Early onset probable linezolid-induced encephalopathy

Linezolid is increasingly being utilized for the treatment of Gram-positive pathogens. While neurological complications with linezolid are rare, long-term exposure can be associated with neurotoxic effects. Patients with pre-existing neurologic sequelae or risk factors, such as alcohol abuse, diabetes, or concomitant administration of chemotherapeutic agents and/or antiretroviral therapy, may be more susceptible to the development of linezolid-induced neurotoxicity. We describe a 41-year-old male who developed early onset encephalopathy after a day and a half of linezolid therapy. Our patient had at least one significant risk factor (alcoholism), making linezolid-induced encephalopathy probable based upon the Naranjo probability scale. Clinicians should be aware of the potential for early onset linezolid-induced neurotoxicity, particularly in patients with concomitant risk factors.     

Clinical applications of biomarkers in pediatric traumatic brain injury

Introduction  

The diagnosis, treatment, and prediction of outcome in pediatric traumatic brain injury (TBI) present significant challenges to the treating clinician. Clinical and radiological tools for assessing injury severity and predicting outcome, in particular, lack sensitivity and specificity. In patients with mild TBI, often there is uncertainty about which patients should undergo radiological imaging and who is at risk for long term neurological sequelae. In severe TBI, often there is uncertainty about which patients will experience secondary insults and what the outcome for individual patients will be. In several other clinical specialties, biomarkers are used to diagnose disease, direct treatment, and prognosticate. However, an ideal biomarker for brain injury has not been found.     

Complications of thoracic spine surgery – Their avoidance and management

As the surgical techniques have been significantly developed, thoracic spine surgery is currently increasingly indicated for a variety of pathologies such as degenerative spondylosis, ligament ossification, spinal deformity, infectious diseases, trauma and tumors. Thoracic spine has the distinctive anatomy with the rib attachment and the proximity to great vessels and lungs, and spinal cord has particular vulnerability due to its unique circulation system. Thus, both anterior and posterior approach surgeries have their own risks unique to this spinal segment. To be capable of challenging the spinal disorders in thoracic spine, surgeons must be aware of possible complications and their avoidance methods as well as management strategy. In the present narrative review paper, the complications in thoracic spine surgery are categorized into approach-related complications, neurological complications, wound-related complications, mechanical and instrument-related complications, as well as medical complications along with pre-, intra- and post-operative considerations. Their pathologies, possible sequelae, incidence, risk factors, prevention and management are discussed. As for some of the complications that are also commonly seen in cervical or lumbar spine, focus is placed on their importance in thoracic spine surgery. To prevent these adverse events associated with thoracic spine surgery, surgeons should be familiar with detailed knowledge of thoracic anatomy related to its approach as well as physiological characteristics.     

Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients

A prospective analysis of 421 patients undergoing coronary artery bypass graft (CABG) surgery as the sole cardiac procedure was carried out to assess the frequency of central nervous system (CNS) complications. In all, 451 variables were assessed in each patient. Stroke occurred in 5.2% but was severe in only 2%. Prolonged encephalopathy occurred in 11.6% but usually resolved before discharge. No statistically significant pre- or intraoperative risk variables for CNS complications were found; specifically, age or pump times in excess of two hours were not significant factors. Postoperative use of an intraaortic balloon pump and pressor agents were significantly correlated with prolonged encephalopathy. The frequency of CNS injury in CABG surgery is similar to that in other forms of open heart surgery, and there has been little change in the frequency of CNS complications over the past seven years. Possible mechanisms of CNS damage during CABG surgery are discussed.     

Neuropsychiatric consequences of coronary artery bypass grafting and noncardiovascular surgery

This paper reviews findings regarding short- and long-term neuropsychiatric consequences of coronary artery bypass grafting (CABG) and noncardiac surgery. Stroke is one of the potentially most serious complications of CABG; studies have identified some demographic and medical risk factors. Short-term neuropsychological deficits are common after CABG, but have been similarly documented in noncardiac surgery patients, and may therefore not be specific to this procedure. Neuropsychological deficits in some cognitive areas may persist over time. Patients with depression before surgery are likely to have persistent depression afterwards. Also, depression does not account for the cognitive decline after CABG. Conflicting findings, and the possible methodological limitations of current published studies, are presented and discussed.     

Does COVID-19 increase the risk of neuropsychiatric sequelae? Evidence from a mendelian randomization approach

Observational studies based on electronic health records (EHR) report an increased risk of neurological/neuropsychiatric sequelae for patients who have had coronavirus disease 2019 (COVID-19). However, these studies may suffer from biases such as unmeasured confounding, residual reverse causality, or lack of precision in EHR-based diagnoses. To rule out these biases, we tested causal links between COVID-19 and different potential neurological/neuropsychiatric sequelae through a two-sample Mendelian randomization analysis of summary statistics from large Genome-Wide Association Scans of susceptibility to COVID-19 and different neurological and neuropsychiatric disorders, including major depression, anxiety, schizophrenia, stroke, Parkinson’s and Alzheimer’s diseases. We found robust evidence suggesting that COVID-19 – notably the hospitalized and most severe forms – carries an increased risk of neuropsychiatric sequelae, particularly Alzheimer’s disease, and to a lesser extent anxiety disorder. In line with a large longitudinal EHR-based study, this evidence was stronger for more severe COVID-19 forms. These results call for a targeted screening strategy to tackle the post-COVID neuropsychiatric pandemic.     

Structural evidence of injury or malformation in the brains of children with congenital heart disease

Neurological and developmental deficits are common in children with congenital heart disease (CHD). These are due to multiple factors that include the etiology of the CHD, the effects of abnormal cardiovascular function, and the possible sequelae of open heart surgery. CHD is frequently part of a multiple malformation syndrome that includes the brain. The causes of these syndromes include known or putative genetic defects. Abnormal cardiovascular function may be associated with poor brain growth, embolic infarction, cerebrovascular thrombosis, and abscess formation. Perioperative neurological complications include diffuse hypoxic-ischemic injury (particularly in neonates who undergo more than 45 to 60 minutes of hypothermic circulatory arrest), cerebral macro- and micro-emboli, dural sinus thrombosis, and cerebral hemorrhage. Neuroimaging, especially magnetic resonance imaging, is a useful prognostic instrument, can easily display gross congenital and acquired lesions, and should be performed preoperatively in addition to genetic studies. In some instances poor brain function may not be predicted unless slow head growth or microcephaly is present and thorough preoperative neurodevelopmental evaluation is encouraged.     

A study of the psychological factors in outcomes for officers who survive ballistic assault

Among law enforcement personnel, who are subject to assault with firearms, there has been a trend toward decreased mortality and physical morbidity associated with the use of personal protective armor (PPA). Although there has been an increase in the rate of survival, studies of the unique psychological factors associated with this type of assault are essentially nonexistent. The prevalence and nature of the negative psychological sequelae associated with this type of assault and psychological injury, along with effective prevention techniques, were studied through retrospective interviews of registrants in two "body armor survival clubs." Significant relationships were found between available interventions and behavioral health outcomes. In addition to reducing the likelihood of poor health outcomes, departmentally based interventions were related to officers' ability to develop positive interpretations of the event and engage in fewer high risk behaviors. These findings suggest that departmental interventions, such as debriefings, are meaningful and may help improve outcomes for officers fired upon, but not wounded, in the line of duty.     

A Follow-up Study of Very Low-birthweight Infants Receiving Ventilatory Support by Face Mask

Recent evidence has suggested that face-mask ventilation of very low birthweight (VLBW) infants may have serious neurological consequences. The 30 surviving VLBW infants from the neonatal intensive care unit at Hammersmith Hospital who had received ventilatory support via face masks over a 25-month period have been reviewed and compared with a control group. Neuropathological findings in the VLBW infants who died during this time have also been reviewed in relation to their ventilatory management. The findings suggest that face-mask treament did not have a major deleterious effect on the surviving infants. The factors which may determine the neurological sequelae of this form of ventilatory support are discussed.     

Benefit of multiple sessions of perilesional repetitive transcranial magnetic stimulation for an effective rehabilitation of visuospatial function

Noninvasive neurostimulation techniques have been used alone or in conjunction with rehabilitation therapy to treat the neurological sequelae of brain damage with rather variable therapeutic outcomes. One potential factor limiting a consistent success for such techniques may be the limited number of sessions carried out in patients, despite reports that their accrual may play a key role in alleviating neurological deficits long‐term. In this study, we tested the effects of seventy consecutive sessions of perilesional high‐frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic neglect deficits in a well‐established feline model of visuospatial neglect. Under identical rTMS parameters and visuospatial testing regimes, half of the subjects improved in visuospatial orienting performance. The other half experienced either none or extremely moderate ameliorations in the neglected hemispace and displayed transient patterns of maladaptive visuospatial behavior. Detailed analyses suggest that lesion location and extent did not account for the behavioral differences observed between these two groups of animals. We conclude that multi‐session perilesional rTMS regimes have the potential to induce functional ameliorations following focal chronic brain injury, and that behavioral performance prior to the onset of the rTMS treatment is the factor that best predicts positive outcomes for noninvasive neurostimulation treatments in visuospatial neglect.     

Post-COVID 19 neurological syndrome: Implications for sequelae’s treatment

Study designLiterature review.ObjectivesDescribe the implications of post-COVID syndrome due to neurological sequelae including treatment and the differences that may exist between this group of patients and those who present these events not associated with COVID-19.MethodsA non-systematic review of the literature was carried out in PubMed and Science Direct databases, using the keywords “Post-acute COVID-19 syndrome”; “Neurological complications”; “Neurologic Manifestations” “COVID-19″ and ”Rehabilitation“, as well as synonyms, which were combined with the operators ”AND“ and ”OR“.ResultsThe COVID-19 viral caustive agent, SARS-CoV-2, has a high affinity for human angiotensin-converting enzyme 2 receptor on type II pneumocytes. This receptor is also expressed in neurons and glial cells. Based on the foregoing and other not so clear mechanisms, it is stated that SARS-CoV-2 has tropism for the nervous system, being evident through the neurological manifestations observed in patients with mild, moderate and severe phenotype of the disease such as anosmia, ageusia, headache, cerebrovascular accidents, Guillain-Barré syndrome, seizures, and encephalopathy. This can generate severe sequelae and even fatal outcomes in those affected.ConclusionsNeurological complications caused by COVID-19 are frequent and represent a risk that compromises the functional capacity and the life of patients. The suspicion of these conditions, the strict control of metabolic alterations and cardiovascular risk factors, the effective and safe treatment of these entities, are a current challenge throughout the pandemic. The rehabilitation process in these patients is a challenge. This is due to the limitations generated by multi-organ damage, as well as risk of brain death.     

老年脑膜瘤术后发生并发症的危险因素分析

目的 探讨老年（年龄≥65岁）脑膜瘤术后发生并发症的危险因素。方法 回顾性分析2014年1月至2019年12月手术治疗的227例老年脑膜瘤的临床资料。术后并发症是指导致住院时间延长、术后神经功能缺失或需行各项临床操作甚至二次手术的异常情况,分为神经系统并发症（如颅内出血、癫痫、脑脊液漏、颅内感染、新发神经功能障碍、精神症状等）和全身并发症（如切口愈合不良、肺部感染、心功能异常、肝肾功能损害、消化道出血、深静脉血栓等）。结果 227例中,术后56例（24.67%）有并发症,其中神经系统并发症39例,全身并发症21例。多因素logistic回归分析显示,术前KPS评分<80分、肿瘤最大直径≥6 cm、肿瘤未全切除是术后发生神经系统并发症的独立危险因素（P<0.05）;美国麻醉医师协会（ASA）分级Ⅲ~Ⅳ级、术前血清白蛋白<35 g/L、术中异体输血是术后发生全身并发症的独立危险因素（P<0.05）。结论 老年脑膜瘤术后并发症发生率较高。肿瘤大小及切除程度与术后神经系统并发症有关,而术前身体状况（例如ASA分级、KPS评分、血清白蛋白）、术中输血与术后全身并发症相关。     

Neurobehavioral aspects of postconcussive symptoms after mild head injury.

The sequelae of severe closed head injury have received much attention in the literature, but the effects of mild closed head injury (MHI) are less well established. There is a subgroup of patients who complain of persisting postconcussive symptoms (PCS) beyond the first weeks of recovery. Although the symptoms generally develop in the absence of clear neurological abnormalities, the condition of PCS can be chronic and disabling. It has been assumed that PCS result from an interaction between organic and psychological factors. Differentiating between the effect of primary neurological injury and secondary psychosocial problems is often difficult for clinicians and engenders controversy. Neuropsychological, neurophysiological, and neuroimaging measures can be helpful in selecting patients at risk of developing PCS. Assessment of the level of cognitive functioning, individual susceptibility to stress, and environmental demands may be beneficial in treating symptomatic patients. It is true that the vague and aspecific nature of the postconcussion syndrome may have given rise to the controversy over this entity, but the many methodological inconsistencies in the experimental approaches to the syndrome have certainly enhanced the confusion about this issue. The ensuing controversy surrounding research on the outcome of MHI and the postconcussion syndrome reflects ambiguities in definition, inconsistencies in criteria for patient selection, variation in procedures for neurobehavioral assessment, and difficulty in obtaining follow-up data.     

Méningoencéphalite à Rickettsia conorii chez un nourrisson

Introduction

Mediterranean spotted fever is an infectious disease due to Rickettsia conori, endemic in the Mediterranean basin. It is usually considered to be a benign disease; however, severe systemic manifestations have been reported in which neurological involvement occurs. These complications are rare in children.

Case report

We report a case of a 14-month-old boy, who was hospitalized for meningoencephalitis after seven days of high fever and maculopapular rash. On clinical observation there were generalized maculopapular elements and an inoculation eschar tache noire at the right ear. The diagnosis of Mediterranean spotted fever was established by epidemiological and clinical features and was confirmed by elevated IgM antibody titres against R. conorii by indirect immunofluorescence assay. Despite treatment with macrolides and corticosteroids, severe neurological sequelae have remained including decreased vision and epileptic seizures.

Conclusion

The physiopathology of Mediterranean spotted fever includes diffuse vasculitis with endothelial injury. Early diagnosis and specific antibiotic treatment may reduce the risk of complications.     

Neurological and neuroradiological findings in long-term survivors of allogeneic bone marrow transplantation

The aim of this study was to assess neurological, neuropsychological, and neuroradiological findings in long-term survivors of allogeneic bone marrow transplantation (BMT) who were recruited from a hematological outpatient clinic. In addition, risk factors for the development of late neurological complications were identified. In contrast to previous studies on autopsied patients, our study design provoked a bias away from increased neurological sequelae, because patients with early complications after BMT were excluded. Fifty-nine allogeneic patients and 7 autologous BMT patients underwent clinical examination, short neuropsychological testing, and cranial magnetic resonance imaging (MRI) 34 ± 26 months after BMT. The pathological results of the neurological examination (abnormal 64%) and the MRI examination (white matter lesions, 54%; atrophy, 11%) were associated with the occurrence of chronic graft-versus-host disease (GvHD) evolving from acute GvHD, with corticosteroid therapy and with cyclosporine medication. Neuropsychological impairment (cognitive deficits, 37%) was associated with long-term cyclosporine medication and age. No influence of pre-BMT disease, BMT donor status, or the conditioning regimen was found. These results suggest that the frequent neurological abnormalities in long-term survivors of allogeneic BMT are associated with chronic GvHD and with the resulting immunosuppression as major risk factors.     

Post Stroke Depression: Treatments and Complications in a Young Adult

Post-stroke depression has been noted to be one of the most frequent complications of stroke with an estimated prevalence of as high as 80%. However, the incidence of stroke in the young is extremely low and evidence based therapy for this complication is quite limited. The case of a 28-year-old woman who experienced a basilar artery vasospasmic stroke resulting in anoxic brain injury to the midbrain and paramedian thalamus is presented, along with a literature review of psychiatric complications of this injury to include post-stroke depression (PSD). Therapeutic modalities such as TCAs, SSRIs, atypical antipsychotics and stimulant medications are also reviewed as these medications may aid in the treatment of such patients but may also contribute to psychiatric sequelae.     

Brain hypoxic-injury of hemorrhagic pattern in newborns: analysis of 1028 autopsies from 1960 to 1995

Hypoxic-ischaemic injury of the central nervous system (CNS) in newborns is a very prevalent entity affecting 1 to 6 children per 1000 births. This injury may induce severe neurological sequelae. We present the analysis of 1028 consecutive cases of hypoxic-ischaemic CNS injuries of haemorrhagic pattern detected in autopsies performed at the Division of Anatomic Pathology, Hospital de Clínicas, University of Paraná, Brazil, from 1960 to 1995. The prevalence of these lesions was high (49.73%) amongst all autopsied newborns. The main types of haemorrhage were microscopical intra-parenchymal haemorrhages, intraventricular and periventricular haemorrhages and subarachnoid foci of bleeding. Our results emphasize that premature children constitute a high risk group for CNS haemorrhage needing special preventive therapeutic procedures to avoid neurological complications.     

Pott's puffy tumour: still not an eradicated entity

Pott's puffy tumour is an infrequent entity characterised by one or more subperiosteal abscesses associated with frontal bone osteomyelitis. Although cases in patients of all ages have been reported, teenagers are the most frequently affected. Early diagnosis and aggressive treatment are essential because of the high risk of severe neurological complications, such as epidural abscess, subdural empyema, and secondary septic thrombosis of the dural sinuses. This paper describes the case of a patient with a subperiosteal abscess resulting from sinusitis, with orbital and intracranial extension, and subsequent neurological complications. Despite modern methods of diagnosis and treatment, 13 new cases have been published in the last 5 years; in at least 3 (23%) of these cases there were serious neurological complications. Upper respiratory infections and sinusitis are leading causes of visits to the emergency department in the paediatric age group; however, no risk factors for poor outcome have so far been identified in any of these patients.     

Neurocognitive sequela of burn injury in the elderly

Elderly individuals are a fast-rising segment of the US population and are at high risk of permanent disability and premature death secondary to traumatic injuries such as burn injury. The current paper will review the extant literature to understand the prevalence of burn injury in the elderly, the neurocognitive complications unique to the aged that places this cohort at risk, and evidence-based recommendations to reduce the early and late neurocognitive effects of burn injury in the aged. The elderly are a high-risk population for burn injury and its neurological sequela. This risk, at least in part, reflects multiple factors: age-related changes in the central and peripheral nervous system; multiple pre-existing co-morbidities (such as dementia and COPD); polypharmacy; suboptimal social support; and increased susceptibility to hypothermia, burn-related infections, and electrolyte and metabolic dysregulations.     

Monitoring the central nervous system in children with congenital heart defects: clinical neurophysiological techniques

The neurological sequelae following surgery for complex cardiac malformations is being increasingly recognized. The electroencephalogram (EEG) and evoked potentials may be used as monitors of neurological integrity. Criteria for a successful intensive care unit monitoring system have been proposed. EEG findings in the preoperative, perioperative, and postoperative periods are reviewed and may aid in the prediction of neurological sequelae. Recent advances in the development of a computerized neurophysiological monitor at the Montreal Children's Hospital are reviewed. Evoked potentials, auditory, somatosensory, and visual can be used to monitor children with complex cardiac lesions and evaluate them for potential neurological sequelae.