ABSTRACT
Facial nerve palsy is a clinical diagnosis differentiating between central upper motor neuron lesions and peripheral lower motor neuron lesions. Rehabilitation is an important issue in peripheral facial nerve palsy management. In this article, we present the case of an adult woman affected by right peripheral facial nerve palsy due to acoustic neuroma surgical excision. She immediately started a rehabilitation plan, but it was stopped due to COVID-19 lockdown and did not resume because of the fear of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, we planned to treat her palsy with remote neurocognitive rehabilitation. After 10 months of treatment, the patient underwent a follow-up physiatric assessment, confirming right facial palsy improvement. There was a slight nasolabial groove flattening and slight left oral rime deviation while smiling (House-Brackmann classification improved from Grade IV to III). Telerehabilitation represents a valid strategy for neurocognitive rehabilitation, not only in a pandemic scenario, but also in other conditions that lead to social distancing.
ABSTRACT
Research on the impact of caring for patients with an acoustic neuroma is scarce. Findings from 12 interviews with primary carers of this patient population highlight six key themes: life disruption, support, well-being, the carer role, lessons learned and the impact of COVID-19. Carers need more practical information and emotional support, starting from the diagnosis stage through to recovery. Recommendations include routine carer assessments, early signposting to auxiliary services and information materials about recovery. This study contributes to the UK literature gap of this under-studied population and demonstrates the importance of carer assessments, as set out in the Carers Act 2014.
ABSTRACT
Introduction: Indomethacin, a non-steroidal anti-inflammatory treatment used in various inflammatory diseases, is one of the drugs that has been related to the appearance of psychotic symptoms as a side effect. Objective(s): Point out the importance of knowing the possible psychiatric symptoms that some drugs can cause as a side effect. Method(s): Description of a clinical case and bibliography review. Result(s): We present the case of a 71-year-old woman, with no previous mental health history, who is referred by her primary care physician due to the presence of auditory hallucinations and selfreferential ideas. As a somatic history, the patient presented Rheumatoid Arthritis under control by rheumatology and acoustic neuroma, under control by neurosurgery. Treatment with Risperidone was started, up to 2 mg, which helped control her symptoms. After an exhaustive study of her situation, the possibility that her symptoms were a side effect of her usual treatment was raised. It was evidenced that the patient had taken a higher dose of Indomethacin than prescribed by the rheumatologist, reason why its daily intake was suspended, and subsequently an improvement and even suppression of symptoms was seen. Later, due to a misunderstanding, the drug was reintroduced, and symptoms appeared again. Conclusion(s): The appearance of psychotic symptoms has been related to the intake of various drugs, including Indomethacin. It is essential to carry out a differential diagnosis if psychotic symptoms appear in the subject.
ABSTRACT
Introduction: The COVID-19 outbreak led to the rapid adoption of telemedicine by many specialties, including neurosurgery. Despite several telemedicine options currently available, the assessments that are specific to patients with neurological diagnoses and cranial nerve deficits remain limited. Our group has developed a novel telemedicine platform that enables patients to undergo cranial nerve and neuro-ophthalmic testing on any personal computer from their own home. In this study, we provide a detailed account of our experience using the Myelin Analytics proprietary platform in a high-volume neuro-oncology practice and share the patient satisfaction results. Methods: This is a prospective, pragmatic, non-randomized controlled study using the Myelin Analytics telemedicine platform to perform cranial nerve and neuro-ophthalmic testing in patients greater than 18 years of age diagnosed with a brain tumor who received care at our institution from June to September 2021. The investigational arm included patients who underwent the novel Myelin Analytics assessment during their inpatient stay or outpatient visit. The control arm included patients with the diagnosis of a brain tumor using conventional telemedicine provided by Teladoc Health for their outpatient visit in the same neuro-oncology practice. Both arms were asked to complete the validated 21-question Telehealth Usability Questionnaire (TUQ) after a telehealth clinic visit. The TUQ used a Likert scale ranging from Strongly Agree to Strongly Disagree to grade patient responses. Patient satisfaction was dichotomized into favorable (included strongly agree and agree responses), and unfavorable (included somewhat agree to strongly disagree). Results: A total of 42 patients met the inclusion criteria for the investigational arm and 34 patients for the control arm. The patients in the investigational and control arms were on average 52.2 ± 15.3 (range: 21-79) and 58 ± 13 years old (range: 29-76), respectively. The most common primary diagnoses were pituitary adenoma, cerebral metastasis, and vestibular schwannoma. Of the 42 patients that used the Myelin Analytics platform, 29 (69%) patients completed the patient satisfaction survey. The Myelin cohort achieved favorable patient satisfaction significantly more frequently in regards to access to healthcare (Q1: 96.6 vs. 73.5%, p = 0.013), clear communication with provider (Q12: 50.0 vs. 23.5%, p = 0.037) and expressing oneself effectively (Q13: 57.7 vs. 32.4%, p = 0.050). Discussion: Current telemedicine tools focus on audiovisual communication but lack the functionalities needed to perform a comprehensive neurological examination. This novel platform enables patients to undergo cranial nerve and neuroophthalmic testing remotely, obviating the need for in-person examination. Our feasibility study demonstrates promising.
ABSTRACT
The Coronavirus pandemic has created unprecedented strain on medical resources at health care institutions around the world. At many institutions, this has resulted in efforts to prioritize cases with an attempt to balance the acuity of medical needs with available resources. Here, we provide a framework for institutions and governments to help adjudicate treatment allocations to patients with neuro-oncologic disease.