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1.
J Am Vet Med Assoc ; 258(9): 971-976, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33856861

RESUMO

OBJECTIVE: To describe a modified approach to neurologic examination of African pygmy hedgehogs (Atelerix albiventris). ANIMALS: 12 adult hedgehogs (7 males and 5 females). PROCEDURES: Aspects of the standard neurologic examination of dogs and cats were evaluated for use with awake hedgehogs, and modified approaches to evaluating their normal behavior and mentation, select cranial nerves and refexes, and gait were then identified. Behavioral analysis and gait analysis were performed by using video recordings of hedgehogs in a novel environment. Performability and repeatability of all feasible aspects of the neurologic examination were assessed. RESULTS: Most aspects of the standard neurologic examination could be successfully performed, with repeatable results. However, certain aspects, especially those evaluating the pelvic limbs, were more difficult to perform successfully or were less repeatable. All hedgehogs lacked a menace response but displayed a contraction of the frontodorsalis muscle. Facial sensation testing was unreliable. CONCLUSIONS AND CLINICAL RELEVANCE: The entire standard neurologic examination could not be performed in hedgehogs. However, many aspects could be performed, and together they provided baseline data for neurologic examination of this species.


Assuntos
Ouriços-Cacheiros , Exame Neurológico , Animais , Feminino , Masculino , Exame Neurológico/veterinária
8.
GMS J Med Educ ; 38(1): Doc9, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33659614

RESUMO

Situation: The COVID-19 pandemic made the traditional bedside teaching inaccessible for medical students. Problem: Within a short period of time, established bedside teaching concepts had to be converted into online formats to meet the requirements of the health authorities. Approach: The Department of Neurology at the University Hospital Essen transformed the examination course in the 5th clinical semester into a live stream, taking into account data protection guidelines. This enabled students to participate from a distance, allowing them to take the medical history from a patient and to interact with the medical examiners. Thus, this concept goes beyond the video-based formats of the examination course. Optimization: During the course, we performed online evaluations to ensure an immediate feedback from the students. This enabled us to implement ongoing changes that had a positive impact on the course format, for example using better equipment to ensure a better video and audio quality. In the future, we hope to create a clinic's own online channel to further increase data security.


Assuntos
/epidemiologia , Educação a Distância/organização & administração , Educação Médica/organização & administração , Exame Neurológico/métodos , Neurologia/educação , Humanos , Pandemias
9.
Br J Radiol ; 94(1121): 20200893, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33661704

RESUMO

OBJECTIVE: To evaluate the association of CT/CT angiography (CTA) findings and clinical characteristics with subsequent vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS-: Consecutive presentation CTA head exams in patients with aSAH between January 2005 and June 2015 were retrospectively evaluated for intracranial arterial calcification, undulation and non-calcified stenosis. Additional variables including modified Fisher Scale (mFS), Glasgow Coma Scale (GCS) and neurological exam status were reviewed. Associations of CTA findings with the incidence of angiographic vasospasm were assessed with multivariate logistic regression models using the least absolute shrinkage and selection operator machine-learning algorithm. Model performance was summarized using c-index with bootstrap optimism-adjustment. RESULTS: Intracranial arterial calcification, seen in 51.7% of 195 total patients, was protective against vasospasm (OR-0.6; 95% CI-0.52-0.67; p = 0.009), while arterial undulation (24%) was associated with subsequent vasospasm (OR-2.6; 95% CI-1.3-5.1; p = 0.007). Non-calcified intracranial arterial stenosis (5%) was associated with subsequent vasospasm, (OR-4.7; 95% CI-1.0-22.8; p = 0.054). Least absolute shrinkage and selection operator selected all three CTA findings as predictors in a multivariate model for vasospasm in addition to clinical factors, which demonstrated superior predictive performance (c-index-0.74; 95% CI-0.69-0.82) compared to a model based on mFS and clinical factors only (c-index-0.66; 95% CI-0.57-0.75; p = 0.010 for the difference). CONCLUSION: Presentation CTA findings combined with clinical factors may better predict the development of vasospasm in patients with aSAH compared to current prognostic models alone. ADVANCES IN KNOWLEDGE: The combination of initial CT/CTA and clinical findings better predict development of vasospasm after aSAH. This can lead to better markers for use in future clinical trials to develop vasospasm preventative treatments and potentially provide better targets for early aggressive treatment.


Assuntos
Angiografia por Tomografia Computadorizada , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/diagnóstico por imagem , Aneurisma Roto/complicações , Calcinose/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Modelos Logísticos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Exame Neurológico , Prognóstico , Estudos Retrospectivos , Vasoespasmo Intracraniano/etiologia
11.
Neurology ; 96(15): e2016-e2027, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33627500

RESUMO

OBJECTIVE: We sought to identify an abbreviated test of impaired olfaction amenable for use in busy clinical environments in prodromal (isolated REM sleep behavior disorder [iRBD]) and manifest Parkinson disease (PD). METHODS: Eight hundred ninety individuals with PD and 313 controls in the Discovery cohort study underwent Sniffin' Stick odor identification assessment. Random forests were initially trained to distinguish individuals with poor (functional anosmia/hyposmia) and good (normosmia/super-smeller) smell ability using all 16 Sniffin' Sticks. Models were retrained using the top 3 sticks ranked by order of predictor importance. One randomly selected 3-stick model was tested in a second independent PD dataset (n = 452) and in 2 iRBD datasets (Discovery n = 241, Marburg n = 37) before being compared to previously described abbreviated Sniffin' Stick combinations. RESULTS: In differentiating poor from good smell ability, the overall area under the curve (AUC) value associated with the top 3 sticks (anise/licorice/banana) was 0.95 in the Development dataset (sensitivity 90%, specificity 92%, positive predictive value 92%, negative predictive value 90%). Internal and external validation confirmed AUCs ≥0.90. The combination of the 3-stick model determined poor smell, and an RBD screening questionnaire score of ≥5 separated those with iRBD from controls with a sensitivity, specificity, positive predictive value, and negative predictive value of 65%, 100%, 100%, and 30%. CONCLUSIONS: Our 3-Sniffin'-Stick model holds potential utility as a brief screening test in the stratification of individuals with PD and iRBD according to olfactory dysfunction. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that a 3-Sniffin'-Stick model distinguishes individuals with poor and good smell ability and can be used to screen for individuals with iRBD.


Assuntos
Aprendizado de Máquina , Exame Neurológico/métodos , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/etiologia , Doença de Parkinson/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Transtorno do Comportamento do Sono REM/diagnóstico , Sensibilidade e Especificidade , Limiar Sensorial
12.
Neurology ; 96(15): e1999-e2005, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33637632

RESUMO

OBJECTIVE: To determine whether providing teleneurology (TN) consultations aiding in determination of death by neurologic criteria (DNC) to a bedside intensivist is feasible and whether timely access and expert input increase the quality of the DNC examination and identification of potential organ donors, we reviewed retrospective data related to outcomes of such consultations. METHODS: Between November 2017 and March 2019, TN consults were requested for sequential comatose patients in the intensive care unit (ICU). We recorded patients' demographic information, causes leading to coma or suspected DNC, and the results of TN consultations. We obtained data on the number of referrals to the organ bank and number of organ donors. RESULTS: Ninety-nine consults were performed with a median time from request to start of the consult of 20.2 minutes (interquartile range 5.4-65.3 minutes). Eighty consults were requested for determination of prognosis, whereas 19 consults were requested for supervision of the DNC examination. In 1 of 80 (1.2%) prognostication consults, the patient was determined by the neurologist to require assessment of DNC and was found to meet DNC criteria; determination of DNC occurred in 11 of the 19 (57.9%) consultations for a supervised DNC examination. In a comparison of the pre-TN (94 months) and post-TN (17 months) periods, there was 2.56-fold increase in the proportion of patients meeting DNC criteria who were medically suitable for donation (pre-TN 8.9% vs post-TN 21.1%, p = 0.02) and a 2.12-fold increase in the proportion of donors (pre-TN 6.14% vs post-TN 13.1%, p = 0.14). CONCLUSIONS: It is feasible to perform TN consultations for patients with severe neurologic damage and to allow expert supervision for DNC examination. Having a teleneurologist as part of the ICU assessment team helped differentiate severe neurologic deficits from DNC and was associated with increase in organ donation.


Assuntos
Morte Encefálica/diagnóstico , Exame Neurológico/métodos , Neurologia/métodos , Encaminhamento e Consulta , Telemedicina/métodos , Idoso , Feminino , Parada Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos/provisão & distribução
13.
J Neurol Sci ; 423: 117283, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33636661

RESUMO

OBJECTIVE: We report the findings from the Spanish Society of Neurology's NeuroCOVID-19 Registry. METHODS: We performed a multicentre study of patients with neurological manifestations of COVID-19. Participating physicians reported demographic, clinical, and paraclinical data and judged the involvement of COVID-19 in causing neurological symptoms. RESULTS: A total of 233 cases were submitted, including 74 different combinations of manifestations. The most frequently reported were stroke (27%), neuromuscular symptoms (23.6%), altered mental status (23.6%), anosmia (17.6%), headache (12.9%), and seizures (11.6%). The mean age of patients was 61.1 years, with 42.1% being women; a higher proportion of women was recorded among patients with altered mental status, anosmia, and headache. The onset of symptoms differed within categories. Onset of anosmia occurred a mean (standard deviation) of 2.9 (2.5) days after the first general symptom, whereas neuromuscular symptoms appeared after 13.9 (10.1) days. Neurological symptoms were persistent in 33% of patients. General symptoms were present in 97.7% of patients, and results from general laboratory studies were abnormal in 99.4% of patients. Cerebrospinal fluid analysis findings were abnormal in 62.7% of the cases in which this test was performed (n = 51), but positive results for SARS-CoV-2 were only found in one case. CONCLUSIONS: The neurological manifestations of COVID-19 are diverse. Anosmia, myalgia, and headache occur earlier in the course of the disease. Altered mental status, neuromuscular symptoms, and stroke are associated with greater severity. COVID-19 must be incorporated into most clinical and radiological differential diagnoses. COVID-19 may cause persistent and disabling neurological symptoms.


Assuntos
/complicações , Doenças do Sistema Nervoso/etiologia , Adulto , Idoso , /etiologia , /epidemiologia , Doenças Cardiovasculares/epidemiologia , Causalidade , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Mialgia/epidemiologia , Mialgia/etiologia , Doenças do Sistema Nervoso/líquido cefalorraquidiano , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/epidemiologia , Neuroimagem , Exame Neurológico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/etiologia , Sistema de Registros , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Virulência
17.
Muscle Nerve ; 63(4): 472-476, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33399235

RESUMO

BACKGROUND: Precise placement of stimulating and recording electrodes is vital when performing nerve conduction studies (NCSs). In this study, we aimed to determine whether ultrasonography (US) was more precise in localizing the superficial radial nerve (SRN), dorsal ulnar cutaneous nerve (DUCN), ulnar nerve (UN) crossing the cubital tunnel, and radial nerve (RN) crossing the spiral groove (SG) compared to conventional techniques. METHODS: Thirty healthy young subjects (15 male) were recruited. Each subject underwent both landmark-based and US-guided NCS. Onset latencies and amplitudes of compound motor action potentials (CMAPs) and sensory nerve action potentials (SNAPs), and stimulation levels (ie, intensity × duration) required to obtain maximal CMAP amplitudes were compared between the two techniques. RESULTS: The mean CMAP amplitudes of the UN above the cubital tunnel (9.55 ± 1.96 vs 8.96 ± 1.94 mV, P = .030), UN below the cubital tunnel (10.11 ± 2.07 vs 9.37 ± 1.95 mV, P < .001), and RN below the SG (5.21 ± 1.56 vs 4.34 ± 1.03 mV, P < .001) were significantly greater using US-guided NCSs compared to landmark-based NCSs. The mean onset latency of the DUCN was significantly shorter using US-guided NCSs (1.49 ± 0.15 vs 1.57 ± 0.14 ms, P = .020). The required stimulation level in the UN and RN was significantly lower using US-guided NCSs. CONCLUSIONS: When performing NCSs, US guidance provides a more precise localization of the stimulator and electrodes for the DUCN, UN, and RN, while providing comparable localization for the SRN, compared to landmark-based techniques.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Exame Neurológico , Nervo Ulnar/diagnóstico por imagem , Ultrassonografia , Potenciais de Ação/fisiologia , Adulto , Eletrodiagnóstico/métodos , Feminino , Guias como Assunto , Humanos , Masculino , Condução Nervosa/fisiologia , Exame Neurológico/métodos , Exame Neurológico/normas , Ultrassonografia/métodos , Ultrassonografia/normas
18.
Muscle Nerve ; 63(4): 546-552, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33452679

RESUMO

BACKGROUND: The most common subtypes of Guillain-Barré syndrome (GBS) are acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). In the first days after the onset of weakness, standard nerve conduction studies (NCS) may not distinguish GBS subtypes. Reduced nerve excitability may be an early symptom of nerve dysfunction, which can be determined with the compound muscle action potential (CMAP) scan. The aim of this study was to explore whether early changes in motor nerve excitability in GBS patients are related to various subtypes. METHODS: Prospective case-control study in 19 GBS patients from The Netherlands and 22 from Bangladesh. CMAP scans were performed within 2 days of hospital admission and NCS 7-14 days after onset of weakness. CMAP scans were also performed in age- and country-matched controls. RESULTS: CMAP scan patterns of patients who were classified as AMAN were distinctly different compared to the CMAP scan patterns of the patients who were classified as AIDP. The most pronounced differences were found in the stimulus intensity parameters. CONCLUSIONS: CMAP scans made at hospital admission demonstrate several characteristics that can be used as an early indicator of GBS subtype.


Assuntos
Tecido Nervoso/fisiopatologia , Condução Nervosa/fisiologia , Sistema Nervoso Periférico/diagnóstico por imagem , Sistema Nervoso Periférico/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios Motores/fisiologia , Países Baixos , Exame Neurológico/métodos
19.
Neurology ; 96(10): e1453-e1461, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33514644

RESUMO

OBJECTIVE: To fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation. METHODS: Twelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates. RESULTS: A total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (ß coefficient [95% confidence interval] -0.5 [-0.97 to -0.02]; p = 0.044), along with age (for 5-year increase, -0.36 [-0.43 to -0.29]; p < 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008-0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019). CONCLUSIONS: A single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.


Assuntos
Morte Encefálica/diagnóstico , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Grupos Étnicos , Feminino , Humanos , Transplante de Pulmão/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Transplante de Órgãos/estatística & dados numéricos , Estudos Prospectivos , Doadores de Tecidos , Adulto Jovem
20.
Aerosp Med Hum Perform ; 92(2): 113-119, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33468292

RESUMO

INTRODUCTION: The neurological impact (or lack thereof) of certain medical histories and imaging findings is important to understand in the context of air and spaceflight. There are a number of neurological conditions that, if present in pilots and astronauts, carry variable (and sometimes adverse) functional implications for safety and overall mission success. In this systematic overview, the authors will refer to the relevant clinical and radiological features of brain tumors and vascular anomalies, cerebral edema and intracranial hypertension, concussion and the traumatic brain injury (TBI) spectrum, hematomas, cerebrospinal fluid circulation anomalies including hydrocephalus and sequestrations, spinal degenerative changes, and cerebral ischemia and demyelination. It is notable that these last two conditions have recently been reported to be a complication in some people with coronavirus disease 2019 (COVID-19). A paradigm for practical neurological workup of symptomatic pilots and astronauts will be discussed, as will the controversial notion of pre-emptive radiological screening (vs. not screening) in asymptomatic or clinically occult situations. The concepts of medical surveillance in the setting of known or diagnosed pathologies, and expert panel review and simulator and flight checks in complex neurological cases, are also elaborated on in this paper. We believe this overview will contribute toward the enhancement of a broad understanding of neurological conditions, their clinical workup, and their precautionary management in the setting of aviation and aerospace.Khurana VG, Jithoo R, Barnett M. Aerospace implications of key neurological conditions. Aerosp Med Hum Perform. 2021; 92(2):113119.


Assuntos
Medicina Aeroespacial , Doenças do Sistema Nervoso/diagnóstico , Pilotos , Avaliação da Capacidade de Trabalho , Diagnóstico Diferencial , Humanos , Anamnese , Exame Neurológico , Medição de Risco
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