontaneous seizures outside of bathing and poor prognosis (p = 0.000). SIGNIFICANCE: Hot water epilepsy, as previously known, is not a self-limiting benign disease. Approximately ¾ of the cases have a good prognosis, but the rest are in the case of chronic epilepsy. The low response rate to antiepileptics' treatment suggests that the pathogenesis of the HWE may differ from other epilepsies.

The relationship between carpal tunnel syndrome, smartphone use, and addiction: A cross-sectional study.

Objectives: This study aims to investigate the use of and addiction to smartphones in individuals with and without carpal tunnel syndrome (CTS). Patients and methods: The cross-sectional study included a total of 404 participants (286 females, 118 males; mean age: 39.7±11.6 years; range, 16 to 75 years) who applied to the Neurology Department of the Firat University Faculty of Medicine, between April 2019 and October 2019. The participants were divided into two groups: 202 patients diagnosed with CTS were included in the case group, and 202 patients and their relatives who did not have hand and wrist complaints were included in the control group. The diagnosis of CTS was made by evaluating the history, physical examination, and electromyography findings. Data were collected with participant information forms and the Smartphone Addiction Scale. Results: It was found that the risk of CTS increased 1.022 times with a one-unit increase in the SAS score and 1.292 times with a 1-h increase in daily smartphone use. Conclusion: Smartphone addiction can be considered as a potential risk factor for CTS; however, the effect of smartphone addiction on CTS severity was not examined in this study. The relationship between disease severity, smartphone use, and smartphone addiction in CTS patients requires further investigation to provide clarification on this issue.

Restless legs syndrome affecting the head region: "restless head syndrome".

OBJECTIVE: Restless legs syndrome (RLS) is a well-established disease that has recently been shown to have variants affecting the arms, face, abdomen, and genital area. To our knowledge, there has been no study reporting on the RLS variant affecting the head region. METHODS: The retrospective study reviewed a total of 460 patients who presented to Firat University Medical School and were diagnosed as having RLS based on the International Restless Legs Syndrome Study Group (IRLSSG) criteria between June 2017 and January 2020. Of these, 18 patients that presented with head-related RLS symptoms (in addition to legs or arms) and four cases that presented with isolated head involvement were included in the study. RESULTS: In 15 out of 18 (81.8%) patients, the restless head syndrome was accompanied by restless arm syndrome (RAS). In the remaining four (18.2%) patients, the disease involved the head region alone. The disease initially emerged in a single region in the body and gradually spread to one or multiple other regions in most patients and the symptoms were relieved by head rubbing. Serum iron level was low in 8 (36.4%) patients and normal in 14 (63.6%) patients. All the patients had normal cranial imaging and the symptoms were eliminated after dopaminergic therapy. CONCLUSIONS: Although RLS typically involves the legs alone, it may also affect other body parts such as upper extremities, abdomen, face, and genital area. We propose that the novel RLS variant described in the present study could be termed "restless head syndrome."

Positive effects of ocrelizumab in patients with familial mediterranean fever and coexistent multiple sclerosis.

OBJECTIVES: This study aims to evaluate the effects of ocrelizumab (OCZ) on familial Mediterranean fever (FMF) attacks in multiple sclerosis (MS) patients with FMF (MS+FMF patients). PATIENTS AND METHODS: This retrospective observational study included 11 patients (2 males, 9 females; mean age 46.6±9.2; range, 22 to 55 years) with MS+FMF hospitalized between January 2016 and July 2019. Demographic, clinical, and laboratory parameters and patient reported outcomes were analyzed in patients treated with OCZ for 18 months. RESULTS: Combining OCZ with colchicine in MS+FMF patients significantly reduced the frequency of FMF attacks (p=0.003) and the frequency of joint attacks (p=0.002). Consistent with the clinical improvement, the maximum serum C-reactive protein levels were significantly decreased after combination therapy compared to before combination therapy (p=0.003). MS+FMF patients reported that FMF disease activity improved after OCZ therapy (Visual Analog Scale [VAS] 74±9.6 vs. VAS 46.5±8.1 mm, p=0.003). CONCLUSION: Ocrelizumab therapy led to a prominent decrease in the frequency of FMF attacks, alleviated functional impairment, and improved quality of life in MS+FMF patients.

Detection of ataxia in low disability MS patients by hybrid convolutional neural networks based on images of plantar pressure distribution.

BACKGROUND: This study aimed to detect ataxia in patients with multiple sclerosis (PwMS) with a deep learning-based approach based on images showing plantar pressure distribution of the patients. The secondary aim of the study was to investigate an alternative and objective method in the early diagnosis of ataxia in these patients. METHODS: A total of 105 images showing plantar pressure distribution of 43 ataxic PwMS and 62 healthy individuals were analyzed. The images were resized for the models including VGG16, VGG19, ResNet, DenseNet, MobileNet, NasNetMobile, and NasNetLarge. Feature vectors were extracted from the resized images and then classified using Support Vector Machines (SVM), K-Nearest Neighbors (K-NN), and Artificial Neural Network (ANN). A 10-fold cross-validation was applied to increase the validity of the classifiers. RESULTS: The VGG19-SVM hybrid model showed the highest accuracy, sensitivity, and specificity values (89.23%, 89.65%, and 88.88%, respectively). CONCLUSION: The proposed method provided an automatic decision support system for detecting ataxia based on images showing plantar pressure distribution in patients with PwMS. The performance of the proposed method indicated that this method can be applied in clinical practice to establish a rapid diagnosis of ataxia that is asymptomatic or difficult to detect clinically and that it can be recommended as a useful aid for the physician in clinical practice.

A case of syncopal convulsions triggered by glossopharyngeal neuralgia.

Syncopal convulsions and epileptic seizures are clinically hard to distinguish and differ in terms of treatment approaches. It is important to consider the cardiac arrhythmias that impair cerebral perfusion in the differential diagnosis of antiepileptic treatment-resistant convulsions. Here we offer a 72 year old male patient glossopharengial neuralgia after swallowing associated with recurrent episodes of syncopal convulsions. The patient was successfully treated with temporary pacemaker and carbamazepine. This phenomenon is noteworthy in terms of both asystole triggered by glossopharengial neuralgia and syncopal convulsions which are rare in the differential diagnosis of epileptic seizures.

Increased serum chemerin levels associated with carotid intima-media thickness.

BACKGROUND: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. OBJECTIVES: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. METHODS: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. RESULTS: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). CONCLUSION: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

Increased serum chemerin levels associated with carotid intima-media thickness / Aumento dos níveis séricos de chemerin associados à espessura das camadas intima-media carotídea

ABSTRACT Background: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. Objectives: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. Methods: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. Results: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). Conclusion: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

RESUMO Introdução: Níveis elevados de chemerin podem prever doenças cerebrovasculares isquêmicas futuras. Embora se acredite que a chemerin desempenhe um papel na inflamação aterosclerótica, ainda não foi determinado se os níveis circulantes de chemerin estão associados à gravidade da aterosclerose Objetivos: Por meio do uso da ultrassonografia Doppler da carótida, nosso objetivo neste estudo foi investigar as relações dos níveis séricos de chemerin com a espessura da íntima-média da carótida (EIMC) como um indicador de aterosclerose generalizada. Métodos: Este estudo comparou 40 pacientes com AVC isquêmico e 40 indivíduos saudáveis. As medidas foram feitas no final da diástole usando ultrassonografia Doppler em cores (USDC), após um intervalo de descanso de 5 minutos em um quarto silencioso e escuro. A EIMC foi definida como a distância entre a borda mais interna do eco luminal e a borda mais interna do eco da mídia/adventícia. EIMC foi medido na parede posterior de ambas as artérias carótidas comuns dentro de 1 cm proximalmente ao bulbo. Três medições foram feitas em ambos os lados e a medição média foi tomada como o EIMC. Os níveis séricos de chemerin foram determinados em todos os pacientes e indivíduos saudáveis. Resultados: Os níveis séricos de chemerin foram significativamente maiores no grupo de pacientes do que no grupo controle (p=0,004). Os níveis séricos de chemerin foram positivamente correlacionados com EIMC (p<0,05). Houve diferença significativa entre os grupos em relação à EIMC (p<0,001). Conclusão: Níveis séricos elevados de chemerin parecem estar associados com a EIMC, sugerindo que existe uma ligação entre chemerin e doença cerebrovascular isquêmica aterosclerótica.

Epileptic olfactory auras: a clinical spectrum.

OBJECTIVE: To investigate the relative frequency of olfactory aura in a large number of patients with focal epilepsy, and examine the full clinical spectrum of epileptic olfactory auras (OAs) and their relationship to hemispheric lateralization and localization of epileptogenic focus. METHODS: This retrospective study was based on the medical records of 1384 patients with focal epilepsy. Of these, 71 (5.1%) patients were present with OAs, comprising 25 (35.2%) men and 46 (64.8%) women with a mean age of 35.43 ± 12.89 years. These 71 patients were classified according to the clinical features of the OAs, and the electroencephalography and magnetic resonance imaging findings were examined. RESULTS: The relative frequency of OAs was 5.1% in the focal epileptic patients. The clinical spectrum of OAs in our cases was outlined as follows, complex OAs and elementary OAs. Elementary OAs were divided into three subgroups: elementary neutral OAs, elementary unpleasant OAs, and elementary pleasant OAs. In our cases, there was no difference between the right and left hemispheres in terms of lateralization of the epileptogenic focus. In all the 71 patients, the epileptogenic zone was most commonly localized in the temporal lobe (n = 58; 81.7%). CONCLUSIONS: The relative frequency of OAs in focal epilepsies is likely to be found higher than expected. Elementary OAs occur much more frequently than complex OAs. Among the elementary OAs, elementary unpleasant OAs and elementary neutral OAs are the most common types, whereas elementary pleasant OAs are extremely rare.

S100B and neuron-specific enolase levels in episodic and chronic migraine.

OBJECTIVES: In recent years, radiological and biochemical data have emerged regarding the development of cellular damage in the brain of patients with migraine, calling into question what has traditionally been accepted as a benign disorder. In order to investigate whether cellular damage develops in the brain of episodic migraine patient, serum levels of neuron-specific enolase (NSE) and S100B have been evaluated in recent studies. However, contradictory results were obtained in these studies. Moreover, there is no study on NSE and S100B in cases of chronic migraine. METHODS: Patients with episodic migraine with or without aura and chronic migraine were included. In addition, 27 healthy volunteers were included as a control group. Control group was selected from healthy volunteers of the same age and sex. We investigated serum NSE and S100B levels during the interictal period in 26 patients with episodic migraine and 27 patients with chronic migraine. RESULTS: The serum NSE and S100B levels were significantly higher in both patients with episodic and chronic migraine than controls. Although there were no significant differences in the serum NSE and S100B levels between the two patients' groups, these markers were found to be higher in cases of chronic migraine. CONCLUSION: These results suggest that there is both neuronal and glial involvement in the two migraine groups. Elevations in these markers in cases of episodic migraine suggest that cellular damage not only results from headache episodes, but that there may be also an ongoing pathological process during the interictal period.

Changes in Neuroendovascular Procedural Volume During the COVID-19 Pandemic: An International Multicenter Study.

BACKGROUND AND PURPOSE: The effect of coronavirus disease 2019 (COVID-19) pandemic on performance of neuroendovascular procedures has not been quantified. METHODS: We performed an audit of performance of neuroendovascular procedures at 18 institutions (seven countries) for two periods; January-April 2019 and 2020, to identify changes in various core procedures. We divided the region where the hospital was located based on the median value of total number of COVID-19 cases per 100,00 population-into high and low prevalent regions. RESULTS: Between 2019 and 2020, there was a reduction in number of cerebral angiograms (30.9% reduction), mechanical thrombectomy (8% reduction), carotid artery stent placement for symptomatic (22.7% reduction) and asymptomatic (43.4% reduction) stenoses, intracranial angioplasty and/or stent placement (45% reduction), and endovascular treatment of unruptured intracranial aneurysms (44.6% reduction) and ruptured (22.9% reduction) and unruptured brain arteriovenous malformations (66.4% reduction). There was an increase in the treatment of ruptured intracranial aneurysms (10% increase) and other neuroendovascular procedures (34.9% increase). There was no relationship between procedural volume change and intuitional location in high or low COVID-19 prevalent regions. The procedural volume reduction was mainly observed in March-April 2020. CONCLUSIONS: We provided an international multicenter view of changes in neuroendovascular practices to better understand the gaps in provision of care and identify individual procedures, which are susceptible to change.

Neuropsychiatric changes during the COVID-19 pandemic in multiple sclerosis patients.

BACKGROUND: This study reported on a variety of psychological reactions related to anxiety, sleep quality, depression, fatigue, and quality of life in individuals with multiple sclerosis (MS), related to the Covid-19 quarantine experience. OBJECTIVE: The aim of this study was to investigate the neuropsychiatric effects of the COVID-19 pandemic in MS patients and to analyze the risk factors contributing to psychological stress. METHODS: The study was designed as a prospective, cross-sectional survey study. Multiple assessment tools that are used in neurological practice, including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fatigue Impact Scale (FIS), Pittsburgh Sleep Quality Index (PSQI), and Multiple Sclerosis Quality of Life-54 (MSQOL-54) were administered prospectively both during the early and the peak stages of COVID-19 outbreak (ESO and PSO, respectively). The survey forms were designed using SurveyMonkey and the participants were participating in the survey via a web link and QR code. RESULTS: Fifty patients were included in the study. BDI scores, PSQI and FSI measurements, cognitive and social subscale scores and total FIS score, MSQOL-54 measurements, physical and mental subscale scores, and total MSQOL-54 score at PSO were significantly different than those at ESO. The body mass index values of the patients increased significantly at PSO compared to those measured at ESO. CONCLUSIONS: The results provide a basis for the development of psychological interventions that could minimize the prevalence of sleep disorders and depression and could improve patients' quality of life during the outbreak.

Neuropsychiatric changes during the COVID-19 pandemic in multiple sclerosis patients / Alterações neuropsiquiátricas durante a pandemia de COVID-19 em pacientes com esclerose múltipla

ABSTRACT Background: This study reported on a variety of psychological reactions related to anxiety, sleep quality, depression, fatigue, and quality of life in individuals with multiple sclerosis (MS), related to the Covid-19 quarantine experience. Objective: The aim of this study was to investigate the neuropsychiatric effects of the COVID-19 pandemic in MS patients and to analyze the risk factors contributing to psychological stress. Methods: The study was designed as a prospective, cross-sectional survey study. Multiple assessment tools that are used in neurological practice, including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fatigue Impact Scale (FIS), Pittsburgh Sleep Quality Index (PSQI), and Multiple Sclerosis Quality of Life-54 (MSQOL-54) were administered prospectively both during the early and the peak stages of COVID-19 outbreak (ESO and PSO, respectively). The survey forms were designed using SurveyMonkey and the participants were participating in the survey via a web link and QR code. Results: Fifty patients were included in the study. BDI scores, PSQI and FSI measurements, cognitive and social subscale scores and total FIS score, MSQOL-54 measurements, physical and mental subscale scores, and total MSQOL-54 score at PSO were significantly different than those at ESO. The body mass index values of the patients increased significantly at PSO compared to those measured at ESO. Conclusions: The results provide a basis for the development of psychological interventions that could minimize the prevalence of sleep disorders and depression and could improve patients' quality of life during the outbreak.

RESUMO Introdução: Este estudo relatou uma variedade de reações psicológicas relacionadas a ansiedade, qualidade do sono, depressão, fadiga e qualidade de vida em indivíduos com esclerose múltipla (EM), relacionadas à experiência de quarentena de COVID-19. Objetivo: O objetivo deste estudo foi investigar os efeitos neuropsiquiátricos da pandemia de Covid-19 em pacientes com EM e analisar os fatores de risco que contribuem para o estresse psicológico. Métodos: O estudo foi desenhado como um estudo prospectivo e transversal. Várias ferramentas de avaliação usadas na prática neurológica, incluindo Inventário de Depressão de Beck (Beck Depression Inventory - BDI), Inventário de Ansiedade de Beck (Beck Anxiety Inventory - BAI), Escala de Impacto de Fadiga (Fatigue Impact Scale - FIS), Índice de Qualidade de Sono de Pittsburgh (Pittsburgh Sleep Quality Index - PSQI) e Qualidade de Vida da Esclerose Múltipla-54 (Multiple Sclerosis Quality of Life-54 - MSQOL-54) foram administrados prospectivamente durante o estágio inicial do surto de COVID-19 (EIS) e o estágio de pico do surto de COVID-19 (EPS). Os formulários da pesquisa foram projetados usando o SurveyMonkey e os participantes participaram da pesquisa por meio de um link da web e código QR. Resultados: Foram incluídos 50 pacientes no estudo. Os escores BDI, PSQI, FSI, subescala cognitiva e social e escore total do FIS, MSQOL-54, subescala física e mental e MSQOL-54 total no PSO foram significativamente diferentes dos do EIS. Os valores do índice de massa corporal dos pacientes aumentaram significativamente na EPS em comparação com os medidos na EIS. Conclusões: Nossos resultados são uma base para o desenvolvimento de intervenções psicológicas que podem minimizar a prevalência de distúrbios do sono e depressão e melhorar a qualidade de vida dos pacientes durante o surto.

Is it possible to detect cerebral dominance via EEG signals by using deep learning?

Each brain hemisphere is dominant for certain functions such as speech. The determination of speech laterality prior to surgery is of paramount importance for accurate risk prediction. In this study, we aimed to determine speech laterality via EEG signals by using noninvasive machine learning techniques. The retrospective study included 67 subjects aged 18-65 years who had no chronic diseases and were diagnosed as healthy based on EEG examination. The subjects comprised 35 right-hand dominant (speech center located in the left hemisphere) and 32 left-hand dominant individuals (speech center located in the right hemisphere). A spectrogram was created for each of the 18 EEG channels by using various Convolutional Neural Networks (CNN) architectures including VGG16, VGG19, ResNet, MobileNet, NasNet, and DenseNet. These architectures were used to extract features from the spectrograms. The extracted features were classified using Support Vector Machines (SVM) and the classification performances of the CNN models were evaluated using Area Under the Curve (AUC). Of all the CNN models used in the study, VGG16 had a higher AUC value (0.83 ±â€¯0.05) in the determination of speech laterality compared to all other models. The present study is a pioneer investigation into the determination of speech laterality via EEG signals with machine learning techniques, which, to our knowledge, has never been reported in the literature. Moreover, the classification results obtained in the study are promising and lead the way for subsequent studies though not practically feasible.