Recent advances in telehealth have improved access to health care for those in rural areas. It is important that examinations conducted via telehealth are comparable to in-person testing. A rural and remote memory clinic in Saskatoon provided an opportunity to compare scores on the Mini-Mental State Examination (MMSE) administered in-person and via telehealth.

After an initial one day assessment in Saskatoon, patients were seen in follow-up at 6 and 12 weeks. Individual patients were randomly assigned to either in-person follow-up assessment in Saskatoon or telehealth assessment in their home community. Patients who initially received in-person assessments were seen by telehealth for their next follow-up visit and vice-versa. The same neurologist administered MMSEs at all visits. The first 71 patients with both 6 and 12 week follow-up assessments were included in this study. The scores of in-person and telehealth MMSE administrations were compared using the methods of Bland and Altman as well as a paired t-test.

MMSE scores did not differ significantly between telehealth (22.34 +/- 6.35) and in-person (22.70 +/- 6.51) assessments.

Telehealth provides an acceptable means of assessing mental status of patients in remote areas.

The purpose of this study was to determine incidence, survival rate, and prognostic factors as well as the frequency of Collins’ Law Violators (CLVs) in an unselected population of medulloblastoma patients. Collins’ Law dictates that ’cure’ of a child with a tumor occurs after a period that includes the child’s age at diagnosis plus 9 months.

Using the Alberta Cancer Registry a population-based review identified 49 patients with medulloblastoma (19 adults, 30 children) diagnosed from 1975-96. Pathology was reviewed in all cases. All patients had surgical resection, followed by radiotherapy in 47 patients and chemotherapy in 17.

The overall 5-year survival was 50%. There was a trend for the extent of resection to be associated with a longer survival (Long rank test, p< 0.06) but this was not significant. Tumor recurrence occurred a median of 22.4 months (range, 6.4-192.3) after diagnosis and median survival after recurrence was 9.3 months (range, 0.4-64.9). The survival curve did not appear to plateau but was affected by tumor-related deaths in 3 (21.4%) of the 21 long-term survivors diagnosed in childhood. These three patients had recurrences a mean of 11.7 years after diagnosis and are designated as CLVs.

The survival rate in an unselected population of patients with medulloblastoma is poor. Aggressive resection of the tumors prolongs survival. The Collins’ Law Violators were relatively common and we suggest this concept be abandoned in medulloblastoma.

Foreign Accent Syndrome (FAS) is a rare acquired syndrome following neurological damage that results in articulatory distortions that are commonly perceived as a “foreign” accent. The nature of the underlying deficit of FAS remains controversial. We present the first reported Canadian case study of FAS following a stroke. We describe a stroke patient, RD, who suffered an acute infarction to the left internal capsule, basal ganglia and frontal corona radiata. She was diagnosed as having FAS without any persistent aphasic symptoms. Family, friends, and health care professionals similarly described her speech as sounding like she had a Canadian East Coast accent, a reported change from her native Southern Ontario accent.

An investigation of this case was pursued, incorporating neuroimaging, neuropsychological and speech pathology assessments, and formalized linguistic analyses.

Linguistic analyses confirmed that RD’s speech does in fact have salient aspects of Atlantic Canadian English in terms of both prosodic and segmental characteristics. However, her speech is not entirely consistent with an Atlantic Canadian English accent.

The fact that RD’s speech is perceived as a regional variant of her native language, rather than the “generic foreign accent” of FAS described elsewhere, suggests that the perceived “foreignness” in FAS is not primarily due to dysfluencies which indicate a non-native speaker, but rather due to very subtle motor-planning deficits which give rise to systemic changes in specific phonological segments. This has implications for the role of the basal ganglia in speech production.

The problem of concussions in professional hockey has attracted much recent attention. To evaluate the current state of this injury in the National Hockey League (NHL), we analyzed the concussion incidence and time lost from play due to concussions during the past ten NHL seasons.

Data were obtained from a complete review of injury reports in two different sports media sources covering the NHL seasons 1997-98 through 2007-08. Time lost from play was measured in missed games per concussion.

The incidence of concussions reported in the regular season ranged from a high of 1.81/1000 athlete exposures in 1998-99 to a low of 1.04/1000 athlete exposures in 2005-06. There was a downward trend in the number of concussions reported per season during the past ten years (p=0.01). However, average time lost from play per concussion increased over the same period (p<0.0005). Forwards suffered a disproportionately high percentage of concussions (p<0.0001).

Possibly related to injury reduction efforts, the number of concussions reported per season in the NHL has trended downward in recent years. However, the incidence of concussion remains high and the average time lost from play per concussion has increased. This may reflect increased injury severity in recent years or, alternatively, increased adherence to modern management guidelines preventing premature return to play.

Intravascular large cell lymphoma (ILCL) is a diagnostic challenge, with neurological, cutaneous and constitutional symptoms. The natural history is usually an evolution to a comatose state. As invasive procedures are usually required for diagnosis, recognizing the typical clinical pattern is critical since an effective treatment is available.

After an extensive literature review of the subject, we report a case of ILCL, analyzing clinical, laboratory, radiological and pathological data. We will also give a special attention to the clinical picture of a conus medullaris (CM) lesion with subsequent encephalopathy in the same patient.

We report here a 61-year-old woman with a paraplegia caused by a CM lesion, evolving about one year latter to encephalopathy and eventual coma, with the diagnosis of ILCL confirmed by autopsy. The present case is similar to eight other cases in literature who had CM lesion associated with ILCL, knowing that 80-90% of these patients will eventually evolve to encephalopathy without treatment. Conclusions: ILCL is a recognized but rare cause of coma. Diagnosing it is tremendously important since it is fatal if left untreated. We propose that this specific picture (conus medullaris lesion, eventually evolving to encephalopathy) is quite characteristic and will directly result in better outcome if recognized.

To determine the distribution of normal alleles, the frequency of larger normal alleles and analysis of the three biallelic markers, in healthy Iranian controls.

Polymerase chain reaction (PCR) was conducted on two hundred unrelated healthy individuals from different ethnic groups living in Iran to determine the size of the alleles. Markers were analyzed by PCR/RFLP on 174 chromosomes from other control healthy individuals.

Our data reveals that 23.7% of alleles had 5 CTG repeats and 7.2% of alleles had >18 CTG repeats. The analysis of haplotypes revealed that 75% of CTG5 and 80% of CTG>18 had the (+++) haplotype.

The frequency of alleles with CTG>18 in Iran is similar to that of Western Europe and Japan.

Reports about the role of autoimmunity in amyotrophic lateral sclerosis (ALS) are inconsistent. The aim of this work was to investigate the effect of IgG from patients with ALS on motor neurons in a physiological-like surrounding.

Using affinity chromatography, IgG from six ALS patients, four disease controls and five healthy subjects was purified. Organotypic spinal cord cultures, which conserve the structure of the spinal cord in a horizontal plane and are suitable for studies with long-term treatment, were used and IgG with different concentrations ranging from 0.05 mg/mL to 0.5 mg/mL was added to the culture medium. Ventral motor neuron survival was evaluated by morphology and SMI-32 immunohistochemistry staining. Lactate dehydrogenase (LDH) level in the culture medium was measured by colorimetry.

After cultures were treated with ALS IgG for three weeks, the number and morphology of motor neurons showed little change. In addition, there was no significant difference in lactate dehydrogenase release between cultures treated with medium alone, normal control IgG, disease control IgG or ALS IgG.

The results indicate that IgG from these ALS patients was insufficient per se to induce motor neuron death in Organotypic slice cultures. However, this does not preclude the possibility that other changes may have occurred in the motor neurons. This work offered a new model to evaluate the role of IgG in the pathogenesis of ALS. Organotypic cultures contribute to study of the impact of IgG on motor neurons by mimicking physiological conditions.

The hippocampus and piriform cortex have a critical role in seizure propagation. In this study, the role of adenosine A1 receptors of piriform cortex on CA1 hippocampal kindled seizures was studied in rats.

Animals were implanted with a tripolar electrode in the right hippocampal CA1 region and two guide cannulae in the left and right piriform cortex. They were kindled by daily electrical stimulation of hippocampus. In fully kindled rats, N6- cyclohexyladenosine (CHA; a selective adenosine A1 receptors agonist) and 1, 3-dimethyl-8-cyclopenthylxanthine (CPT a selective adenosine A1 receptor antagonist) were microinfused into the piriform cortex. The animals were stimulated at 5, 15 and 90 minutes (min) after drag injection.

Obtained data showed that CHA (10 and 100 μM) reduced afterdischarge duration, stage 5 seizure duration, and total seizure duration at 5 and 15 min after drag injection. There was no significant change in latency to stage 4 seizure. CPT at concentration of 20 μM increased afterdischarge duration, stage 5 seizure duration, and total seizure duration and decreased latency to stage 4 seizure at 5 and 15 min post injection. Pretreatment of rats with CPT (10 μM), 5 min before CHA (100 μM), reduced the effect of CHA on seizure parameters.

These results suggested that activity of adenosine A1 receptors in the piriform cortex has an anticonvulsant effect on kindled seizures resulting from electrical stimulation of the CA1 region of the hippocampus.