A 54-year-old Caucasian female presented with a 1 year history of intermittent numbness of the left leg progressing to bilateral, lower extremity sensory loss that advanced to include impaired vibration and proprioception. The subsequent thoracic spine magnetic resonance imaging (MRI) scan revealed a heterogeneous, avidly enhancing, centrally situated spinal cord mass involving T7 through T10 in association with thick linear enhancement of the anterior and posterior cord surfaces extending both superiorly and inferiorly. Both the cervical and lumbar spine MRI demonstrated diffuse leptomeningeal disease as well. A brain MRI revealed focal leptomeningeal enhancement in the left and right sylvian fissures, the suprasellar cistern, and the posterior fossa; a pattern consistent with metastatic disease. The patient underwent a T6-T10 laminectomy for tumor biopsy and debulking. Histology revealed a WHO grade III glioneuronal tumor with rosetted neuropil-like islands. Synaptophysin and neurofilament (NF) positive staining was noted within the neural appearing component, whereas, glial fibrillary acidic protein (GFAP) immunopositivity was evident in the fibrillary astrocytoma component of the tumor. The Ki-67 labeling index was 7%. This tumor pattern, now included in the 2007 World Health Organization (WHO) classification of central nervous system tumours as a pattern variation of anaplastic astrocytoma (Kleihues et al. In: Louis et al. (eds) WHO classification of tumours of the central nervous system, 2007), was first described in a four-case series by Teo et al. in 1999. The majority of subsequently reported cases described them as primary tumors of the cerebrum. Herein, we report a unique example of a spinal glioneuronal tumor with neuropil-like islands with associated leptomeningeal dissemination involving the entire craniospinal axis.

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Background: Analyses from the SAMMPRIS trial showed that good control of vascular risk factors (SBP, LDL, and exercise) was associated with fewer vascular events and exercise had the biggest impact on outcome. We sought to determine the type and duration of exercise performed by SAMMPRIS patients during the trial. Methods: SAMMPRIS aggressive medical management included a telephonic lifestyle modification program, INTERVENT, that was provided free of charge to all subjects during the study. We analyzed self-reported data collected by INTERVENT on the patients’ type and duration of exercise from baseline (n= 394) to 3 years (n=132). We calculated the mean duration for each exercise type at each time period and then compared the change in exercise duration from baseline using paired t-tests and Wilcoxon signed rank tests. Results: Walking was the most common form of exercise at all time points, as measured by both the duration of exercise and the number of patients performing the exercise. The mean duration of walking and other aerobic activities increased significantly from baseline to all other time points. Conclusion: The type of self-reported exercise performed by SAMMPRIS patients included mostly walking or other aerobic activity and increased significantly during follow-up.

The straight jump is performed by gymnasts of all levels in warm-up routines on the floor and on the beam. Refining this basic skill serves gymnasts when learning high-difficulty jumps. It is common practice for gymnasts to master skills on floor before transferring them onto the beam. The aim of this study was to investigate the kinematic differences of the straight jump on the floor and on the beam performed by county and national level gymnasts. Four county (9±1 y; 133.5±7.6 cm; 29.8±1.9 Kg) and four junior national (13±1 y; 148.5±8.2 cm; 42.8±5.6 Kg) gymnasts volunteered to participate. The straight jump performances were video recorded (80Hz). Simi Motion was used to track nine markers on the gymnast's body. The floor and beam apparatus were instrumented with a pressure mat connected to a digital timer. A 2x2 factorial ANOVA (apparatus x expertise) analysed the following variables: relative angles of shoulder, hip, knee and ankle joints at take-off, peak of the flight and at the minimum vertical displacement of the centre of mass during landing. There was no interaction between apparatus and expertise. There was a main effect of apparatus for shoulder angle at the take-off (fl=132±12°; bm=119±12°), shoulder (fl=154±18°; bm=143±16°) and hip (fl=180±7°; 175±10°) joint angles at the peak of the flight. Expertise showed an effect on the hip joint angle at the take-off (c=164±9°; n= 179±6°) and jump height (c=25.0±7.8 cm; 33.5±4.2 cm). The present study showed that kinematic differences occurred at the instant of take-off between floor and beam and between county and national gymnasts when performing the straight jump, thus some caution should be used in transferring jumping skills from the floor to the beam. Apparatus-specific drills should be used with young gymnast to master these jumping abilities.

Background and Purpose: The goals of telestroke programs are to provide safe and efficient stroke care to hospitals. An important marker of efficient acute stroke care delivery is door-to-needle (DTN) time, the time it takes from entrance into the emergency department to administration of alteplase. We sought to determine if DTN time was improving over time within our statewide telestroke network. Methods: From 5/4/2008-7/12/2015, we prospectively collected data on DTN time from consultations performed in our 18-hospital statewide telestroke network. DTN time was recorded on 765 of the 4985 consults where alteplase recommendations were documented. For all active hospital sites combined, the yearly mean DTN time was determined and compared by year with a one-way ANOVA and Tukey test. Results: Of the total 6116 consults performed over the time period, there was an average of 95.5 total consults/year among all 18 sites and an average of 8.3 consults/active site/year. The mean +/- SD DTN for all of the consults in all years was 85.4+/-42.0. As shown in the Figure, we found a significant decrease in DTN over time at (p<0.001). In the post-hoc test, the following pairs were determined to be significantly different (at p<0.05): 2008 vs. 2015; 2009 vs. 2013, 2014, and 2015; 2010 vs. 2013, 2014, and 2015; 2011 vs. 2013, 2014, and 2015; 2012 vs. 2013, 2014, and 2015. Conclusions: Among a statewide Telestroke network, the mean DTN time continued to decrease over the last 7 years, reflecting more efficient delivery of acute stroke treatment. Since more efficient stroke care delivery is associated with better outcomes, this may be a contributing factor to the overall improved stroke mortality within the state.