Ocular Motility Abnormalities in Head Injury Patients

To study the effects of head trauma on extraocular movements. Eye movements are known to be affected in patients after severe head injuries. However, this has not been sufficiently studied in patients with mild to moderate head injuries. In addition, it has not been determined how long the abnormalities of ocular motility may persist.VBbraininjur

Comparison of Pupillography with Clinical RAPD

To determine the timing paradigm and dynamic response parameters that best correlate with the clinical relative afferent pupillary defect (RAPD)

Complete Optic Tract Lesion Following Gamma Knife Radiosurgery

Gamma knife radiosurgery is a very efficacious means of treating deep-seated arteriovenous malformations (AVM's). A total obliteration rate of 87% with a 3% incidence of permanent neurologic side effects has been reported

An Unusual Case of Sarcoidosis?

A previously healthy 24 year old woman developed acute nausea and emesis followed by headache, transient blurred vision, diplopia, and finally, disorientation over the ensuing 24 hours. The patient denied any toxin, tick or tuberculosis exposure, recent wight gain, menstrual changes, or oral contraceptive use. The initial neurologic exam revealed disorientation to time and place, right sixth cranial nerve palsy and papilledema OD

Cognitive impairment predicts social disability in persons with epilepsy

Introduction. Cognitive dysfunction is one of the main comorbidities of epilepsy which co-exists with seizures and contributes to the adverse impact of the disease on employment, education and interpersonal relationships. A fundamental question regarding cognitive dysfunction in epilepsy goes as follows: in comparison to seizures, what role does cognitive dysfunction play in causing social disability? The purpose of this review was to evaluate our understanding of the role cognitive impairment plays in social disability in persons with epilepsy (PWE). We systematically searched the medical literature and identified studies which assessed the impact of seizures and cognitive function on some aspect of social disability in PWE

Pre-operative electrodiagnostic studies and intraoperative neurophysiologic monitoring: power and pitfalls

Outpatient electrodiagnostic studies and intraoperative monitoring are essential tools for the surgical management of nerve injury. Decisions are based on the diagnostic certainty afforded by outpatient electrodiagnostic studies, which are more sensitive and specific than clinical examinations regarding the nature and localization of a nerve lesion. Intraoperative neurophysiologic monitoring detects changes in neurologic function during surgery. It provides significantly better information than visual inspection of the operative field, minimizing postoperative neurologic deficits due to surgical manipulation (e.g., stretching, compression, heating from electrocauterization, constriction, or clamping of local blood vessels). These techniques exploit similar neurophysiologic principles to afford enhanced diagnostic and real-time functional data during surgery. However, an understanding of their limitations is critical for the interpretation of these data. This review discusses these techniques, including their use, advantages, and disadvantages in diagnosing and managing three essential nerve lesions amenable to surgical management-radiculopathy, mononeuropathy, and brachial plexopathy

Possible axonal regrowth in late recovery from the minimally conscious state

We used diffusion tensor imaging (DTI) to study 2 patients with traumatic brain injury. The first patient recovered reliable expressive language after 19 years in a minimally conscious state (MCS); the second had remained in MCS for 6 years. Comparison of white matter integrity in the patients and 20 normal subjects using histograms of apparent diffusion constants and diffusion anisotropy identified widespread altered diffusivity and decreased anisotropy in the damaged white matter. These findings remained unchanged over an 18-month interval between 2 studies in the first patient. In addition, in this patient, we identified large, bilateral regions of posterior white matter with significantly increased anisotropy that reduced over 18 months. In contrast, notable increases in anisotropy within the midline cerebellar white matter in the second study correlated with marked clinical improvements in motor functions. This finding was further correlated with an increase in resting metabolism measured by PET in this subregion. Aberrant white matter structures were evident in the second patient’s DTI images but were not clinically correlated. We propose that axonal regrowth may underlie these findings and provide a biological mechanism for late recovery. Our results are discussed in the context of recent experimental studies that support this inference