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New cerebral monitoring techniques allow direct measurement of brain oxygenation and metabolism. Investigation using these new tools has provided additional insight into the understanding of the pathophysiology of acute brain injury and suggested new ways to guide management of secondary brain injury. Studies of focal brain tissue oxygen monitoring have suggested ischemic thresholds in focal regions of brain injury and demonstrated the interrelationship between brain tissue oxygen tension (P bt O 2 ) and other cerebral physiologic and metabolic parameters. Jugular venous oxygen saturation (SjVO 2 ) monitoring may evaluate global brain oxygen delivery and consumption, providing thresholds for detecting brain hypoperfusion and hyperperfusion. Furthermore, critically low values of P bt O 2 and SjVO 2 have also been predictive of mortality and worsened functional outcome, especially after head trauma. Cerebral microdialysis measures the concentrations of extracellular metabolites which may be relevant to cerebral metabolism or ischemia in focal areas of injury. Cerebral blood flow may be measured in the neurointensive care unit using continuous methods such as thermal diffusion and laser Doppler flowmetry. Initial studies have also attempted to correlate findings from advanced neuromonitoring with neuroimaging using dynamic perfusion computed tomography, positron emission tomography, and Xenon computed tomography. Additionally, new methods of data acquisition, storage, and analysis are being developed to address the increasing burden of patient data from neuromonitoring. Advanced informatics techniques such as hierarchical data clustering, generalized linear models, and heat map dendrograms are now being applied to multivariable patient data in order to better develop physiologic patient profiles to improve diagnosis and treatment.

The accessory olfactory system is involved in processing pheromone signals and mediating stereotypical behaviors and neuroendocrine responses. Slice preparations of the murine accessory olfactory bulb (AOB) and whole cell patch clamp recordings were employed to study the intrinsic electrophysiological and synaptic properties of AOB mitral cells (MCs). The majority of MCs exhibited a spontaneous action potential firing rate that could be modulated by glutamate and GABA receptor antagonists. Excitatory and inhibitory spontaneous postsynaptic currents (psc's) were detected in the MCs, suggesting that inhibitory interneurons, in addition to vomeronasal organ (VNO) input, may influence MC output. As one AOB glomerulus can receive multiple VNO inputs, these results support the hypothesis that integration of pheromone signals may occur at the level of the AOB. The olfactory projection to the amygdala, and intra-amygdaloid projections, are limbic relays involved in behavioral reinforcement, a property that can be influenced by nicotine and mediated by presynaptic nicotinic acetylcholine receptors (nAChRs). Co-cultures consisting of murine olfactory bulb (OB) explants and dispersed amygdala neurons were developed to reconstruct this pathway in vitro. Patch-clamp recordings were obtained from amygdala neurons contacted by OB explant neurites, and spontaneous and evoked synaptic currents were characterized. The majority of innervated amygdala neurons exhibited glutamatergic spontaneous psc's and a smaller population exhibited GABAergic spontaneous psc's. Direct extracellular stimulation of OB explants elicited glutamatergic synaptic currents in amygdala neurons. Immunocytochemistry of the OB explants was consistent with the targeting of nAChR protein to presynaptic sites of MC projections. Hence, the role of presynaptic nAChRs in modulating synaptic transmission in these co-cultures was examined. Nicotine markedly increased the frequency of spontaneous psc's in 39% of neurons that exhibited glutamatergic spontaneous psc's and 35% of neurons that exhibited GABAergic spontaneous psc's (peak fold increase = 125.2 ± 33.3 and 63.9 ± 34.3, respectively). Thus, presynaptic nAChRs can enhance glutamatergic and GABAergic synaptic transmission in the amygdala, suggesting that they may modulate behaviors mediated by olfactory projections to the amygdala, where integration of olfactory and pheromonal input is thought to occur.

Teleneurology has expanded the availability of acute stroke treatment, particularly thrombolysis, as well as increased the availability of neurointerventional therapies to patients beyond large medical centers (El Khoury, Neurology 79(13 Suppl 1):S26–34, 2012). By promoting the appropriate triage of acute stroke patients, teleneurology helps facilitate the appropriate transfer of patients to appropriate centers to receive intra-arterial therapy for a variety of disorders, including acute ischemic stroke and subarachnoid hemorrhage. The objective of this chapter is to outline the workings of one large telestroke network, illustrating how teleneurology helps triage patients requiring neurointerventional therapy and facilitates the transfer of such patients for definitive treatment. The role of teleneurology in research and development of neurointerventional therapy is also discussed.