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Results for “Neurologic Recovery”

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PubMed1990

Effect of thyrotropin-releasing hormone on the time course of neurologic recovery after spinal cord injury in the rat.

Spinal cord injuries in rats were experimentally produced by compressing the cord at the eleventh thoracic vertebral level for 60 minutes with stainless steel screws (2 mm in diameter and 2.8 mm in length). The main neurologic signs produced by cord compression were motor as well as sensory deficits and urinary incontinence. Rats with a neurologic score, based on both motor and sensory deficits, of 1 (complete paraplegia but responsive to tail pinching) 24 hours after injury were used to study the relative effect of subcutaneous treatment with TRH once or twice daily for 7 consecutive days on the time course of recovery after spinal cord injury and the dose-dependency of this effect. Once daily (5, 15, or 45 mg/kg/day) or twice daily (2.5, 7.5, or 22.5 mg/kg x 2/day) treatment with TRH starting 24 hours after injury improved the neurological signs and reduced the incidence of urinary incontinence, dose-dependently. The minimum effective doses for once and twice daily treatments were 45 mg/kg/day and 7.5 mg/kg x 2/day. These results indicate that the neurologic recovery-accelerating effect of TRH administered 24 hours after cord injury for 7 days is dose-dependent and that a twice daily dosage schedule tends to produce better improvement in the neurologic state than a once daily schedule dose.

Animals↗

PubMed1983

Neurologic recovery after out-of-hospital cardiac arrest.

A retrospective cohort study of the neurologic sequelae of out-of-hospital cardiac arrest was done using 459 consecutive patients resuscitated and admitted to a teaching hospital over 10 years. Awakening was defined as having comprehensible speech or following commands. One hundred and eighty patients (39%) never awakened and 279 (61%) awakened, 188 without and 91 with persistent neurologic deficits. Fifty-nine patients had cognitive deficits and 32 patients had motor and cognitive deficits. Patients who did not awaken died, with a median survival of 3.5 days. The longer a patient survived without awakening, the smaller the probability of ever awakening and awakening without deficits. Fourteen patients awakening after 4 days had some deficits, and after 14 days six had severe deficits. Neurologic sequelae of cardiac arrest are common and related to awakening. The probability of future awakening and neurologic sequelae for patients not awake at specific times after cardiac arrest can be estimated.

Adolescent↗

PubMed2002

Neurological recovery by EEG bursting after resuscitation from cardiac arrest in rats.

INTRODUCTION: The return of neurological function during the early period after resuscitation from cardiac arrest (CA) has not been evaluated systematically. We report the temporal analysis of EEG bursting pattern during the very early periods after resuscitation. DESIGN/METHOD: A balanced group of good and poor outcome animals was selected from a population of rats subjected to either 5 or 7 min of asphyxial cardiac arrest (ACA) on the basis of a single criteria: 24 h neurobehavioral function based on the neurodeficit score (NDS). The EEGs of six consecutive good outcome rats (NDS > or = 60) and six consecutive poor outcome rats (NDS < 60) were selected for the study. The EEGs of these animals were given to two EEG examiners who were blinded to the selection process, the experimental conditions and the neurobehavioral recovery. The EEG bursting characteristics, such as rate, peak and duration of bursting were studied. RESULTS: There was significantly higher EEG bursting in the good outcome animals (P < 0.05) and the burst complexes evolved into continuous activity by 90 min. Lower frequency bursting that persisted and failed to evolve into continuous activity was observed in the poor outcome group. CONCLUSION: Increased EEG bursting during first 30-40 min after resuscitation from moderate to severe ACA was observed in rats with good neurological outcome at 24 h. Early EEG bursting patterns may provide additional prognostication after resuscitation from CA.

Analysis of Variance↗

PubMedDate not supplied

Prehospital cardiac arrest survival and neurologic recovery.

Many studies of prehospital defibrillation have been conducted but the effects of airway intervention are unknown and neurologic follow-up has been incomplete. A non-randomized cohort prospective study was conducted to determine the effectiveness of defibrillation in prehospital cardiac arrest. Two ambulance companies in the study area developed a defibrillation protocol and they formed the experimental group. A subgroup of these patients received airway management with an esophageal obturator airway (EOA) or endotracheal intubation (ETT). The control group was composed of patients who suffered a prehospital cardiac arrest and did not receive prehospital defibrillation. All survivors were assessed for residual deficits using the Sickness Impact Profile (SIP) and the Dementia Rating Scale (DRS). A total of 221 patients were studied over a 32-month period. Both the experimental group (N = 161) and the control group (N = 60) were comparable with respect to age, sex distribution, and ambulance response time. Survival to hospital discharge was 2/60 (3.3%) in the control group and 12/161 (6.3%) in the experimental group. This difference is not statistically significant. Survival in the experimental group by airway management technique was basic airway support (3/76 3.9%), EOA (3/67 4.5%), and ETT (6/48 12.5%). The improved effect on survival by ETT management was statistically significant. Survivors had minor differences in memory, work, and recreation as compared to ischemic heart disease patients as measured by the SIP and DRS. No effect of defibrillation was found on survival to hospital discharge. However, endotracheal intubation improved survival in defibrillated patients. Survivors had a good functional outcome.

Aged↗

PubMed1998

Neurological recovery in diabetic rats following spinal cord injury.

This study was designed to assess the effect of spinal cord injury on neurobehavioral, electrophysiological, structural, and biochemical changes in normal and diabetic rats. Experimental diabetes was induced in Sprague-Dawley male rats (weighing 250-280 g) with streptozotocin (50 mg/kg i.p.). Eight weeks after the treatment with streptozotocin the animals were anaesthetized with chloral hydrate and laminectomy was performed at T 7-8 level leaving the dura intact. A compression plate (2.2 x 5.0 mm) loaded with a weight of 35 g was placed on the exposed spinal cord for 5 min. Postoperative neurological function was assessed using inclined plane test, modified Tarlov score, and vocal and sensory score daily for 10 days. Electrophysiological changes were assessed using somatosensory and corticomotor evoked-potentials. The animals were sacrificed at different time intervals and injured site of the spinal cord was analyzed for changes in vitamin E and glutathione levels (as markers of oxidative stress). Pathological changes in spinal cord were also studied using light microscopy. The data on neurobehavioral study clearly indicated that the compression of spinal cord produced highly significant neurological deficit and poor recovery in diabetic rats as compared to nondiabetic rats. Our histopathological and electrophysiological results also confirmed that diabetic animals are more susceptible to compressive spinal cord injury as compared to nondiabetic animals. A higher depletion of antioxidant defense markers (vitamin E and glutathione) was observed in diabetic rats as compared to nondiabetic rats. These results point toward the role of free radicals in poor recovery in diabetic rats following neurotrauma. Further studies are warranted to assess the neuroprotective potential of antioxidants to retard the secondary pathophysiological events following neurotrauma and to enhance the recovery.

Animals↗

PubMed2004

Full neurologic recovery after fulminant thrombotic thrombocytopenic purpura with status epilepticus.

Thrombotic thrombocytopenic purpura (TTP) is an ischemic vasculopathy frequently associated with neurological dysfunction including seizures. However, status epilepticus (SE) has rarely been reported in this condition. We report on a 70-year-old woman with fulminant TTP who developed convulsive SE despite high therapeutic serum levels of phenytoin and phenobarbital. Her electroencephalogram (EEG) was characterized by bilateral independent periodic lateralizing epileptiform discharges (BIPLEDs) propagating into clinical and electrographic seizures. She recovered completely after intensive plasmapheresis and treatment with pentobarbital induced coma for 5 days. This case illustrates that aggressive treatment with pentobarbital and plasmapheresis may prevent permanent neurologic deficits when TTP is complicated by SE and that periodic lateralizing epileptiform discharges (PLEDs) in this syndrome can be the manifestation of a reversible ischemic insult.

Aged↗

PubMed2001

A comparison of complete blood replacement with varying hematocrit levels on neurological recovery in a porcine model of profound hypothermic (<5 degrees C) circulatory arrest.

Profound hypothermia (<5 degrees C) may afford better neurological protection after circulatory arrest; however, there are theoretical concerns related to microcirculatory sludging of blood components at these ultra-low temperatures. We hypothesized that at temperatures <5 degrees C, complete blood replacement results in superior neurological outcome. Twelve Yorkshire pigs (30 kg) underwent thoracotomy, cardiopulmonary bypass (CPB), and were randomly assigned to one of three target hematocrits during circulatory arrest: 0%, 5%, 15%. Hextend (6% hetastarch in a balanced electrolyte vehicle) was used for the CPB prime and as an exchange fluid. Animals were cooled to a temperature <5 degrees C, underwent 1-h circulatory arrest, and were warmed to 35 degrees C with administration of blood to increase the hematocrit to >25% before separation from CPB. The primary outcome, peak postoperative neurobehavioral score, was compared between groups. The 0% group (mean +/- SD) had significantly (P: < 0.02) better neurobehavioral scores than the 5% and 15% groups (6.0 +/- 2.9 vs 1.3 +/- 1.0 and 1.5 +/- 0.6) respectively. Other variables (e.g., intracranial pressure) were similar between groups. In a porcine model of profound hypothermia (<5 degrees C) and circulatory arrest, complete blood replacement resulted in superior neurological outcome. This finding suggests that at ultralow temperatures, the presence of some blood component (e.g., erythrocytes, leukocytes) may be deleterious.

Animals↗

PubMed2004

Hypothermic circulatory arrest with and without cold selective antegrade cerebral perfusion: impact on neurological recovery and tissue metabolism in an acute porcine model.

OBJECTIVE: Clinically, selective antegrade cerebral perfusion (SACP) seems to be associated with a better neurological outcome compared to hypothermic circulatory arrest (HCA) alone, but the pathophysiological mechanisms are not well understood. Therefore, this study was undertaken to assess the effects of HCA with and without SACP on the cerebral integrity using multimodal neurophysiological monitoring. METHODS: 12 pigs were randomly assigned to 100 min HCA at 20 degrees C brain temperature with (n = 6) and without (n = 6) SACP. Haemodynamics, metabolics and neurophysiology (EEG, SSEP, ICP, spectroscopy, cerebral tissue monitoring) were monitored. Animals were sacrified 4 h after reperfusion and the brains perfused for histopathological assessment. RESULTS: There were no clinically relevant differences in hemodynamics between groups. During reperfusion, EEG and SSEP recovery was significantly faster in the SACP group (P < 0.05). The rise in ICP during reperfusion was markedly reduced in the SACP group (P < 0.01) for the trend). Three hours after reperfusion, median ICP was 130% compared to baseline in the SACP group and 225% in the HCA group (P < 0.01). Invasive as well as noninvasive cerebral monitoring indirectly indicates the occurrence of tissue acidosis in the HCA group even 4 h after HCA. CONCLUSIONS: Cold SACP is associated with better neurophysiological recovery and less cerebral edema, indicated by lower intracranial pressures during reperfusion. Neurophysiological recovery correlated well with the rise in ICP. HCA alone causes prolonged acidosis in the brain tissue during reperfusion. From these data, SACP appears to be superior to HCA alone, but further studies have to elucidate the optimal regimes for SACP.

Animals↗

PubMed1988

No correlation between cerebral blood flow and neurologic recovery after reversible total cerebral ischemia in the dog.

This study was conducted to determine if regional cerebral flow during the first day after total cerebral ischemia was correlated with neurologic deficit and eventual survival. Dogs were subjected to 11 min of total cerebral ischemia (TCI) produced by an arterial and venous double balloon occlusion method. Recovery was allowed for up to 7 days after reperfusion, whereupon it was reassessed in survivors. Blood flow, determined by the radiolabeled microsphere method, was determined before TCI and at times up to 24 h after reperfusion. Blood flow during reperfusion after TCI followed the expected pattern of immediate hyperperfusion followed by prolonged hypoperfusion. TCI of 11 min duration resulted in a 50% mortality rate by 1 week. No positive correlation between magnitude or duration of hypoperfusion and neurologic deficit or mortality was found. It was concluded that improved postischemic blood flow cannot be used as a criterion for assessing drug therapy without reference to metabolic demand. The observation of a statistical correlation between dogs that survived and lower hematocrit was reported. It was suggested that the prolonged hypoperfusion encountered after TCI was not pathological, but rather served as a mechanism to limit oxygen exposure to the brain during a vulnerable period and, thus, was part of a controlled attempt at recovery of function by the central nervous system.

Animals↗

PubMed1986

The effects of large doses of methylprednisolone on neurologic recovery and survival in the Mongolian gerbil following three hours of unilateral carotid occlusion.

Using a scoring system designed to assess the severity of neurologic deficit in gerbils during and after temporary unilateral carotid occlusion, the effects of large doses of methylprednisolone sodium succinate (MPSS: Solu-Medrol sterile powder) on experimental stroke have been examined. By scoring gerbils hourly for torso curvature, circling, inability to walk, ptosis, barrel rolling, opisthotonus, generalized seizures, and loss of righting reflex, their level of neurologic deficit can be easily, quantitatively, and reproducibly evaluated. Approximately 37% of gerbils subjects to a 3-hour unilateral carotid occlusion attained average scores of 4.0-4.5 during the first hour. There was a slight, though not significant, worsening (increase) of scores over the 3-hour occlusion period that was not altered by pretreatment of gerbils with 60 mg/kg of MPSS 10 minutes before occlusion. Following removal of occlusion at 3 hours, gerbils recovered only minimally during the ensuing 4-hour period, with deficit scores remaining around 3.2 +/- 0.3. Pretreatment of gerbils with 60 mg/kg of MPSS, however, resulted in a striking improvement in their deficit scores to 1.6 +/- 0.2 (p less than 0.05) by 2 hours after occlusion removal. Treatment of gerbils with lower (30 mg/kg) or higher (100 mg/kg) doses of MPSS was not as effective in promoting improvement. The survival of 3-hour occluded gerbils was significantly enhanced by pretreatment with 60 mg/kg of MPSS. Vehicle-treated gerbils had survival rates of 41.7%, 16.7%, and 16.7% at 24 hours, 48 hours, and 7 days, respectively, compared with 90.9%, 72.7%, and 45.4%, respectively, for MPSS-treated gerbils.

Animals↗

PubMed1994

Neurological recovery after liver transplantation: a prospective study of 22 patients.

A group of 22 liver transplantation patients were examined pre- and postoperatively using clinical neurological, neurophysiological and neuroradiological methods. After the operation improvement was observed in neurological symptoms, and in neuropsychological and neurophysiological test results. Our study shows that liver recipients have a high prevalence of nervous system dysfunction and that successful transplantation is followed by significant improvement.

Adult↗

PubMed2004

Long-term clinical and neurologic recovery in the hand after surgery for severe cubital tunnel syndrome.

PURPOSE: Functional outcomes of cubital tunnel surgery may decline as the severity of preoperative ulnar neuropathy increases. When functional recovery will be adequate, or whether tendon transfers should be required, may be unclear. We investigated the extent of functional recovery, the duration of the recovery process, and the necessity of restoring intrinsic muscle function in patients with severe cubital tunnel syndrome after surgery. METHODS: We retrospectively studied outcomes after cubital tunnel release in 15 patients with marked intrinsic muscle atrophy, claw-hand deformity, immeasurable (electrically silent) sensory and motor nerve conduction velocities, and Semmes-Weinstein test (SWT) results ranging from purple (3.84-4.31) to red (4.56-6.65). We evaluated subjective (numbness and activities of daily living [ADL] disturbances), objective (manual muscle testing [MMT] of index-finger abduction, and SWT), and neurophysiologic (nerve conduction velocity) outcomes. Overall functional outcome was evaluated by Akahori's criteria. RESULTS: At a median follow-up evaluation of 4.5 years all outcomes had improved. Numbness was gone in 5 patients and greatly reduced in 9 patients; 6 patients reported slight difficulties in ADLs; and 9 patients had no difficulties. Motor nerve conduction velocity was measurable (mean, 35.3 m/s) in all 15 patients and sensory nerve conduction velocity was measurable (mean, 43.4 m/s) in 12. Recoveries in nerve conduction velocities persisted beyond 2 years. The SWT results were blue (3.22-3.61) in 6 patients, purple (3.84-4.31) in 8 patients, and red (4.56-6.65) in 1 patient. MMT of index finger abduction was grade 4 or 5 in 11 of 15 patients. Half the patients over 70 years old, however, were grade 3 or less. Akahori's criteria were excellent in 3 patients, good in 6 patients, and fair in 6 patients. CONCLUSIONS: Patients with severe intrinsic muscle atrophy and absent motor and sensory nerve conduction velocities can expect satisfactory long-term functional results after surgery. Function continues to improve beyond 2 years. Restoring index finger abduction is not always necessary for ADLs, although recovery requires several years and is poorer in the elderly.

Activities of Daily Living↗

PubMed2004

Robotics, motor learning, and neurologic recovery.

Robotic devices are helping shed light on human motor control in health and injury. By using robots to apply novel force fields to the arm, investigators are gaining insight into how the nervous system models its external dynamic environment. The nervous system builds internal models gradually by experience and uses them in combination with impedance and feedback control strategies. Internal models are robust to environmental and neural noise, generalized across space, implemented in multiple brain regions, and developed in childhood. Robots are also being used to assist in repetitive movement practice following neurologic injury, providing insight into movement recovery. Robots can haptically assess sensorimotor performance, administer training, quantify amount of training, and improve motor recovery. In addition to providing insight into motor control, robotic paradigms may eventually enhance motor learning and rehabilitation beyond the levels possible with conventional training techniques.

Algorithms↗

PubMed1994

Neurological recovery after conservative treatment of cervical cord injuries.

We reviewed a series of 53 patients with closed traumatic complete injuries of the cervical spinal cord. They were admitted within two days to a spinal injuries centre, treated conservatively by six weeks of bedrest and skull traction, then mobilised in a neck support for six weeks. Eight patients had temporary neurological deterioration, four spontaneously and four after cervical manipulation; seven of these recovered to the initial neurological level without surgery. Of 40 patients followed for more than 12 months, 19 recovered useful motor power in local muscles which were initially paralysed (zonal recovery); one patient showed distal motor recovery. Zonal recovery did not correlate with the mechanism of skeletal injury or with the degree of residual canal stenosis. Sensory sparing and an initial neurological level higher than the level of skeletal injury were both good prognostic signs for zonal recovery.

Adolescent↗

PubMed1998

Donal Munro Lecture: Functional and neurologic recovery following acute SCI.

Patient management in the current health care environment requires the provider to make reliable and valid clinical decisions regarding patient care, decisions that are cost effective and will lead to optimal functional improvement. Neurologic examination, according to the Standards for Neurological and Functional Classification of Spinal Injury developed by the American Spinal Injury Association, provides every clinician with simple clinical tools that are highly predictive of functional recovery following a spinal cord injury. The ability to predict motor recovery provides a rational basis to help support the provider's recommendation for the patient's goals and care planning, as well as differentiates care that is essential for improving functional outcomes from care that is not.

Activities of Daily Living↗

PubMed1998

Neurological recovery after systemic thrombolytic therapy in a chronic stroke case.

We describe a patient who in 1983 suffered a stroke which resulted in severe hemiplegia and somatosensory loss. His neurological condition remained stable until January 1996, when, because of a myocardial infarction, the patient underwent systemic thrombolytic therapy which led to a remarkable improvement of both motor and somatosensory functions. This finding suggests the existence of 'idling neurons' which remain viable for a long time after stroke, and opens a fascinating window on the therapeutic potential of thrombolytic therapy in chronic stroke patients.

Aged↗

PubMed1990

Neurologic recovery in quadriplegia following operative treatment.

Records and radiographs of 90 patients suffering complete or motor-complete quadriplegia and treated surgically were reviewed. There were 76 men or boys and 14 women or girls; ages ranged from 15 to 75. Eighty-one were complete quadriplegics and nine had some degree of sensory preservation. After surgery 30 were unchanged, 47 obtained root recovery, and 13 recovered cord function, including two who became ambulatory. Fifty-three of the 74 (71%) patients undergoing decompressive procedures showed neurological improvement while seven of the 16 (49%) patients with fusion and no root decompression had improvement (p less than 0.05). All 26 patients with dislocations underwent closed or open reduction as part of their operative procedures; this did not appear to improve the likelihood of nerve root recovery. Since independence and quality of life may be improved by cord and root recovery, decompression of all neural structures should be considered in cervical spinal cord injury.

Adolescent↗

PubMed2003

Tongue protrusion: a simple test for neurological recovery in rats following focal cerebral ischemia.

A simple tongue protrusion (TP) test is described for rats following focal ischemia induced by middle cerebral artery occlusion (MCAO). MCAO resulted in a dramatic decrease in TP that correlated with a concomitant decline in neurological performance in standard 5- and 20-point tests and deficits in performance in the Morris water maze and the accelerating rotarod. TP values also correlated with infarct size at 7 and 24 days following MCAO. This simple and inexpensive test, that monitors the ability of rats to lick food out of a glass tube, is easily administered, can be administered frequently without changing baseline performance, is not susceptible to behavioral compensation and should not interfere with other tests used concurrently to evaluate neurological deficit. The TP test may, therefore, serve as a useful addition to the battery of tests commonly used to assess neurological damage in rats, particularly in models of stroke.

Animals↗