Day 1 :
Headaches, TBI and Memory Research Institute, USA
Suresh Kumar is a Triple Board Certified Brain Injury Specialist, Neurologist and Director of Headaches, TBI and Memory Research Institute in Southern USA. He completed his Residency training in Neurology from Louisiana State University and later board certification in Headaches Medicine & Traumatic Brain Injury Medicine. He is User Interface Software Architect; Neuro Scientist & Clinician operating research based clinical practice. He has helped more than 50 patients with memory impairment after TBI and mild to moderate dementia under Regain Memory 360 protocol approach. He has published and presented many abstracts and papers on diagnosis, treatment of mild traumatic brain injury and cognitive deficit.
Background: Traumatic brain injuries (TBI) are widespread and well documented. However, impact of a single episode mTBI has been under-diagnosed with symptoms and underlying microscopic injuries being ignored. Studies with functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI) and reconstruction software are becoming more popular in mTBI diagnoses. These methods have proven problematic and their use as a diagnostic tool for mTBI has been called into question.
Methods: Retrospective study on 250 mTBI patients was conducted in TBI clinic over last four years. 160 patients were given WMS-IV standardized test after scoring <26 on MoCA cognitive screening. Functional magnetic resonance imaging (fMRI)/diffusion tensor imaging (DTI) tests were performed within average of 22 months after initial mTBI. 31 patients were further tested with fMRI, Swan, Flair and DTI with fractional anisotropy (FA) on white matter (WM), and the cortical thickness was measured in grey matter (GM) with color representation. Magnetic resonance spectroscopy (MRS) was done on bilateral frontal lobe and posterior cingulate consistently in all patients, if decreased cortical thickness was observed with neuronal loss. We identified subject-specific regions of abnormally high and low FA, axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) across all white matter voxels and several WM regions.
Results: The decrease cortical thickness in left frontal lobe (LFL) and RFL 89% (26/29) patients had MRS with decreased NAA, increased choline and myo-inositol were compared WM tract low FA. Corpus callosum (CC) WM DTI with decrease FA is 83.33% correlated with LFL, GM and MRS. Similarly, CC is 95% related with RFL with p value<0.05. 23/29 79% of lesions in the CC, hippocampus and SLF are well published in DTI literature as characteristic of mTBI. Immediate and delayed memory index is 36.79% related with Rt. temporal lesion. Decrease probability of attention score is 61.25% related with RLF and 64.51% with CC with P value<0.039. Executive functioning probability of low score is 100% related with LFL and 82.6% with RFL with P value<0.05.
Conclusion: There is no statistical difference between the areas tested by MRS in GM and DTI on WM, but they complement each other by detecting the lesions in the same patients in two different places. These tests can be used simultaneously to increase the predictive value. The MRS study with cerebral metabolites changes were seen at an average of 22 months, which was a longer interval than prior studies. WMS-IV findings of delayed recall and executive functioning are hallmarks of TBI and confirm disruptions in the memory circuit pathway. Functional magnetic resonance imaging (fMRI)/diffusion tensor imaging (DTI) study further support the memory loss in patients with cognitive deficits on WMS IV battery. There is a direct correlation between single-incident mTBI to underlying cerebral lesions and cognitive deficits. Strong correlations are seen secondary to patient selection, after low WMS-IV scores.
Pitié-Salpêtrière Hospital, France
Keynote: New technique of Brain protection in OHCA stroke and brain trauma by CO2 expansion to provide therapeutic hypothermia
Time : 09:30-10:15
Fontaine H Guy has made 15 original contributions at the inception of pacemakers since early 60s. He has serendipitously identified Arrhythmogenic Right Ventricular Dysplasia in the late 70s. He has published more than 900 scientific papers including 201 book chapters. He was the Reviewer of 17 journals in Clinical and Basic Science. He served during five years as a Member of the Editorial Board of Circulation. He has been invited to give 11 master lectures of 90 minutes each during three weeks in the top universities of China (2014).
Therapeutic hypothermia produced by evaporation of per fluorocarbon in the fossa nasalis in a flow of oxygen reported in a prospective multicenter study has demonstrated a tendency to improve outcome in out of hospital cardiac arrest. When I saw the experiments on pigs at the Weil Institute of Cardiac Care Medicine (WICCM), I was immediately convinced that another approach of cooling could be abrupt decompression of gas. After multiple experiments, I demonstrated that it was possible to obtain on the same model a drop of brain temperature similar to the work previously reported at the WICCM. However, the simultaneous work on infrared images on severed pig heads suggested that it was possible to cool the brain by the decompression of gas inside the mouth instead of the nose which looks to be an even less invasive and faster method on the field. The second major interest of this new technique seems to be its application in stroke also suggested by animal models. It was during these experiments that my wife watching TV beside me experienced an episode of cardiac arrest that I was able to diagnose immediately. I started cardio pulmonary resuscitation followed by defibrillation performed by an old but still working defibrillator that I kept in the basement of my house when the original study of the method of fulguration was completed. Before arrival of fire brigade, I used a bottle of compressed gas also available in the basement of my house and delivered the cooling gas at that time in the fossa nasalis. Despite a period of 6 minutes of no-flow, she was able to recover after five days of coma with absolutely no neurologic deficit. This fortuitous resuscitation using for the first time brain cooling by decompressed gas will be used for the first pilot study supported by the Schiller Company (Switzerland). It will start soon in the city of Lugano which is already famous for its highest success rate of resuscitation (50%).
Pontifi cia Catholica University of Campinas, Brazil
Keynote: Development and improvement of multidisciplinary work in the treatment of major vascular lesions of the nervous system
Time : 11:20-12:05
Aguinaldo Pereira Catanoce completed his Graduation and Post-graduation in Medicine and Neurosurgery at Catholic University of Campinas in Brazil in 2007. He is a member of Brazilian Society of Neurosurgery since 2009. He has eight years of experience in “Neurosurgery and video endoscopes for brain tumors at the base of skull and intra-ventricular area in addition to the improvement of microsurgical treatment of vascular lesions”. He is a Neurosurgeon and Professor in Department of Neurosurgery at University of Campinas, Brazil; Manager; Medical and Technical Director at University Hospital, São Paulo, Brazil with seven years of experience in Hospital Management.
Development and improvement of multidisciplinary work in the treatment of major vascular lesions of the nervous system. Implemented a corporative hospital management system and clinical care aimed at the fast and efficient service in cases of hemorrhagic stroke, especially of the cerebral aneurysm and feasibility of endovascular or surgical treatment. Described and documented the efficiency and the good results through the organization of medical and multidisciplinary team associated with the corporate organization focused on innovation in the management model.
Chiropractic Research Institute, USA
Keynote: Chiropractic cranial treatment model and neuroplasticity in a post stroke 72-year-old male: A case report
Time : 12:05-12:50
Esther M Remeta is a practicing Chiropractor and Clinical Researcher. She is currently the Executive Director at Chiropractic Research Institute (CRI) in Clemmons. She completed her Doctor of Chiropractic Degree at National College of Chiropractic in Illinois. She is a SOTO-USA Board Certified Sacro Occipital Technique and Craniopathy Practitioner and a Diplomat with the American Academy of Pain Management.
Stroke is often associated with paralysis, leading to poor outcomes and quality of life as well as reduced activities-of-daily-living (ADL). The purpose of this presentation is to illustrate how chiropractic care can be used to facilitate neuroplasticity of the brain as a means to reduce/reverse any secondary stroke paralysis. This novel manner of multidisciplinary care incorporates the fields of allopathy, chiropractic, psychology, neurorehabilitation and nutrition. Care was measured with videotaping of progress, monitoring of ADLs and work capacity levels along with standard biomechanical orthopedic, neurological and chiropractic evaluation studies. Treatment included sacro occipital technique (SOT) which incorporated cranial manipulative care while simultaneously performing normal side extremity specific range of motion and then immediately following with performing the same range of motion activities on the abnormal side. Pre/post-videotaping of patient found continued progress over years, with showing walking 18-years later even though CT-scan illustrated the same area of initial brain tissue damage. Generally treatment of similar cases requires a minimum of six-month treatment followed-up with life-long wellness treatment, for the once compromised areas. Finding low risk therapeutic options to help a patient recover from brain trauma is a challenging endeavor. This presentation addresses the success of SOT chiropractic care and suggests that neuroplasticity may have a biomechanical-neurological connection pathway. Further studies are needed to identify if a subset of stroke patients might be responsive to chiropractic cranial manipulation to help facilitate biomechanical neuroplasticity. This may offer a low-risk, low-cost option for successful care of a post-stroke patient