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Feasibility, acceptability and effectiveness data of a virtual adaptation of the WHO Caregiver Skills Training (CST; n = 25) were compared with those of a pilot RCT of CST delivered in person (n = 43) against treatment as usual (TAU; n = 43). Virtual CST was delivered with high levels of integrity, but received lower ratings in some caregiver- and facilitator-rated acceptability and feasibility dimensions. Qualitative analysis identified both benefits (flexibility, convenience, clinical usefulness) and challenges, (technological issues, distraction from family members, emotional distance). Virtual and in-person CST improved significantly more on caregiver competence than TAU; there were no other significant effects. Potential for use of virtual CST as a clinical response in contexts where in-person delivery is not possible is discussed., (© 2022. The Author(s).)

Objective: To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions., Method: We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0-5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges' g) and pre-post-treatment change scores (SMD) were computed., Results: A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = -0.46 [95% CIs: -0.59, -0.33]), motor (g = -0.35 [CIs: -0.48, -0.21]) and language (g = -0.43 [CIs: -0.66, -0.19]) development, social (g = 0.23 [CIs: 0.03, 0.43]) and emotional (g = 0.46 [CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 [CIs: 0.18, 0.43]) and sleep (g = 0.29 [CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 [CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 [CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 [CIs: 0.05, 0.64] to -0.87 [CIs: -1.35, -0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 [CIs: 0.22, 0.64]) and working memory (SMD = 0.37 [CIs: 0.06, 0.69])., Conclusion: Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study., (Copyright © 2021 American Academy of Child & Adolescent Psychiatry. All rights reserved.)

We report the entire course of a case of thrombosis of the venous sinuses, very probably caused by contraceptive pill use, documented by MR imaging. MRI appears to be the examination of choice in such cases.

A patient with a severe amnesic syndrome following a glioma of the splenium of the corpus callosum is reported. The long-term memory deficit involved anterograde as well as retrograde events dating back to 40 years and causing topographical disorientation. Short-term memory test performance was in the normal range, with the exception of tactile memory which was severely impaired.The patient also showed disconnection symptoms, due to severing of occipito-parietal and parieto-temporal connections, while parieto-parietal connections were undamaged.

A case of spinal epidural haematoma diagnosed by means of Gadolinium-DTPA-enhanced MR imaging is described. The sensitivity of this recent technique is underlined.

Two hundred and twenty three right-handed patients consecutively admitted to the wards in a 21-month period for a left-sided cerebrovascular disease were examined 15 to 30 days after the stroke for the presence of aphasia. Twenty-seven of them could not be assessed. Of the remaining 196, 108 (55.1%) were aphasic. The incidence of global aphasia (43%) in the latter group was higher than in previous studies. Based on CT-scan data it was associated in 32% of patients with a deep lesion and only in 53% with an antero-posterior cortical-subcortical lesion, contrary to what is traditionally assumed. There was no sex difference in the incidence and distribution of aphasia.

A retrospective study of all admissions to the University of Modena Neurological Department from 1976-1986; 51 cases of amyotrophic lateral sclerosis (ALS) were found. ALS mean annual incidence was 0.78/100,000 inhabitants, while prevalence was 2.35/100,000. Mean age at onset was 61.43 years, mean and median duration of illness were, respectively, 28.83 and 24.5 months, and survival at 5 years post-onset was 24.4%. A tendency to higher incidence and prevalence of ALS in the ceramic district, when compared with those of the rest of the province was found. However, the small number of cases did not allow any conclusive statistical correlation between environmental exposure to lead and frequency of ALS.

Control patients and patients with hemispheric lesion were given a paired-associate memory test made up of meaningful figures and their performance was compared on two measures: number of errors over the first three trials and trials to criterion. Impairment on the former measure was associated with left brain damage and found to be related to the degree of aphasic deficit, suggesting the involvement of the verbal code in the early stages of the learning process. However, analysis of trials to criterion showed that a defective performance was confined to patients of either hemispheric group having posterior lesions and bore non relationship to measures of language impairment. It is inferred that, as the learning process consolidates, the aid provided by verbal mediation to recognizing visual images progressively recedes.

This study investigated the relation of apraxia to the nature of the stimulus which is given to elicit the gesture. Patients were required to perform a movement imitation test and to demonstrate the use of the same ten objects, once on verbal command, once with the object shown but not handled, and once with the object handled but not seen. One set of comparisons concerned the performance on two tasks involving the visual modality, movement imitation and use of objects presented visually. Although the majority of left brain-damaged patients either failed or passed both tests, there were at least 13 patients who showed an exceedingly poor performance on demonstration of use as compared to imitation. We infer that the distinction between ideational and ideomotor apraxia is warranted. Another set of comparisons concerned the performance on the use of objects presented in the verbal, visual and tactile modalities. A greater percentage of patients failed on the verbal or visual modalities than on the tactile modality. Out of 64 left brain-damaged patients who were diagnosed as apraxic in at least one modality, 23 had an exceedingly poor score on one test as compared to their score on either or both other tests. Fourteen patients selectively failed on verbal presentation, 14 on visual presentation and 2 on tactile presentation. These findings are viewed as supporting the hypothesis that apraxia results from the disconnection between the areas where information is processed and the areas where the movement is programmed.

Voluntary eye movements and following movements have been assessed on a 3 point scale in 33 cerebrovascular patients, examined immediately after the stroke and in 52 patients examined 6-9 days after the stroke. The two types of movements were found to be impaired to the same extent in the majority of patients, especially those with severe neurological deficits. The "agreement index" between them, though high, was significantly inferior to 1. This suggests that voluntary and following movements are subserved by adjacent, but not identical neuronal structures. The available neuro-radiological evidence points to the parieto-temporal cortex as the area critically involved in eye movement disorders.

Risk factors, neurological, neuroradiological and ophthalmological features of 13 cases of acute pseudotumor cerebri were studied. After a 53-month period of mean follow-up, ophthalmological complications were taken into consideration: one patient (8%) showed unilateral optic atrophy with complete loss of vision, another subject complained of visual field constriction, and a third one of transient horizontal diplopia. Papilledema, which was present in 100% of the patients in the acute phase, persisted in 62%.

Cerebrovascular risk factors, characteristics of the lesion (ischaemia or haemorrhage in the carotid or vertebro-basilar area) and mortality in the acute phase were studied in 503 patients admitted for first stroke. Seventy-five per cent of the patients had an ischaemic lesion and 25% a hemorrhagic one. Most of the ischaemic lesions occurred in patients aged 71-80 years, while haemorrhagic strokes hit subjects aged 61-70 years. Hypertension favors haemorrhage and heart disease and the older age favors ischaemia. Coma at onset negatively influences prognosis; mortality is more frequent among older patients, subjects in coma or with haemorrhagic lesions. Twelve per cent of the patients died in the first three weeks post-onset.

In an attempt to establish the efficacy of the different diagnostic tests, 41 multiple sclerosis (MS) patients at different stages of the disease were studied by means of visual evoked potential (VEP) recording, T-lymphocyte subset determination cerebrospinal fluid (CSF) analysis and magnetic resonance (MR) imaging. MR and CSF oligoclonal bands (OB) were the most sensitive techniques for the diagnosis of MS, being positive in 88% of patients, while VEP and helper/suppressor (H/S) T-cell ratio were altered in 54% and 46% of patients respectively. Low significant agreement coefficient were found among the 4 tests and the major value, even though "fairly" significant, was between MR and OB.

Normal subjects and chronic alcoholics without clinical evidence of memory disorders have been compared on two tasks of verbal learning of a word list, one administered with the classical procedure and the other with the "selective reminding" technique developed by Bushke. Results showed that the selective reminding technique has the same discriminative power as the classical procedure: both brought out a remarkable learning deficit in chronic alcoholics. The selective reminding procedure is easier to administer and can distinguish between storage and retrieval deficits; it seems therefore preferable for diagnostic purposes. Practical criteria to distinguish a normal from pathologic performance on this test are suggested. Alcoholics were also inferior on Raven Progressive Matrices. The scope of the impairment produced by chronic alcohol consumption is wider than suggested by clinical observations and deserves careful assessment.

A review of the literature shows that long-lasting neurological complications of eclampsia are rare, but that, when present, they frequently involve visual function. Two patients are reported, whose symptomatology suggested damage to the posterior region of both cerebral hemispheres. The first patient showed a Balint's syndrome with complete inability to perceive more than one object at a time, erratic gaze movements and optic ataxia. After a year and half a marked improvement was observed. The second patient presented with severe of dyscalculia, spatial memory disorders, constructional apraxia and mild aphasia. She recovered completely in one year. This symptomatology might result from ischemic lesions in the watershed area between the territories of the middle and posterior cerebral arteries, the underlying mechanism being the compression of the posterior cerebral artery against the tentorium, caused by edema.