Brain oncological surgery must pursue maximal tumour resection to achieve oncological benefits while preserving acceptable neurological function. Neuromonitoring techniques and brain mapping have been developed over the last decades to intraoperatively assess the exact location of neurological functions and secure their preservation. However, the fact that they cannot offer preoperative information and require in some cases the patient’s collaboration during displeasing awake surgeries raised the interest during last years on noninvasive techniques offering preoperative functional information. Navigated transcranial magnetic stimulation (nTMS) is a noninvasive technique able to create small magnetic fields and electrically stimulate brain cortex, emulating the effect obtained by cortical direct electrical stimulation (DES). It is a promising tool for performing pre-operative cortical brain mapping. We performed a unicenter prospective descriptive study including patients diagnosed with intra axial brain tumours neighboring cortical zones apparently implicated in motor and/or language functions who were planned for surgical resection. We performed preoperative nTMS (SofTaxic Neuro navigation system 3.0, EMS, Bologna) in all of them to define the location of these functions. Between November 2020 and December 2021 we included 18 patients (11 men, 7 women) with a mean age of 56 years (range 29-71). Location (8 temporal, 6 frontal, 3 parietal and 1 insular) and laterality (12 left, 6 right) of the brain tumours were registered. In all cases, cortical brain motor mapping with nTMS was performed with positive results, obtaining a mean anteroposterior diameter of the motor cortex of 22,75 mm. In 11 cases language mapping was also performed, detecting a total of 40 cortical language positive sites (31 frontal, 9 temporal) in those patient’s left hemispheres. No relevant side effects were noticed after nTMS performance. Definitive pathological results after surgery revealed high-grade glioma in 15 cases and low-grade glioma in 3. nTMS is a recent noninvasive technique that allows the realization of preoperative cortical brain mapping. The information provided by this technique is of extreme value to better define surgical candidates and to plan brain tumour resection surgeries, according to functional cortical sites identified. The available literature describes its applications, mainly in localizing motor and language cortices, showing good concordance with intraoperative cortical DES, which is still the gold standard technique for brain mapping. Its integration in the pre-operative brain tumour assessment offers important advantages without adding relevant morbidity.

Introduction: Critical illness myopathy (CIM) and polyneuropathy (CIP) are the most common cause of acquired weakness in intensive care units (ICU).However, its exact pathogenesis remains unclear.Abnormal excitability of muscle due to a sodium channelopathy is one of the mechanisms proposed.The aim of this study is to test for the presence of anti-ganglioside antibodies in serum from patients with CIM or both combined CIM/CIP, since there is evidence that they can cause reversible dysfunction of voltage-gated sodium channels.Methods: In a prospective way, we studied 35 patients admitted in ICU by weekly EMG.When positive spontaneous activity (PSA) was detected, a muscle biopsy was performed.Twenty patients met criteria of CIM; five of them also developed overlapping CIP.We did not detect any kind of abnormality in 10 patients during the follow up period.Sera were analyzed for the presence of antiganglioside antibodies (Ganglioside-profile 2 Euroline, Euroimmun).Results: Overall, positive reactivity against anti-GT1b was found in one patient with CIM, representing 2.8% (1/35) of the total sample.Conclusion: Reduced percentage of patients affected of CIM or CIM/CIP exhibits positive reactive against anti-ganglioside antibodies.Thus, it could be suggested they do not play a primary role in their pathogenesis.

Purpose We performed a cross-sectional study of neurocognitive function in non-brain cancer patients treated with long-term bevacizumab. Methods/patients From 2015 to 2017, we included patients with different types of cancer treated with bevacizumab with or without chemotherapy (BEV; N = 20) or only chemotherapy (ChT; N = 19) for at least 34 weeks, patients who received non-brain radiotherapy (RxT; N = 19), and healthy controls (HC; N = 19) were assessed once at week 34 of treatment (BEV and ChT) or at completion of radiotherapy. Neurocognition was evaluated with the Hopkins Verbal Learning Test-Revised (HVLT-R) total and delayed recall, the Trail Making Test A and B, and the Controlled Oral Word Association Test in the four groups. Non-parametric tests were used to assess differences between groups. Results The BEV, ChT, and RxT groups scored significantly lower than the HC group on all tests and especially on the HVLT-R total recall. In no case were the mean scores of the BEV group significantly lower than those of the ChT or RxT groups. Conclusions Neurocognitive impairment was seen even in patients treated with local non-brain radiotherapy. Treatment with bevacizumab for a long period of time does not seem to worsen neurocognitive function to a greater extent than chemotherapy.

Low performances in visuomotor processing speed and executive functions were found after 34 weeks of treatment with bevacizumab plus radiotherapy (XRT) and temozolomide (TMZ) in first line treated glioblastoma patients but not in patients treated with TMZ and XRT, suggesting that bevacizumab was the cause of those alterations. Our aim was to explore the neurocognitive effects of bevacizumab in non-brain cancer patients in order to assess if the use of this antiangiogenic therapy interfered with the results of the neuropsychological tests. Seventy-seven cancer patients distributed among four groups were enrolled. None of the subjects suffered from central nervous system (CNS) disorders or had previously diagnosed neurological diseases. The first group (n=20) was treated with bevacizumab and chemotherapy (BEV), the second one (n=19) with chemotherapy alone (ChT), the third group (n=19) received only non-brain radiotherapy (RxT), and the last group (n=19) were healthy people without cancer (HC). Verbal memory, visuomotor scanning speed, executive functions, and verbal fluency were evaluated with the next tests: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Tests (TMTA, TMTB), Controlled Oral Word Association Test (COWAT). Assessments were administered to each patient after 34 weeks from the treatment’s start date (in BEV and ChT groups), or after having completed the radiotherapy sessions (in the RxT group). All patients with cancer (BEV, ChT and RxT) showed significant alterations of the HVLT-R total recall (HVLT-R TR) in front of the HC (p<0.05). Moreover only the RxT showed a lower performance than the HC in the delayed recall (DR) of the HVLT-R (p=0.011). No statistically significant differences were observed in any tests among cancer patients groups. Our results suggest that the use of bevacizumab during 34 weeks does not produce a neurocognitive decline in cancer patients without CNS disease, in front of the group treated with chemotherapy alone. This means that combining bevacizumab with chemotherapy does not impact on neurocognitive performance. The spontaneous recall resulted impaired in all cancer patients’ groups, and the words delay recall just in the RxT group, when compared to the HC. These are important outcomes to consider as it seems that that the oncologic disease itself could impair the neuro-cognitive functions, despite the treatment administered. Accordingly, other factors such as anxiety, depression, pain, or stress, could interfere with the neuro-psychological assessment.

Background:Randomized trials and meta-analyses indicate positive effects of stroke unit (SU) care on survival and dependency of patients with stroke. However, data on the advantages of SU in 'real-world' settings are limited. We prospectively assessed, in a large University Hospital, the effect of SU versus other conventional wards (OCW) care on all-cause mortality, death or dependency, death or institutionalization.Methods:In a prospective observational study in the European Registers of Stroke Project, patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, 3-month and 1-year survival, and functional outcome.Results:Overall, 355 patients (54.1% men, mean age 73.4 +/- 14.5 years) were registered, 140 (39.4%) admitted to the SU, and 215 (60.6%) to OCW. OCW patients were older, whilst SU patients had more severe strokes according to NIHSS (P for trend = 0.025). SU patients were significantly more often treated by specialists in stroke medicine, stroke nurses, physiotherapists and speech therapists (all P < 0.001), psychologists (P = 0.025), dietitians (P < 0.001), and social workers (P = 0.003). MRI, carotid, and transcranial Doppler were significantly more often performed in SU patients (all P < 0.001). Intravenous fluids (P = 0.003) and intravenous anticoagulation (P < 0.001) were more often prescribed in SU. Controlling for case-mix, SU significantly reduced 1-year mortality (P = 0.020), death or dependency at 3 months (P = 0.006) and 1 year (P = 0.043), and death or institutionalization at 3 months (P = 0.001) and 1 year (P = 0.009).Conclusions:We confirmed the benefits of SU care in a clinical setting. Further analyses should define the contribution of individual components of care to stroke outcome.

Background:Different factors may weight on time from stroke onset to hospital arrival, and patients' alert certainly contributes to it. We sought to identify clinical and sociodemographic factors associated with a delayed alert and to delineate the profile of the potential latecomer in Catalonia (Spain).Methods:We used data from the Stroke Code (SC) registry that prospectively recruited consecutive patients with acute stroke, in whom SC was activated (SCA) or not (SCNA), admitted to all Catalan hospitals. Additionally, SCNA patients underwent a structured interview to explore additional beliefs and attitudes related to a delayed alert. We applied a 6-h cut-off to define alert delay according to the time limit for SC activation in Catalonia. We determined independent predictors of delay amongst clinical and sociodemographic data by multivariate logistic regression and applied sample weighting because of different study periods in the SCA and SCNA arms.Results:Of the patients, 37.2% delayed alert beyond 6 h. Compared to non-delayers, latecomers were more likely diabetics, illiterates, belonged to an unfavored social class, and were living alone. Fewer had concomitant atrial fibrillation and alerted through emergency medical service (EMS)/112 whilst suffering a mild or moderate stroke. Amongst patients interviewed, being unaware of stroke's vascular nature and erroneously self-perceiving stroke as a reversible or irrelevant condition independently predicted a longer delay.Conclusions:Delaying alert after stroke shows a multifactorial background with implication of pre-stroke health status, socioeconomic factors, stroke-related features and patients' beliefs and attitudes toward the disease. In planning future educational campaigns, all these features should be considered.