Immediate Resolution of Hemispatial Neglect and Central Post-Stroke Pain After Perispinal Etanercept: Case Report
Abstract
Neglect as a consequence of right brain damage has been recognized at least since J. Hughlings Jackson’s 1876 case report [1]. It was later appreciated that impairment in brain functional connectivity and resulting brain network dysfunction (‘connectopathy’, ‘disconnection syndrome’) underlies hemispatial neglect, a common sequela of right hemispheric stroke [2, 3]. A variety of bedside tests have been found useful as a measure of hemispatial neglect, including the Clock-Drawing Test [4]. The signature pattern of hemispatial neglect seen after right brain damage with the ClockDrawing Test is a clock face, drawn from memory, lacking numerals in its left half, which has been termed neglect of the left hemispace [5] (Fig. 1a). Advanced brain imaging methods, including functional magnetic resonance and positron emission tomography (PET), allow the in vivo assessment of functional connectivity and neuroinflammation, respectively. These imaging methods have expanded our understanding of post-stroke neuroinflammation. A growing body of evidence suggests that stroke may result in persistent global brain inflammation and that neuroinflammation may impair brain functional connectivity [2, 3, 6–12]. Neuroinflammation after stroke involves microglial activation [9, 12]. Elevated levels of the cytokine tumor necrosis factor (TNF) in the brain have been implicated in a wide range of brain disorders [13]. Elevated levels of TNF may adversely affect brain network function because TNF’s…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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