Risk factors and prognostic implications of surgery-related strokes following resection of high-grade glioma.

Surgery-related strokes are an important cause of morbidity following resection of high-grade glioma (HGG). We explored the incidence, risk factors and clinical consequences of intra-operative ischemic strokes in surgeries for resection of HGG. We retrospectively followed a cohort of 239 patients who underwent surgical resection of HGG between 2013 and 2017. Tumor types included both isocitrate dehydrogenase (IDH) wildtype glioblastoma and IDH-mutant WHO grade 4 astrocytoma. We analyzed pre- and post-operative demographic, clinical, radiological, anesthesiology and intraoperative neurophysiology data, including overall survival and functional outcomes. Acute ischemic strokes were seen on postoperative diffusion-weighted imaging (DWI) in 30 patients (12.5%), 13 of whom (43%) developed new neurological deficits. Infarcts were more common in insular (23%, p = 0.019) and temporal surgeries (57%, p = 0.01). Immediately after surgery, 35% of patients without infarcts and 57% of those with infarcts experienced motor deficits (p = 0.022). Six months later, rates of motor deficits decreased to 25% in the non-infarcts group and 37% in the infarcts group (p = 0.023 and 0.105, respectively) with a significantly lower Karnofsky-Performance Score (KPS, p = 0.001). Intra-operative language decline in awake procedures was a significant indicator of the occurrence of intra-operative stroke (p = 0.029). In conclusion, intraoperative ischemic events are more common in insular and temporal surgeries for resection of HGG and their intra-operative detection is limited. These strokes can impair motor and speech functions as well as patients' performance status.

Quantitative Meta-Analyses: Lateralization of Memory Functions Before and After Surgery in Children with Temporal Lobe Epilepsy.

RATIONALE: Memory deficits in children with epilepsy have been reported in some but not all studies assessing the effects of side of seizures and resection from the temporal lobe on cognitive performance. This meta-analysis provides a quantitative systematic review of previous studies on this issue. METHOD: A critical review and meta-analysis of the literature on memory performance in children with Temporal Lobe Epilepsy (TLE) was conducted. Search identified 25 studies, 13 of which compared children with TLE to healthy age-matched controls and 12 of which compared children with TLE before and after surgery. RESULTS: Heterogeneity of the comparisons of children with TLE to healthy controls impeded drawing definitive conclusions. However, in 55% of the studies, verbal memory in children with left TLE (LTLE) was impaired as compared to healthy controls. Verbal memory performance slightly declines after pediatric LTLE surgery, but nonverbal memory tasks are not affected. By contrast, verbal memory performance is not affected by pediatric right TLE (RTLE) surgery. CONCLUSIONS: The findings suggest that side of the epileptogenic zone and resection from the temporal lobe affect verbal memory in children with LTLE. Right resection seems to be safe with respect to verbal memory performance.

Traumatic brain injury hinders learning of road hazard awareness by repeated exposure to video-based hazards.

OBJECTIVE: To better understand hazard awareness abilities among traumatic brain injury (TBI) survivors of which little is currently known. TBI survivors express degradation in driving abilities, particularly the proactive strategy in which indicators of potentially hazardous situations are sought and identified. The current study examined differences in hazard awareness learning between TBI survivors and noninjured control individuals matched for age and driving experience. METHOD: Forty individuals equally divided among the 2 groups were assessed by exposure to repetitive video-based hazard scenarios, which have been shown to improve hazard awareness in noninjured individuals. Differences in participants' eye movements and behavioral response while watching video clips of genuine traffic scenes were recorded. RESULTS: Although survivors of TBI demonstrated relatively intact hazard awareness abilities under baseline conditions, they failed to learn from repetitive presentation of the same hazardous situation (i.e., they did not improve hazard detection) and thus failed to adjust their scanning and behavioral reaction (e.g., time to reaction, adapt of scanning behavior). Differences were more prominent for hidden hazards. Our results show impoverished anticipation abilities in driving simulation tasks performed in the subacute recovery phase after TBI and that differences in materialized hazards awareness are distinguishable between TBI survivors and noninjured drivers of similar age and driving experience. CONCLUSIONS: Our findings signal the need for further research to clarify the relationship between TBI and hazard awareness training that might be supportive of driving rehabilitation after TBI. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The effects of repetitive presentation of specific hazards on eye movements in hazard perception training, of experienced and young-inexperienced drivers.

Recent evidence shows that compared to experienced drivers, young-inexperienced drivers are more likely to be involved in a crash mainly due to their poor hazard perception (HP) abilities. This skill develops with experience and may be developed through training. We assumed that as any other skill, HP developed through implicit learning. Nevertheless, current training methods, rely on deliberate learning where young-inexperienced drivers are instructed what hazards that they should seek and where they might be located. In this exploratory study, we investigated the effectiveness of a novel training procedure, in which learners were repeatedly exposed to target video clips of driving scenarios embedded within filler scenarios. Each of the target videos included scenarios of either a visible hazard, a hidden materialized hazard or hidden unmaterialized hazard. Twenty-three young-inexperienced drivers and 35 experienced drivers participated in training session followed by a learning transference testing session and 24 additional young-inexperienced drivers participated only in the transference testing session with no training, during which participants were shown novel hazards video clips. Participants responded by pressing a button when they identified a hazard. Eye movement was also tracked using fixations patterns as a proxy to evaluate HP performance. During training, young-inexperienced drivers gradually increased their focus on visible materialized hazards but exhibited no learning curve with respect to hidden hazards. During the learning transference session, both trained groups focused on hazards earlier compared to untrained drivers. These results imply that repetitive training may facilitate HP acquisition among young-inexperienced drivers. Patterns concerning experienced drivers are also discussed.

Prosaccade and Antisaccade Paradigms in Persons with Alzheimer's Disease: A Meta-Analytic Review.

Persons with Mild Cognitive Impairment (MCI) are at high Alzheimer's Disease (AD) risk but the development of sensitive measures to assess subtle cognitive decline in this population poses a major challenge for clinicians and researchers. Eye movement monitoring is a non-invasive, sensitive way to assess subtle cognitive processes in clinical populations. We conducted a critical review and a meta-analysis of the literature on pro and antisaccade paradigm in AD/MCI. The meta-analysis included 20 studies, all of which used the prosaccade paradigm and 13 of which studied the antisaccade paradigm as well. Our meta-analysis showed that AD but not MCI patients showed longer prosaccade latencies when compared to controls. While antisaccade latencies did not differentiate between patients from controls, antisaccade error rate were significantly increased among patients in comparison to controls in over 87% of the studies. These findings highlight antisaccade error rate as a reliable tool to distinguish inhibition abilities between AD/MCI and healthy older persons.