Różnice wartości zautomatyzowanej pupilometrii służą jako wskaźnik prognostyczny, nawet gdy mieszczą się w normalnym zakresie

Introduction. The pupillary light reflex (PLR) is an integral aspect of the neurologic exam. With the enhancement of automated infrared pupillometry (AIP), the Neurological Pupil index (NPi) is being increasingly used when performing a neurological examination. NPi difference (the absolute difference between paired NPi readings from the left and right eye) is a relatively unexplored variable in AIP assessment.Aim. This study evaluates the association between Glasgow Coma Scale (GCS) scores and NPi differences between the left and right eyes, when the NPi is normal, in patients enrolled in a multi-center prospective database.Material and Methods. Restricting observations to only include NPi values ≥ 3 (normal), there were 2,572 qualifying patients with 3,519 pupillometer readings linked to GCS values. Linear regression and ANOVA models were developed to investigate the relationship between GCS and NPi difference.Results. Subject mean age was 55.88 (16.95) years and 54.5% were female. Mean NPi difference was 0.36 and mean GCS was 12.06. Regression analysis indicated a slight negative association between NPi difference and GCS (r2 = 0.0696, P < .0001). When observations were dichotomized as either NPi difference ≥ 0.7 (large) or < 0.7 (small), there was a statistically significant difference in the mean GCS (10.76 [3.90]) for large NPi difference vs. small NPi difference (13.15 [2.68]; P < .0001).Conclusions. Even among patients with normal PLR, a large NPi difference is associated with lower GCS scores. Trending and evaluating the NPi difference may become an important aspect of patient assessment. (JNNN 2021;10(4):168–174)Wstęp. Odruch źreniczny na światło (PLR) jest integralną częścią badania neurologicznego. Wraz z udoskonaleniem automatycznej pupilometrii w podczerwieni (AIP), wskaźnik neurologiczny źrenicy (NPi) jest coraz częściej używany podczas wykonywania badań neurologicznych. Różnica NPi (bezwzględna różnica między sparowanymi odczytami NPi z lewego i prawego oka) jest stosunkowo niezbadaną zmienną w ocenie AIP.Cel. Niniejsze badanie ocenia związek między wynikami w skali Glasgow (GCS) a różnicami NPi między lewym i prawym okiem, gdy NPi jest prawidłowe, u pacjentów włączonych do wieloośrodkowej prospektywnej bazy danych.Materiał i metody. Ograniczając obserwacje tylko do wartości NPi ≥ 3 (normalne), zakwalifikowano 2572 pacjentów z 3519 odczytami z pupilometru powiązanymi z wartościami GCS. Opracowano modele regresji liniowej i ANOVA w celu zbadania związku między różnicami między GCS a NPi.Wyniki. Średnia wieku badanych wynosiła 55,88 (16,95) lat i 54,5% stanowiły kobiety. Średnia różnica NPi wynosiła 0,36, a średnia GCS 12,06. Analiza regresji wykazała niewielki negatywny związek między różnicą NPi a GCS (r2 = 0,0696, P < 0,0001). Gdy obserwacje zostały rozdzielone jako różnica NPi ≥ 0,7 (duża) lub < 0,7 (mała), wystąpiła statystycznie istotna różnica w średniej GCS (10,76 [3,90]) dla dużej różnicy NPi vs małej różnicy NPi (13,15 [2,68]); P < 0,0001).Wnioski. Nawet wśród pacjentów z prawidłowym PLR duża różnica w NPi wiąże się z niższymi wynikami GCS. Trendy i ocena różnicy NPi mogą stać się ważnym aspektem oceny pacjenta. (PNN 2021;10(4):168–174

Neurology exit examination system in India: a survey of examiners' perceptions and recommendations

Background: The traditional Neurology exit examination in India has remained unchanged over the last few decades. In developed countries, objective evaluation methods have replaced the traditional ones. A need for such methods has not been explored in India. Objective: We aimed to study the perceptions and key recommendations of Neurology examiners on the existing examination pattern. Material and Methods: We conducted an online survey of examiners perceptions and recommendations using a set of 10 multiple-choice questions and an open-ended question. Results: 46 examiners provided completed responses suitable for analysis. Nearly equal proportions (30%) of the examiners had 10 years, 10–25 years and >25 years' experience. 92% were not satisfied with current system, 95% did not find adequate time for correction of theory scripts, 90% felt that theory questions were random, and 95% had legibility issues. 84% felt that the practical exams do not test true learning, 98% felt the examination stress impairs the performance and 85% felt that there are no objective criteria to pass the candidate. 83% felt the current system-needed changes. The key suggestions provided by the examiners to improve the system included objective assessments like MCQ, OSCE, OSLER and DOPS, inclusion of larger number of short answer type questions and periodic internal assessments of the candidates. Conclusions: A vast majority of examiners favoured changes to the current examination system and provided key recommendations. A larger study is needed to extrapolate these findings to the rest of India

Oral anticoagulant re-initiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts

<div><p>Background</p><p>While oral anticoagulants (OACs) are highly effective for ischemic stroke prevention in atrial fibrillation, intracerebral hemorrhage (ICH) remains the most feared complication of OAC. Clinical controversy remains regarding OAC resumption and its timing for ICH survivors with atrial fibrillation because the balance between risks and benefits has not been investigated in randomized trials.</p><p>Aims/Hypothesis</p><p>To survey the practice of stroke neurologists, thrombosis experts and neurosurgeons on OAC re-initiation following OAC-associated ICH.</p><p>Methods</p><p>An online survey was distributed to members of the International Society for Thrombosis and Haemostasis, Canadian Stroke Consortium, NAVIGATE-ESUS trial investigators (Clinicatrials.gov identifier NCT02313909) and American Association of Neurological Surgeons. Demographic factors and 11 clinical scenarios were included.</p><p>Results</p><p>Two hundred twenty-eight participants from 38 countries completed the survey. Majority of participants were affiliated with academic centers, and >20% managed more than 15 OAC-associated ICH patients/year. Proportion of respondents suggesting OAC anticoagulant resumption varied from 30% (for cerebral amyloid angiopathy) to 98% (for traumatic ICH). Within this group, there was wide distribution in response for timing of resumption: 21.4% preferred to re-start OACs after 1–3 weeks of incident ICH, while 25.3% opted to start after 1–3 months. Neurosurgery respondents preferred earlier OAC resumption compared to stroke neurologists or thrombosis experts in 5 scenarios (p<0.05 by Kendall’s tau).</p><p>Conclusions</p><p>Wide variations in current practice exist among management of OAC-associated ICH, with decisions influenced by patient- and provider-related factors. As these variations likely reflect the lack of high quality evidence, randomized trials are direly needed in this population.</p></div