Archives of Neuroscience
Volume:9 Issue: 2, Apr 2022

Decompressive hemicraniectomy (DC) is the final surgical remedy for refractory raised intracranial pressure (ICP). Even with years of experience and profound refination of technique, the procedure has less rewarding results in traumatic brain injury (TBI). Besides, arrangements for bone flap preservation and the necessity of follow-up surgery in the form of cranioplasty bring in unavoidable monetary and logistic burdens to the patients. Step-ladder expansive cranioplasty was conceptualized as an alternative to achieve adequate intracranial volume expansion to help normalize ICP, with immediate reinstitution of the Monro-Kellie doctrine. It is also expected to prevent cerebral cortical pressure injury to the cortex underlying the craniectomy defect. The evolution of this concept, as worked out on different models, the surgical technique, and our experience with this technique are discussed in this article.

Multiple research projects undertaken by our team to build up the concept and acquire data necessary to plan the surgical procedure have been published over last eight years. This review article attempts to evaluate the existing knowledge and our clinical experience so far.

Step-ladder expansive cranioplasty allows an assured centrifugal displacement of the inner table and underlying dural bag at craniotomy site by at least 9 mm, thereby achieving a minimum volume expansion of 120 cc for a circular craniectomy defect of 10cm dia. Both of these parameters can be increased as considered necessary by the surgeon.

Step-ladder expansive cranioplasty offers an alternative that takes the centripetal pressure exerted by the combination of the tensile strength of the scalp and atmospheric pressure off the brain surface while achieving an assured augmentation of intracranial volume that can be optimized on a case-to-case basis, based on our future understanding of the subject. While it can be a single-stage surgery for those satisfied with the cosmesis, a revision cranioplasty (if required) will be easier, cheaper, and cosmetically superior to the presently popular cranioplasty techniques achieving cover over a craniotomy defect routinely done after DC.

Patients with multiple sclerosis (MS) visit Emergency Departments (ED) due to both neurological and non-neurological symptoms.

Our main aim was to study some epidemiologic features of the ED visits of MS cases in a referral hospital.

This cross-sectional study was conducted during 22 September 2018 - 21 September 2019 in Sina Hospital, Tehran, Iran. Admission causes were divided into two categories: patients admitted because of neurological complaints (MS true attacks and pseudo attacks) and patients admitted due to non-neurological reasons that may or may not be related to the disease. To compare the differences between the two categories, t and χ2 tests were used.

A total of 375 visits by 346 MS patients were reviewed. We observed that 239 (63.7%) visits were due to neurologic complaints, of which 213 (89.1%) were diagnosed with true MS relapses. Moreover, 136 visits were because of non-neurologic complaints, with urinary tract infection (UTI) being the most common complaint. The patients with MS visiting the ED were mostly female, though there was no significant difference between men and women diagnosed with true relapses (P = 0.154). Patients with neurologic symptoms were significantly younger than those with non-neurologic symptoms (P = 0.007). Our findings showed that 90% of patients with neurological symptoms underwent magnetic resonance imaging (MRI), and the yield of MRI was about 50%. Furthermore, the duration of admission was significantly higher in patients with neurological symptoms (P < 0.001).

MS relapse was the most frequent cause of ED visits by individuals with MS. There were also many ED visits by MS patients due to non-neurological causes, and the UTI was the most prevalent chief complaint.

The disease burden of acute ischemic stroke (AIS) is an important health issue in today’s patient care. Urgent intravenous thrombolytic (UIT) therapy is one of the most popular treatments in these cases.

This study aimed to evaluate the 1-month outcome of patients with AIS who received urgent intravenous fibrinolytic therapy.

In a prospective cross-sectional study, we evaluated the 1-month outcome of cases with a confirmed diagnosis of AIS who had received UIT therapy at the emergency department. Demographic data, mortality and morbidity, hospital length of stay, admission functional disability by Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), and final disposition of patients were all evaluated and recorded via their medical records or structured telephone inquiries. We compared all variables between the 2 groups (i.e., survived and expired groups).

Among 490 cases we assessed, age had a mean ± SD of 69.41 ± 12.25 years, and most cases were males (74.3%). The 1-month mortality rate in our sample was 4.08% (20 cases). The mean ± SD of hospital length of stay was 6.84 ± 7.32 days, with no significant difference between the 2 groups (P = 0.869). Demographic data showed no significant differences between the 2 groups. NIHSS and MRS scores were significantly higher in the expired group than in the survived group (P = 0.005 and P = 0.001, respectively).

NIHSS and MRS scores were significantly higher in the expired cases. The 1-month mortality rate in this study was 4.08%.

Finding neural correlates underlying deception may have implementations in judicial, security, and financial settings. Telling a successful lie may activate different brain regions associated with risk evaluation, subsequent reward/punishment possibility, decision-making, and theory of mind (ToM). Many other protocols have been developed to study individuals who proceed with deception under instructed laboratory conditions. However, no protocol has practiced lying in a real-life environment. We performed a functional MRI using a 3Tesla machine on 31 healthy individuals to detect the participants who successfully lie in a previously-designed game to earn or lose the monetary reward. The results revealed that lying results in an augmented activity in the right dorsolateral and right dorsomedial prefrontal cortices, the right inferior parietal lobule, bilateral inferior frontal gyri, and right anterior cingulate cortex. The findings would contribute to forensic practices regarding the detection of a deliberate lie. They may also have implications for guilt detection, social cognition, and the societal notions of responsibility.

Cerebral palsy (CP) results from damage to the central nervous system, leading to disturbances of motor and sensory functions, especially the balance. Virtual reality exercise intervention (VRI) is a promising technique to improve motor function in children with CP by engaging such individuals in real-like world events through simulations. This review study examines the effects of VRI on static and functional balances and summarizes the effective protocols of virtual reality-based rehabilitation interventions for the CP patients.

A comprehensive search was performed using the following databases: Medline/PubMed, Scopus, Cochrane Library, PEDro, EBSCOhost, and the Online Library of the University of London. The PEDro scale was used to assess the methodological quality. The data extracted from the reviewed studies were coded according to Cooper and Hedges’ guidelines considering the following criteria: (I) Patients' characteristics, (II) intervention protocols, (III) outcomes, and (IV) results. To this end, twelve RCTs with 248 patients aged 4 - 20 years old were analyzed and assessed as "fair" to "good" methodological quality according to Pedro’s scale (4 to 8). VRI alone or in combination with a standard physiotherapy program or with other tools such as tDCS was applied.

Twelve RCTs met the inclusion criteria. The meta-analysis showed the good effect of VRI on the static and functional balances of patients with CP (Cohen’s d = 0.66). The funnel plot revealed no significant asymmetry or heterogeneity among the studies (P = 0.271, I2 = 19.71%), reflecting the absence of publication biases.

This review reports four major perspectives of the VRI applications: (1) VRI settings, (2) selection of exercises, (3) outcome measures, and (4) long-term effects. Moreover, this review summarizes the specific effects of VRI on balance improvement in patients with CP from different perspectives. However, considering the limited number of well-conducted RCTs in this field, a large homogeneous samples size is still needed for future RCTs.

Sex-related differences in the incidence, prevalence, symptoms, and side effects of drug use, especially narcotics, have been previously shown in animal models and human studies.

In the presents study, the effects of different doses of testosterone on morphine extinction period were investigated in a rat model.

Forty mature male Wistar rats were randomly allocated to four categories (10 in each group), including control (received intramuscular injection of vehicle) and testosterone (received intramuscular injection of testosterone at 1, 2.5 and 5 mg/kg) during the extinction period. Conditioned place preference (CPP) test was done to assess the psychological phenomena of drug craving and relapse. The CPP score was calculated in five stages, including the baseline (preconditioning), acquisition (conditioning), expression (postconditioning), extinction, and reinstatement.

Our results demonstrated that testosterone (1, 2.5 and 5 mg/kg) significantly extended morphine extinction duration compared to the control group. It has been shown that dopamine neurotransmission in mesocorticolimbic system is affected by testosterone through androgen receptors in adolescence and alteration in testosterone level could affect drug use vulnerability.

It seems that normalization of testosterone levels reduces the symptoms of opioid withdrawal syndrome and have important clinical implication for clinicians to understand the effects of testosterone dysregulation on the extinction and withdrawal periods.