Background: Nutrition in early life plays a critical role in the growth and neurodevelopment of preterm neonates. However, whether early nutrition modified the association of white matter injury (WMI) with brain maturation and neurodevelopmental outcomes remains unclear. Methods: In this prospective cohort study, very preterm neonates were recruited from the NICU at BC Women’s Hospital. MRI and measures of NAA/choline were obtained. Energy intake was recorded over the first two weeks of life and the cohort was dichotomized. Neurodevelopmental outcomes were assessed at 4.5 years of age using WPPSI-III. Results: Neonates in the high lipid group had higher levels of NAA/choline in the basal ganglia. When accounting for confounders, this relationship was only significant in neonates without WMI (p=0.04).

Overall, neonates with larger WMI volumes had lower IQ scores at 4.5 years (p<0.001). However, this relationship was attenuated in the high lipid group (p=0.002) relative to the lower lipid intake group. Conclusions: In this cohort, higher energy intake is associated with increased brain maturation. Similarly, neonates with large WMI had higher full-scale IQ if they received greater lipid intake in the neonatal period, suggesting that greater early lipid intake may contribute to blunting the deleterious effects of WMI on neurodevelopmental outcomes.

A previously healthy 48-year-old female presented to the emergency department with a 2-week history of low back pain, progressive lower extremities weakness, and right leg numbness. There were no bowel or bladder dysfunction symptoms. Spine magnetic resonance imaging (MRI) showed an intradural cystic lesion dorsal to the spinal cord at the level of L1 measuring 1.6 × 2.1 × 4.1 cm, which was T1 hypointense and T2 hyperintense, with a small soft tissue component and no gadolinium enhancement (Figure 1). A small lipomatous component was also noted. There were no associated vertebral anomalies. The patient underwent a T12-L2 laminectomy and cyst resection, which was subtotal due to the cyst adherence to the conus medullaris. Histopathology showed characteristic features of a neurenteric cyst, with respiratory-type epithelium in the cyst wall (Figure 2). Eight months later, follow-up MRI showed no evidence of recurrence. The patient reported improved sensation in the lower extremities; however, there was some residual weakness predominantly in the proximal hip flexors bilaterally.

Synkinesis is a distressing sequela of peripheral facial palsy (PFP). This study aimed to translate and validate the Synkinesis Assessment Questionnaire (SAQ), a reliable patient-reported outcome evaluation tool for synkinesis, in French. The SAQ was translated following a standard forward–backward translation procedure. After a cognitive debriefing with 10 PFP patients, the SAQ-F was assessed amongst 50 patients for internal consistency, known-group validity, construct validity, criterion validity, and test–retest reliability. Results demonstrated that the SAQ-F was valid, reliable, and had a unidimensional structure. The SAQ-F should be accompanied by clinician-based scales, to provide valuable additional information on the severity of synkinesis.

Endovascular thrombectomy (EVT) has revolutionized the care of patients with acute ischemic stroke. The efficacy of EVT is dependent on the optimal setup of a stroke system. Extrapolating the results of clinical trials to any individual stroke center should be done with caution. This is more important for centers with suboptimal stroke systems of care. The Canadian registry has helped highlight the suboptimal outcome post EVT in Manitoba. This could potentially be optimized with the addition of an acute stroke unit in the near future. Our study will serve as a baseline for future improvement in acute stroke care.

Prolonged remission of dystonia occurs rarely; however, well-documented cases are lacking. We report the clinical characteristics and course of four patients with botulinum toxin (BoNT)-associated prolonged remission of idiopathic cervical dystonia. Mean age at onset was 40 years. All had a relatively short duration of symptoms (mean 10.3 months), and with remission occurring after ≤ 3 treatments with BoNT. At last examination, the remission duration was 2–5 years. In the two cases that subsequently relapsed after 4–5 years, there was an altered phenomenology and worsened severity than at the onset. Recognizing this rare phenomenon has valuable clinical implications.

We reviewed stroke care delivery during the COVID-19 pandemic at our stroke center and provincial telestroke system. We counted referrals to our prevention clinic, code strokes, thrombolysis, endovascular thrombectomies, and activations of a provincial telestroke system from February to April of 2017–2020. In April 2020, there was 28% reduction in prevention clinic referrals, 32% reduction in code strokes, and 26% reduction in telestroke activations compared to prior years. Thrombolysis and endovascular thrombectomy rates remained constant. Fewer patients received stroke services across the spectrum from prevention, acute care to telestroke care in Ontario, Canada, during the COVID-19 pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led an implementation of institutional infection control protocols. This study will determine the effects of these protocols on outcomes of acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: Uninterrupted time series analysis of the impact of COVID-19 safety protocols on AIS patients undergoing EVT. We analyze data from prospectively collected quality improvement databases at 9 centers from March 11, 2019 to March 10, 2021. The primary outcome is 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics. Results: Preliminary analysis of one stroke center included 214 EVT patients (n=144 pre-pandemic). Baseline characteristics were comparable between the two periods. Time metrics “last seen normal to puncture” (305.7 vs 407.2 min; p=0.05) and “hospital arrival to puncture” (80.4 vs 121.2 min; p=0.04) were significantly longer during pandemic compared to pre-pandemic. We found no significant difference in 90-day mRS (2.0 vs 2.2; p=0.506) or successful EVT rate (89.6% vs 90%; p=0.93). Conclusions: Our results indicate an increase in key time metrics of EVT in AIS during the pandemic, likely related to infection control measures. Despite the delays, we found no difference in clinical outcomes between the two periods.

Background: Obsessive compulsive disorder (OCD) and major depressive disorder (MDD) are common, often refractory, neuropsychiatric conditions for which new treatment approaches are urgently needed. Magnetic resonance guided focused ultrasound (MRgFUS) is a novel surgical technique permitting incisionless ablative neurosurgery. Methods: We examined the safety profile, clinical response, and imaging correlates of MRgFUS anterior capsulotomy (MRgFUS-AC) in patients with refractory OCD (n=7) and MDD (n = 10). Results: There were no serious adverse clinical or radiographic events. 5/7 OCD patients and 3/10 MDD patients met pre-established clinical response criteria. Neurocognitive performance improved on several measures of executive function (p<0.05). By 6 months, there were significant reductions in cerebral glucose metabolism, and reductions in the bilateral tracts connecting the thalamus with the orbitofrontal cortices, anterior cingulate cortex (p<0.05). Preoperative functional connectivity between the right ventral striatum and hippocampus was predictive of eventual clinical response (p-FDR<0.05). Conclusions: MRgFUS-AC is safe and demonstrates important evidence of efficacy in treatment resistant psychiatric disease, particularly OCD. The procedure was associated with structural and metabolic changes in brain networks implicated in affective regulation, Resting-state fMRI offers the ability to predict response, and potentially select patients most likely to improve.

Spontaneous intermittent generalized attenuations (SIGAs) are defined as a transient decrease in amplitude of electroencephalography (EEG) activity in response to a physiologic process, external stimuli, or as a result of a pathologic condition. We seek to investigate their relationship to clinical outcomes. Demographic information, modified Rankin Scale (mRS), and clinical information were noted on 22 consecutive patients with SIGAs on their EEG. 12 of the 22 patients (54.5%) died, and 12 patients (54.5%) were admitted to the intensive care unit or coronary care unit. Future studies should attempt to prospectively compare outcomes among patients with SIGAs against a control group.

This is an observational cohort study comparing 156 patients evaluated for acute stroke between March 30 and May 31, 2020 at a comprehensive stroke center with 138 patients evaluated during the corresponding time period in 2019. During the pandemic, the proportion of COVID-19 positive patients was low (3%), the time from symptom onset to hospital presentation was significantly longer, and a smaller proportion of patients underwent reperfusion therapy. Among patients directly evaluated at our institution, door-to-needle and door-to-recanalization metrics were significantly longer. Our findings support concerns that the current pandemic may have a negative impact on the management of acute stroke.