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Background: Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. Objectives: Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. Methods: The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. Results: The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20–60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. Conclusions: Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting. [ABSTRACT FROM AUTHOR]

Background: The Neurological Fatigue Index (NFI) is the instrument used to evaluate stroke patients' fatigue. There was no Urdu version of NFI available officially. Objective: This study aimed to translate the Neurological Fatigue Index into Urdu and to determine the validity and reliability of Urdu NFI among stroke patients. Methodology: It is a cross-cultural validation study. According to international guidelines in phase I, a process of translation was carried out. In phase II, using the sample of 120 participants, validity and reliability of the Urdu version of the Neurological Fatigue Index scale was conducted. The Urdu version's content validity, convergent/concurrent validity, test-retest reliability, and internal consistency were determined. The latest version of SPSS was used for the data analysis. Results: The Urdu version of NFI was drafted after the expert's review. The content validity index was used to analyze the content validity. The reliability and validity of the Urdu version NFI were evaluated by calculating Cronbach's alpha (α = 0.86), and intra-class correlation coefficient (ICC = 0.823). Correlations with other scales were the fatigue Severity Scale (FSS) (r = 0.76), Mental Fatigue Scale (MFS) (r = 0.68), Beck Depression Inventory (BDI) (r = 0.53) and Epworth Sleepiness Scale (ESS) (r = 0.47). Conclusion: The Urdu Version was linguistically acceptable for the fatigue assessment in post-stroke patients. It showed good content validity, convergent/concurrent validity, internal consistency, and test-retest reliability. [ABSTRACT FROM AUTHOR]

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Abstract Background Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. Objectives Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. Methods The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. Results The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20–60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. Conclusions Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting.

Abstract Background The Neurological Fatigue Index (NFI) is the instrument used to evaluate stroke patients’ fatigue. There was no Urdu version of NFI available officially. Objective This study aimed to translate the Neurological Fatigue Index into Urdu and to determine the validity and reliability of Urdu NFI among stroke patients. Methodology It is a cross-cultural validation study. According to international guidelines in phase I, a process of translation was carried out. In phase II, using the sample of 120 participants, validity and reliability of the Urdu version of the Neurological Fatigue Index scale was conducted. The Urdu version’s content validity, convergent/concurrent validity, test-retest reliability, and internal consistency were determined. The latest version of SPSS was used for the data analysis. Results The Urdu version of NFI was drafted after the expert’s review. The content validity index was used to analyze the content validity. The reliability and validity of the Urdu version NFI were evaluated by calculating Cronbach’s alpha (α = 0.86), and intra-class correlation coefficient (ICC = 0.823). Correlations with other scales were the fatigue Severity Scale (FSS) (r = 0.76), Mental Fatigue Scale (MFS) (r = 0.68), Beck Depression Inventory (BDI) (r = 0.53) and Epworth Sleepiness Scale (ESS) (r = 0.47). Conclusion The Urdu Version was linguistically acceptable for the fatigue assessment in post-stroke patients. It showed good content validity, convergent/concurrent validity, internal consistency, and test-retest reliability.

Introduction: Breast cancer in males is a very rare entity, and survival is mainly influenced by the stage at diagnosis. The lack of early detection tools in men results in a diagnostic delay of about 5–10 years and a higher percentage of metastatic disease at diagnosis. However, the characteristics of head metastases are not well defined. Case Reports: We present 2 cases of male breast cancer with metastases affecting cranial nervous structures and we provide imaging and histologic data. Both were middle-aged patients with ductal-type, HER-2- negative, and androgen receptor-positive primary tumors. Conclusion: Although central nervous system involvement is uncommon, this entity should be considered in middle-aged males with focal neurologic symptoms. More cases would be necessary to better understand the biology of this condition in order to establish an adequate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: The use of multimodal neuromonitoring in pediatrics is in its infancy relative to adult neurocritical care. Multimodal neuromonitoring encompasses the amalgamation of information from multiple individual neuromonitoring devices to gain a more comprehensive understanding of the condition of the brain. It allows for adaptation to the changing state of the brain throughout various stages of injury with potential to individualize and optimize therapies. Methods: Here we provide an overview of multimodal neuromonitoring in pediatric neurocritical care and its potential application in the future. Results: Multimodal neuromonitoring devices are key to the process of multimodal neuromonitoring, allowing for visualization of data trends over time and ideally improving the ability of clinicians to identify patterns and find meaning in the immense volume of data now encountered in the care of critically ill patients at the bedside. Clinical use in pediatrics requires more study to determine best practices and impact on patient outcomes. Potential uses include guidance for targets of physiological parameters in the setting of acute brain injury, neuroprotection for patients at high risk for brain injury, and neuroprognostication. Implementing multimodal neuromonitoring in pediatric patients involves interprofessional collaboration with the development of a simultaneous comprehensive program to support the use of multimodal neuromonitoring while maintaining the fundamental principles of the delivery of neurocritical care at the bedside. Conclusions: The possible benefits of multimodal neuromonitoring are immense and have great potential to advance the field of pediatric neurocritical care and the health of critically ill children. [ABSTRACT FROM AUTHOR]

Patients with movement disorders such as Parkinson's disease (PD) living in remote and underserved areas often have limited access to specialized healthcare, while the feasibility and reliability of the video-based examination remains unclear. The aim of this narrative review is to examine which parts of remote neurological assessment are feasible and reliable in movement disorders. Clinical studies have demonstrated that most parts of the video-based neurological examination are feasible, even in the absence of a third party, including stance and gait—if an assistive device is not required—bradykinesia, tremor, dystonia, some ocular mobility parts, coordination, and gross muscle power and sensation assessment. Technical issues (video quality, internet connection, camera placement) might affect bradykinesia and tremor evaluation, especially in mild cases, possibly due to their rhythmic nature. Rigidity, postural instability and deep tendon reflexes cannot be remotely performed unless a trained healthcare professional is present. A modified version of incomplete Unified Parkinson's Disease Rating Scale (UPDRS)-III and a related equation lacking rigidity and pull testing items can reliably predict total UPDRS-III. UPDRS-II, -IV, Timed "Up and Go", and non-motor and quality of life scales can be administered remotely, while the remote Movement Disorder Society (MDS)-UPDRS-III requires further investigation. In conclusion, most parts of neurological examination can be performed virtually in PD, except for rigidity and postural instability, while technical issues might affect the assessment of mild bradykinesia and tremor. The combined use of wearable devices may at least partially compensate for these challenges in the future. [ABSTRACT FROM AUTHOR]

IntroductionIncreasing shortage of neurologists compounded by the global aging of the population have translated into suboptimal care of patients with chronic neurological diseases. While some patients might benefit from expanding telemedicine, monitoring neurological disability via telemedicine is challenging. Smartphone technologies represent an attractive tool for remote, self-administered neurological assessment. To address this need, we have developed a suite of smartphone tests, called neurological functional test suite (NeuFun-TS), designed to replicate traditional neurological examination. The aim of this study was to assess the ability of two NeuFun-TS tests—short walk and foot tapping—to quantify motor functions of lower extremities as assessed by a neurologist.MethodsA cohort of 108 multiple sclerosis (MS) patients received a full neurological examination, imaging of the brain, and completed the NeuFun-TS smartphone tests. The neurological exam was digitalized using the NeurEx™ platform, providing calculation of traditional disability scales, as well as quantification of lower extremities-specific disability. We assessed unilateral correlations of 28 digital biomarkers generated from the NeuFun-TS tests with disability and MRI outcomes and developed machine learning models that predict physical disability. Model performance was tested in an independent validation cohort.ResultsNeuFun-TS-derived digital biomarkers correlated strongly with traditional outcomes related to gait and lower extremities functions (e.g., Spearman ρ > 0.8). As expected, the correlation with global disability outcomes was weaker, but still highly significant (e.g., ρ 0.46–0.65; p

IntroductionNeuroworsening may be a sign of progressive brain injury and is a factor for treatment of traumatic brain injury (TBI) in intensive care settings. The implications of neuroworsening for clinical management and long-term sequelae of TBI in the emergency department (ED) require characterization.MethodsAdult TBI subjects from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot Study with ED admission and disposition Glasgow Coma Scale (GCS) scores were extracted. All patients received head computed tomography (CT) scan

Abstract Background No available literature supports the claim that the patellar and withdrawal (flexor) reflexes are the only reliable segmental reflexes in dogs. Objective Measure intra‐ and interobserver agreement of 8 segmental reflexes in dogs without clinical evidence of orthopedic or neurologic disease. Animals One‐hundred and one client‐ or staff‐owned dogs between 1 and 10 years of age with no clinical evidence of orthopedic disease, myelopathy, or neuromuscular disease. Methods Descriptive study. The intraobserver proportion of agreement (%) of responses to selected segmental reflexes in right versus left limbs by 3 observers was calculated and reported. The interobserver agreement of 2 observers of responses to selected reflexes was estimated by calculating proportions of agreement, kappa values, and 95% confidence intervals. A segmental reflex with an acceptable agreement was defined as that with a proportion of agreement ≥90% and a Kappa value ≥0.61 in both limbs. Results The intraobserver proportion of agreement for all 3 observers was high (≥95%) for the extensor carpi radialis, withdrawal, patellar, and cranial tibial reflexes. Between observers 1 and 3 and observers 2 and 3, the interobserver proportion of agreement was high (≥ 92%) for the extensor carpi radialis (κ 0.66, not determined [ND]), withdrawal (both limbs, κ ND), patellar (κ ND), and cranial tibial reflexes (κ ND). Conclusions and Clinical Importance The extensor carpi radialis, withdrawal, patellar, and cranial tibial reflexes had a higher proportion of agreement and kappa values between 2 observers.

This study aimed to assess the prevalence of neurological symptoms and related imaging findings in patients with von Hippel-Lindau (VHL) at Rasool Akram Hospital from September 2018 to September 2021. This analytical observational study examined eligible patients over the period from September 2018 to September 2021. We collected demographic information (age, gender) along with imaging findings and results of neurological and eye examinations. Comparison between qualitative variables was also done using the Chi-square test or Fisher's exact test. Also, an independent t -test was used to compare quantitative variables between the two groups. SPSS version 22 software was used for statistical analysis of data. A significant level was considered less than or equal to 0.05. Of the 54 examined patients (48.1% were male and 51.9% were female) with an average age of 36.42 ± 13.37 years. A significant majority (87.0%) reported a positive family history of the disease. The most common type of disease was Type 1 observed in 94.4% of cases and Type 2A was the next most frequent (3.7%). The most common pattern of retinal pathological lesions seen in the examination was related to bilateral lesions (79.6%). The most common pathological finding was related to the presence of a mass in cerebellar magnetic resonance imaging (48.1%). Considering the findings of the present study, which highlight a significant frequency of bilateral retinal lesions as well as masses in the central nervous system and endocrine system, it is evident that patients require careful follow-up and various interventions after being diagnosed with the disease. This approach is essential to manage and potentially mitigate the complications associated with these conditions. [ABSTRACT FROM AUTHOR]

Background: No available literature supports the claim that the patellar and withdrawal (flexor) reflexes are the only reliable segmental reflexes in dogs. Objective: Measure intra‐ and interobserver agreement of 8 segmental reflexes in dogs without clinical evidence of orthopedic or neurologic disease. Animals: One‐hundred and one client‐ or staff‐owned dogs between 1 and 10 years of age with no clinical evidence of orthopedic disease, myelopathy, or neuromuscular disease. Methods: Descriptive study. The intraobserver proportion of agreement (%) of responses to selected segmental reflexes in right versus left limbs by 3 observers was calculated and reported. The interobserver agreement of 2 observers of responses to selected reflexes was estimated by calculating proportions of agreement, kappa values, and 95% confidence intervals. A segmental reflex with an acceptable agreement was defined as that with a proportion of agreement ≥90% and a Kappa value ≥0.61 in both limbs. Results: The intraobserver proportion of agreement for all 3 observers was high (≥95%) for the extensor carpi radialis, withdrawal, patellar, and cranial tibial reflexes. Between observers 1 and 3 and observers 2 and 3, the interobserver proportion of agreement was high (≥ 92%) for the extensor carpi radialis (κ 0.66, not determined [ND]), withdrawal (both limbs, κ ND), patellar (κ ND), and cranial tibial reflexes (κ ND). Conclusions and Clinical Importance: The extensor carpi radialis, withdrawal, patellar, and cranial tibial reflexes had a higher proportion of agreement and kappa values between 2 observers. [ABSTRACT FROM AUTHOR]

A 25-year-old woman presented to the hospital 7 to 8 hours after intentionally ingesting around 50 to 60 grams of zinc phosphide (ZnP). The patient's neurological examination was normal, but she had gastrointestinal complaints including nausea, vomiting, and mild epigastric pain. Her electrocardiogram was normal and her vital signs were stable. The results of her routine laboratory tests including coagulation profile, liver function tests, complete blood count, blood urea nitrogen (BUN), creatinine (Cr), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), blood sugar, sodium, potassium, magnesium, calcium, phosphate, and venous blood gas analyses were all within normal ranges.

Objective: The current study aimed to translate the Hammersmith Infant Neurological Examination (HINE) into Brazilian Portuguese and analyze the reliability of the translated version for a population of Brazilian infants. Methods: This was a methodological study, approved by the Ethics Committee, carried out between June 2020 and May 2021. HINE is a standardized clinical neurological examination used for the early detection of cerebral palsy. The quantitative section, “neurological examination”, contains 26 items scored from 0 to 3 points, divided into five categories: cranial nerve function, posture, movements, muscle tone and reflexes, and reactions. The HINE translation followed four steps: translation, synthesis, back-translation, and evaluation by an expert committee. To verify the reliability of the HINE-Br (Portuguese-Brazil version) two independent examiners evaluated 43 infants, between 3 and 22 months of age. Internal consistency was verified by Cronbach’s Alpha coefficient and interrater reliability by the intraclass correlation coefficient (ICC). Results: The translated version was similar to the original version and a few semantic and idiomatic adjustments were necessary. Appropriate internal consistency (Alpha=0.91) was found for the 26 items of the HINE-Br, as well as strong interrater reliability for the total score (ICC2.1=0.95), and also for the five categories (ICC2.1=0.83–0.95). Conclusions: The HINE-Br presents adequate rates of internal consistency and interrater reliability, and can be used for the evaluation of children at risk for cerebral palsy, between 3 and 24 months of age, by pediatricians and pediatric physical therapists. [ABSTRACT FROM AUTHOR]

This study aimed to assess the prevalence of neurological symptoms and related imaging findings in patients with von Hippel-Lindau (VHL) at Rasool Akram Hospital from September 2018 to September 2021. This analytical observational study examined eligible patients over the period from September 2018 to September 2021. We collected demographic information (age, gender) along with imaging findings and results of neurological and eye examinations. Comparison between qualitative variables was also done using the Chi-square test or Fisher’s exact test. Also, an independent t-test was used to compare quantitative variables between the two groups. SPSS version 22 software was used for statistical analysis of data. A significant level was considered less than or equal to 0.05. Of the 54 examined patients (48.1% were male and 51.9% were female) with an average age of 36.42 ± 13.37 years. A significant majority (87.0%) reported a positive family history of the disease. The most common type of disease was Type 1 observed in 94.4% of cases and Type 2A was the next most frequent (3.7%). The most common pattern of retinal pathological lesions seen in the examination was related to bilateral lesions (79.6%). The most common pathological finding was related to the presence of a mass in cerebellar magnetic resonance imaging (48.1%). Considering the findings of the present study, which highlight a significant frequency of bilateral retinal lesions as well as masses in the central nervous system and endocrine system, it is evident that patients require careful follow-up and various interventions after being diagnosed with the disease. This approach is essential to manage and potentially mitigate the complications associated with these conditions.

ABSTRACT Objective: The current study aimed to translate the Hammersmith Infant Neurological Examination (HINE) into Brazilian Portuguese and analyze the reliability of the translated version for a population of Brazilian infants. Methods: This was a methodological study, approved by the Ethics Committee, carried out between June 2020 and May 2021. HINE is a standardized clinical neurological examination used for the early detection of cerebral palsy. The quantitative section, “neurological examination”, contains 26 items scored from 0 to 3 points, divided into five categories: cranial nerve function, posture, movements, muscle tone and reflexes, and reactions. The HINE translation followed four steps: translation, synthesis, back-translation, and evaluation by an expert committee. To verify the reliability of the HINE-Br (Portuguese-Brazil version) two independent examiners evaluated 43 infants, between 3 and 22 months of age. Internal consistency was verified by Cronbach’s Alpha coefficient and interrater reliability by the intraclass correlation coefficient (ICC). Results: The translated version was similar to the original version and a few semantic and idiomatic adjustments were necessary. Appropriate internal consistency (Alpha=0.91) was found for the 26 items of the HINE-Br, as well as strong interrater reliability for the total score (ICC2.1=0.95), and also for the five categories (ICC2.1=0.83–0.95). Conclusions: The HINE-Br presents adequate rates of internal consistency and interrater reliability, and can be used for the evaluation of children at risk for cerebral palsy, between 3 and 24 months of age, by pediatricians and pediatric physical therapists.

While the COVID-19 pandemic has catalyzed the expansion of telemedicine into nearly every specialty of medicine, few articles have summarized current practices and recommendations for integrating virtual care in the practice of neuro-oncology. This article identifies current telemedicine practice, provides practical guidance for conducting telemedicine visits, and generates recommendations for integrating virtual care into neuro-oncology practice. Practical aspects of telemedicine are summarized including when to use and not use telemedicine, how to conduct a virtual visit, who to include in the virtual encounter, unique aspects of telehealth in neuro-oncology, and emerging innovations.

Patients with movement disorders such as Parkinson’s disease (PD) living in remote and underserved areas often have limited access to specialized healthcare, while the feasibility and reliability of the video-based examination remains unclear. The aim of this narrative review is to examine which parts of remote neurological assessment are feasible and reliable in movement disorders. Clinical studies have demonstrated that most parts of the video-based neurological examination are feasible, even in the absence of a third party, including stance and gait—if an assistive device is not required—bradykinesia, tremor, dystonia, some ocular mobility parts, coordination, and gross muscle power and sensation assessment. Technical issues (video quality, internet connection, camera placement) might affect bradykinesia and tremor evaluation, especially in mild cases, possibly due to their rhythmic nature. Rigidity, postural instability and deep tendon reflexes cannot be remotely performed unless a trained healthcare professional is present. A modified version of incomplete Unified Parkinson’s Disease Rating Scale (UPDRS)-III and a related equation lacking rigidity and pull testing items can reliably predict total UPDRS-III. UPDRS-II, -IV, Timed “Up and Go”, and non-motor and quality of life scales can be administered remotely, while the remote Movement Disorder Society (MDS)-UPDRS-III requires further investigation. In conclusion, most parts of neurological examination can be performed virtually in PD, except for rigidity and postural instability, while technical issues might affect the assessment of mild bradykinesia and tremor. The combined use of wearable devices may at least partially compensate for these challenges in the future.

A fundamental aspect of caring for neurocritical patients is interpreting and understanding their neurological signs and symptoms. This will be a helpful key to determining the brain injury or dysfunction's location, extent, and severity. The semiotics of the neurocritical patient encompasses various domains, including motor, sensory, cognitive, and autonomic functions. A comprehensive understanding of the semiotics of the neurocritical patient empowers clinicians to make timely and accurate diagnoses, predict outcomes, and implement targeted therapeutic interventions. It also enables effective communication among the interdisciplinary team members involved in the patient's care. This article review shows the importance of accurately recognizing and deciphering these signs to guide clinical decision-making. [ABSTRACT FROM AUTHOR]

An accurate and reliable neurological examination is pivotal in diagnosing patients with neurological and neurosurgical conditions. Despite the advancement of neuroscientific knowledge and the ever-progressing technologies and modalities that are being adopted to help achieve the challenge of accurate diagnosis, the neurologic examination is still crucial in both ambulatory and emergency settings. It provides the physician a tool to recognise neurologic involvement in certain disease states, and thereby allow proper work-up and treatment for patients. A basic neurologic examination can be performed rapidly with practice. Manual muscle testing of the lower limbs was carried out in accordance with a bedside clinical examination involving a clinical personnel examiner and a patient. This testing was performed in a rostro-caudal manner, starting from the hip and progressing to the toes. The neurological exam can be intimidating to perform for a lot of physicians. Deficiencies in accurate muscle testing have always presented a challenge for medical students and clinicians. By referring to the examination methods mentioned in our text and with the help of related video, it is our aim to improve the quality of neurological examination among medical personnel so that diseases may be recognised and managed earlier in their course. [ABSTRACT FROM AUTHOR]

Clinical evaluation of abdominal, cremasteric, and sacral area reflexes allows identification of the level of central nervous system injury and enables more precise diagnosis and safer rehabilitation of the patient with pelviperineal dysfunction. Neurological examination in pelviperineal dysfunctional disorders is indicated as a preliminary element to rehabilitation treatment tailored to the specific needs of the patient. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive load theory provides a theoretical framework through which the teaching of skills to health students can be optimised. The aim of this study was to evaluate the intrinsic and extraneous cognitive load of first-year osteopathy students as they learn a psychomotor-based clinical skill (neurological examination of the upper limb). Methods: First-year osteopathy students (n = 78) at an Australian university completed an 8-item cognitive load survey at the end of the session where they were taught, and conducted, their first hands-on assessment task (neurological examination of the upper limb). The task was completed in a learning environment designed with low-medium complexity, medium fidelity and high levels of instructional support for learners. Results: Intrinsic and extraneous load data indicate varied levels of cognitive demand of the task across the cohort. On average, intrinsic load made up three quarters of the total cognitive load associated with this task. Conclusion: Understanding and utilising cognitive load theory in the design of lesson plans may provide improved opportunity to optimise student learning of novel clinical skills. Extraneous load was much lower than intrinsic load, suggesting the learning environment was fit for purpose for these learners. [ABSTRACT FROM AUTHOR]

Background: The survival of premature infants has improved in the recent era due to advances in perinatal and neonatal healthcare practices. These infants are at risk of neuro-sensorimotor impairment, as well as learning and behavioral disorders.Methods: A longitudinal follow-up study was planned over 6 months at a High-Risk Clinic, Civil Hospital, Ahmedabad, India, to conduct the neurological examination and hearing assessment of premature infants born with gestational age less than 32 weeks. Infants who were born preterm at

Background Percussion is an important part of the neurological examination and reflex hammers are necessary to obtain it properly. Objective We aimed to review the historical aspects of the main reflex hammers and to define the favorite one of Brazilian neurologists. Methods We searched original and review articles about historical aspects of the reflex hammers in Scielo and Pubmed and conducted an online survey to investigate the favorite reflex hammer of Brazilian neurologists. Results In the first part, we describe the major milestones in the creation of the reflex hammers. Following, we exhibit the results of the online survey: Babinski-Rabiner was the most voted. Conclusions The origins of the reflex hammers goes back long before their creation, from a basic clinical examination method: percussion. Since the description of deep tendon reflexes and the creation of percussion hammers, much has been improved in this technique. Among all the hammers surveyed, the Babinski-Rabiner was the chosen one by a significant portion of Brazilian neurologists.

Psychogenic gait is common in patients with medically unexplained neurological symptoms and provides significant challenges to healthcare providers. Clinicians may arrive at a correct diagnosis earlier if distinctive positive signs are identified and acknowledged. Psychogenic disorders of posture and gait are common and are the major manifestation in 8–10 % of patients with psychogenic movement disorders. Psychogenic movement disorders can present with varied phenomenology that may resemble organic movement disorders. The diagnosis is based on clinical evaluation with a supporting history and classic features on neurologic examination. In functional gait disorders, walking is often bizarre and does not conform to any of the usual patterns observed with neurologic gait disorders. Astasia-abasia, an inability to stand (astasia) or walk (abasia) in the absence of other neurologic abnormalities, was the term applied by investigators in the mid to late 19thcentury to describe certain patients with a frankly functional gait. Other descriptive terms include gaits that resemble walking on ice, walking a sticky surface, walking through water (bringing to mind excessive slowness), tightrope walking, habitual limping, and bizarre, robotic, knock-kneed, trepidant, anxious, and cautious gaits. Ancillary testing, such as imaging and neurophysiologic studies, can provide supplementary information but is not necessary for diagnosis.

A relative shortage of pediatric neurologists in proportion to estimated neurological disorders often results in general pediatricians evaluating and treating children with complex neurological conditions. Dedicated rotations in pediatric neurology are not mandated during medical school or pediatric residency. We evaluated the perceptions of a large cohort of pediatric residents and program directors (PDs) regarding child neurology training. Using an online tool, surveys were sent to pediatric residents and pediatric and pediatric neurology PDs. Response rates were 41% from pediatric residency programs, yielding 538 resident responses; 31% from pediatric PDs; and 62% from pediatric neurology PDs. Only 27% of the surveyed residents reported completing a neurology rotation during residency, 89% of whom expressed a subjective improvement in confidence with neurological assessments. Factors affecting comfort with eliciting a neurological history included exposure to a neurology rotation during residency, year of training, duration of neurology rotation in medical school, and inpatient exposure to neurological patients, whereas those associated with examination additionally included program size and postresidency plans. Overall, 80% of surveyed residents, 78% of pediatric PDs, and 96% of pediatric neurology PDs acknowledged the potential value of a mandatory pediatric neurology rotation during residency. We suggest that a mandatory pediatric neurology rotation will boost the confidence of current and future pediatric trainees in assessing common neurological conditions of childhood. [ABSTRACT FROM AUTHOR]

The goal of this study was to validate a series elastic actuator (SEA)-based robotic arm that can mimic three abnormal muscle behaviors, namely lead-pipe rigidity, cogwheel rigidity, and spasticity for medical education training purposes. Key characteristics of each muscle behavior were first modeled mathematically based on clinically-observed data across severity levels. A controller that incorporated feedback, feedforward, and disturbance observer schemes was implemented to deliver haptic target muscle resistive torques to the trainee during passive stretch assessments of the robotic arm. A series of benchtop tests across all behaviors and severity levels were conducted to validate the torque estimation accuracy of the custom SEA (RMSE: ~ 0.16 Nm) and the torque tracking performance of the controller (torque error percentage: < 2.8 %). A clinical validation study was performed with seven experienced clinicians to collect feedback on the task trainer’s simulation realism via a Classification Test and a Disclosed Test. In the Classification Test, subjects were able to classify different muscle behaviors with a mean accuracy > 87 % and could further distinguish severity level within each behavior satisfactorily. In the Disclosed Test, subjects generally agreed with the simulation realism and provided suggestions on haptic behaviors for future iterations. Overall, subjects scored 4.9 out of 5 for the potential usefulness of this device as a medical education tool for students to learn spasticity and rigidity assessment.

The pupillary light reflex is a component of bedside neurological examinations in neurological intensive care units (neuroICUs). A quantitative pupillometer provides a non-invasive and objective pupil reactivity parameter clinically significant for changes in the pupillary light reflex in neuroICUs. This article reviews the physiology and importance of the pupillary light reflex and the parameters of quantitative pupillometers. Moreover, this review discusses the clinical applications of quantitative pupillometers for post-cardiac arrest prognostication and monitoring of elevated intracranial pressure and neurological worsening in stroke, seizures, and other neurological diseases in the neuroICU. Quantitative pupillometry is a routine part of neurological examinations and an important monitoring tool for neurological diseases in neuroICUs.

Introduction: Olfactory changes are quite common in the population, causing a significant impact on the quality of life. Documentation of the olfactory function is essential for the diagnosis, treatment and follow-up of patients with inflammatory diseases of the upper airways, neurodegenerative diseases or viral infections. Among the different existing smell tests, the CCCRC is an inexpensive test, easy to apply, but it has not yet been evaluated on a large scale in the Brazilian population. Objective: To validate the CCCRC smell test, after adaptation for the Brazilian population, evaluating the performance of healthy volunteers and the stability of the test in retests. Methods: In this study, we carried out a cultural adaptation of the CCCRC test to Brazil. To validate and determine the normality scores, we applied the test to 334 healthy volunteers, aged >18 years of age. The retest was also carried out in up to four weeks on 34 additional volunteers to assess validity of the results. Results: When evaluating the participants’ performance, normosmia and mild hyposmia values were obtained in more than 95% of them. Women (58.4%) showed better accuracy than men (41.6%): p

The purpose of this case study on giant cell arteritis (GCA) is to ensure that emergency nurse practitioners (ENPs) are knowledgeable on this disease process to prevent serious complications such as permanent blindness in patients presenting to the emergency department (ED). The case study reviews emergency management of GCA, which includes diagnostic workup, pharmacological treatment, consults, disposition, follow-up care, and when to return to the ED. The classification criteria will be discussed for GCA from the American College of Rheumatology and the European Alliance of Associations for Rheumatology. In addition, risk assessment, clinical presentation, and physical examination findings will be listed. After reviewing this case study, ENPs should be able to identify GCA and manage care to reduce complications and recurrence of GCA in a patient presenting to the ED. [ABSTRACT FROM AUTHOR]

Background: The survival of premature infants has improved in the recent era due to advances in perinatal and neonatal healthcare practices. These infants are at risk of neuro-sensorimotor impairment, as well as learning and behavioral disorders. Methods: A longitudinal follow-up study was planned over 6 months at a High-Risk Clinic, Civil Hospital, Ahmedabad, India, to conduct the neurological examination and hearing assessment of premature infants born with gestational age less than 32 weeks. Infants who were born preterm at <32 weeks of gestational age and those attending the high-risk clinic at 3, 6, 9, and 12 months of corrected gestational age were enrolled in the study. These infants were assessed for tone via the Amiel-Tison method and hearing impairment via BERA. Results: During the study period, 69 infants were included with a mean gestational age of 30.4±1.2 weeks. On the assessment of tone, at 3 months of corrected age, 3 and 1 infants had hypertonia and hypotonia, respectively. At 6 months of corrected age, 4 and 3 infants had hypertonia and hypotonia, respectively. Moreover, 1 and 2 infants had hypertonia and hypotonia at 9 months of corrected age, respectively, and 1 infant had hypertonia at 12 months of corrected age. Out of 69 enrolled infants, 5 (7%) infants had hearing loss at 3 months of corrected gestational age, whereas 64 (93%) infants had normal hearing assessment via BERA at the corrected gestational age of 3 months. Conclusion: Preterm infants are at very high risk of neurodevelopmental impairment and need frequent follow-up visits and early intervention. [ABSTRACT FROM AUTHOR]

Background Percussion is an important part of the neurological examination and reflex hammers are necessary to obtain it properly. Objective We aimed to review the historical aspects of the main reflex hammers and to define the favorite one of Brazilian neurologists. Methods We searched original and review articles about historical aspects of the reflex hammers in Scielo and Pubmed and conducted an online survey to investigate the favorite reflex hammer of Brazilian neurologists. Results In the first part, we describe the major milestones in the creation of the reflex hammers. Following, we exhibit the results of the online survey: Babinski-Rabiner was the most voted. Conclusions The origins of the reflex hammers goes back long before their creation, from a basic clinical examination method: percussion. Since the description of deep tendon reflexes and the creation of percussion hammers, much has been improved in this technique. Among all the hammers surveyed, the Babinski-Rabiner was the chosen one by a significant portion of Brazilian neurologists. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) without radiographic abnormality (SCIWORA) is a syndrome that usually occurs in children primarily because of the unique biomechanics of the pediatric spine. We recently found that the histopathological and behavioral effects of SCI with radiographic abnormality (SCIWRA) and SCIWORA are very different from each other in animal models. Although numerous studies were conducted to understand the epidemiological and clinical characteristics of the overall pediatric SCI population and the pediatric SCIWORA population, the characteristics of the pediatric SCIWRA population and their differences from those of the SCIWORA population are poorly understood. To describe the epidemiology and clinical outcomes of pediatric patients with SCIWRA and their differences from those with SCIWORA. Retrospective study. A total of 47 pediatric SCIWRA patients. Epidemiological characteristics, injury severities, functional deficits, and management and recovery outcomes. Review of all cases with SCIWRA at Beijing Children's Hospital between July 2007 and December 2019 and comparison between the present data and our previous SCIWORA data. Of the 187 pediatric SCI patients, 47 had SCIWRA (age: 7.06 ± 3.75 years, male-to-female ratio: 3:2). Main causes of SCIWRA were fall (38%) and traffic accidents (38%). Lesions were often located at multiple levels (62%). Incubation period was 3 ± 18 hours. According to the American Spinal Injury Association impairment scale (AIS), many SCIWRA patients had incomplete impairment (AIS B, 9%; AIS C, 9%; AIS D, 32%). Specifically, many of them had abnormal upper and lower limb muscle powers (55% and 60%), upper and lower limb muscle tones (34% and 49%), sensation (38%), and knee, ankle, and abdominal reflexes (47%, 34%, and 36%). 72% of SCIWRA patients were treated with methylprednisolone, dexamethasone, or both. 81% of them showed neurological improvement before discharge. There was no association between corticosteroid therapy and neurological improvement. Moreover, functional outcomes of their upper and lower limb muscle powers were significantly associated with functional outcomes of their upper and lower limb muscle tones (p < 0.01), respectively. In comparison to the SCIWRA population, the SCIWORA population had a higher ratio of younger and female patients of sports-related thoracic injuries with long incubation period leading to lower-body deficits and complete impairment (p<0.05 or p<0.01). Despite all the differences, their neurological improvement was similar (p>0.05). Demographic differences exist in the SCIWRA population. Corticosteroids do not appear to be effective in the different types of pediatric SCI. Limb muscle tone may be used to evaluate the functional status of limb muscle power. The epidemiological and clinical characteristics of SCIWRA and SCIWORA are very different from each other. It is important to formulate tailor-made prevention, evaluation, and management strategies for the pediatric population to optimize the SCI outcomes. [ABSTRACT FROM AUTHOR]

* SYNOPSIS: Neurological testing is essential for screening and diagnosing suspected peripheral neuropathies. Detecting changes in somatosensory and motor nerve function can also have direct implications for management decisions. Nevertheless, there is considerable variation in what is included in a bedside neurological examination and how it is performed. Neurological examinations are often used as screening tools to detect neurological deficits but not used to their full potential for monitoring progress or deterioration. Here, we advocate for better use of the neurological examination within a clinical reasoning framework. Constrained by the lack of research in this field, our Viewpoint is based on neuroscientific principles. We highlight 6 challenges for clinicians when conducting neurological examinations and propose ways to overcome these challenges in clinical practice. We challenge widely held ideas about how the results of neurological examinations for peripheral neuropathies are interpreted and how the examinations are performed in practice. [ABSTRACT FROM AUTHOR]

Background: Infants born at 29-36 weeks gestational age (GA) are at risk of experiencing neurodevelopmental challenges. We hypothesize that cerebral hemodynamics and oxygen metabolism measured by bedside optical brain monitoring are potential biomarkers of brain development and are associated with neurological examination at term-equivalent age (TEA). Methods: Preterm infants (N D 133) born 29-36 weeks GA and admitted in the neonatal intensive care unit were enrolled in this prospective cohort study. Combined frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) were used from birth to TEA to measure cerebral hemoglobin oxygen saturation and an index of microvascular cerebral blood flow (CBFi) along with peripheral arterial oxygen saturation (SpO2). In combination with hemoglobin concentration in the blood, these parameters were used to derive cerebral oxygen extraction fraction (OEF) and an index of cerebral oxygen metabolism (CMRO2i). The Amiel-Tison and Gosselin Neurological Assessment was performed at TEA. Linear regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and GA at birth. Logistic regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and neurological examination at TEA. Results: Steeper increases in CBFi (p < 0.0001) and CMRO2i (p D 0.0003) were associated with higher GA at birth. Changes in OEF, CBFi, and CMRO2i from birth to TEA were not associated with neurological examination at TEA. Conclusion: In this population, cerebral FDNIRS-DCS parameters were not associated with neurological examination at TEA. Larger increases in CBFi and CMRO2i from birth to TEA were associated with higher GA. Non-invasive bedside FDNIRS-DCS monitoring provides cerebral hemodynamic and metabolic parameters that may complement neurological examination to assess brain development in preterm infants. [ABSTRACT FROM AUTHOR]

Simple Summary: Neurological examination is crucial for clinicians when animals present neurological symptoms. Rabbits, as prey animals, can be easily frightened and may not react as anticipated during examinations. Most of the literature describing how to perform neurological examinations in rabbits is limited to personal experience, with only one recent study evaluating neurological examinations in healthy rabbits. However, some tests were not included in that study, and our clinical experience differed from some of their conclusions. The current study focused on postural reaction tests and evaluated whether the rabbit was willing to cooperate with each test and the normal response rate for each test/method. In addition, the response rates of tests/methods with similar neuroanatomical pathways were compared. In total, 34 clinically healthy rabbits were enrolled in this study. Our results demonstrate that the response to postural reaction tests is highly variable in healthy rabbits. Moreover, the hopping reaction (by holding and lowering the rabbit quickly towards the floor with only the tested limb touching the ground), hemi-walking, wheelbarrowing, and righting response are tests likely to elicit consistent and normal reactions. Neurological examination remains a fundamental step in the care of patients with neurological disorders. However, studies evaluating the feasibility and validity of neurological examination in rabbits are limited. In this study, postural reaction tests or methods commonly performed in dogs and cats were evaluated in clinically healthy rabbits, and we aimed to postulate a simplified examination list according to the results. The feasibility and validity of each test were determined and screened using a cut-off value of 90%. For the remaining tests/methods, the response rates of tests with similar neuroanatomical pathways were compared. Among the 34 healthy rabbits tested, one method of the hopping reaction (holding then lowering the rabbit quickly towards the floor with only the tested limb touching the ground), the hemi-walking test, the wheelbarrowing test, and the righting response yielded a feasibility and validity of over 90%. When comparing tests/methods with similar neuroanatomical pathways, the normal response rate of the hopping reaction was comparable to that of the hemi-walking test. We conclude that in healthy rabbits, hopping reaction tests using the method mentioned above, hemi-walking, wheelbarrowing, and righting responses are likely to be feasible postural reaction tests that yield consistent and normal responses. [ABSTRACT FROM AUTHOR]

Usha Rani Kandula, Eshete Teklewold, Yoseph Zemene, Dinkinesh Begna, Techane Sisay Tuji Department of Clinical Nursing, College of Health Sciences, Arsi University, Asella, EthiopiaCorrespondence: Usha Rani Kandula, Department of clinical nursing, College of Health Sciences, Arsi University, Oromia Region, P.O. Box-396, Asella, Ethiopia, Tel +251-939052408, Email neha2010dec@gmail.com; usharani2020@arsiun.edu.etBackground: The central nervous system assessment is typically perceived as a complicated exam that would be both time-consuming and challenging. A disciplined approach and directed guidelines can ameliorate much of the difficulties involved. Nursing staff should have the required knowledge of neurological examination is intended to facilitate the physician in clinical check-ups, which would lead to the client’s enhanced well-being.Objective: The study’s goal is to determine the “Effect of implementing an educational program regarding neurological examination on nurses”.Methods: Quasi-experimental research work was carried out at Asella teaching referral hospitals in the Oromia Region of Ethiopia to assess the effect of implementing an educational program regarding neurological examination on nurses. To hand pick up 56 study samples, a convenient sampling technique was asserted. At first, a comprehension set of questions on neurological examination has been used to undertake a pre-measurement evaluation, which was accompanied by a two-week self-administered intervention in an educational program regarding the neurological examination. Followed that, the same comprehension set of questions on neurological examination was used for post-measurement evaluation among nursing professionals. The acquired data was entered into epi-info version-7 for coding and error prevention and transferred to SPSS version 22 for analysis employing descriptive and inferential statistics, and after the results of the research have been contextualized.Findings: The investigation outcomes showed that the pre-measurement mean and SD were 13.02± 2.62, while the post-measurement mean and SD were 22.63± 3.21. The paired-t-test resulted in t=26.24 (p=0.00, df-55, S*) for the effect of implementing an educational program regarding neurological examination among nurses. Whereas, linear multiple regression was explained with no statistically significant association between pre-measurement knowledge and the study’s demographic factors.Conclusion: The study strongly indicates that there is a significant effect of implementing an educational program regarding neurological examination among nurses.Keywords: effect, implementation, educational program, neurological examination, Nurses Oromia Region, Ethiopia

BackgroundInfants born at 29–36 weeks gestational age (GA) are at risk of experiencing neurodevelopmental challenges. We hypothesize that cerebral hemodynamics and oxygen metabolism measured by bedside optical brain monitoring are potential biomarkers of brain development and are associated with neurological examination at term-equivalent age (TEA).MethodsPreterm infants (N = 133) born 29–36 weeks GA and admitted in the neonatal intensive care unit were enrolled in this prospective cohort study. Combined frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) were used from birth to TEA to measure cerebral hemoglobin oxygen saturation and an index of microvascular cerebral blood flow (CBFi) along with peripheral arterial oxygen saturation (SpO2). In combination with hemoglobin concentration in the blood, these parameters were used to derive cerebral oxygen extraction fraction (OEF) and an index of cerebral oxygen metabolism (CMRO2i). The Amiel-Tison and Gosselin Neurological Assessment was performed at TEA. Linear regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and GA at birth. Logistic regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and neurological examination at TEA.ResultsSteeper increases in CBFi (p < 0.0001) and CMRO2i (p = 0.0003) were associated with higher GA at birth. Changes in OEF, CBFi, and CMRO2i from birth to TEA were not associated with neurological examination at TEA.ConclusionIn this population, cerebral FDNIRS-DCS parameters were not associated with neurological examination at TEA. Larger increases in CBFi and CMRO2i from birth to TEA were associated with higher GA. Non-invasive bedside FDNIRS-DCS monitoring provides cerebral hemodynamic and metabolic parameters that may complement neurological examination to assess brain development in preterm infants.

Introduction: As knowledge about neurological examination findings in autosomal dominant Alzheimer disease (ADAD) is incomplete, we aimed to determine the frequency and significance of neurological examination findings in ADAD. Methods: Frequencies of neurological examination findings were compared between symptomatic mutation carriers and non mutation carriers from the Dominantly Inherited Alzheimer Network (DIAN) to define AD neurological examination findings. AD neurological examination findings were analyzed regarding frequency, association with and predictive value regarding cognitive decline, and association with brain atrophy in symptomatic mutation carriers. Results: AD neurological examination findings included abnormal deep tendon reflexes, gait disturbance, pathological cranial nerve examination findings, tremor, abnormal finger to nose and heel to shin testing, and compromised motor strength. The frequency of AD neurological examination findings was 65.1%. Cross‐sectionally, mutation carriers with AD neurological examination findings showed a more than two‐fold faster cognitive decline and had greater parieto‐temporal atrophy, including hippocampal atrophy. Longitudinally, AD neurological examination findings predicted a significantly greater decline over time. Discussion: ADAD features a distinct pattern of neurological examination findings that is useful to estimate prognosis and may inform clinical care and therapeutic trial designs. [ABSTRACT FROM AUTHOR]

Neurological pathology has known a marked expansion in recent years in veterinary practice in Romania, the diversity and complexity of cases representing a constant challenge for clinicians. Consequently, the diagnostic methodology was in a continuous dynamic, being influenced by the particularities of each patient and the accuracy of the available diagnostic methods. However, identifying the localisation of the lesion according to the correspondence of the neurological deficits with the functional segment of the brain (forebrain, brainstem, cerebellum, vestibular apparatus) remained an essential stage. Decerebrate rigidity, a comatose mental status accompanied by a decrease in the activity of the vital centres, and multiple deficits of the cranial nerves are cardinal signs of a brain stem lesion. This paper aims to present the clinical, neurological, and imaging features of 15 patients (dogs and cats) diagnosed with brainstem deficits in the Faculty of Veterinary Medicine of Bucharest, in 2021. Each case was conducted according to a standard protocol and the results were analysed to observe the population dynamics and possible predisposing factors. [ABSTRACT FROM AUTHOR]

Background. Brain concussion is an immediate transient alteration of the neurological functions due to direct or indirect traumatic head injury followed by a post-concussion syndrome of variable duration. Concussion is included in the group of mild head injuries and is manifested in the form of immediate and transient changes in the central nervous system function caused by the brain's impact against the skull's bony wall. Strangulation is a strong compression around the neck. The damage is caused when pressure is applied to the front of the neck, preventing air and sometimes blood from passing to the brain. These phenomena can lead to short-term loss of consciousness Methods. A bibliographic survey was done. Results. In high-level sports, concussion is common and recurrent, especially in high-speed contact or collision sports such as boxing, rugby, American football, ice hockey, soccer and others. When concussion occurs, the athlete requires a recovery period during which he/she is unable to continue sports practice. Former elite athletes, who have suffered from repetitive concussion reported mental alterations such as headaches, anxiety, depression and sleep disturbances. The most common means used to assess the severity of sports concussion is the 5th version of the Sport Concussion Assessment Tool (SCAT5) which incorporates several tests. Strangulation usually occurs in mattress sports such as judo and wrestling. The management of concussion and strangulation by the medical staff must follow existing guidelines, beginning in the sports arena or ground immediately after occurrence, and continuing until the athlete is allowed to return to play. Conclusions. 1) Concussion obliges medical staff to assess the athlete's level of consciousness immediately after the trauma and involves an incapacity to continue sport practice with a variable period of recovery. 2) Air choking, blood choking and vagal phenomenon probably explains most cases of loss of consciousness after strangulation. [ABSTRACT FROM AUTHOR]