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Introduction: Traumatic brain injuries are of concern to the sports and military communities because of the age of the participants and costly burden to society. To markedly reduce the impact of traumatic brain injury and its sequela (TBI-S), it is necessary to determine the initial vulnerability of individuals as well as identify new technologies that indicate early signs of TBI-S., Materials and Methods: Currently, diverse methods have been used by the authors and others in laboratory settings to reveal early signs of persistent TBI-S including simulation modeling of the effect of rapid deceleration on the deviatoric strain (shear force) imposed on specific brain regions, auditory evoked potential (AEP) measurements to determine injury to the auditory cortex optokinetic nystagmus (OKN) measures sensitive to vestibular trauma, and optical coherence tomography (OCT) measures that reveal changes in central visual function obtained noninvasively by examination of the retina., Results: Simulation studies provided technical information on maximal deviatoric strain at the base of the sulci and interface of gray and white matter consistent with results from neuropathology and from magnetic resonance imaging. The AEP and OKN reveal measurable injury to similar regions below the Sylvian fissure including auditory cortex and midbrain, and the OCT reveals changes to the retina consistent with forceful deceleration effects., Conclusions: The studies and results are consistent with prior work demonstrating that noninvasive tests may be sensitive to the presence of TBI-S, potentially in the training field as advances in the portability of test instruments are underway. When combined with baseline data gathered from individuals in quantitative form, key variances can emerge. Therefore, it is hypothesized that AEP, OKN, and OCT, taken together, may yield faster objective and quantitative neurophysiological measures serving as a "signature" of neural injury and more indicative of potentially persistent TBI-S-recommending larger scale longitudinal studies., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Traumatic brain injury (TBI) has become a concern in sports, automobile accidents and combat operations. A better understanding of the mechanics leading to a TBI is required to cope with both the short-term life-threatening effects and long-term effects of TBIs, such as the development chronic traumatic encephalopathy (CTE). Kornguth et al. (1) proposed that an inflammatory and autoimmune process initiated by a water hammer effect at the bases of the sulci of the brain is a mechanism of TBI leading to CTE. A major objective of this study is to investigate whether the water hammer effect is present due to blunt impacts through the use of computational models. Frontal blunt impacts were simulated with 2D finite element models developed to capture the biofidelic geometry of a human head. The models utilized the Arbitrary Lagrangian Eulerian (ALE) method to model a layer of cerebrospinal fluid (CSF) as a deforming fluid allowing for CSF to move in and out of sulci. During the simulated impacts, CSF was not observed to be driven into the sulci during the transient response. However, elevated shear strain levels near the base of the sulci were exhibited. Further, increased shear strain was present when differentiation between white and gray matter was taken into account. Both of the results support clinical observations of (1)., (At least a portion of this work is authored by Brian T. Fagan and Sikhanda S. Satapathyon on behalf of the U.S. Government and, as regards Dr. Fagan, Dr. Satapathyon and the U.S. Government, is not subject to copyright protection in the United States. Foreign and other copyrights may apply.)

Competing Interests: Competing interests: SAA: local principal investigator (PI) for HEAT, FRED and STARRT trials. JEDA: consultant for Medtronic, Penumbra, Sequent Medical and Accriva Diagnostics. DH: consultant for Stryker Neurovascular. SWH: consultant for Medina and Neuravi, and research contracts with Stryker Neurovascular, Siemens, MicroVention Terumo. Hirsch: consultant for Medtronic. RK: proctor and speaker for Medtronic. JM: consultant for Rebound Therapeutics, TSP Inc, Cerebrotech, Lazarus Effect, Pulsar, Medina;. investor in Blockade Medical, TSP Inc, Lazarus effect, Medina; PI/Co-PI for THERAPY (PI), FEAT (PI), INVEST (Co-PI), COMPASS (Co-PI), LARGE (Co-PI), COAST (Co-PI), POSITIVE (Co-PI) trials; on steering committee for the MAPS trial. CP: consultant for Codman Neurovascular (serving on Data and Safety Monitoring Board (DSMB)). GLP: consultant for Sequent Medical (DSMB for web-IT study). PR: investor, Scientific Advisory Board and stock holder—Blockade Medical; consultant/honorarium—Medtronic; Scientific Advisory Board and stock holder— Nervive Medical and Perflow Medical; Scientific Advisory Board—Stryker Neurovascular. PS: protctoring for Medtronic; investigator in STRATIS (Medtronic) and CARE (Penumbra) studies.

Background: We examined the influence of catheter ablation and periprocedural anticoagulation regimen on trajectory of migraine in atrial fibrillation patients with or without migraine history., Methods and Results: Forty patients with (group 1: 64 ± 8 years; men 78%) and 85 (group 2: 61 ± 10 years; men 73%) without migraine history undergoing atrial fibrillation-ablation were enrolled. Migraine status and quality of life were evaluated using standardized questionnaires. Diffusion magnetic resonance imaging of brain was performed for all at pre and 24 hours post procedure. Catheter ablation was performed with (88, 70%) or without (37, 30%) continuous warfarin treatment. Fifty-four patients (11 and 43 from groups 1 and 2, respectively) had subtherapeutic international normalized ratio on procedure day. At 17 ± 5 months follow-up, from group 1, 25 (63%) reported no migraine, 10 (25%) had < 1, and 3 (8%) had 2 to 3 monthly symptoms. Intensity of pain decreased from baseline 7 (Q1-Q3, 4-8) to 2 (0-4) scale points at follow-up (P < 0.001) and duration of headache from median 8 (Q1-Q3, 4-15) to 0.5 (Q1-Q3, 0-2) hours (P < 0.001). Two patients from group 1 reported increased migraine severity and 2 from group 2 had new-onset migraine. Follow-up diffusion magnetic resonance imaging revealed new infarcts in 9.6% (12/125) patients; of which 11 had subtherapeutic preprocedural international normalized ratio on or off continuous warfarin. Quality of life improved significantly in patients with successful ablation, being more pronounced in group 1., Conclusions: In most patients, migraine symptoms improved substantially after catheter ablation. Interestingly, the only cases of new migraine and aggravation of pre-existent headache had subtherapeutic international normalized ratio during the procedure and new cerebral infarcts., (© 2015 American Heart Association, Inc.)

Background: The magnitude of treatment effect in acute stroke depends on several factors, including time from symptom onset (TFSO) to treatment and severity of the initial insult., Objective: To report further evaluation of NeuroFlo therapy, focusing on the effect of time and stroke severity., Methods: SENTIS was a prospective randomized trial (N=515) comparing standard medical therapy with/without NeuroFlo therapy. For this analysis, we evaluated outcomes in groups of patients based on TFSO and stroke severity: patients randomized <6 h, 6-10 h, and >10 h with mild (NIHSS<8), moderate (8-14), and severe (>14) symptoms at randomization. 90-Day mRS (modified Rankin Scale) scores and stroke-related death rates were compared between treatment groups., Results: For patients randomized <6 h TFSO (n=128), the OR for mRS 0-2 was 3.11 (CI 1.30 to 7.46, p=0.011) for treated versus non-treated patients. In patients with disease of moderate severity (NIHSS 8-14, n=214), NeuroFlo-treated patients were more likely to have a good outcome (mRS 0-2; OR=1.84, CI 1.02 to 3.33, p=0.043). The stroke-related death rate was better in the treated group with TFSO >10 h and NIHSS >14 (n=42) (OR=7.10, CI 1.13 to 44.55, p=0.036)., Conclusions: The results of our analysis support the importance of careful selection of outcome measures and the impact that rapid treatment and initial stroke severity have on outcome.

Abnormal levels of brain iron have been reported in parkinsonism, which is characterized principally by degeneration of dopaminergic (DA) nigrostriatal neurons. There are conflicting reports, however, of both increased and decreased iron in parkinsonism. An animal model of parkinsonism was used to clarify the contribution of the loss of nigrostriatal DAergic neurons to abnormal iron accumulations. In rats with 6-hydroxydopamine induced unilateral DA depletion, brain iron deposition and its day-to-day stability was studied in vivo using T2-weighted magnetic resonance imaging (MRI) scans taken on 4 consecutive days beginning 1-2 months post-surgery and post-mortem by Perls'-DAB histochemical stain. Unilateral DA depletion (parkinsonism model) produced large day-to-day fluctuations in T2 relaxation time in the striatum. The T2 relaxation time in Sham control rats was relatively minor. The uptake and transport of iron by intrinsic cells of the striatum may vary, and this variability may have been exaggerated by the destruction of DAergic nigrostriatal neurons, which are known to modulate the activity of the intrinsic cells. Inconsistent reports of increased or decreased iron in parkinsonism may reflect, in part, single time-point measures of widely fluctuating iron.

Gastric emphysema is a rare condition in which gas from a nonbacterial source accumulates within the wall of the stomach. Gastric distension and vomiting frequently precede the formation of the intramural air. Pulmonary disease, instrumentation of the stomach, and obstructing lesions of the antrum and pylorus are also common contributing factors. A case report and an extensive review of the literature are presented.

Heavily T2-weighted high-field MR images provide a unique opportunity for the evaluation of the extrapyramidal motor system. The images are affected by the presence of small amounts of naturally occurring paramagnetic substances--principally iron--that delineate the neostriatum (caudate and putamen), globus pallidus, red nucleus, substantia nigra, and dentate nucleus, primarily by a decrease in signal secondary to the T2* effect. Movement disorders are associated with either increased or decreased signal or both in these structures, depending on the pathologic process. In the initial evaluation of 113 patients with a variety of movement disorders, good correlation of imaging abnormalities can be made with a simplified schema of the extrapyramidal pathways and a system of classification of abnormal movements, parkinsonism/tremor, dystonia, chorea, myoclonus, and hemiballismus. Parkinsonisms are characterized by abnormalities of the cortico-ponto-cerebello-dentato-rubro-thalamo-cortico-spinal tract or the nigrostriatal tract. Dystonias are characterized by abnormalities of the neostriatum predominantly affecting the putamen. Choreas are also characterized by abnormalities of the neostriatum but predominantly affecting the caudate nucleus. Hemiballismus is characterized by lesions affecting the subthalamic nucleus or associated pathway.

Huntington's Disease (HD) is a progressive neurological disorder whose cardinal features are involuntary movements and cognitive decline. Severe emotional and/ or psychiatric disturbances are common features of the mental deterioration. When the emotional disturbance precedes the development of the movement disorder, HD is often misdiagnosed as a psychiatric condition. The present case study taken from the University of Texas Neuropathology Museum illustrates these issues. The patient was diagnosed and treated for depression for over a decade before the behavioral and neurological deterioration progressed to the point that an HD diagnosis could be made. Only with the detection of a positive family history and the onset of the hallmark choreiform movements was the final diagnosis of HD made. The patient's behavioral features are presented and current pathological and neuropsychological findings in HD are reviewed and discussed.

We have described a unique example of intratracheal neurofibroma in a patient with neurofibromatosis. Although tracheal neoplasms are rare, they should be considered in the presence of obstructive respiratory symptoms. Careful scrutiny of plain roentgenograms with special views should be undertaken for optimal evaluation.

Patients with facial palsy and middle ear disease, which may be chronic but clinically occult, may have a cholesteatoma with extension medially along the facial canal. In two patients, axial computed tomographic (CT) scans demonstrated involvement of the medial petrous bone. Patients with vertigo and chronic middle ear disease may have a cholesteatoma with a "fistula" between the middle and inner ears. Although the fistula usually involves the lateral semicircular canal, the cholesteatoma may pass through the oval window. In two patients, coronal CT scans showed extension to the oval window in one and through it in the other.