Repetitive transcranial magnetic stimulation improves consciousness disturbance in stroke patients A quantitative electroencephalography spectral power analysis

Repetitive transcranial magnetic stimulation is a noninvasive treatment technique that can directly alter cortical excitability and improve cerebral functional activity in unconscious patients. To investigate the effects and the electrophysiological changes of repetitive transcranial magnetic stimulation cortical treatment, 10 stroke patients with non-severe brainstem lesions and with disturbance of consciousness were treated with repetitive transcranial magnetic stimulation. A quantitative electroencephalography spectral power analysis was also performed. The absolute power in the alpha band was increased immediately after the first repetitive transcranial magnetic stimulation treatment, and the energy was reduced in the delta band. The alpha band relative power values slightly decreased at 1 day post-treatment, then increased and reached a stable level at 2 weeks post-treatment. Glasgow Coma Score and JFK Coma Recovery Scale-Revised score were improved. Relative power value in the alpha band was positively related to Glasgow Coma Score and JFK Coma Recovery Scale-Revised score. These data suggest that repetitive transcranial magnetic stimulation is a noninvasive, safe, and effective treatment technology for improving brain functional activity and promoting awakening in unconscious stroke patients.

Survey study of the etiology of non-traumatic altered consciousness in the Emergency Department at Suez Canal University Hospital in Egypt

BACKGROUND Disorders of consciousness including coma in non-trauma patients can be caused by a wide variety of pathologies affecting the central nervous system.They represent a frequent challenge in emergency medicine and are combined with a very high in-hospital mortality.Hence,early treatment of these patients is vital and increases the likelihood of a good outcome.AIM To identify the causes of altered consciousness presentation to the Emergency Department at Suez Canal University Hospital.METHODS This was a descriptive cross-sectional study conducted on 87 patients with acute non-traumatic disturbed level of consciousness(DLOC)at the Emergency Department.RESULTS The mean age of the studied patients was 60.5±13.6 years.Among them,60%were males and 40%were females.The most common cause of acute non-traumatic DLOC was systemic infection,such as sepsis and septic shock(25.3%),followed by respiratory causes(24.1%)and neurological causes(18.4%).CONCLUSION The most common cause of acute non-traumatic DLOC was systemic infections followed by respiratory and neurological causes.

Non-alcoholic Wernicke encephalopathy in an esophageal cancer patient receiving radiotherapy:A case report

BACKGROUND, Wernicke encephalopathy is a rare but potentially fatal adverse event caused by thiamine deficiency. Reports of non-alcoholic Wernicke encephalopathy due to malignancy are scarce in the literature, with those reported mainly being on haematological cancer, followed by gastrointestinal cancer. As a result, there is considerable under-recognition and delay in the diagnosis and treatment of Wernicke encephalopathy in oncology departments. To our knowledge, there has been no report of Wernicke encephalopathy in a patient with esophageal cancer while receiving radiotherapy.CASE SUMMARY A 64-year-old man presented to the oncology outpatient clinic with a history of dysphagia for 2 mo, and was diagnosed with locally advanced esophageal squamous cell carcinoma(stage ⅢB). Radiotherapy was initiated to alleviate dysphagia due to malignant esophageal stenosis;however, the patient exhibited consciousness disturbances starting on day 10 of radiotherapy. Brain magnetic resonance imaging indicated the development of Wernicke encephalopathy. Subsequent treatment with thiamine led to rapid improvement in the patient’s neurological symptoms.CONCLUSION Wernicke encephalopathy may develop in non-alcoholic patients undergoing radiotherapy for esophageal cancer. Early diagnosis and sufficient thiamine supplementation during radiotherapy are essential.

Microstructural changes in memory and reticular formation neural pathway after simple concussion

Patients with concussion often present with temporary disturbance of consciousness. The microstructural and functional changes in the brain associated with concussion, as well as the relationship with transient cognitive disorders, are currently unclear. In the present study, a rabbit model of simple concussion was established. Magnetic resonance-diffusion tensor imaging results revealed that the corona radiata and midbrain exhibited significantly decreased fractional anisotropy values in the neural pathways associated with memory and the reticular formation. In addition, the apparent diffusion coefficient values were significantly increased following injury compared with those before injury. Following a 1-hour period of quiet rest, the fractional anisotropy values significantly increased, and apparent diffusion coefficient values significantly decreased, returning to normal pre-injury levels. In contrast, the fractional anisotropy values and apparent diffusion coefficient values in the corpus callosum, thalamus and hippocampus showed no statistical significant alterations following injury. These findings indicate that the neural pathways associated with memory and the reticular formation pathway exhibit reversible microstructural white matter changes when concussion occurs, and these changes are exhibited to a different extent in different regions.

Wake-Promoting Effect of Bloodletting Puncture at Hand Twelve Jing-Well Points in Acute Stroke Patients:A Multi-center Randomized Controlled Trial

Objective To assess the effect and safety of bloodletting puncture at hand twelve Jing-Well points(HTWPs)in acute stroke patients with conscious disturbance.Methods In this multi-center and randomized controlled trial,360 patients suffered from ischemic or hemorrhagic stroke with conscious disturbance within 48 h from the onset of symptom were divided into bloodletting(180 cases)and control(180 cases)groups using a block randomization.Patients in both groups received routine Western medicine,and patients in the bloodletting group received additional bloodletting puncture at HTWPs on admission immediately before conventional treatment.The primary outcome measure was Glasgow Coma Scale(GCS)score and the secondary outcomes included blood pressure,respiratory rate and pulse rate.All variables were evaluated at baseline(before bloodletting),0(after bloodletting immediately),15,30,50 and 80 min post bloodletting.Results At 80 min post bloodletting,the proportion of patients with improved consciousness in the bloodletting group was greater than the control group(P<0.05).In the separate analysis of moderate consciousness disturbance subgroup,bloodletting therapy benefited ischemic patients,and improved the eye and language response of GCS score at 15,30,50,80 min post bloodletting(P<0.05 or P<0.01).No significant differences were observed regarding the secondary outcomes between two groups(P>0.05).Conclusion The bloodletting puncture at HTWPs was safe and could improve conscious levels of ischemic stroke patients,highlighting a first-aid intervention for acute stroke.

Cervical spine clearance in obtunded patients after severe polytrauma

Objective： To provide clinicians with data supporting three different clearance techniques in the obtunded patients after severe polytrauma. Methods： This study gave an overview of the available and pertinent literature regarding cervical spine clearance in obtunded patients after severe polytrauma. Results： Currently, there were three accepted techniques for clearance of the cervical spine in obtunded patients after severe polytrauma. Each of these methods has advantages and disadvantages to both of the patients and the clinicians, Conclusions： There are continuous improvements in both computed tomography （CT） and magnetic resonance imaging （MRI） techniques that increase their sensitivities. The continued use of plain radiographs is called into question with respect to cost and time requirements. An algorithmic approach to the evaluation of the cervical spine in the obtunded patients will lead to fewer missed injuries.