Publications by authors named "Steven Galetta"

243 Publications

Clinical Reasoning: A 29-Year-Old Man With Fevers and Rapidly Progressive Cranial Neuropathies.

Neurology 2021 Apr 23. Epub 2021 Apr 23.

Alexa Dessy, Department of Neurology, NYU Langone Medical Center, New York, NY; Stephen Berger, Department of Neurology, NYU Langone Medical Center, New York, NY; Arooshi Kumar, Department of Neurology, NYU Langone Medical Center, New York, NY; Scott Grossman, Department of Neurology, NYU Langone Medical Center, New York, NY; Myrna Cardiel, Department of Neurology, NYU Langone Medical Center, New York, NY; Steven Galetta, Department of Neurology, NYU Langone Medical Center, New York, NY.

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http://dx.doi.org/10.1212/WNL.0000000000012085DOI Listing
April 2021

HIV-Associated Rapidly Progressive Lymphoma of the Cavernous Sinus.

J Neuroophthalmol 2021 Apr 14. Epub 2021 Apr 14.

Department of Neurology, New York University Grossman School of Medicine, New York, New York.

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http://dx.doi.org/10.1097/WNO.0000000000001198DOI Listing
April 2021

Toxic Metabolic Encephalopathy in Hospitalized Patients with COVID-19.

Neurocrit Care 2021 Mar 16. Epub 2021 Mar 16.

Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.

Background: Toxic metabolic encephalopathy (TME) has been reported in 7-31% of hospitalized patients with coronavirus disease 2019 (COVID-19); however, some reports include sedation-related delirium and few data exist on the etiology of TME. We aimed to identify the prevalence, etiologies, and mortality rates associated with TME in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients.

Methods: We conducted a retrospective, multicenter, observational cohort study among patients with reverse transcriptase-polymerase chain reaction-confirmed SARS-CoV-2 infection hospitalized at four New York City hospitals in the same health network between March 1, 2020, and May 20, 2020. TME was diagnosed in patients with altered mental status off sedation or after an adequate sedation washout. Patients with structural brain disease, seizures, or primary neurological diagnoses were excluded. The coprimary outcomes were the prevalence of TME stratified by etiology and in-hospital mortality (excluding comfort care only patients) assessed by using a multivariable time-dependent Cox proportional hazards models with adjustment for age, race, sex, intubation, intensive care unit requirement, Sequential Organ Failure Assessment scores, hospital location, and date of admission.

Results: Among 4491 patients with COVID-19, 559 (12%) were diagnosed with TME, of whom 435 of 559 (78%) developed encephalopathy immediately prior to hospital admission. The most common etiologies were septic encephalopathy (n = 247 of 559 [62%]), hypoxic-ischemic encephalopathy (HIE) (n = 331 of 559 [59%]), and uremia (n = 156 of 559 [28%]). Multiple etiologies were present in 435 (78%) patients. Compared with those without TME (n = 3932), patients with TME were older (76 vs. 62 years), had dementia (27% vs. 3%) or psychiatric history (20% vs. 10%), were more often intubated (37% vs. 20%), had a longer hospital length of stay (7.9 vs. 6.0 days), and were less often discharged home (25% vs. 66% [all P < 0.001]). Excluding comfort care patients (n = 267 of 4491 [6%]) and after adjustment for confounders, TME remained associated with increased risk of in-hospital death (n = 128 of 425 [30%] patients with TME died, compared with n = 600 of 3799 [16%] patients without TME; adjusted hazard ratio [aHR] 1.24, 95% confidence interval [CI] 1.02-1.52, P = 0.031), and TME due to hypoxemia conferred the highest risk (n = 97 of 233 [42%] patients with HIE died, compared with n = 631 of 3991 [16%] patients without HIE; aHR 1.56, 95% CI 1.21-2.00, P = 0.001).

Conclusions: TME occurred in one in eight hospitalized patients with COVID-19, was typically multifactorial, and was most often due to hypoxemia, sepsis, and uremia. After we adjustment for confounding factors, TME was associated with a 24% increased risk of in-hospital mortality.
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http://dx.doi.org/10.1007/s12028-021-01220-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962078PMC
March 2021

Increase in Ventricle Size and the Evolution of White Matter Changes on Serial Imaging in Critically Ill Patients with COVID-19.

Neurocrit Care 2021 Mar 5. Epub 2021 Mar 5.

Department of Neurology, NYU Langone Medical Center, New York, NY, 10016, USA.

Background: Evolution of brain magnetic resonance imaging (MRI) findings in critically ill patients with coronavirus disease 2019 (COVID-19) is unknown.

Methods: We retrospectively reviewed 4530 critically ill patients with COVID-19 admitted to three tertiary care hospitals in New York City from March 1 to June 30, 2020 to identify patients who had more than one brain MRI. We reviewed the initial and final MRI for each patient to (1) measure the percent change in the bicaudate index and third ventricular diameter and (2) evaluate changes in the presence and severity of white matter changes.

Results: Twenty-one patients had two MRIs separated by a median of 22 [Interquartile range (IQR) 14-30] days. Ventricle size increased for 15 patients (71%) between scans [median bicaudate index 0.16 (IQR 0.126-0.181) initially and 0.167 (IQR 0.138-0.203) on final imaging (p < 0.001); median third ventricular diameter 6.9 mm (IQR 5.4-10.3) initially and 7.2 mm (IQR 6.4-10.8) on final imaging (p < 0.001)]. Every patient had white matter changes on the initial and final MRI; between images, they worsened for seven patients (33%) and improved for three (14%).

Conclusions: On serial imaging of critically ill patients with COVID-19, ventricle size frequently increased over several weeks. White matter changes were often unchanged, but in some cases they worsened or improved, demonstrating there is likely a spectrum of pathophysiological processes responsible for these changes.
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http://dx.doi.org/10.1007/s12028-021-01207-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935478PMC
March 2021

Seeing the Finish Line: Can Baseline OCT Values Predict Long-term Disability and Therapeutic Management in Multiple Sclerosis?

Neurology 2021 Apr 2;96(16):731-732. Epub 2021 Mar 2.

From Stanford University (P.V.), CA; Langone Medical Center (S.L.G.), New York University, NY; and Queen Square MS Centre (A.T.), Department of Neuroinflammation, UCL Institute of Neurology, University College London, UK.

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http://dx.doi.org/10.1212/WNL.0000000000011793DOI Listing
April 2021

Sleep-deprived residents and rapid picture naming performance using the Mobile Universal Lexicon Evaluation System (MULES) test.

eNeurologicalSci 2021 Mar 2;22:100323. Epub 2021 Feb 2.

Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA.

Objective: The Mobile Universal Lexicon Evaluation System (MULES) is a rapid picture naming task that captures extensive brain networks involving neurocognitive, afferent/efferent visual, and language pathways. Many of the factors captured by MULES may be abnormal in sleep-deprived residents. This study investigates the effect of sleep deprivation in post-call residents on MULES performance.

Methods: MULES, consisting of 54 color photographs, was administered to a cohort of neurology residents taking 24-hour in-hospital call ( = 18) and a group of similar-aged controls not taking call (n = 18). Differences in times between baseline and follow-up MULES scores were compared between the two groups.

Results: MULES time change in call residents was significantly worse (slower) from baseline (mean 1.2 s slower) compared to non-call controls (mean 11.2 s faster) ( < 0.001, Wilcoxon rank sum test). The change in MULES time from baseline was significantly correlated to the change in subjective level of sleepiness for call residents and to the amount of sleep obtained in the 24 h prior to follow-up testing for the entire cohort. For call residents, the duration of sleep obtained during call did not significantly correlate with change in MULES scores. There was no significant correlation between MULES change and sleep quality questionnaire score for the entire cohort.

Conclusion: The MULES is a novel test for effects of sleep deprivation on neurocognition and vision pathways. Sleep deprivation significantly worsens MULES performance. Subjective sleepiness may also affect MULES performance. MULES may serve as a useful performance assessment tool for sleep deprivation in residents.
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http://dx.doi.org/10.1016/j.ensci.2021.100323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876539PMC
March 2021

Practical Approach to the Tele-Neuro-Ophthalmology and Neuro-Otology Visits: Instructional Videos.

J Neuroophthalmol 2021 Mar;41(1):10-12

Department of Neurology (RC, SNG, CC, SLG, LJB, JCR), New York University Grossman School of Medicine, New York, New York; Department of Ophthalmology (NR, LS), University of California San Francisco, San Francisco, California; Departments of Ophthalmology (SLG, LJB, JCR) and Population Health (LJB), New York University Grossman School of Medicine, New York, New York.

Abstract: A collection of instructional videos that illustrate a step by step approach to tele-neuro-ophthalmology and neuro-otology visits. These videos provide instruction for patient preparation for their video visit, patient and provider interface with an electronic medical record associated video platform, digital applications to assist with vision testing, and practical advice for detailed remote neuro-ophthalmologic and neuro-otologic examinations.
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http://dx.doi.org/10.1097/WNO.0000000000001195DOI Listing
March 2021

Resident and Fellow Training in a Pandemic.

J Neuroophthalmol 2021 Mar;41(1):6-9

Departments of Neurology (SG) and Ophthalmology (SG, SLG), NYU Grossman School of Medicine, New York, New York; Department of Ophthalmology (AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Neurology (AGL), Neurosurgery, and Ophthalmology, Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology (AGL), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Ophthalmology (AGL), Texas A&M University College of Medicine, Houston, Texas; Department of Ophthalmology (AGL), Baylor College of Medicine and the Center for Space Medicine (AGL), Houston, Texas; Department of Ophthalmology (AGL), University of Iowa Hospitals and Clinics (AGL), Iowa City, Iowa; and Department of Ophthalmology (AGL), University of Buffalo (AGL), Buffalo, New York.

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http://dx.doi.org/10.1097/WNO.0000000000001215DOI Listing
March 2021

Cerebrospinal fluid in COVID-19: A systematic review of the literature.

J Neurol Sci 2021 02 10;421:117316. Epub 2021 Jan 10.

Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA.

Objective: We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2.

Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom.

Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings.

Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS- CoV-2 are unlikely to be related to direct viral neuroinvasion.
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http://dx.doi.org/10.1016/j.jns.2021.117316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833669PMC
February 2021

Funding the Educational Mission in Neurology.

Neurology 2021 03 8;96(12):574-582. Epub 2021 Feb 8.

From the Department of Neurology (D.M.G.), Boston University School of Medicine; Department of Neurology (J.M., H.P.), Yale School of Medicine/VA Connecticut Healthcare System; Department of Neurology (D.R.T.), University of Nebraska Medical Center; Department of Neurology (M.S.), Rush University Medical Center; Department of Neurology (S.C.), Texas Tech University Health Sciences Center; Department of Neurology (L.T.), Miller School of Medicine, University of Miami; Department of Neurology (L.G.), University of Indiana School of Medicine; Department of Neurology (R.S.), Unversity of Miami Health System; and Department of Neurology (S.G.), New York University Langone Health.

Although it is self-evident that education in neurology is important and necessary, how to fund the educational mission is a frequent challenge for neurology departments and clinicians. Department chairs often resort to a piecemeal approach, cobbling together funding for educators from various sources, but frequently falling short. Here, we review the various sources available to fund the educational mission in neurology, understanding that not every department will have access to every source. We describe the multiple different teaching models and formats used by the modern student and educator and their associated costs, some of which are exorbitant. We discuss possible nonfinancial incentives, including pathways to promotion, educational research, and other awards and recognition. Neurological education is commonly underfunded, and departments and institutions must be nimble and creative in finding ways to fund the time and effort of educators.
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http://dx.doi.org/10.1212/WNL.0000000000011635DOI Listing
March 2021

How sandbag-able are concussion sideline assessments? A close look at eye movements to uncover strategies.

Brain Inj 2021 Mar 2;35(4):426-435. Epub 2021 Feb 2.

Department of Neurology, NYU School of Medicine, New York, NY, United States.

Sideline diagnostic tests for concussion are vulnerable to volitional poor performance ("sandbagging") on baseline assessments, motivated by desire to subvert concussion detection and potential removal from play. We investigated eye movements during sandbagging versus best effort on the King-Devick (KD) test, a rapid automatized naming (RAN) task. Participants performed KD testing during oculography following instructions to sandbag or give best effort. Twenty healthy participants without concussion history were included (mean age 27 ± 8 years). Sandbagging resulted in longer test times (89.6 ± 39.2 s vs 48.2 ± 8.5 s, < .001), longer inter-saccadic intervals (459.5 ± 125.4 ms vs 311.2 ± 79.1 ms, < .001) and greater numbers of saccades (171.4 ± 47 vs 138 ± 24.2, < .001) and reverse saccades (wrong direction for reading) (21.2% vs 11.3%, < .001). Sandbagging was detectable using a logistic model with KD times as the only predictor, though more robustly detectable using eye movement metrics. KD sandbagging results in eye movement differences that are detectable by eye movement recordings and suggest an invalid test score. Objective eye movement recording during the KD test shows promise for distinguishing between best effort and post-injury performance, as well as for identifying sandbagging red flags.
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http://dx.doi.org/10.1080/02699052.2021.1878554DOI Listing
March 2021

Optic Nerve in Multiple Sclerosis Diagnostic Criteria: An Aye to the Eyes?

Neurology 2021 01 16;96(4):139-140. Epub 2020 Dec 16.

From the Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (W.J.B.), UCL Institute of Neurology, London, UK; and NYU Langone Health (S.G.), New York, NY.

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http://dx.doi.org/10.1212/WNL.0000000000011344DOI Listing
January 2021

The complexity of eye-hand coordination: a perspective on cortico-cerebellar cooperation.

Cerebellum Ataxias 2020 Nov 13;7(1):14. Epub 2020 Nov 13.

Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA.

Background: Eye-hand coordination (EHC) is a sophisticated act that requires interconnected processes governing synchronization of ocular and manual motor systems. Precise, timely and skillful movements such as reaching for and grasping small objects depend on the acquisition of high-quality visual information about the environment and simultaneous eye and hand control. Multiple areas in the brainstem and cerebellum, as well as some frontal and parietal structures, have critical roles in the control of eye movements and their coordination with the head. Although both cortex and cerebellum contribute critical elements to normal eye-hand function, differences in these contributions suggest that there may be separable deficits following injury.

Method: As a preliminary assessment for this perspective, we compared eye and hand-movement control in a patient with cortical stroke relative to a patient with cerebellar stroke.

Result: We found the onset of eye and hand movements to be temporally decoupled, with significant decoupling variance in the patient with cerebellar stroke. In contrast, the patient with cortical stroke displayed increased hand spatial errors and less significant temporal decoupling variance. Increased decoupling variance in the patient with cerebellar stroke was primarily due to unstable timing of rapid eye movements, saccades.

Conclusion: These findings highlight a perspective in which facets of eye-hand dyscoordination are dependent on lesion location and may or may not cooperate to varying degrees. Broadly speaking, the results corroborate the general notion that the cerebellum is instrumental to the process of temporal prediction for eye and hand movements, while the cortex is instrumental to the process of spatial prediction, both of which are critical aspects of functional movement control.
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http://dx.doi.org/10.1186/s40673-020-00123-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666466PMC
November 2020

Neuro-ophthalmologic complications of coronavirus disease 2019 (COVID-19).

Neurosci Lett 2021 01 25;742:135531. Epub 2020 Nov 25.

NYU Langone Medical Center, Departments of Neurology and Ophthalmology, 222 E. 41(st) St., New York, NY, 10017, USA. Electronic address:

Multiple neuro-ophthalmological manifestations have been described in association with COVID-19. These symptoms and signs may be the result of a range of pathophysiological mechanisms throughout the course from acute illness to recovery phase. Optic nerve dysfunction, eye movement abnormalities and visual field defects have been described.
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http://dx.doi.org/10.1016/j.neulet.2020.135531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687583PMC
January 2021

Dr. Norman Schatz.

J Neuroophthalmol 2020 12;40(4):e65-e73

Departments of Neurology and Ophthalmology, New York University Grossman School of Medicine, New York, New York.

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http://dx.doi.org/10.1097/WNO.0000000000001042DOI Listing
December 2020

Treatment with Zinc is Associated with Reduced In-Hospital Mortality Among COVID-19 Patients: A Multi-Center Cohort Study.

Res Sq 2020 Oct 26. Epub 2020 Oct 26.

Zinc impairs replication of RNA viruses such as SARS-CoV-1, and may be effective against SARS-CoV-2. However, to achieve adequate intracellular zinc levels, administration with an ionophore, which increases intracellular zinc levels, may be necessary. We evaluated the impact of zinc with an ionophore (Zn+ionophore) on COVID-19 in-hospital mortality rates. A multicenter cohort study was conducted of 3,473 adult hospitalized patients with reverse-transcriptase-polymerase-chain-reaction (RT-PCR) positive SARS-CoV-2 infection admitted to four New York City hospitals between March 10 through May 20, 2020. Exclusion criteria were: death or discharge within 24h, comfort-care status, clinical trial enrollment, treatment with an IL-6 inhibitor or remdesivir. Patients who received Zn+ionophore were compared to patients who did not using multivariable time-dependent cox proportional hazards models for time to in-hospital death adjusting for confounders including age, sex, race, BMI, diabetes, week of admission, hospital location, sequential organ failure assessment (SOFA) score, intubation, acute renal failure, neurological events, treatment with corticosteroids, azithromycin or lopinavir/ritonavir and the propensity score of receiving Zn+ionophore. A sensitivity analysis was performed using a propensity score-matched cohort of patients who did or did not receive Zn+ionophore matched by age, sex and ventilator status. Among 3,473 patients (median age 64, 1947 [56%] male, 522 [15%] ventilated, 545[16%] died), 1,006 (29%) received Zn+ionophore. Zn+ionophore was associated with a 24% reduced risk of in-hospital mortality (12% of those who received Zn+ionophore died versus 17% who did not; adjusted Hazard Ratio [aHR] 0.76, 95% CI 0.60-0.96, P=0.023). More patients who received Zn+ionophore were discharged home (72% Zn+ionophore vs 67% no Zn+ionophore, P=0.003) Neither Zn nor the ionophore alone were associated with decreased mortality rates. Propensity score-matched sensitivity analysis (N=1356) validated these results (Zn+ionophore aHR for mortality 0.63, 95%CI 0.44-0.91, P=0.015). There were no significant interactions for Zn+ionophore with other COVID-19 specific medications. Zinc with an ionophore was associated with increased rates of discharge home and a 24% reduced risk of in-hospital mortality among COVID-19 patients, while neither zinc alone nor the ionophore alone reduced mortality. Further randomized trials are warranted.
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http://dx.doi.org/10.21203/rs.3.rs-94509/v1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605567PMC
October 2020

COVID-19-Induced Neurovascular Injury: a Case Series with Emphasis on Pathophysiological Mechanisms.

SN Compr Clin Med 2020 22;2(11):2109-2125. Epub 2020 Oct 22.

Department of Pathology, Division of Neuropathology, NYU Langone Health, 550 First Avenue, New York, NY 10016 USA.

Coronavirus disease 2019 (COVID-19) is associated with a high inflammatory burden that can induce severe respiratory disease among other complications; vascular and neurological damage has emerged as a key threat to COVID-19 patients. Risk of severe infection and mortality increases with age, male sex, and comorbidities including cardiovascular disease, hypertension, obesity, diabetes, and chronic pulmonary disease. We review clinical and neuroradiological findings in five patients with COVID-19 who suffered severe neurological disease and illustrate the pathological findings in a 7-year-old boy with COVID-19-induced encephalopathy whose brain tissue sample showed angiocentric mixed mononuclear inflammatory infiltrate. We summarize the structural and functional properties of the virus including the molecular processes that govern the binding to its membrane receptors and cellular entry. In addition, we review clinical and experimental evidence in patients and animal models that suggests coronaviruses enter into the central nervous system (CNS), either via the olfactory bulb or through hematogenous spread. We discuss suspected pathophysiological mechanisms including direct cellular infection and associated recruitment of immune cells and neurovirulence, at least in part, mediated by cytokine secretion. Moreover, contributing to the vascular and neurological injury, coagulopathic disorders play an important pathogenic role. We survey the molecular events that contribute to the thrombotic microangiopathy. We describe the neurological complications associated with COVID-19 with a focus on the potential mechanisms of neurovascular injury. Our thesis is that following infection, three main pathophysiological processes-inflammation, thrombosis, and vascular injury-are responsible for the neurological damage and diverse pathology seen in COVID-19 patients.
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http://dx.doi.org/10.1007/s42399-020-00598-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577845PMC
October 2020

Role for OCT in detecting hemi-macular ganglion cell layer thinning in patients with multiple sclerosis and related demyelinating diseases.

J Neurol Sci 2020 Dec 28;419:117159. Epub 2020 Sep 28.

Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, USA. Electronic address:

Objective: Investigations have found associations of homonymous thinning of the macular ganglion cell/ inner-plexiform layer (GCIPL) with demyelinating lesions in the post-chiasmal visual pathway among patients with multiple sclerosis (MS). Retinal thinning may also occur through retrograde trans-synaptic degeneration, a process by which lesions in post-geniculate visual pathway structures lead to thinning of the GCIPL across thalamic synapses. The purpose of our study was to determine the frequency of homonymous hemimacular thinning that occurs in association with post-chiasmal visual pathway demyelinating lesions in patients with MS and other demyelinating diseases.

Methods: Adult patients with demyelinating diseases (MS, neuromyelitis optica spectrum disorder [NMOSD], myelin oligodendrocyte glycoprotein antibody disease (anti-MOG)) who were participants in an ongoing observational study of visual pathway structure and function were analyzed for the presence of hemimacular GCIPL thinning on OCT scans. Brain MRI scans were examined for the presence of post-geniculate visual pathway demyelinating lesions.

Results: Among 135 participants in the visual pathway study, 5 patients (3.7%) had homonymous hemimacular GCIPL thinning. Eleven patients (8.1%) had a whole+half pattern of GCIPL thinning, characterized by hemimacular thinning in one eye and circumferential macular thinning in the contralateral eye. All but one patient with homonymous hemimacular thinning had demyelinating lesions in the post-geniculate visual pathway; however, these lesions were located in both cerebral hemispheres.

Conclusion: Homonymous hemimacular thinning in the GCIPL by OCT is associated with post-chiasmal visual pathway demyelinating lesions but it appears to be a relatively uncommon contributor to GCIPL loss. Patients with this pattern of GCIPL often fail to complain of hemifield visual loss. Future studies with prospective and detailed MR imaging may be able to more closely associate demyelinating lesions in anatomically appropriate regions of the post-chiasmal visual pathways with homonymous hemimacular thinning.
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http://dx.doi.org/10.1016/j.jns.2020.117159DOI Listing
December 2020

A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.

Neurology 2021 01 5;96(4):e575-e586. Epub 2020 Oct 5.

From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK.

Objective: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.

Methods: We conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.

Results: Of 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, < 0.001).

Conclusions: Neurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.
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http://dx.doi.org/10.1212/WNL.0000000000010979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905791PMC
January 2021

Concerning Vision Therapy and Ocular Motor Training in Mild Traumatic Brain Injury.

Ann Neurol 2020 11 16;88(5):1053-1054. Epub 2020 Sep 16.

Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.

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http://dx.doi.org/10.1002/ana.25875DOI Listing
November 2020

Pearls & Oy-sters: Leukoencephalopathy in critically ill patients with COVID-19.

Neurology 2020 10 11;95(16):753-757. Epub 2020 Aug 11.

From the Departments of Neurology (H.H., H.E., M.C., E.V., I.K., L.K., H.W., S.G., J.F., T.Z., D.E.K., A. Lord, A. Lewis) and Neurosurgery (J.F., T.Z., D.E.K., A. Lord, A. Lewis), NYU Langone Medical Center, New York, NY.

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http://dx.doi.org/10.1212/WNL.0000000000010636DOI Listing
October 2020