Diagnosis and Management of Mild TBI via Eye Tracking

ObjectiveThe purpose of this study is to expose the prevalence of mild traumatic brain injuries among high school football players and to explore the possibility of implementing eye tracking performance as an objective way to assess cases of potential concussion.BackgroundConcussions are one of the most common forms of traumatic brain injury (TBI). Unfortunately, current research suggests that mild TBIs cannot always be accurately diagnosed via routine neurologic examination. Also, most evaluations, such as ImPACT, are survey-style assessments that are time intensive and subjective. Lack of an objective method to rapidly assess concussions on the field raises concern for second-impact syndrome (SIS), which can lead to permanent brain damage or even fatality.Design/MethodsThis multi-part study included a population of 849 high school athletes in from Lubbock, TX. Student athletes filled out a baseline concussion survey, then assessed their eye tracking performance with the EyeGuide Focus, a 10-second test that involves visually tracking a continuous, figure-8 shape. A vector-based system was used to measure the eye-tracking deviation.ResultsForty-two athletes were recorded with a baseline eye-tracking score, and a subsequent eye-tracking score that was labelled as a suspected concussion by a physician. Of those 42, 17 had a follow-up eye-tracking test 2 weeks later. Test scores labelled with suspected concussion had a significantly higher mean raw score than the baseline score. Higher scores indicate greater vector deviation from accurately tracing the figure-8 with the eyes.ConclusionsThe survey results show underdiagnosing of concussions at lower levels of youth sports, which may indicate a lack of resources. As the data shows marked changes between the concussed, baseline, and follow-up scores, eye-tracking promises to be a quick and efficient tool to assess sports-related concussions.

Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement

Diabetes mellitus may arise abruptly and decompensate suddenly, leading to a hyperglycaemic hyperosmolar state. Coma often ensues, although this usually reverses after the metabolic abnormalities have resolved. Acute symptomatic seizures can also occur in patients who are conscious, although these usually resolve after osmolarity and glycaemia have normalised. We describe an elderly woman who failed to regain vigilance despite prompt treatment; the cause was an unusual non-convulsive status epilepticus arising from the mesial temporal lobe and promoting a progressive and selective hippocampal involvement. During follow-up, her seizures recurred after stopping antiseizure medication and she developed hippocampal sclerosis, although she subsequently became seizure-free with antiseizure medications. Patients who are unresponsive in a hyperglycaemic hyperosmolar state may be having subclinical epileptiform discharges and risk developing permanent brain damage and long-term epilepsy.

Intensive Care Management of Multiorgan Dysfunction and Hypoxic Brain Injury Secondary to Refractory Status Epilepticus

Refractory Status Epilepticus (RSE) is a medical emergency that may lead to permanent brain damage or death.Mortality rate is 16-39%. It is the life threatening condition in which continuous fits occur, despite treatmentwith benzodiazepines and one antiepileptic drug.A 25-year-old female, brought in emergency department with high-grade fever and frequent fits. GlasgowComa Scale (GCS) was 3/15 with unstable hemodynamics. Resuscitation started immediately and managed asstatus epilepticus. Patient was in multi organ failure on arrival. On the basis of history and examination, hypoxicbrain injury was diagnosed initially. Later on, refractory status epilepticus (RSE) with multi organ dysfunctionsyndrome (MODS) was diagnosed, after necessary investigations and treatment. Patient was managed as ateam with multidisciplinary approach and after continuous effort of 2 weeks, patient was successfullydischarged to home.

Glutamate Dehydrogenase as a Promising Target for Hyperinsulinism Hyperammonemia Syndrome Therapy.

: Hyperinsulinism-hyperammonemia syndrome (HHS) is a rare disease characterized by recurrent hypoglycemia and persistent elevation of plasma ammonia, and it can lead to severe epilepsy and permanent brain damage. It has been demonstrated that functional mutations of glutamate dehydrogenase (GDH), an enzyme in the mitochondrial matrix, are responsible for the HHS. Thus, GDH has become a promising target for the small molecule therapeutic intervention of HHS. Several medicinal chemistry studies are currently aimed at GDH, however, to date, none of the compounds reported has been entered clinical trials. This perspective summarizes the progress in the discovery and development of GDH inhibitors, including the pathogenesis of HHS, potential binding sites, screening methods, and research models. Future therapeutic perspectives are offered to provide a reference for discovering potent GDH modulators and encourage additional research that will provide more comprehensive guidance for drug development.

Case Report: The Physiology of a Preventable Near Death in a Hot Tub

This is a case report of a very preventable near-death event involving a 6-year-old female who had a syncopal event due to hyperthermia in an overheated hot tub and drowned. She was resuscitated but due to the combination of anoxia and hyperthermia has been left with permanent brain damage.

Attitude and knowledge about electroconvulsive therapy (ECT) among medical students in Nepal: a pilot survey

AimsElectroconvulsive Therapy (ECT) is an important modality of treatment for treatment resistant psychiatric disorders. Young medical students like general public might harbor several misconceptions about ECT. In this pilot survey, we explored the knowledge and attitude about ECT amongst young medical students training in a medical college affiliated to a teaching hospital in Southern Nepal.MethodA 23-item questionnaire in English language with either ‘True’ or ‘False’ response as outcome was developed by reviewing findings from previous studies. Brief information was also taken to record familiarity of medical students with ECT as a treatment procedure. The study was conducted as a departmental pilot survey for quality improvement of Psychiatry Undergraduate Training. A total of 128 medical students in early clinical year enrolled in MBBS curriculum at a teaching hospital in Southern Nepal participated in the survey. The students were not exposed to any specific teaching regarding ECT while participating in the study.ResultThe students were aged between 21 and 28 years with almost equal gender distribution. Among them, 89.1% had heard about ECT before whereas 15.6% knew someone who has received ECT. Although 90.6 % of students believed ECT can be lifesaving many times, a substantial number of students had misconception about ECT such as assuming it as a painful procedure (71.9%). Almost half of them believed ECT can have severe consequences like death or permanent brain damage. Around one fourth to one third believed ECT is inhumane, without scientific proof or a form of punishment for violent angry patients. Surprisingly, a significant higher percentage of male students believed that ‘ECT leads to permanent loss of memory’ (11/34 vs. 3/30, p = 0.04) and ‘ECT is given as a punishment to violent/angry patients’ (15/34 vs. 4/30, p = 0.01).ConclusionSeveral misconceptions about ECT are prevalent in medical students that need to be adequately addressed during their training to develop a positive attitude and basic knowledge about the treatment.

Abrupcija na polazištu zajedničke karotidne arterije bez neurološkog deficita

Objective: In this case, we present a patient who despite iatrogenic common carotid artery disruption had no neurological impairment after vascular reconstruction. Case report: During the neck dissection in a young patient a complete abruption of the common carotid artery occurred. Median sternotomy was done for proximal bleeding control. Vascular reconstruction was done using temporary carotid shunting. The patient had no neurological consequences afterward. Conclusion: The lesion of major neck vessels is one of the most severe complications during the surgery which must be dealt with as soon as possible in best way in order to avoid permanent brain damage. In situations of iatrogenic lesions of major neck arteries heparin admission, which is usually normal therapy during vascular reconstruction, is not an option due to abrupt and uncontrollable bleeding. Thus, establishing surgically proximal and distal vascular control over the bleeding artery by vessel clamping and urgent placing of temporary intraluminal carotid shunting and best medical intraoperative therapy in this critical period of surgery might be the crucial therapeutic moment for brain protection.

Papa

In this personal narrative, the author details her grandfather’s and father’s experiences of police brutality in Los Angeles, a pattern that continues from one generation to another. She shows the long legacy of violence and racism that Black men face at the hands of the Los Angeles Police Department – from her grandfather Roy Wyche, who was beaten so badly in 1974 that he sustained permanent brain damage, to her father who suffered severe injuries after being wrongly suspected of a crime in 1983. These stories, she argues, are common occurrences that are part of a long history of injustice and systemic racism that Black people continue to face in the present day.

Intracerebral Haemorrhage Caused by Endosulfan Intoxication: A Case Report

Introduction: many chemical substances used in industry, households, agriculture, often result in bad side effects to people and environment. As an agricultural country, the frequency of the use of pesticides in Indonesia is quite high since those chemical substances are still badly needed by the people for their farming. The bad side effects should strongly be avoided. Related with the disadvantages or dangers of those, especially pesticides. It is often found that a sudden death can be related with intoxication. It is sometimes difficult to differentiate them, whether if caused by disease, violence or intoxication. During 2008-2018 extra toxicological examination performed in the Forensic Laboratory of Toxicology in East Java Regional Police Headquarter in the period of 2008 up to 2018 indicated 44% of 25 cases were dominated by intoxication, which were mostly caused by propoxur intoxication (carbamate insecticide) 90 % and by endosulfan 10%. It means that endosulfan as the restricted pesticides can be the cause of death, wether by accidental action or even homicide and suicide action. Objective: To be able to analyze the changes or the clinical effects due to endosulfan intoxication, especially in death acutely which shown the intracerebral haemorrage from the death. Method: case report of the sudden death on women suspected poisoning by endosulfan. Conclussion: Symptoms of acute endosulfan poisoning include hyperactivity, tremors, convulsion, lack of coordination, staggering, difficulty of breathing, nausea/vomiting, diarrhea, and in severe cases, unconsciousness and many cases of sub lethal poisoning have resulted in permanent brain damage.

CEREBRAL PALSY: CLINICAL AND SOCIAL PROBLEMS

Introduction: Cerebral palsy / MPD/is a motor and postural disorder caused by permanent brain damage that occurred at an early stage of development. Cerebral palsy is the most common cause of disability in children. The aim: To present cerebral palsy as a clinical problem and to outline the importance of physiotherapy in the treatment of cerebral palsy patients. Materials and methods: The study included 67 children with cerebral palsy (mean age was 9 years) treated and followed up for 6 months at the “Górka” Orthopaedic and Rehabilitation Hospital in Busko Zdrój. The clinical presentation was dominated by manifestations of motor and postural abnormalities resulting from upper motor neuron and corticospinal tract damage. A diagnostic survey was used as the research method. The physiotherapy and rehabilitation used in the patients consisted of kinesiotherapy (usually Bobath/NDT) and physical therapy procedures (magnetic stimulation, laser therapy, LED light therapy). The study used a survey questionnaire that collected information about problems with everyday life and functioning of cerebral palsy patients and opinions about their rehabilitation programme. Results: Follow-up data were analysed in patient groups, which were created based on the method of ambulation in children with cerebral palsy. The results emphasise the role of physiotherapy in the rehabilitation of cerebral palsy patients. Systematic motor rehabilitation contributed to an improved physical fitness and better everyday functioning. Parents of children walking with aids reported having problems with access to specialist healthcare, which resulted from the fact that they did not live close enough to an appropriate centre. Parents of non-ambulatory patients reported that they lacked financial means and parents of children who were able to walk unassisted complained of long waiting times for rehabilitation. Conclusions: 1. MPD is a difficult clinical and social problem. 2. Physical improvement procedures is an essential element in the treatment of this group of patients.