Spontaneous Conus Medullary Infarction in the Absence of Cardiovascular Risk Factors

Spinal cord infarction (SCI) is rare and most often occurs in individuals with predisposing cardiovascular risk factors and traumatic injuries As there are no distinct diagnostic criteria for SCI, diagnosis is difficult in patients presenting without predisposing factors and is often mistaken for transverse myelitis. Delay in early diagnosis contributes to the high case fatality rate of SCI. This case highlights the importance of including SCI in the differential of a patient with acute paraparesis even in the absence of co-existing risk factors

Case report: Invasive neuromonitoring in status epilepticus induced hypoxic ischemic brain injury

ObjectivesLiterature on invasive neuromonitoring and bilateral decompressive craniectomies (BDC) in patients with refractory status epilepticus (RSE)-mediated hypoxic-ischemic brain injury (HIBI) is limited. Neuromonitoring can guide decision making and treatment escalation.Methods and resultsWe report a case of a 17 years-old male who was admitted to our hospital’s intensive care unit for RSE. HIBI was detected on neuroimaging on this patient’s second day of admission after he developed central diabetes insipidus (DI). Invasive neuromonitoring revealed raised intracranial pressure (ICP) and brain hypoxia as measured by reduced brain tissue oxygen tension (PbtO2). Treatments were escalated in a tiered fashion, including administration of hyperosmolar agents, analgesics, sedatives, and a neuromuscular blocking drug. Eventually, BDC was performed as a salvage therapy as a means of controlling refractory ICP crisis in the setting of diffuse cerebral edema (DCE) following HIBI.DiscussionSE-mediated HIBI can result in refractory ICP crisis. Neuromonitoring can help identify secondary brain injury (SBI), guide treatment strategies, including surgical interventions, and may lead to better outcomes

Peace accords in Northeast India : journey over milestones

For more about the East-West Center, see http://www.eastwestcenter.org/This monograph examines the effectiveness and sustainability of peace accords in Northeast India. A comparative examination of thirteen accords signed in the region between 1949 and 2005 finds that only one--the Mizo Accord of 1986--was successful in creating an enduring peace. Most often, mediators and negotiators have seen a peace accord as an endpoint instead of viewing it as just one part of a peace process.Unfortunately, the accord-making processes in Northeast India have been flawed: preaccord talks have not been inclusive; the provisions agreed upon with one group frequently conflict with the interests of another; accords contain provisions that cannot be implemented; or they do not deal with core issues. Moreover, no responsive and accountable political infrastructure has been created in Northeast India either for conflict resolution or for governance itself.Arguing that holistic peace processes are more important than peace accords on their own, the author argues that to be successful peace processes should contain multiple platforms for dialogue, build civil society's ability to engage in the process, be inclusive and sustained, involve separate pacts for each area of agreement rather than omnibus accords, and imagine nonterritorial solutions

National Integration: The State in Search of Community

347 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1998.Chapter 1 lays out the intellectual context---Euro-American and South Asian---of the problem. Chapter 2 is a discussion of the political issues involved in writing and teaching history with a view to integrating the people in a state. Chapter 3 reconstructs the histories of the three communities studied on the basis of oral narratives and published accounts. Chapter 4 explicates the state's vision as stated in their constitutions and contrasts them with the views of the elite in the three communities. Chapter 5 shows that while the bases of vision might lie in history and socialization, the terrain of their contest is the definition of units within the state. Chapter 6 discusses the major findings of the study. The study, finding that the state is no more, no less than the primary facilitator of integration, identifies reconciliation and accommodation as important principles of both constitutional self-definition and state policy.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Hierarchical Cluster Analysis Identifies Distinct Physiological States After Acute Brain Injury

Background Analysis of intracranial multimodality monitoring data is challenging, and quantitative methods may help identify unique physiological signatures that inform therapeutic strategies and outcome prediction. The aim of this study was to test the hypothesis that data-driven approaches can identify distinct physiological states from intracranial multimodality monitoring data. Methods This was a single-center retrospective observational study of patients with either severe traumatic brain injury or high-grade subarachnoid hemorrhage who underwent invasive multimodality neuromonitoring. We used hierarchical cluster analysis to group hourly values for heart rate, mean arterial pressure, intracranial pressure, brain tissue oxygen, and cerebral microdialysis across all included patients into distinct groups. Average values for measured physiological variables were compared across the identified clusters, and physiological profiles from identified clusters were mapped onto physiological states known to occur after acute brain injury. The distribution of clusters was compared between patients with favorable outcome (discharged to home or acute rehab) and unfavorable outcome (in-hospital death or discharged to chronic nursing facility). Results A total of 1704 observations from 20 patients were included. Even though the difference in mean values for measured variables between patients with favorable and unfavorable outcome were small, we identified four distinct clusters within our data: (1) events with low brain tissue oxygen and high lactate-to-pyruvate ratio-values (consistent with cerebral ischemia), (2) events with higher intracranial pressure values without evidence for ischemia (3) events which appeared to be physiologically "normal," and (4) events with high cerebral lactate without brain hypoxia (consistent with cerebral hyperglycolysis). Patients with a favorable outcome had a greater proportion of cluster 3 (normal) events, whereas patients with an unfavorable outcome had a greater proportion of cluster 1 (ischemia) and cluster 4 (hyperglycolysis) events (p < 0.0001, Fisher-Freeman-Halton test). Conclusions A data-driven approach can identify distinct groupings from invasive multimodality neuromonitoring data that may have implications for therapeutic strategies and outcome predictions. These groupings could be used as classifiers to train machine learning models that can aid in the treatment of patients with acute brain injury. Further work is needed to replicate the findings of this exploratory study in larger data sets

Image_1_Safety and efficacy of peripheral nerve blocks to treat refractory headaches after aneurysmal subarachnoid hemorrhage – A pilot observational study.pdf

ObjectivesHeadache after aneurysmal subarachnoid hemorrhage (HASH) is common, severe, and often refractory to conventional treatments. Current treatment standards include medications including opioids, until the pain is mitigated. Peripheral nerve blocks (PNBs) may be an effective therapeutic option for HASH. We conducted a small before-and-after study of PNBs to determine safety, feasibility, and efficacy in treatment of HASH.MethodsWe conducted a pilot before-and-after observational study and collected data for 5 patients in a retrospective control group and 5 patients in a prospective intervention PNB group over a 12-month period. All patients received a standard treatment of medications including acetaminophen, magnesium, gabapentin, dexamethasone and anti-spasmodics or anti-emetics as needed. Patients in the intervention group received bilateral greater occipital, lesser occipital, and supraorbital PNBs in addition to medications. The primary outcome was pain severity, measured by Numeric pain rating scale (NPRS). All patients were followed for 1 week following enrollment.ResultsThe mean ages in the PNB group and control group were 58.6 and 57.4, respectively. One patient in the control group developed radiographic vasospasm. Three patients in both groups had radiographic hydrocephalus and IVH, requiring external ventricular drain (EVD) placement. The PNB group had an average reduction in mean raw pain score of 2.76 (4.68, 1.92 p = 0.024), and relative pain score by 0.26 (0.48, 0.22 p = 0.026), compared to the control group. The reduction occurred immediately after PNB administration.ConclusionPNB can be a safe, feasible and effective treatment modality for HASH. Further investigations with a larger sample size are warranted.</p

Table_1_Safety and efficacy of peripheral nerve blocks to treat refractory headaches after aneurysmal subarachnoid hemorrhage – A pilot observational study.docx

ObjectivesHeadache after aneurysmal subarachnoid hemorrhage (HASH) is common, severe, and often refractory to conventional treatments. Current treatment standards include medications including opioids, until the pain is mitigated. Peripheral nerve blocks (PNBs) may be an effective therapeutic option for HASH. We conducted a small before-and-after study of PNBs to determine safety, feasibility, and efficacy in treatment of HASH.MethodsWe conducted a pilot before-and-after observational study and collected data for 5 patients in a retrospective control group and 5 patients in a prospective intervention PNB group over a 12-month period. All patients received a standard treatment of medications including acetaminophen, magnesium, gabapentin, dexamethasone and anti-spasmodics or anti-emetics as needed. Patients in the intervention group received bilateral greater occipital, lesser occipital, and supraorbital PNBs in addition to medications. The primary outcome was pain severity, measured by Numeric pain rating scale (NPRS). All patients were followed for 1 week following enrollment.ResultsThe mean ages in the PNB group and control group were 58.6 and 57.4, respectively. One patient in the control group developed radiographic vasospasm. Three patients in both groups had radiographic hydrocephalus and IVH, requiring external ventricular drain (EVD) placement. The PNB group had an average reduction in mean raw pain score of 2.76 (4.68, 1.92 p = 0.024), and relative pain score by 0.26 (0.48, 0.22 p = 0.026), compared to the control group. The reduction occurred immediately after PNB administration.ConclusionPNB can be a safe, feasible and effective treatment modality for HASH. Further investigations with a larger sample size are warranted.</p