Annals of neurology
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Annals of neurology · Nov 2006
Randomized Controlled TrialEffects of intraoperative hypothermia on neuropsychological outcomes after intracranial aneurysm surgery.
Subarachnoid hemorrhage and surgical obliteration of ruptured intracranial aneurysms are frequently associated with neurological and neuropsychological abnormalities. We reported that intraoperative cooling did not improve neurological outcome in good-grade surgical subarachnoid hemorrhage patients, as assessed by the Glasgow Outcome Scale score or other neurological and functional measures (National Institutes of Health Stroke Scale, Rankin Disability Scale, Barthel Activities of Daily Living). We now report the results of neuropsychological testing in these patients. ⋯ This is the largest prospective evaluation of neuropsychological function after subarachnoid hemorrhage to date. Testing was completed in a high fraction of patients, demonstrating the feasibility of such testing in a large trial. However, the frequent inability to complete testing in poor-outcome patients suggests that testing may be best used to refine outcome assessments in good-grade patients. Many patients showed impairment on at least one test, with global impairment present in 17 to 20% of patients (18-21% of survivors). This was true even among the patients with the best preoperative condition (WFNS = 1). There was no difference in the incidence of impairment between hypothermic and normothermic groups.
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Annals of neurology · Nov 2006
Case ReportsFukutin gene mutations cause dilated cardiomyopathy with minimal muscle weakness.
The fukutin gene (FKTN) is the causative gene for Fukuyama-type congenital muscular dystrophy, characterized by rather homogeneous clinical features of severe muscle wasting and hypotonia from early infancy with mental retardation. In contrast with the severe dystrophic involvement of skeletal muscle, cardiac insufficiency is quite rare. Fukuyama-type congenital muscular dystrophy is one of the disorders associated with glycosylation defects of alpha-dystroglycan, an indispensable molecule for intra-extra cell membrane linkage. ⋯ FKTN mutations could cause much wider spectrum of clinical features than previously perceived, including familial dilated cardiomyopathy and mildest limb girdle muscular dystrophy.
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Annals of neurology · Nov 2006
Superficial brain is cooler in small piglets: neonatal hypothermia implications.
Hypothermia was not neuroprotective in low body weight (BW) infants on subgroup analysis in a recent clinical trial of selective head cooling (SHC) in neonatal encephalopathy (CoolCap Trial). ⋯ Brain cooling (under normothermia, WBC, or SHC) was more efficient with lower BW due to greater head surface area-to-volume ratios. In the CoolCap Trial, low BW infants might have been excessively cooled. WBC and SHC may require BW adjustment to accomplish consistent regional temperatures and optimal neuroprotection.
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Annals of neurology · Nov 2006
Delayed Nogo receptor therapy improves recovery from spinal cord contusion.
Myelin-associated inhibitors play a role in limiting axonal growth in the adult central nervous system. Blocking these inhibitors may promote neurological recovery from spinal cord contusion. ⋯ NgR(310)ecto-Fc treatment improves outcome in a rodent model that closely mimicked human spinal cord injury.