Neurologische Störungen

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic. It is currently established that patients with COVID-19 have a high risk of thromboembolic complications such as acute ischemic stroke which emerge as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2). In this sense, we present the case of a 68 year old male with a history of mitral valve replacement that developed a devastating acute ischemic stroke in multiple vascular territories in the setting of mild COVID-19 infection despite adherence to therapeutic anticoagulation. It is likely that multiple mechanisms are involved in stroke related to COVID-19. Although, vascular inflammation and coagulopathy are emerging as features defining pathology underlying COVID-19. Given the failure of anticoagulants in the prevention of ischemic strokes in some cases, despite an optimized anticoagulation strategy, more research is required to explore new methods of anti-thrombotic and anti-inflammatory therapy for stroke prevention in patients diagnosed with COVID-19.

Alzheimer’s Disease (AD) is very common neurological diseases these days. Alzheimer’s is one such gradual disorder that destroys memory and other significant mental functions that leads to dementia. It is necessary to detect and treat it in the initial stages itself in order to avoid any major disintegration. Using normal medical methods AD is very difficult to detect, so they used various classifications using MRI images to detect. In order to get better result, Image acquisition and pre-processing has been done. Over these years there are several approaches to detect and treat the brain diseases, now as the technology progressing rapidly this project has come up with an idea to integrate deep learning techniques to detect and understand the severity of brain’s condition of patient.

Introduction: Disorders of the spine (as defined by the musculoskeletal structures surrounding the spinal neural elements) require evidence based, approach to their care. This evaluation used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to evaluate the methodological quality of evidence based guidelines on spine disorders published by The National Institute for Health and Care Excellence (NICE).

Materials and methods: We systematically searched clinical guidelines on spine disorders published by NICE until December 2019. Four appraisers across three international centers independently evaluated the quality of eligible clinical guidelines using AGREE II. Mean AGREE II scores for each domain were calculated. In higher quality domains scores for individual items were analysed. The guidelines were grouped according to type and year of publication. Comparative statistics and intraclass correlation (ICC) calculations were performed.

Results: A total of 37 guidelines published by NICE on spine disorders were identified. Mean scores for all six domains were as follows: Scope and Purpose (73.2%), Stakeholder Involvement (63.9%), Rigour of Development (68.1%), Clarity of Presentation (73.6%), Applicability (53.2%) and Editorial Independence (64.5%). The mean score for overall quality of all NICE spinal related guidelines was 68.8% (95% CI: 62.3-75.3). Interventional Procedure Guidelines were evaluated as possessing significantly lower overall quality than other types (p=0.007). Overall quality was significantly associated with year of publication (rs=0.476, p=0.0029). Evaluator ICC for each guideline ranged from 0.39 to 0.95.

Conclusion: NICE guidelines on spine disorders demonstrated acceptable or good quality across most domains. Despite deficiencies in the applicability domain, their quality has improved over time. We recommend use of NICE guidelines for assessment and treatment of spine disorders.

Objective: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disease. Acute unilateral peripheral vestibulopathy (AUPVP), previously termed vestibular neuritis (VN), is the 3^rd most common peripheral vestibular neuropathy with unknown etiology and pathogenesis. This study aimed to explore the association between BPPV and AUPVP (VN) and identify the potential etiology and pathogenesis of AUPVP (VN).

Methods: The clinical characteristics of 11 patients with sudden-onset vertigo associated with persistent spontaneous torsional nystagmus (PSTN) and imbalance were retrospectively reviewed. The effectiveness of the CCRM treatment was evaluated. The diagnosis of these patients was re.

Results: Balance dysfunction significantly improved after the first CCRM treatment and was completely alleviated after two CCRM treatments. PSTN was transformed to gaze-evoked persistent torsional nystagmus after the first CCRM treatment, and the degree of nystagmus was reduced. PSTN stopped in subsequent CCRM treatments. The severity of the vertigo gradually reduced after each treatment. The clinical manifestations of these patients after one or three CCRM treatments were the same as those of BPPV patients. Vertigo, PSTN, and imbalance were alleviated entirely in all patients after several CCRM treatments, suggesting that these patients had atypical BPPV.

Conclusion: Sudden-onset vertigo associated with PSTN and imbalance is a unique clinical manifestation of BPPV, caused by the canalith jam in the posterior semicircular canal or otolithiasis in multiple semicircular canals. The CCRM treatment is an effective therapeutic method for sudden-onset vertigo associated with PSTN and imbalance when central vestibular vertigo was excluded.

Fibrous dysplasia is a rare disease belonging to benign, noncancerous bone and soft tissue related developmental disorders. A 34 year old male was admitted to the maxillofacial surgery unit to diagnose a rapidly growing, painless lesion with swelling in the right buccal region and increasing facial deformity for three months. Computed tomography (CT) images revealed an inhomogeneous, ill-defined lesion in the maxilla and maxillary sinus. Despite the lesion, the patient had no clinically significant neurological abnormalities. The lesion was diagnosed as fibrous dysplasia on the basis of preoperative tissue biopsy. The treatment of choice was complete surgical excision with immediate reconstruction and fixation of the orbital floor by implanting an alloplastic titanium mesh implant. Then, the patient underwent a secondary reconstruction of tissue defects using a personalized, 3D-printed titanium implant. Reconstruction of post resection defects covering a large craniofacial area is a challenge for maxillofacial surgeons due to the specific location of the face, especially considering psychological and technical aspects. The reconstruction method should be predictable and safe and should guarantee the best aesthetic effect, close to perfection. The ideal solution seems to be the use of an individually prepared, personalized 3D-printed titanium implant with anatomical detail mapping, which can perfectly recreate the missing tissues.