Cortical Grey matter volume depletion links to neurological sequelae in post COVID-19 "long haulers".

Objective: COVID-19 (SARS-CoV-2) has been associated with neurological sequelae even in those patients with mild respiratory symptoms. Patients experiencing cognitive symptoms such as "brain fog" and other neurologic sequelae for 8 or more weeks define "long haulers". There is limited information regarding damage to grey matter (GM) structures occurring in COVID-19 "long haulers".

Gray Matter Matters: A Longitudinal Magnetic Resonance Voxel-Based Morphometry Study of Primary Progressive Multiple Sclerosis.

Multiple Sclerosis (MS) lesions in white matter (WM) are easily detected with conventional MRI which induce inflammation thereby generating contrast. WM lesions do not consistently explain the extent of clinical disability, cognitive impairment, or the source of an exacerbation. Gray matter (GM) structures including the cerebral cortex and various deep nuclei are known to be affected early in Primary Progressive Multiple Sclerosis (PPMS) and drive disease progression, disability, fatigue, and cognitive dysfunction.

SSEP retains its value as predictor of poor outcome following cardiac arrest in the era of therapeutic hypothermia.

Objectives: To re-evaluate the role of median nerve somatosensory evoked potentials (SSEPs) and bilateral loss of the N20 cortical wave as a predictor of unfavorable outcome in comatose patients following cardiac arrest (CA) in the therapeutic hypothermia (TH) era.

Methods: Review the results and conclusions drawn from isolated case reports and small series of comatose patients following CA in which the bilateral absence of N20 response has been associated with recovery, and evaluate the proposal that SSEP can no longer be considered a reliable and accurate predictor of unfavorable neurologic outcome.

Results: There are many methodological limitations in those patients reported in the literature with severe post anoxic encephalopathy who recover despite having lost their N20 cortical potential.

Therapeutic hypothermia does not diminish the vital and necessary role of SSEP in predicting unfavorable outcome in anoxic-ischemic coma.

Rational medical management of patients who remain comatose following cardio-pulmonary resuscitation (CPR) due to anoxic-ischemic encephalopathy depends upon the early identification of those with a hopeless prognosis - regardless of how aggressively they are managed. Conversely, it is mandatory that we recognize those patients with the potential to recover in order to institute aggressive therapeutic measures. The bilateral absence of the N20 Cortical Somatosensory Evoked Potential has been identified as the most reliable predictor of an unfavorable prognosis in normothermic patients.

Therapeutic hypothermia and reliability of somatosensory evoked potentials in predicting outcome after cardiopulmonary arrest.

The loss of the N20 component on testing median somatosensory evoked potentials (SSEP) has been established as the most reliable indicator of unfavorable prognosis in post-cardiopulmonary arrest patients. With the intervention of therapeutic hypothermia in the management of patients who remain comatose following cardiopulmonary arrest that association is now in dispute. Abandoning SSEP as a key prognostic indicator of neurologic outcome would be a serious loss and cannot be justified.

A late complication of γ knife radiosurgery.

An 85-year-old man was hospitalized after developing sudden weakness on his right side and mild expressive aphasia. He had undergone γ knife stereotactic radiosurgery to the left thalamus 7.5 years earlier for a disabling essential tremor; the surgery had led to remarkable improvement in his ability to write and use utensils.

The utility of median somatosensory evoked potentials in anoxic-ischemic coma.

The early recognition of comatose patients with a hopeless prognosis--regardless of how aggressively they are managed--is of utmost importance. Median somatosensory evoked potentials (SSEP) supplement and enhance neurological examination findings in anoxic-ischemic coma and are useful as an early guide in predicting outcome. The key finding is that bilateral absence of cortical evoked potentials reliably predicts unfavorable outcome in comatose patients after cardiac arrest.

Recovery from near death following cerebral anoxia: A case report demonstrating superiority of median somatosensory evoked potentials over EEG in predicting a favorable outcome after cardiopulmonary resuscitation.

An electroencephalogram disclosing electrocerebral silence (ECS) after cardiopulmonary resuscitation (CPR) is usually considered an unfavorable prognostic indicator associated with brain death or persistent vegetative state. I report a case of a comatose patient following cardiac arrest, whose initial electroencphalography (EEG) was isoelectric taken 5 h after onset. Median somatosensory evoked potentials (SSEP) obtained immediately after the initial EEG were normal.