The Relationship Between Brain Metabolites Alterations and Neuropsychological Deficits in Patients with Methamphetamine Use Disorder: A Proton Magnetic Resonance Spectroscopy Study.

INTRODUCTION: Chronic use of methamphetamine induces neuropsychological deficits and neurochemical changes in frontostriatal regions. This study aimed to examine the relationship between brain metabolites alterations in frontostriatal regions and neuropsychological deficits in patients with methamphetamine use disorder. METHOD: A total of 30 methamphetamine users and 20 control participants were selected and a battery of standardized executive function, attention, and memory tasks, including the Wisconsin Card Sorting Test, Stroop Test, and Wechsler Memory Scale, was administered to them. Proton-Magnetic resonance spectroscopy (H-MRS) of N-Acetylaspartate/Creatine (NAA/Cr), Choline/Creatine (Cho/Cr), and glutamate + glutamine/creatine (Glx/Cr) in dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), and basal ganglia (BG) were also undertaken. RESULTS: Current findings indicated that there were significant differences between two groups in metabolite ratios including NAA/Cr, Cho/Cr, and Glx/Cr in three areas, except for Glx/Cr in BG. Moreover, compared to healthy controls, methamphetamine users showed poorer performance in all neuropsychological tests. Finally, a significant relationship was found between regional metabolites alterations, particularly in the ACC, and neuropsychological deficits in methamphetamine users. CONCLUSIONS: In addition to neurochemical changes and neuropsychological deficits in patients with methamphetamine use disorder, current results highlighted the relationship between these changes in DLPFC, ACC, and BG with cognitive deficits in methamphetamine users.

Hyperextension thoracic spine fracture with complete neurological recovery after surgical fixation: A case report.

BACKGROUND: Hyperextension thoracic spine fractures (HTSFs) typically involve the anterior ligamentous complex of the spine. These patients often present with paraplegia and warrant early surgical reduction/fixation even though few deficits resolve. Here, we present the unusual case of a 40-year-old male whose paraparetic deficit resolved following reduction/fixation of a T7-T8 HTSF. CASE DESCRIPTION: A 40-year-old male presented with a thoracic computed tomography (CT) documented T7- T8 HTSF following a motor vehicle accident. His neurological examination revealed severe paraparesis, but without a sensory level (ASIA motor score 78). The chest CT angiogram scan revealed a hypodensity in the aorta, representing a small traumatic aortic dissection responsible for the patient's right hemothorax; 450 ml of blood was removed on chest tube placement. He underwent urgent/emergent thoracic spine reduction and fixation at the T7-T8 level. Within 5 postoperative months, he recovered fully neurological function (ASIA motor score 100). CONCLUSION: We recommend urgent/emergent surgical reduction/stabilization for patients with thoracic HTSF to decrease offer the potential for neurological recovery and avoid secondary injury due to continued compression.

The incidence of traumatic brain injury in Tehran, Iran.

PRIMARY OBJECTIVE: To assess the demographics, causes, treatment and outcome of traumatic brain injury (TBI) in Tehran, Iran. RESEARCH DESIGN AND METHODS: This retrospective study was conducted in a major trauma centre in south of Tehran using clinical data registry of 3818 traumatic patients who admitted to the hospital from 2009 to 2013. The main factors measured were the external cause of trauma, the type of TBI, and treatment outcome. MAIN OUTCOMES AND RESULTS: The highest rate of TBIs occurred in age categories 21‒30 (31.5%), 31‒40 (19.2%) and 41‒50 (12.3%) years. Transport accidents were the most common cause of TBIs (2915 cases, 76.4%). The most frequent types of head injuries were subarachnoid (1676, 43.9%) subdural (1140, 29.8%), and epidural haemorrhage (974, 25.5%). A binomial logistic regression showed that mortality (612 patients, 16%) was significantly associated with the external cause of TBI, the type of main and additional head injuries, cervical spine injury, intra-abdominal organ injury, having a brain or abdominal surgery, and length of hospital stay. CONCLUSION: The mechanism of TBI, the type of head injuries, and accompanying spine and abdominal injuries were significant prognostic factors in traumatic patients.

Diagnostic Value of Serum Levels of GFAP, pNF-H, and NSE Compared With Clinical Findings in Severity Assessment of Human Traumatic Spinal Cord Injury.

STUDY DESIGN: An analytical cohort study. OBJECTIVE: This study aimed to evaluate severity of traumatic spinal cord injury (SCI) based on the serum levels of phosphorylated form of heavy subunit of neurofilament (pNF-H), neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP), which are axonal, neural cell body, and glial cell injury markers, respectively. SUMMARY OF BACKGROUND DATA: Prior studies have reported elevated serum levels of pNF-H, NSE, and GFAP as biomarkers for the detection of traumatic SCI in animals. However, in this study, these biomarkers were studied in humans and with an extended level of timing. METHODS: The study included 35 patients with SCI with a mean age of 36.5 years. All patients were evaluated using the American Spinal Injury Association Impairment Scale, followed by examinations including radiography and spinal computed tomography for determining the injury level. Serum levels of NSE, pNF-H, and GFAP were determined using enzyme-linked immunosorbent assay. RESULTS: The mean serum level of GFAP was significantly higher in patients with SCI than in the control group. Mean serum levels of pNF-H and NSE were significantly higher during 24 and 48 hours after injury in patients with SCI than in the control group. The serum level of GFAP was appropriate for estimating the severity of SCI in the first 24 hours after injury. CONCLUSION: Our findings suggest that increased serum levels of GFAP, NSE, and pNF-H can be used for the diagnosis and degree of SCI severity in trauma patients. During 48 hours after injury, estimation of serum levels of pNF-H, NSE, and GFAP, combined with neurological testing, could predict the presence of SCI and severity prior to spinal computed tomography and surgical or conservative interventions. LEVEL OF EVIDENCE: 2.