This is the first study demonstrating a pronounced inflammatory reaction centrally (as reflected in CSF) as a consequence of arthroplastic knee surgery in humans. Notably, the relative cytokine increase in CSF is much larger than in serum. The lack of correlations between peripheral (that is, serum) and central levels of cytokines may indicate that inflammatory reactions in the brain during non-neurologicalsurgery are regulated separately from the periphery. However, a subgroup of subjects revealed a stronger inflammatory response. This effect seemed related to high BBB permeability, suggesting that some individuals, without any known neurological or psychiatric diagnosis, may have a more sensitive BBB and be particularly prone to exaggerated neuroinflammatory responses following peripheral surgery. Considering that CNS inflammation is a risk factor for neuropsychiatric complications, such as postoperative delirium, such indi- viduals may be considered high-risk and may benefit from anti-inflammatory interventions. Consequently, novel approaches for preventing neuropsychiatric surgical complications could possibly target the inflammatory process.
Director, Adult Brain & Spinal Cord Tumor Programs, Levine Cancer Institute, Carolinas HealthCare System and Presbyterian Hospital; Co-Medical Director, Neuroscience Institute, Carolinas HealthCare System; Clinical Professor of NeurologicalSurgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
No discussion on the subject of medical-legal issues and testimony would be complete without referring to the guidelines for expert opinion as established and updated by national societies, in particular, the American Association of Neurological Surgeons  . Such national standards have been imposed to provide for responsible and appropriate reviews and testimony, to identify departure from generally accepted neurosurgical practice rather than a personal opinion. The stated rules also require the neurosurgical expert witness to be an bimpartialQ educator for attorneys, judges, and jurors, virtually impossible in an adversary system when the expert is engaged by one side with the intention of supporting its particular position. Although hardly impartial, the expert can at least apply restraint in his testimony to avoid excessive and irresponsible opinions. The long-standing Professional Conduct Committee of the American Association of Neurological Surgeons receives complaints from neurosurgeons who have grievances concerning testimony of plaintiff experts and provides a judicial type of review to determine if there has been infraction of the rules. This may of course act as a deterrent of incorrect testimony, but it can also represent yet another layer of controversial opinion short of a reasonable solution. The Journal of the American Medical Association in a critical editorial condemned the adversary practice of pitting physicians against each other and called the attempt at bringing out expert medical testimony a bdisgraceful failureQ
The focus and thoroughness of the neurological examination must be tailored to the chief complaint and symptoms manifest by the patient. Furthermore, the examination must be modified by the condition of the patient. A trauma patient with multiple injuries requires a focused and rapid neurological examination to enable the trauma surgeon and the neurosurgeon to prioritize the injuries and proceed with appropriate diagnostic tests and, ultimately, treatment. In a patient seeking relief for back and leg pain associated with nerve root compression, spending extensive time examining higher cerebral function, cerebellar and cranial nerve function may not represent the most economical use of the surgeon’s and patient's time.
In this paper, Neurological Disorder Diagnosis System (NDDS) has been developed which by applying a question answer session with the patient detect the neurological disorder of the patient. The approach used for this system is rule based approach which uses backward chaining procedure for its implementation. The system can diagnose about 10 type of neurological disorder with this approach with accuracy equivalent to that of an expert. There are various stages in the development of the system.
Migraine is a primary headache disorder characterized by periodic attacks that are variably associated with nausea, vomiting, and neurological symptoms. Pain is typically associated with increased sensitivity to light and noise. The attacks last 4-72 hours and their frequency is variable. The majority of patients have one attack or less per week which lasts <24 hours Migraine affects >10% of the world’s population and its frequency is reported to be >5% in Africa. A family history of migraine is present in most patients and people usually suffer their first attack in their teens or early twenties, or before the age of 40 yrs. Women are affected twice as often as men. There are a number of well known triggers for individual attacks of migraine; these include stress, relaxation, fatigue, hunger, exercise, menstruation and specific foods including cheese, chocolate, red wine, citrus fruits, food additives and caffeine. Spontaneous remission may occur during pregnancy and after the menopause.
Background: Neurological involvement in dengue was previously observed as an encephalopathy mainly due to prolonged shock, hyponatremia and liver failure. Recently, direct neurotropic potential of the virus has been recognized. This study was performed to record the neurological complications in children with dengue infection. Methods: A prospective, cross-sectional study was conducted in 315 consecutive pediatric cases of dengue fever to record the neurological complications and perform detailed clinical evaluation and laboratory assessment. These patients were admitted in the pediatric ward or ICU of the Department of Pediatrics of a tertiary care teaching hospital located 50 km from Jaipur city amidst rural surroundings from 1 st January 2016 till 31 st October 2017. Appropriate
Cerebral oxygen and glucose consumption generally in- crease in hyperthermic states, but the precise relationship with temperature is unclear, and there is considerable re- gional variability . With modest increases in core temperature, cerebral metabolic rate increases in some areas, but decreases in others. In more extremes of hyper- thermia, mitochondrial oxygen metabolism may not be in- creased beyond that experienced at normothermia, and beyond 40 °C may then decrease . This may imply either impaired uptake of mitochondrial oxygen at hyper- thermic temperatures, but in the absence of a raised lac- tate may indicate a reduction in cerebral metabolic activity at increased temperatures, and thereby account for the cognitive and neurological signs and symptoms.
ly but can lead to various immediate and de- layed neurological and neuropsychological consequences. Many physicians are familiar with high voltage injury with signifi cant full thickness burns, peripheral nerve damage, and possibly brain ischaemia secondary to cardi- orespiratory arrest. Other indirect neurologi- cal consequences are traumatic brain and spinal cord injury secondary to a fall after the electrical injury. Neurologists may be less familiar with delayed spinal cord damage and a clinical pic- ture such as a lower motor neuron syndrome, amyotrophic lateral sclerosis, or transverse my- elitis – days or decades following the electrical injury.
The studies done on the various neurological manifestations at various centres in different countries were reviewed. There are no larger studies on CNS vasculitis in RA and most of them are case reports. Cerebral vasculitis in rheumatoid arthritis has been reported rarely and spinal cord vasculitis not at all. Watson P et al reported a patient with rheumatoid arthritis and necrotizing vasculitis affecting only the central nervous system. Clinical and pathological involvement by this process was shown in both cerebral hemispheres, the pons and spinal cord (19). Mandybur TI et al reported three cases of cerebral amyloid angiopathy. There was also a chronic cerebral vasculitis characterized by segmental fibrinoid necrosis, chronic adventitial inflammatory infiltrates, obliterative "endarteritis" and hyaline arteriolar change, resembling rheumatoid vasculitis. Two of these cases had rheumatoid arthritis, and one had unspecified "arthritis" at the onset of dementia. Both vasculitis and amyloidosis involved the leptomeningeal and cerebral cortical vessels. In the two autopsy-verified cases, the vascular disease was limited to the brain. In the third case, only a brain biopsy was available. Amyloid-containing neuritic plaques were present in the cerebral cortex in all three cases, but they were abundant only in one, which also showed numerous Alzheimer tangles (20).Kim RC et al have reported extensive rheumatoid lesions in the cranial dura, falx, and choroid plexus in a 63-year-old
Microelectrode mapping was done with three electrodes. Test stimulation was performed to verify correct placement and define the therapeutic window (TW). Once desired position depth was reached at the central part of the STN, the stylets were replaced with segmented DBS electrodes The right STN stimulation was started at -5mm from the target point. At -4mm anterior and central a sufficient stimulation effect was seen. Sufficient stimulation could be continued till +1.5mm. At the target point sufficient stimulation was seen in all three microelectrodes. A sufficient reduction of rigor and tremor in the neurological examination was