Frontiers in neurology
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Background: Trials have demonstrated efficacy for endovascular thrombectomy (EVT) for anterior circulation acute ischaemic stroke (AIS) up to 24-h from symptom onset. The magnitude of effect suggests benefit may exist beyond 24-h. Objectives: To perform a retrospective review of all patients undergoing EVT for anterior circulation LVO stroke beyond 24-h from symptom onset and assess safety and efficacy. ⋯ Four patients achieved functional independence at 90-days (mRS 0-2). Conclusion: Endovascular thrombectomy for AIS patients beyond 24-h from symptom onset appears to be safe and effective in this limited study. There is a need for further evidence-based trials of benefit vs. risk in very prolonged time windows.
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Frontiers in neurology · Jan 2018
Psychological Resilience Is Associated With Participation Outcomes Following Mild to Severe Traumatic Brain Injury.
Traumatic brain injury (TBI) causes physical and cognitive-behavioral impairments that reduce participation in employment, leisure, and social relationships. Demographic and injury-related factors account for a small proportion of variance in participation post-injury. Personal factors such as resilience may also impact outcomes. ⋯ Resilience was a significant predictor of higher participation, along with shorter PTA duration, more years since injury, higher education and IQ, and younger age. Mediation analyses revealed depression mediated the relationship between resilience and participation. As greater resilience may protect against depression and enhance participation this may be a focus of intervention.
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Frontiers in neurology · Jan 2018
Case ReportsSporadic MM-1 Type Creutzfeldt-Jakob Disease With Hemiballic Presentation and No Cognitive Impairment Until Death: How New NCJDRSU Diagnostic Criteria May Allow Early Diagnosis.
Sporadic Creutzfeldt-Jakob disease is the most common human prion disorder. Although associated with heterogeneous clinical phenotypes, its distinctive feature is the presence of a rapidly progressive multidomain cognitive impairment. ⋯ We review sporadic Creutzfeldt-Jakob disease diagnostic criteria and their updates since their first formulation, highlighting their limitations in clinical diagnostic work-up. Finally, we discuss the recently introduced National Creutzfeldt-Jakob Disease Research and Surveillance Unit diagnostic criteria, suggesting how their application could support an early clinical diagnosis, even in atypical cases, such as the one presented.
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Frontiers in neurology · Jan 2018
Sport-Related Concussion Alters Indices of Dynamic Cerebral Autoregulation.
Sport-related concussion is known to affect a variety of brain functions. However, the impact of this brain injury on cerebral autoregulation (CA) is poorly understood. Thus, the goal of the current study was to determine the acute and cumulative effects of sport-related concussion on indices of dynamic CA. ⋯ Sustaining an acute sport-related concussion induces transient impairments in the capabilities of the cerebrovascular pressure-buffering system that may persist beyond 2 weeks and may be due to a period of autonomic dysregulation. Athletes with a history of three or more concussions did not exhibit impairments relative to those with zero prior concussions, suggesting recovery of function over time. Findings from this study support the potential need to consider physiological recovery in deciding when patients should return to play following a concussion.
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Frontiers in neurology · Jan 2018
Functional Connectivity of Anterior Insula Predicts Recovery of Patients With Disorders of Consciousness.
Background: We hypothesize that the anterior insula is important for maintenance of awareness. Here, we explored the functional connectivity alterations of the anterior insula with changes in the consciousness level or over time in patients with disorders of consciousness (DOC) and determined potential correlation with clinical outcomes. Methods: We examined 20 participants (9 patients with DOC and 11 healthy controls). ⋯ Conclusions: Our findings indicate that the recovery of consciousness is associated with an increased connectivity of the dAI to IPL and temporal pole. This possibly highlights the role of the insula in human consciousness. Moreover, longitudinal variations in dAI-IPL and dAI-temporal pole connectivity may be potential hallmarks in the outcome prediction of DOC patients.