Neurology 2022

Improving the treatment speed and diagnostic accuracy of acute ischemic stroke

Faculty Mentor’s Name: Dr. Christina Wilson
Email: christina.wilson@neurology.ufl.edu
Phone Number: (352) 273-5576
Project Category: Clinical
International Component or Travel: No

Research Project Description:

“Time is brain” is a common mantra in the treatment of acute ischemic stroke, as each second of an untreated stroke can result in permanent damage to over 32,000 neurons. Comprehensive stroke centers continuously strive to improve their treatment times in order to improve outcomes for patients. The UF Stroke Team has multiple ongoing projects to identify and address barriers to improving these times within specific patient populations.

For example, one project is to understand factors that contribute to administration of thrombolytics later than desired (ie, greater than 30 minutes after arrival to the hospital), so that interventions can be designed to target these specific patient populations for faster treatment. Another ongoing study is to determine predictors of inaccurately-called inpatient stroke alerts as a first step towards creating targeted educational material for nursing to ensure that stroke team resources can remain focused on actual stroke patients. Other projects are available as well, and students with general interest in this area are encouraged to apply, Medical students will assist with data collection via retrospective chart review.

These projects will likely lead to one or more presentations and publications, and best of all – your work will lead to improvements in the quality of stroke patient care!

Example publication: J Neurosci Nurs. 2021 Jun 1;53(3):134-139

Headache trajectories in subarachnoid hemorrhage

Faculty Mentor’s Name: Katharina Busl
Email: k.busl@ufl.edu
Phone Number: (352) 294-8453
Project Category: Case Review
International Component or Travel: No

Research Project Description:

Headache is ubiquitous in patients with non-traumatic subarachnoid hemorrhage. Its etiology is incompletely understood, as is its course and severity for individual patients.

We are evaluating different trajectories of headaches, their response to treatment, and their association with other clinical factors. Our hypothesis is that different, yet succinct trajectories exist, and may require different approach to treatment. Our study is a retrospective observational study.

The role for the medical student is to learn the importance of standardized data abstraction, engage in data acquisition via RedCap and Epic, participate in data analysis and interpretation, and in manuscript preparation.

Saving the Survivors of Cardiac Arrest – Improving the Technique for Corneal Exam

Faculty Mentor’s Name: Dr. Carolina Maciel
Email: carolina.maciel@neurology.ufl.edu
Phone Number: (191) 735-5250
Project Category: Literature Review
International Component or Travel: No

Research Project Description:

Background:
The corneal reflex is a major component of the coma exam, and has a crucial role in brain death determination and in neuroprognostication. Multiple different techniques to elicit corneal reflex are used and may lead to varying degrees of corneal stimulation. Commonly used corneal stimulating methods are: A) air puff; B) drops of sterile water or saline; or C) gentle pressure with gauze or cotton swab. While it is intuitive that the degree of stimulation is higher with gentle pressure when compared to saline squirt or puff of air, there are no head to head clinical trials demonstrating the effectiveness of one technique over the other.

Specific aims and Hypothesis
#1: Determine the technique associated with highest sensitivity for corneal reflex.
Patients in deep coma are more likely to have a corneal reflex present if tested with
A) gentle touch of soft solid object vs a drop of sterile water
B) Drop of sterile water versus air puff.

Methods:
This is a prospective, open study comparing the yield of three different stimuli in eliciting the corneal reflex. Eligible subjects include patients that are under the care of a neurointensivist in whom there is an indication for corneal reflex testing (Glasgow Coma Scale-M score <6), regardless of etiology of depressed level of consciousness. The corneal reflexes will be tested using A) air puff, B) sterile saline squirt, C) gentle touch with cotton swab applicator tip. The response will be recorded by using a video camera. The data will be analyzed using SPSS, R programming language and Python.

Importance:
Corneal reflex is one of the cardinal brain stem reflexes that is used in brain death evaluation. Determination of a technique that best evaluates the corneal reflex will impact brain death examination and neuroprognostication.

Factors affecting recovery and long-term prognosis following acute motor (AMAN) and motor-sensory axonal neuropathy (AMSAN) Guillain-Barre Syndrome variants

Faculty Mentor’s Name: Dr. Miguel Chuquilin
Email: miguel.chuquilin@neurology.ufl.edu
Phone Number: (314) 322-6363
Project Category: Case Review
International Component or Travel: No

Research Project Description:

A retrospective chart review of patients admitted to Shands from 1990 to 2019 for AMAN and AMSAN. Prognostic factors of age, preceding illness, time from onset to admission, autonomic and bulbar dysfunction, time to maximum weakness, presence of mechanical ventilation and duration, treatment type, CSF
findings, and ganglioside auto-antibodies will be correlated to MRC and GBS disability score at admission and follow-up visits (1, 2, 6, 9, 12, 24 mos).

Mechanisms of subarachnoid hemorrhage associated acute brain injury, vasospasm, and delayed cerebral ischemia

Faculty Mentor’s Name: Dr. Brian Hoh
Email: brian.hoh@neurosurgery.ufl.edu
Phone Number: (352) 273-9000
Project Category: Translational
International Component or Travel: No

Research Project Description:

Our laboratory is studying mechanisms of subarachnoid hemorrhage associated acute brain injury, vasospasm, and delayed cerebral ischemia.

Cerebral Aneurysm Healing

Faculty Mentor’s Name: Dr. Brian Hoh
Email: brian.hoh@neurosurgery.ufl.edu
Phone Number: (352) 273-9000
Project Category: Translational
International Component or Travel: No

Research Project Description:

Our laboratory is developing novel methods to treat brain aneurysms and studying mechanisms of cerebral aneurysm healing.

Four Possible Projects: 1) Aging and Callosal Disconnection; 2) Spatial Memory; 3) Aging Alexithymia; Clock Faces

Faculty Mentor’s Name: Dr. Kenneth Heilman
Email: heilman@neurology.ufl.edu
Phone Number: (352) 514-4580
Project Category: Clinical
International Component or Travel: No

Research Project Description:

FOUR DIFFERENT POSSIBLE RESEARCH PROJECTS

Kenneth M. Heilman MD (email: heilman@neurology.ufl.edu)

  1. Aging and Callosal Disconnection

With aging there is often a progressive loss of being able to recall the names of people when viewing their face. One explanation of this is pro-active interference, such that we have learned the names of so many other people that have similar names, that it is difficult to make this section from the deep and full pool of names, However, there may be another explanation.

With aging there may be is a reduction of the portion of the corpus callosum that is important in connecting the images of faces processed by the right hemisphere, with the names associated with these images which are stored in the left hemisphere. To learn if there is support for this callosal hypothesis we might be able to use the ink blot test, where participants view ink blots and are asked to give a name for each of these different inkblots. If there is a problem with callosal disconnection then older participants with impaired face naming should also have a reduced ability (perseveration and slowing) when performing this test. In addition, imaging of the posterior corpus callosum may also reveal atrophy.


  1. Spatial Memory

What happens to spatial biases with memory? When normal participants are attempting to bisect horizontal lines. we deviate to the left and with vertical lines upward. The goal of this study is to learn how short-term memory might influence the allocations of spatial attention by having healthy participants, both immediately and after a 20 second delay, replicate the location of different intersections on horizontal and vertical lines.

The participants with be healthy people, who will be presented with either vertical or horizontal lines, in a random order, that have a shorter line intersecting (at 90 degrees) with the longer vertical or horizontal lines and after seeing these lines for 5 seconds, these lines with intersections will be removed. The either immediately of after a 20 second delay, the participant with be presented with an unmarked line and asked to demonstrate (mark) the location on this new line the location of the intersection seen on the previously viewed line.


  1. Aging Alexithymia

I did not see anything in the chapter that discusses aging and alexithymia. In our book Cognitive Changes in the Aging Brain, we do have a section mentioning this. Although I did not want to bring this up with these authors, in this chapter we do mention that with aging there is an increase of alexithymia. Based on the right hemi-aging hypothesis as well as the hemispheric valence hypothesis, I was wondering if we showed pictures from the International Affective Picture System and we asked older versus younger participants what they saw, if the older people would use more happy than sad words when compare to the younger participants.


  1. Clock-Faces

When healthy adults draw a clock face, they most often draw the circle in a counter-clock wise fashion. The reason for this leftward initiation bias is not known.

One possible hypothesis has to do with hemispheric dominance and directionality. Based on studies of patients with strokes and healthy people it appears that each hemisphere mediates attention primarily toward contralateral hemispace. However, in addition to these lateral differences there may also be hemispheric asymmetries in the allocation of vertical attention. For example, when patients with right hemisphere lesions perform cancellation tests, in addition to failing to cancel targets in left hemispace, they are often more likely to be unaware of the targets in lower than upper left hemispace. Although it is possible that this vertical deficit is related to the location of the injury (e.g., parietal lobe) it is also possible that the right hemisphere mediates downward attention and the left upward. Therefore, there may be an interaction between lateral and vertical attention, such that when moving leftward there is a preference to move downward and vice versa. When drawing a clock-face, most people start at the top, and since they also have to first move downward, they may have a leftward bias and thus draw the face in a counter clock-wise direction.

If a person was asked to draw a clock face and start at the hour 9, they would have to move rightward and if asked to draw a clock starting at 3 they would have to move leftward. If the right-up, left-down hypothesis is correct then healthy right-handed participants would be more likely to draw the face in clockwise direction if they started from 9 than if they started from 12, 6, or 3.

To test this hypothesis healthy people can be asked to draw clock faces from 12, 3, 6, and 9, in a random order over several trials and learn if there is a greater chance of drawing the face in a clockwise direction versus counter-clockwise from these areas. It would also be of interest to see if there are differences between right and left hand participants and the use of their right versus left hand.

Alpha synuclein regulation of dopamine transmission

Faculty Mentor’s Name: Dr. Habibeh Khoshbouei
Email: Habibeh@ufl.edu
Phone Number: (352) 273-8115
Project Category: Translational
International Component or Travel: No

Research Project Description:

TBD