Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction

Activation of the NF-kB pathway during Neocortical Development

During neural development a wide variety of neuronal and glial cells are produced from neural precursor cells. The regulation of the transition from proliferation to differentiation, migration and final functional integration into neural circuits is a highly elaborate process requiring complex and tightly regulated interactions of various extrinsic and intrinsic factors present in the developing central nervous system. Disturbance of one or more of these processes may result in severe perturbations of normal development and function of the brain. The NF-κB signaling pathway is important for several brain functions such as neuronal survival, plasticity, learning, memory consolidation and neurodegeneration. Although it has been recently shown that NF-κB is activated during development of the forebrain, virtually nothing is known about its possible involvement in neurogenesis. This work aimed at characterizing the pattern of NF-κB activation during telencephalic neurogenesis in developing mouse embryos. It is shown here that NF-κB signaling is activated in neural progenitor cells in the dorsal telencephalon, as well as in post-mitotic neurons of the cortical plate throughout the period of neurogenesis. The possible role of NF-κB in neural progenitor cell proliferation and maintenance is discussed.Au cours du développement neuronal, une grande variété de cellules neuronales et gliales sont produites à partir de cellules précurseurs neurales. Le contrôle de la transition de la phase proliférative vers la différenciation cellulaire, de même que la migration et l'intégration fonctionnelle finale à l'intérieur de circuits neuronaux sont des processus hautement complexes nécessitant des interactions complexes et étroitement contrôlées de divers facteurs extrinsèques et intrinsèques présents dans le système nerveux central en développement. Des perturbations d'un ou de plusieurs de ces processus peuvent entraîner des troubles graves du développement et du fonctionnement normal du cerveau. Il a été démontré que la voie de signalisation NF-kB est importante pour plusieurs fonctions cérébrales telles que la survie neuronale, la plasticité, l'apprentissage, la consolidation de la mémoire et la neurodégénérescence. Bien qu'il ait été récemment montré que la voie NF-kB est activé au cours du développement du cerveau antérieur, son éventuelle implication dans la neurogenèse n'est pas connue. Ce travail vise à caractériser le modèle de l'activation de la voie NF-kB cours de la neurogenèse télencéphalique d'embryons de souris en développement. Cette etude démontre que la signalisation NF-kB est activée dans les cellules progénitrices neurales du télencéphale dorsal, ainsi que dans les neurones post-mitotiques de la plaque corticale pendant toute la durée de la neurogenèse. Le rôle presumé de la voie NF-kB au cours de la prolifération et du maintient des cellules progénitrices neurales seront discutés

Camel Bite Associated with Depressed Skull Fracture with Rapidly Spreading Subgaleal Cellulitis

Camel bite represents a minimal proportion, and most of them are from the Middle East countries. Their infectious potential is poorly understood, and the guidelines for antimicrobial treatment are not well developed. We describe a 40-year-old male, who works as a camel herder and was bitten by a camel while he was tying it down which led to a unilateral depressed skull fracture and multiple bilateral teeth-puncture wounds in the scalp. He arrived to our emergency department 3 hours after injury. All the wounds were dry and the skin around them was healthy looking with no subcutaneous collections. CT scan of the head showed depressed skull fracture on the left temporal region. Within 12 hours, the patient developed spreading cellulitis in the scalp. This necessitated an urgent surgical intervention. The added challenge is the presence of a dural breach. Our patient presented a challenge at several levels. He presented early with clean puncture wounds that were treated according to the most agreed upon guidelines. But our novel finding of rapidly spreading cellulitis requires alteration of recommendation towards more aggressive therapeutic attitude including early surgical intervention, especially for those patients suspected of a dural tear with the depressed skull fracture, even if treated with appropriate antibiotics

Early abnormal transient hyperemic response test can predict delayed ischemic neurologic deficit in subarachnoid hemorrhage

Abstract Background Early detection of vasospasm is crucial to prevent significant delayed ischemic neurological deficit post subarachnoid hemorrhage. The standard methods of detection, including cerebral angiogram and computed tomography are invasive and not safe to be repeated, as is very often indicated clinically. Transient hyperemic response test has been previously used to predict autoregulation failure in traumatic brain injury and subarachnoid hemorrhage. Aims We investigate the usability of transient hyperemic response test as a predictor of clinical vasospasm in a cohort of patients with aneurismal subarachnoid hemorrhage. Methods A retrospective review of all THRT examinations done between January 2011 and July 2012 conducted at Montreal Neurological Institute and Hospital and the Montreal General Hospital. Patients diagnosed with aSAH in which the THRT was performed within the first 24–48 h of admission were included in the study. Two-dimensional transcranial Doppler images were obtained and velocities were recorded. A positive response was one in which the velocity was increased by more than 9% of the baseline systolic velocity, indicating an intact cerebral autoregulation. Lindegaard ratio > 3 is considered abnormal and in the context of elevated systolic velocity of the MCA, is highly suggestive of DIND. Results Fifteen patients met the inclusion criteria. A total of 6 patients developed clinical and radiological vasospasm. Out of these 6 patients, 5 (83%) had an abnormal THRT in the initial TCD assessment (p = 0.0406). We found that abnormal transient hyperemic response test readings are predictive of subsequent vasospasm development. Conclusions The results of this small retrospective study support the notion that transient hyperemic response test has predictive value in vasospasm development and may prove useful in patient monitoring and successful clinical management

Functional results of electrical cortical stimulation of the lower sensory strip

The aim of this paper is to provide functional results obtained from electrical cortical stimulation of the lower postcentral gyrus in patients who underwent either lesional or non-lesional epilepsy surgery. Group I (n = 393) included those patients with gliosis or normal tissue and Group 11 (n = 107) included patients with space-occupying lesions. For cortical stimulation, a unipolar voltage-controlled electrode was used. The tongue, lip, and hand/finger sequences over the lower postcentral gyrus lateromedially in both groups were in agreement with classic teaching. The presence of structural lesions, such as tumors and dysplasia, did not affect the vertical representation of the body parts on the lower sensory strip. Individual variations, which included mosaicism over the sensory strip, were frequent. Whether the functional variability and mosaicism within the sensory cortex result from a pathological condition or not remains to be elucidated in healthy humans using advanced non-invasive brain mapping techniques. Crown Copyright (C) 2009 Published by Elsevier Ltd. All rights reserved

Spinal muscular atrophy and ependymoma

Spinal muscular atrophy (SMA) is an autosomal recessive disorder, characterized by a progressive degeneration of anterior horn cells of the spinal cord resulting in hypotonia, skeletal muscle atrophy and weakness. We report the case of a 33-year-old female with SMA type IV (SMA4) who presented with symptoms of spinal cord lesion that was initially missed. Further evaluation resulted in the diagnosis of ependymoma. To the best of our knowledge, this is the first time that the coexistence of SMA4 and ependymoma has been reported

CT Perfusion to Guide Placement of Invasive Cerebral Perfusion Monitor in Subarachnoid Hemorrhage Induced Vasospasm

Background. Vasospasm is a challenging component of the subarachnoid hemorrhage “syndrome” that is unpredictable and very difficult to monitor using noninvasive or invasive monitoring technologies in neurocritical units. Methods. We describe the novel use of computerized tomography perfusion (CTP) imaging to choose proper targets for invasive cerebral blood flow monitors. Results. A total of 3 patients are included in this report. CTP parameters were used to generate points of interest to target using invasive cerebral monitoring of the cerebral blood flow and initiate vasodilator therapy and subsequently guide its weaning. Conclusions. CTP can be useful in localizing a specific anatomical target for invasive monitoring in subarachnoid hemorrhage patients suffering from vasospasm

Sellar hematoma as a new potential radiological clue for superior hypophyseal artery aneurysm rupture

Background. In cases of spontaneous subarachnoid haemorrhage (SAH) with multiple intracranial aneurysms (MIAs) detected on angiography, some radiological clues assist in determining the site of a ruptured aneurysm which is bleeding is quite beneficial for the selection of the best treatment strategy. Case description. We report a case of a 60 years old patient who presented with spontaneous SAH, sellar hematoma, and three different aneurysms detected in angiography. Although the right Posterior communicating artery (PcomA) aneurysms showed Murphy’s teat on angiography intraoperatively, we discovered that the right superior hypophyseal aneurysm (SHA) was the source of the index bleeding. Both aneurysms were clipped successfully. Conclusion. From the preoperative radiological and intraoperative surgical findings, we propose that sellar hematoma on a non-contrast CT scan is a new potential sign to be correlated with superior hypophyseal artery aneurysm rupture