Effect of Professional Fighters' Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes

ObjectiveTo evaluate the relationship between professional fighter weight class and neuropsychiatric outcomes.BackgroundTraumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown.Design/Methodsn = 53 boxers and n = 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (=139.9 lb), middleweight (140.0–178.5 lb), and heavyweight (>178.5 lb).ResultsCompared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis.ConclusionsAlthough more research is needed, greater per-fight decrements in lightweights may be related to practices of weight-cutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.

Functional Network Connectivity Imprint In Febrile Seizures

Complex febrile seizures (CFS), a subset of paediatric febrile seizures (FS), have been studied for their prognosis, epileptogenic potential and neurocognitive outcome. We evaluated their functional connectivity differences with simple febrile seizures (SFS) in children with recent-onset FS. Resting-state fMRI (rsfMRI) datasets of 24 children with recently diagnosed FS (SFS n=11; CFS n=13) were analysed. Functional connectivity (FC) was estimated using time series correlation of seed region to whole brain voxels and network topology was assessed using graph theory measures. Regional connectivity differences were correlated with clinical characteristics (FDR corrected p < 0.05). CFS patients demonstrated increased FC of the bilateral middle temporal pole (MTP), and bilateral thalami when compared to SFS. Network topology study revealed increased clustering coefficient and decreased participation coefficient in basal ganglia and thalamus suggesting an inefficient-unbalanced network topology in patients with CFS. The number of seizure recurrences negatively correlated with the integration of Left Thalamus ( r= -0.58 ) and FC measures of Left MTP to 'Right Supplementary Motor and left Precentral' connectivity (r=-0.53). The FC of Right MTP to Left Amygdala, Putamen, Parahippocampal, and Orbital Frontal Cortex ( r=0.61 ) and FC of Left Thalamus to left Putamen, Pallidum, Caudate, Thalamus Hippocampus and Insula (r 0.55) showed a positive correlation to the duration of the longest seizure. The findings of the current study report altered connectivity in children with CFS proportional to the seizure recurrence and duration. Regardless of the causal/consequential nature, such observations demonstrate the imprint of these disease-defining variables of febrile seizures on the developing brain.

Prolonged PT and APTT Results Caused by Combined Usage of Rivaroxaban and Celecoxib: a Case Report

Background: Data related to coagulation in patients or changes of coagulation parameters induced by rivaroxaban combined celecoxib remains scarce in a community setting. Case presentation: We reported a 79-year-old woman was sent to the emergency department of our hospital for intracerebral hemorrhage of left thalamus on February 7th, 2021. On March 25th, after taking rivaroxaban combined celecoxib, her prothrombin time (PT: 23.0 sec) and activated partial thromboplastin time (APTT: 46.3 sec) results were longer than her historical results ((13.0-13.9) sec and (31.7-35.1) sec), the results were not consistent with her clinical symptoms. It turns out that this is unusual side effects of drug combination. After withdrawal the medicine of celecoxib, the results of PT and APTT returned to normal.Conclusions: Although this situation only occurs in a small number of patients, the accumulation of clinical experience can help doctors save their lives. For boosting the safety of clinical medications, doctors should strengthen the evaluations of bleeding risk.

Imaging of Acute Stroke patient with Covid-19: A serial case

Background: Coronavirus Disease 2019 (COVID-19) has been declared as a pandemic in March 2020 by WHO. Apart from respiratory symptoms, COVID-19 is also associated with various neurological manifestations, one of which is stroke. We reported three cases with diagnosis of stroke in confirmed COVID-19 patients. Case Presentation: Head CT scan without contrast in the three reported cases showed different types of strokes. The first case showed ischemia in the right insular lobe and right parietal lobe. The second case showed intracerebral hemorrhage in the left thalamus and intraventricular hemorrhage, whereas the third case showed acute infarction in right frontotemporal lobe, right lentiform nucleus, right insular cortex, that supports prelenticulostriate segment I MCA embolism. Conclusion: CT scan is an important imaging modality in stroke cases both in COVID-19 and non-COVID-19 cases. CT scans are good at detecting the presence of bleeding, widely available, faster to operate, and less expensive than MRI. The types of stroke in COVID-19 patients can appear as different types of stroke. Generally, it appears as ischemic stroke, but hemorrhagic stroke can also occur with a less frequent occurrence. Further research is needed to explain the exact correlation between stroke and COVID-19.

Aberrant Topological Patterns of Structural Covariance Networks in Cognitively Normal Elderly Adults With Mild Behavioral Impairment

Mild behavioral impairment (MBI), characterized by the late-life onset of sustained and meaningful neuropsychiatric symptoms, is increasingly recognized as a prodromal stage of dementia. However, the underlying neural mechanisms of MBI remain unclear. Here, we examined alterations in the topological organization of the structural covariance networks of patients with MBI (N = 32) compared with normal controls (N = 38). We found that the gray matter structural covariance networks of both the patients with MBI and controls exhibited a small-world topology evidenced by sigma value larger than one. The patients with MBI had significantly decreased clustering coefficients at several network densities and local efficiency at densities ranging from 0.05 to 0.26, indicating decreased local segregation. No significant differences in the characteristic path length, gamma value, sigma value, or global efficiency were detected. Locally, the patients with MBI showed significantly decreased nodal betweenness centrality in the left middle frontal gyrus, right inferior frontal gyrus (opercular part), and left Heschl gyrus and increased betweenness centrality in the left gyrus rectus, right insula, bilateral precuneus, and left thalamus. Moreover, the difference in the bilateral precuneus survived after correcting for multiple comparisons. In addition, a different number and distribution of hubs was identified in patients with MBI, showing more paralimbic hubs than observed in the normal controls. In conclusion, we revealed abnormal topological patterns of the structural covariance networks in patients with MBI and offer new insights into the network dysfunctional mechanisms of MBI.

A Case of Reversible Cerebral Vasoconstriction Syndrome: Postpartum Cerebral Angiopathy in a 32-Year-Old Primigravid Treated with Intravenous Immunoglobulin

This is a case of a 32-year-old primigravid who developed sudden severe headache on the 7th day postpartum associated with focal neurologic deficits and altered sensorium. She had a GCS score of 6, anisocoric pupils and an NIHSS score of 31. Cranial MRI with MRA showed multifocal hyperacute to acute infarcts on the left occipital lobe, left thalamus, and midbrain which was more prominent on the right. Due to clinical deterioration, a repeat Cranial MRI with MRA was done and showed progression of infarcts involving both thalami and right pons with interval appearance of contour irregularities in the proximal anterior cerebral, posterior cerebral, basilar and internal carotid arteries. Serial transcranial Doppler showed significant distal right middle cerebral artery vasospasm. She was managed as a case of reversible cerebral vasoconstriction syndrome, associated with postpartum cerebral angiopathy. Intravenous pulse methylprednisolone was started subsequently IVIG was initiated. Intravenous immunoglobulin was given for 5 days. The patient gradually improved, underwent rehabilitation therapy, and was discharged stable after 6 weeks.

Isolated thalamic stroke – analysis of clinical characteristics and asymmetry of lesion distribution in a retrospective cohort study

Background More patients with left-hemispheric than right-hemispheric strokes are admitted to hospitals. This is due to the easier recognition of cortical symptoms of the dominant-hemisphere. The thalamus constitutes a “micro-model” of the brain cortex with structure-function relationships known to be asymmetric, especially for language, memory, and visuo-spatial neurocognitive functions. The goal of this study was to characterize clinical symptoms and lesion distribution patterns of patients with acute isolated thalamic stroke (ITS) and to evaluate whether left-sided lesions are overrepresented in the hospital. Methods We performed a radiological database search including all brain scans performed in the Center of Neurology and Neurosurgery of the University Hospital Frankfurt between 2010 and 2019. A total of 5733 patients presenting with acute ischemic stroke were screened for ITS. Based on the MRI data, a lesion-overlap map was then generated to visualize the ITS lesion distribution. Results Fifty-eight patients with unilateral ITS were identified. A majority of 38 patients (65.5%) showed left-sided ITS, whereas only 20 patients (34.5%) had right-sided ITS (p = 0.012). A particular difference was found for ITS lesions in the anterior thalamus of the anterolateral (n = 10) and anteromedian (n = 3) vascular territory, which were located in the left thalamus in 85% of patients (p = 0.011). No distribution difference was found for ITS lesions in the inferomedial (n = 7), central (n = 8), inferolateral (n = 23) and posterior (n = 7) vascular territories. The neuropsychological symptoms of thalamic aphasia (n = 8), neurocognitive impairment (n = 6), behavioral changes (n = 2), neglect (n = 2) and memory deficits (n = 3) were described predominantly in patients with left-sided ITS (p < 0.01). In contrast, other stroke symptoms (e.g., sensorimotor hemi-syndromes) did not reveal a side preponderance. Conclusions The better recognizability of left anterior compared to right anterior thalamic stroke symptoms may have an impact on the frequency in which ITS patients are admitted to the hospital. Clinical characteristics of right anterior thalamic stroke should therefore be further investigated, and diagnostic instruments towards their detection be identified.

Altered Functional Connectivity Strength at Rest in Medication-Free Obsessive-Compulsive Disorder

Background. Previous studies explored the whole-brain functional connectome using the degree approach in patients with obsessive-compulsive disorder (OCD). However, whether the altered degree values can be used to discriminate OCD from healthy controls (HCs) remains unclear. Methods. A total of 40 medication-free patients with OCD and 38 HCs underwent a resting-state functional magnetic resonance imaging (rs-fMRI) scan. Data were analyzed with the degree approach and a support vector machine (SVM) classifier. Results. Patients with OCD showed increased degree values in the left thalamus and left cerebellum Crus I and decreased degree values in the left dorsolateral prefrontal cortex, right precuneus, and left postcentral gyrus. SVM classification analysis indicated that the increased degree value in the left thalamus is a marker of OCD, with an acceptable accuracy of 88.46%, sensitivity of 87.50%, and specificity of 89.47%. Conclusion. Altered degree values within and outside the cortical-striatal-thalamic-cortical (CSTC) circuit may cocontribute to the pathophysiology of OCD. Increased degree values of the left thalamus can be used as a future marker for OCD understanding-classification.

Shared and specific patterns of structural and functional thalamo-frontal disturbances in manic and euthymic pediatric bipolar disorder

Bipolar disorder (BD) is clinically defined by alternating depressive and manic episodes with a separated period of euthymia. Thalamo-frontal loop plays vital role in psychotic symptoms, altered motor control and executive difficulties in BD. It remains unclear that structural and functional alterations of thalamo-frontal loop among the different mood states in BD, especially in pediatric BD(PBD).Twenty manic PBD (mPBD), 20 euthymic PBD (ePBD) and 19 healthy controls (HCs) were included in the study. By analyzing the T1 images and fMRI signals, thalamus volume and frontal grey matter cortical thickness were tested, and functional connectivity (FC) between bilateral thalamus and frontal cortex was calculated. Relationship between clinical indices and thalamo-frontal FC was also evaluated in mPBD and ePBD adolescents.Compared to HCs, the cortical thickness of left middle frontal gyrus (MFG), bilateral superior frontal gyrus (SFG) was significantly decreased in both mPBD and ePBD patients, and volume of left thalamus and cortical thickness of right MFG significantly decreased in mPBD patients. Compared to that of the HCs and ePBD subjects, thalamo-frontal hyperconnectivity with MFG was found in mPBD, and compared with that of HCs, thalamo-frontal hypoconnectivity with precentral gyrus/SFG was found in ePBD. In ePBD patients, episode times positively correlated with FC values between thalamus and precentral gyrus.The findings of the present study demonstrate detailed knowledge regarding shared and specific structural and functional disruption in thalamo-frontal loop in mPBD and ePBD subjects. Thalamo-frontal abnormalities reported in adult BD subjects were also observed in adolescent BD patients, and thalamo-frontal dysfunction may be a crucial treatment target in BD.

Belief in Communism and Theory of Mind

A belief in communism refers to the unquestionable trust and belief in the justness of communism. Although former studies have discussed the political aim and social value of communism, the cognitive neural basis of a belief in communism remains largely unknown. In this study, we determined the behavioral and neural correlates between a belief in communism and a theory of mind (ToM). For study 1, questionnaire scores were measured and for study 2, regional homogeneity (ReHo) and resting-state functional connectivity (rsFC) were used as an index for resting-state functional MRI (rs-fMRI), as measured by the Belief in Communism Scale (BCS). The results showed that a belief in communism is associated with higher ReHo in the left thalamus and lower ReHo in the left medial frontal gyrus (MFG). Furthermore, the results of the rsFC analysis revealed that strength of functional connectivity between the left thalamus and the bilateral precuneus is negatively associated with a belief in communism. Hence, this study provides evidence that spontaneous brain activity in multiple regions, which is associated with ToM capacity, contributes to a belief in communism.