Electrographic Correlates of Plateau Waves in Patients With Leptomeningeal Metastases.

We describe video electroencephalography (video-EEG) correlates of transient neurological attacks due to plateau waves-paroxysmal elevations in intracranial pressure-in patients with leptomeningeal metastases. We identified 3 patients with leptomeningeal metastases, intracranial hypertension, and transient neurological attacks captured on video-EEG without evidence of seizures or epileptiform activity. We identified all clinical events on video and reviewed the corresponding EEG data for evidence of abnormalities. All 3 patients had mild to moderate slowing and 2 had frontal intermittent rhythmic delta activity during background EEG recording. There were 33 clinical events recorded and stereotyped for each patient. All 33 events were associated with an increase in delta range slowing of ≥30% compared to the background. This abnormality started ≤2 minutes before the onset of clinical symptoms and persisted for minutes after clinical resolution. This study is the first to carefully describe the electrographic correlates of transient neurological attacks due to plateau waves in patients with leptomeningeal metastasis. Clinical attacks were consistently associated with a possible EEG signature of diffuse delta range slowing. Future studies can validate the sensitivity and specificity of these EEG changes as a prognostic and/or response biomarker in patients with leptomeningeal metastases with or without intracranial hypertension.

Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit.

BACKGROUND: The aim of this study is to evaluate the characteristics of unplanned transfers of adult patients from hospital wards to a neurological intensive care unit (NICU). METHODS: We retrospectively reviewed consecutive unplanned transfers from hospital wards to the NICU at our institution over a 3-year period. In-hospital mortality rates were compared between patients readmitted to the NICU ("bounce-back transfers") and patients admitted to hospital wards from sources other than the NICU who were then transferred to the NICU ("incident transfers"). We also measured clinical characteristics of transfers, including source of admission and indication for transfer. RESULTS: A total of 446 unplanned transfers from hospital wards to the NICU occurred, of which 39% were bounce-back transfers. The in-hospital mortality rate associated with all unplanned transfers to the NICU was 17% and did not differ significantly between bounce-back transfers and incident transfers. Transfers to the NICU within 24 h of admission to a floor service accounted for 32% of all transfers and were significantly more common for incident transfers than bounce-back transfers (39 vs. 21%, p = .0002). Of patients admitted via the emergency department who had subsequent incident transfers to the NICU, 50% were transferred within 24 h of admission. CONCLUSIONS: Unplanned transfers to an NICU were common and were associated with a high in-hospital mortality rate. Quality improvement projects should target the triage process and transitions of care to the hospital wards in order to decrease unplanned transfers of high-risk patients to the NICU.

The effect of prophylactic knee bracing on performance.

This study examined the effect of prophylactic knee bracing upon performance in 35 college-aged athletes. Twenty-five male and ten female subjects completed two sets of tests to determine quadriceps peak torque, rise time, time to fatigue, anaerobic power, and blood lactate accumulation. On one trial the subjects wore a Stromgren dual-hinged prophylactic knee brace. MANOVA analysis revealed that bracing did not significantly affect the performance of football players (males) but did inhibit the overall performance of lacrosse players (females) (P less than 0.05). Post hoc analyses determined that rise time (time to develop peak torque) was the greatest contributor among the dependent variables to the multivariate difference observed in the females. However, no isolated variable was identified as significantly different between the conditions by repeated-measures t-tests. Additional analyses disclosed that familiarity with brace wearing, order of testing, or a trial effect (i.e., learning) did not alter the performance results. It was concluded that wearing a protective knee brace does not improve performance and may inhibit performance in some asymptomatic athletes. It is suggested that athletes and coaches reexamine the use of prophylactic braces based upon these findings and other research described in this paper.

The late life counseling service: a program for the elderly.

Many old people who are trying to cope with crises in their lives at a time when their physical and emotional resources are lowered could benefit from mental health counseling. A special late counseling service was established for that population in Milwaukee County, despite initial cynicism about its usefulness from both senior citizens and mental health professionals. Minority, economically deprived, and handicapped clients are vigorously recruited. Services include initial and sometimes subsequent home visits; staff deal with such problems as strained family relationships, unhealthy dependencies, and depressions of varying degrees. The authors discuss the importance of home visits, thorough assessment of clients, and public education to overcome ageism in the community at large and among mental health professionals.