Faculty Bibliography

BACKGROUND/UNASSIGNED:High intensity focused ultrasound (HiFU) is a relatively new incisionless intervention used for treatment of essential tremor and Parkinson's disease tremor. Understanding the indications, benefits, risks and limitations of HiFU, as well as how it compares to deep brain stimulation (DBS), is important in guiding appropriate recommendations for prospective patients. METHODS/UNASSIGNED:Current literature on efficacy and safety of HiFU in essential tremor and Parkinson's disease was reviewed. We additionally reviewed data on the patients who presented to our center for HiFU consultation, including outcomes of patients with low skull density ratios, and distances traveled for the procedure. RESULTS/DISCUSSION/UNASSIGNED:HiFU is an effective and generally well-tolerated treatment for tremor. Adverse events, especially gait instability, are typically temporary but should be discussed with patients. The risk of tremor recurrence in certain patients with Parkinson's disease is also of note. Identifying appropriate candidates for either intervention remains crucial and involves considering each patient's circumstances and preferences, potential adverse effects, and practical aspects like access to follow-up and expectations. Data on bilateral HiFU lesioning, use of HiFU in patients with low skull density ratios, and emerging targets like the pallidothalamic tract are discussed as well.

BACKGROUND/UNASSIGNED:that requires emergent postoperative MR confirmation of the classical "white cord" (i.e., high intrinsic T2W MR cord signal reflecting edema/swelling). METHODS/UNASSIGNED:Most frequently, postoperative MR studies in newly paretic/injured patients following cervical operations will show evidence of direct intraoperative ("iatrogenic") spinal cord injury. Less frequently, findings may include new non-operative vs. operative pathology (i.e., hematomas/hematomyelia, graft extrusions/malpositioning, new/residual/recurrent disc/stenosis/Ossification of the Posterior Longitudinal Ligament (OPLL), and other pathology). RESULTS/UNASSIGNED:WCS/RI after cervical spine surgery is extremely rare, being reported in only 17 cases as of 2020, and cannot be diagnosed based on "clinical judgment" alone; rather, it requires a STAT corroborate postoperative MR to demonstrate the classical "white cord". However, most likely postoperative MR studies document "iatrogenic" cord injuries, and less likely show new non-surgical and/or new surgical compressive pathology warranting reoperations to remediate the extent/severity of neurological injuries. CONCLUSION/UNASSIGNED:that requires STAT postoperative MR documentation of the classical swollen/edematous "white cord".

Individuals with Lewy body dementia (LBD) rely on family caregivers. Caregiving demands limit caregivers' ability to attend to their own health needs, increasing their vulnerability to the psychological effects of caregiving. We previously piloted a peer mentoring intervention with experienced (mentor) and less experienced (mentee) LBD caregivers. Matched mentor-mentee dyads spoke weekly for 16 weeks, guided by an intervention handbook. LBD knowledge and attitudes towards dementia improved post-intervention. We hypothesized that caregiver health status moderates response to peer mentoring. Post hoc analyses (N = 30 dyads) showed that 75% of mentees and 66% of mentors endorsed ≥1 comorbidity. Mentees and mentors with comorbidities showed greater improvement in LBD knowledge postintervention (P = 0.039) and dementia attitudes post-training (P = 0.016), respectively. Caregivers with comorbidities and thus greater exposure to health care may derive excess benefit from an effective LBD caregiver intervention than healthier counterparts, enhancing both the objective knowledge and their confidence in caring for their loved ones.

Amid the dismantling of state structures in Haiti, the first Black republic faces significant health disparities compared to its former colonial power, France. These disparities include lower life expectancy (64.8 vs. 82.3 years) and higher infant and maternal mortality rates. The situation is further exacerbated by widespread mental health issues, severe food insecurity (50% acute vs. 37% moderate), and elevated homicide rates (13.35 vs. 1.35 per 100,000 inhabitants). As calls grow for France to return the independence ransoms extracted from Haiti, there remains limited data on how reparations could impact the country's public health, community well-being, or effective implementation of healing programs. Between Spring and Fall 2023, we conducted 4 focus groups: 1st with Haitian men and women residing in the United States, a 2nd-with men in Haiti, a 3rd with women in Cap-Haïtien and Les Cayes, and a 4th with women in Cité Soleil. We conducted focus groups structured interview protocol, comprised of open-ended questions categorized into 4 thematic sections. These questions provided insights into participants' perceptions on mental health, the daily challenges and barriers to access care, and community-based healing. Participants emphasized need for policies that address the social determinants of health, ensure safety and justice, and promote healthier workplace environments. They also advocated for mental health education aimed at reducing stigma, cultivating trust, and strengthening community support systems; with an emphasis on developing professional training, ethics, and sustainable long-term mental health services accessible for individuals of all ages. Haitian participants underscore the critical need to restore security, address the social determinants of health, and implement community-based mental health initiatives. We propose a biopsychosocial-ecological approach to guide reparations efforts. A targeted investment of $30 billion could yield substantial improvements in healthcare, mental health services, and public safety-contributing to increased life expectancy, reduced mortality rates, and decreased violence.

BACKGROUND/UNASSIGNED:Early treatment of cerebrospinal fluid (CSF) infections, including meningitis and/or ventriculitis (MV) is critical to minimize morbidity/mortality. Infections/MV are typically attributed to; recurrent postoperative lumbar CSF fistulas with drainage through the skin (12.2-33.3%), lumbar drains, and/or various intracranial devices (i.e. external ventricular drains, intracranial pressure monitors). METHODS/UNASSIGNED:Lumbar MR examinations best document recurrent postoperative dural fistulas with subcutaneous extension leading to leaking wounds; the longer these leaks persist, the greater the risk of CSF infection and MV. Classical cranial MR findings of MV due to prior lumbar surgery, lumbar drains or multiple intracranial devices include; ventricular debris, ependymal enhancement, hydrocephalus, extra-axial fluid collections, infarcts (arteritis/ventriculitis), abscesses, and granulomas. RESULTS/UNASSIGNED:Surgery for recurrent postoperative lumbar CSF leaks typically warrant wound reexploration with direct sutured-dural repairs, use of muscle patch grafts (avoid fat - it resorbs), fibrin sealants/fibrin glues (FS/FG), lumbar drains, lumboperitoneal and/or pseudomeningocele-peritoneal shunts. For patients who additionally develop meningitis/ventriculitis, one should consider adding intraventricular (IVT) or lumbar intrathecal (IT) antibiotic therapy to routine intravenous antibiotics. Notably, all efforts should be made to avoid the high mortality rates associated with VM (i.e., 13% to 60%). CONCLUSION/UNASSIGNED:Recurrent postoperative lumbar CSF leaks (i.e., especially after CSF breaches the skin), lumbar drains, and/or intracranial devices/implants may cause infections including meningitis and ventriculitis (MV). It is critical to recognize and treat these infections/MV early to avoid high morbidity and mortality rates.

BACKGROUND:Despite fall-related injuries accounting for over two-thirds of older adult trauma injuries, fall-related injuries are more likely to be under-triaged. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is an injury risk-triage tool. This study aims to validate STTGMA's accuracy in predicting fall-related mortality among older adult trauma patients and compare its predictive accuracy with the Geriatric Trauma Outcome Score (GTOS) and the Revised Trauma Score (RTS). METHODS:Using a retrospective cohort design, we selected 6,458 older adult trauma patients (aged 65 years and older) from a single institutional trauma database (2017-2023). The primary outcome variable was in-hospital death, measured as a binary variable. The primary predictor variable was the STTGMA score, measured as a continuous variable and a four-level categorical variable. The secondary predictor variables were the GTOS and the RTS. We compared the predictive accuracy (95% confidence interval (CI)) of the STTGMA, GTOS, and RTS. We further assessed the relationships between the STTGMA risk categories and time-to-death and hospital length of stay using multivariable time-varying Cox proportional hazard analysis and multivariable quantile regression analysis, respectively. RESULTS:A total of 130 patients (2.0%) died during admission, and the median hospital length of stay was 2 days. STTGMA exhibited 84% (95% CI: 77.3-89.8) accuracy in predicting in-hospital fall-related mortality, while the GTOS and RTS both exhibited 71% diagnostic accuracies. Compared to the minimal risk category, older adult trauma patients classified as low, moderate, and high risks each had significantly longer hospital stays and adjusted mortality risks, in a dose-response pattern. CONCLUSION/CONCLUSIONS:STTGMA can accurately predict in-hospital mortality and risk-stratify the length of stay and the time to death among older adult trauma patients with fall-related injuries.

BACKGROUND AND PURPOSE/OBJECTIVE:Assessment of brain lesions on magnetic resonance imaging (MRI) is crucial for research in multiple sclerosis (MS). Manual segmentation is time-consuming and inconsistent. We aimed to develop an automated MS lesion segmentation algorithm for T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI. METHODS:We developed FLAIR Lesion Analysis in Multiple Sclerosis (FLAMeS), a deep learning-based MS lesion segmentation algorithm based on the nnU-Net 3D full-resolution U-Net and trained on 668 FLAIR 1.5 and 3 tesla scans from persons with MS. FLAMeS was evaluated on three external datasets: MSSEG-2 (n = 14), MSLesSeg (n = 51), and a clinical cohort (n = 10), and compared to SAMSEG, LST-LPA, and LST-AI. Performance was assessed qualitatively by two blinded experts and quantitatively by comparing automated and ground truth lesion masks using standard segmentation metrics. RESULTS:, whereas the benchmark methods missed larger lesions in addition to smaller ones. CONCLUSIONS:FLAMeS is an accurate, robust method for MS lesion segmentation that outperforms other publicly available methods.

Repetitive head impacts are common in contact and collision sports and are linked to structural brain changes and an elevated risk of neurodegenerative diseases such as Chronic Traumatic Encephalopathy. Identifying early in vivo structural markers remains challenging. Although diagnosis currently requires post-mortem confirmation, clinical symptoms, including cognitive impairment and behavioural changes, are reflected in the diagnosis of Traumatic Encephalopathy Syndrome. These symptoms align with dysfunction in key brain regions-amygdala, hippocampus and thalamus-which support memory, emotion and behaviour and commonly show tau pathology in Chronic Traumatic Encephalopathy. This study uses shape analysis to examine structural differences in these regions between former American football players and unexposed asymptomatic controls and evaluates the influence of age, head impact exposure and clinical diagnosis on brain structure. We analyzed brain morphology in former American football players (n = 163) and unexposed, asymptomatic controls (n = 53). Structural segmentation was performed with FreeSurfer 7.1, and the shape analysis pipeline was used to generate subregional reconstructions. Vertex-level morphometry, based on the logarithm of the Jacobian determinant and radial distance, quantified local surface area dilation and thickness. Group differences were examined with covariate-adjusted linear regression models contrasting football players and controls, as well as participants with and without a Traumatic Encephalopathy Syndrome diagnosis. Partial correlations examined the influence of age, age of first football exposure and cumulative head impact index metrics, including frequency, linear acceleration and rotational force. Models were adjusted accordingly for age, body mass index, education, race, imaging site, apolipoprotein

PURPOSE/UNASSIGNED:To explore the phenotypic spectrum and genetic etiologies of Moebius Syndrome (MBS), a rare neurological disorder defined by congenital, nonprogressive facial weakness and limitations in ocular abduction. METHODS/UNASSIGNED:We applied strict diagnostic criteria and conducted clinical phenotyping of 149 individuals with MBS. Subsequently, we performed exome and/or genome sequencing on 67 of these individuals and 117 unaffected family members. RESULTS/UNASSIGNED:(HGNC:9968). CONCLUSION/UNASSIGNED:We did not identify a strong or unifying germline genetic etiology for MBS. Future studies may explore alternative causes, including environmental exposures, somatic variants, and/or complex inheritance patterns affecting brainstem and organ embryogenesis.