Aurelian Anghelescu

On the feasibility of using motor imagery EEG-based brain-computer interface in chronic tetraplegics for assistive robotic arm control: a clinical test and long-term post-trial follow-up.

Study design:Survey and long-term clinical post-trial follow-up (interviews/correspondence) on nine chronic, post spinal cord injury (SCI) tetraplegics.Objective:To assess feasibility of the use of Electroencephalography-based Brain–Computer Interface (EEG–BCI) for reaching/grasping assistance in tetraplegics, through a robotic arm.Settings:Physical and (neuromuscular) Rehabilitation Medicine, Cardiology, Neurosurgery Clinic Divisions of TEHBA and UMPCD, in collaboration with ‘Brain2Robot’ (composed of the European Commission-funded Marie Curie Excellence Team by the same name, hosted by Fraunhofer Institute-FIRST), in the second part of 2008.Methods:Enrolled patients underwent EEG–BCI preliminary training and robot control sessions. Statistics entailed multiple linear regressions and cluster analysis. A follow-up—custom questionnaire based—including patients’ perception of their EEG–BCI control capacity was continued up to 14 months after initial experiments.Results:EEG–BCI performance/calibration-phase classification accuracy averaged 81.0%; feedback training sessions averaged 70.5% accuracy for 7 subjects who completed at least one feedback training session; 7 (77.7%) of 9 subjects reported having felt control of the cursor; and 3 (33.3%) subjects felt that they were also controlling the robot through their movement imagination. No significant side effects occurred. BCI performance was positively correlated with beta (13–30 Hz) EEG spectral power density (coefficient 0.432, standardized coefficient 0.745, P-value=0.025); another possible influence was sensory AIS score (range: 0 min to 224 max, coefficient −0.177, standardized coefficient −0.512, P=0.089).Conclusion:Limited but real potential for self-assistance in chronic tetraplegics by EEG–BCI-actuated mechatronic devices was found, which was mainly related to spectral density in the beta range positively (increasing therewith) and to AIS sensory score negatively.

Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

Background The unilateral fetal variant of the posterior cerebral artery (FPCA) is characterized by the congenital absence of the P1 arterial segment. The artery of Percheron (AOP) is an uncommon vascular variant, in which a single dominant thalamoperforating arterial trunk arises from one P1 segment, bifurcates, and provides bilateral supply to the paramedian thalami and rostral midbrain. Case Presentation This is a retrospective case study of a 37-year-old man with multiple lifestyle risk factors (chronic marijuana and tobacco abuse), who suffered a thalamomesencephalic stroke, rapidly worsening to comatose state. After restoration of consciousness, he clinically manifested with left paramedian midbrain syndrome. Imaging demonstrated an asymmetric paramedian thalamic infarction with mesencephalon extension, patency of the basilar, vertebral arteries, and left PCA and right-sided FPCA, respectively. Left-sided thalamoperforating arterioles were not differentiated; AOP was inferred. Neither evident clinical source of embolus nor prothrombotic states were found. Mobile cardiac telemetry and transesophageal echocardiography were not available. The diagnosis was established too late for thrombolytic treatment. Anticoagulation was indicated during the acute and subacute stages, followed by low dose of antiplatelet. Discussion This uncommon cerebrovascular configuration (FPCA+AOP) might be the fourth case described in the literature. Sustained rehabilitation and abstinence from tobacco and cannabis led to favorable outcomes.

Prevention of diving-induced spinal cord injuries—preliminary results of the first Romanian mass media prophylactic educational intervention

Study Design:The study was an observational study of the seasonal incidence of diving accidents, according to the summer weather pattern and the influence of an educative prophylactic intervention.Objectives:The study analyzed the preliminary results of a national project, disseminated on social networking (Facebook) and broadcasted on main national and international Romanian TV channels.Setting:The study was conducted at the Neurorehabilitation, Teaching Emergency Hospital ‘Bagdasar-Arseni.’Methods:The study had a dichotomous design (a retrospective review and a prospective component), and it analyzed the evolution trends of diving accidents, before and after the prophylactic intervention. The retrospective review analyzed 41 diving accidents, registered during 2011–2015. The prospective component focused on cases registered in 2016. Spearman’s Rho non-parametric test was used to evaluate the association between two variables (the air temperature and the number of diving accidents).Results:The study involved 46 males and 1 female, with a mean age (at the time of injury) 26.4±7.02 (median 25, mode 23), admitted to rehabilitation in an early post-acute status after surgical intervention. Male youths and young adults <35 years old represented 83% of all cases. During 2011–2015, a monotonic association between the summer climate and the incidence of diving-induced tetraplegia (R=0.97468; P=0.00482) was noticed. Analyzing the evolutionary trends of similar cases registered in 2016, variables did not increase in value together (R=0.73561; P=0.09561). In 2016, the number of diving-induced quadriplegics was reduced on average by 26.8%.Conclusions:One year is not enough for a successful, durable educative intervention. It is compulsory to continue, extend and intensively promote this program.

Acute spontaneous thoracic epidural hematoma, triggered by weight-lifting training, in a retired sportsman: case report and literature review

IntroductionSpontaneous spinal epidural hematoma (SSEH) is a rare clinical entity, most often with acute symptomatic spinal cord compression and potentially permanent neurologic deficits. SSEH usually has surgical solutions and a good outcome after hematoma evacuationCase presentationA 61-year-old professional weight-lifting coach presented to the emergency department with sudden back pain, rapidly progressive paraparesis, and neurogenic bladder, after an intense training, 5 h previously. Magnetic resonance imaging revealed a ventral thoracic epidural hematoma with significant compression at Th3-Th6. Surgical procedure was performed within the first 12 h: decompressive laminectomy from Th3 to Th7 vertebral levels and near total epidural hematoma removal. The patient improved rapidly from Th5 AIS-C to Th7 AIS-D paraplegia with independent ambulation, after the intervention. The rehabilitation program led to further improvement of the neurologic deficits and a favorable outcome, to AIS-E.DiscussionWeightlifting has been reported as SSEH precipitating factor in young athletes. Our case is unique however, because the athlete was older. The underlying pathophysiological mechanism is represented by intravenous pressure changes and bleeding of the epidural venous plexus during a prolonged Valsalva maneuver, induced by strenuous, repeated efforts. Spondylosis, hypertension, and low doses of aspirin were incriminated as risk factors for SSEH. Prompt diagnosis, emergent decompressive intervention, early rehabilitation, and secondary prophylaxis were essential for a good outcome.

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic.

The ankylosing spondylitis (AS) is a systemic, multi-factorial, chronic rheumatic disease. Patients are highly susceptible to vertebral fractures with or without spinal cord injury (AS-SCI), even after a minor trauma. The study is a retrospective descriptive survey of post-acute, traumatic AS-SCI patients, transferred from the neurosurgical department and admitted in a Romanian Neurorehabilitation Clinic, during 2010–2014. There were 11 males associating AS-SCI (0.90% of all consecutive SCI admitted cases), with an average age of 54.6 years (median 56, limits 42–73 years). The average duration between the medically diagnosed AS and the actual associated spinal fracture(-s) moment was 21.4 years (median 23; limits 10–34 years). Low-energy trauma was incriminated in 54.5% cases. The spinal level of fracture was: cervical (four cases), thoracic (three), lumbar (four), assessed at admission as: American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (four subjects), C (five) and D (two). By the time of discharge, neither patient has neurologically deteriorated; five patients (45.5%) improved of at least grade 1 (AIS). The overall complications were mainly infections: symptomatic urinary tract infections (seven patients; 63.6%), pulmonary (three subjects; 27.3%) and spondylodiscitis (one case; 9%). The average follow-up period was 15.3 months (median 12; limits 1–48 months) after discharge; three subjects gained functional improvement to AIS-E. The clinical profile (different risk factors, mechanisms, types and levels of spinal fractures, additional encephalic and/or cord lesions, co-morbidities), different post-surgical and/or general complications acquired during admission in our rehabilitation ward, served us for future prevention strategies and a better therapeutic management.

Iontophoresis with Potassium Iodide, Inedited Palliative Physiatric Method for Hemifacial Spasm-Case Report and Literature Review

Background: Hemifacial spasm (HFS) is a rare entity, characterized by alternating involuntary twitching (clonic or tonic contractions) of the facial muscles on one side of the face. In most cases the pathophysiological mechanism is represented by a neurovascular conflict. Methods and findings: The actual case refers to a 62 years old Caucasian woman, with a typical progressive left side HFS, manifested at the age of 55. She was admitted twice (in November 2015 and February 2016) in the rehabilitation department, and investigated for an optimal therapeutic approach. Magnetic resonance angiography (MRA) revealed a mechanical neurovascular conflict, inflicted by an ipsilateral dolichoectatic, compressive vertebral artery. The patient categorically refused the conventional standard therapies (the functional neurolysis with botulinum toxin injections, or the microvascular surgical decompression alternative). She was treated in a conservative manner, using iontophoresis with potassium iodide (KI) applied to the twitched hemiface, for 10 days, in two therapeutic sequences. After the second treatment session, the patient noticed a 47% global reduction of her disturbances, reflected by the self-assessment questionnaires scores. Conclusion: Iontophoresis with KI is an inedited, conservative treatment applied in a typical form of HFS (with vascular compressive etiology), indicated as a therapeutic palliative alternative, to a patient who refused the conventional treatment methodology. It is a cheap procedure, painless, without adverse reactions, repeatable, controllable. The patient had a good compliance and therapeutic satisfactions, although symptoms alleviation was partial and temporary (as long as the trigger persisted).

A long-term, complex, unitary appraisal regarding neurorestorative, including neurorehabilitative, outcomes in patients treated with Cerebrolysin ® , following traumatic brain injury

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Journal of Neurorestoratology 2014:2 85–93 Journal of Neurorestoratology Dovepress

EARLY POST-ACUTE CLINICAL and EVOLUTIVE PARTICULARITIES of CERVICAL SPINAL CORD INJURY (CSCI) at ELDERLY SUBJECTS

Study design: Retrospective analysis, focused on the early post acute evolution of 291 elderly ( >65 years) patients with CSCI, first time admitted in the Rehabilitation Clinic, during 2004-2013. Methods: analysis of the medical files. Results: There were 205 males and 86 females (ratio 2,4). Most of the patients (215 74%) were from rural regions, and 57% of the CSCI happened during agricultural activity; the etiology was dominated (79 %) by accidental falls from the same level (22%), falls from height (from chariot 48%, from trees 5,5%), but also traffic accidents (21%). Vertebral lesions consisted in facet dislocation (bilateral in 32%, unilateral in 11% cases) or/and (associated) disk hernia (54%); about 37% patients had no radiological evidence of bone injury. Conservative management was indicated in 106 subjects (36,4%) vs. operated (63,6%), with significant improvement of the neurological status in the surgical approached group, versus the non-operated (Fisher test, p < 0.01). Early admission in our department and specialized treatment favored a better neurological outcome, from totally paralisis (AIS type A+B) to incomplete lesions (AIS type C+D) (p=0.006). Most of the patients 175 (60%) were discharged at home, whereas 63 (21,6%) were admitted in nursing home, aspect significantly correlated with the marital status vs. single (widow or divorced) ( p<0,01). A low mortality rate (2%) and miscellaneous medical complications were noticed, mainly transient postural hypotension 192 subjects (65,9%), asymptomatic urinary tract infections 259 (89%), haematuria (42 14,4%), bronchopneumonia (11,3%), depression (58,7%), central pain (44%), mild decubitus ulcer 7 patients (2,4%). Conclusions: CSCI at elderly has etiological and physiopathological particularities. Geriatric associated pathology and poor social conditions favored the incidence of CSCI. Comprehensive inter/ multidisciplinary therapeutic approach, early admission in the rehabilitation department after surgical stabilization, favored a better outcome and a low mortality rate.