Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba
IMPORTANCE: From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena. OBJECTIVE: To describe the neurological manifestations that followed exposure to an unk...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2018-03, Vol.319 (11), p.1125-1133 |
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| creator | Swanson, Randel L Hampton, Stephen Green-McKenzie, Judith Diaz-Arrastia, Ramon Grady, M. Sean Verma, Ragini Biester, Rosette Duda, Diana Wolf, Ronald L Smith, Douglas H |
| description | IMPORTANCE: From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena. OBJECTIVE: To describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena. DESIGN, SETTING, AND PARTICIPANTS: Preliminary results from a retrospective case series of US government personnel in Havana, Cuba. Following reported exposure to auditory and sensory phenomena in their homes or hotel rooms, the individuals reported a similar constellation of neurological symptoms resembling brain injury. These individuals were referred to an academic brain injury center for multidisciplinary evaluation and treatment. EXPOSURES: Report of experiencing audible and sensory phenomena emanating from a distinct direction (directional phenomena) associated with an undetermined source, while serving on US government assignments in Havana, Cuba, since 2016. MAIN OUTCOMES AND MEASURES: Descriptions of the exposures and symptoms were obtained from medical record review of multidisciplinary clinical interviews and examinations. Additional objective assessments included clinical tests of vestibular (dynamic and static balance, vestibulo-ocular reflex testing, caloric testing), oculomotor (measurement of convergence, saccadic, and smooth pursuit eye movements), cognitive (comprehensive neuropsychological battery), and audiometric (pure tone and speech audiometry) functioning. Neuroimaging was also obtained. RESULTS: Of 24 individuals with suspected exposure identified by the US Department of State, 21 completed multidisciplinary evaluation an average of 203 days after exposure. Persistent symptoms (>3 months after exposure) were reported by these individuals including cognitive (n = 17, 81%), balance (n = 15, 71%), visual (n = 18, 86%), and auditory (n = 15, 68%) dysfunction, sleep impairment (n = 18, 86%), and headaches (n = 16, 76%). Objective findings included cognitive (n = 16, 76%), vestibular (n = 17, 81%), and oculomotor (n = 15, 71%) abnormalities. Moderate to severe sensorineural hearing loss was identified in 3 individuals. Pharmacologic intervention was required for persistent sleep dysfunction (n = 15, 71%) and headache (n = 12, 57%). Fourteen individuals (67%) were held from work at the time of multidisciplinary evaluation. Of those, 7 began graduated return to work with restrict |
| doi_str_mv | 10.1001/jama.2018.1742 |
| format | Article |
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Sean ; Verma, Ragini ; Biester, Rosette ; Duda, Diana ; Wolf, Ronald L ; Smith, Douglas H</creator><creatorcontrib>Swanson, Randel L ; Hampton, Stephen ; Green-McKenzie, Judith ; Diaz-Arrastia, Ramon ; Grady, M. Sean ; Verma, Ragini ; Biester, Rosette ; Duda, Diana ; Wolf, Ronald L ; Smith, Douglas H</creatorcontrib><description>IMPORTANCE: From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena. OBJECTIVE: To describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena. DESIGN, SETTING, AND PARTICIPANTS: Preliminary results from a retrospective case series of US government personnel in Havana, Cuba. Following reported exposure to auditory and sensory phenomena in their homes or hotel rooms, the individuals reported a similar constellation of neurological symptoms resembling brain injury. These individuals were referred to an academic brain injury center for multidisciplinary evaluation and treatment. EXPOSURES: Report of experiencing audible and sensory phenomena emanating from a distinct direction (directional phenomena) associated with an undetermined source, while serving on US government assignments in Havana, Cuba, since 2016. MAIN OUTCOMES AND MEASURES: Descriptions of the exposures and symptoms were obtained from medical record review of multidisciplinary clinical interviews and examinations. Additional objective assessments included clinical tests of vestibular (dynamic and static balance, vestibulo-ocular reflex testing, caloric testing), oculomotor (measurement of convergence, saccadic, and smooth pursuit eye movements), cognitive (comprehensive neuropsychological battery), and audiometric (pure tone and speech audiometry) functioning. Neuroimaging was also obtained. RESULTS: Of 24 individuals with suspected exposure identified by the US Department of State, 21 completed multidisciplinary evaluation an average of 203 days after exposure. Persistent symptoms (>3 months after exposure) were reported by these individuals including cognitive (n = 17, 81%), balance (n = 15, 71%), visual (n = 18, 86%), and auditory (n = 15, 68%) dysfunction, sleep impairment (n = 18, 86%), and headaches (n = 16, 76%). Objective findings included cognitive (n = 16, 76%), vestibular (n = 17, 81%), and oculomotor (n = 15, 71%) abnormalities. Moderate to severe sensorineural hearing loss was identified in 3 individuals. Pharmacologic intervention was required for persistent sleep dysfunction (n = 15, 71%) and headache (n = 12, 57%). Fourteen individuals (67%) were held from work at the time of multidisciplinary evaluation. Of those, 7 began graduated return to work with restrictions in place, home exercise programs, and higher-level work-focused cognitive rehabilitation. CONCLUSIONS AND RELEVANCE: In this preliminary report of a retrospective case series, persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin. These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2018.1742</identifier><identifier>PMID: 29450484</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Abnormalities ; Adult ; Audiology ; Audiometry ; Balance ; Brain ; Brain - diagnostic imaging ; Brain Concussion - diagnosis ; Brain Concussion - etiology ; Brain injury ; Cognitive ability ; Cuba ; Diagnosis, Differential ; Diplomatic facilities ; Evaluation ; Exposure ; Eye injuries ; Eye movements ; Federal agencies ; Female ; Government Employees ; Head injuries ; Headache ; Headache - etiology ; Hearing loss ; Hearing Loss, Sensorineural - diagnosis ; Hearing Loss, Sensorineural - etiology ; Humans ; Impairment ; Male ; Medical imaging ; Middle Aged ; Nervous System Diseases - diagnosis ; Nervous System Diseases - etiology ; Nervous System Diseases - rehabilitation ; Neuroimaging ; Neurological disorders ; Neurology ; Neuropsychological Tests ; Noise - adverse effects ; Oculomotor coordination ; Oculomotor Nerve Diseases - etiology ; Online First ; Personnel ; Pharmacology ; Postural Balance ; Preliminary Communication ; Public officials ; Rehabilitation ; Saccadic eye movements ; Sensation Disorders - etiology ; Sensory perception ; Sleep ; Smooth pursuit eye movements ; Somatoform Disorders - diagnosis ; Somatoform Disorders - etiology ; Somatoform Disorders - rehabilitation ; United States ; Vestibular system ; Vestibulo-ocular reflex</subject><ispartof>JAMA : the journal of the American Medical Association, 2018-03, Vol.319 (11), p.1125-1133</ispartof><rights>Copyright American Medical Association Mar 20, 2018</rights><rights>Copyright 2018 American Medical Association. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a437t-ba548f74b437e3df8d52242ddb2f404eeb19577c0b165e48e52e5dfece35772c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.2018.1742$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.1742$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,780,784,885,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29450484$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Swanson, Randel L</creatorcontrib><creatorcontrib>Hampton, Stephen</creatorcontrib><creatorcontrib>Green-McKenzie, Judith</creatorcontrib><creatorcontrib>Diaz-Arrastia, Ramon</creatorcontrib><creatorcontrib>Grady, M. Sean</creatorcontrib><creatorcontrib>Verma, Ragini</creatorcontrib><creatorcontrib>Biester, Rosette</creatorcontrib><creatorcontrib>Duda, Diana</creatorcontrib><creatorcontrib>Wolf, Ronald L</creatorcontrib><creatorcontrib>Smith, Douglas H</creatorcontrib><title>Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>IMPORTANCE: From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena. OBJECTIVE: To describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena. DESIGN, SETTING, AND PARTICIPANTS: Preliminary results from a retrospective case series of US government personnel in Havana, Cuba. Following reported exposure to auditory and sensory phenomena in their homes or hotel rooms, the individuals reported a similar constellation of neurological symptoms resembling brain injury. These individuals were referred to an academic brain injury center for multidisciplinary evaluation and treatment. EXPOSURES: Report of experiencing audible and sensory phenomena emanating from a distinct direction (directional phenomena) associated with an undetermined source, while serving on US government assignments in Havana, Cuba, since 2016. MAIN OUTCOMES AND MEASURES: Descriptions of the exposures and symptoms were obtained from medical record review of multidisciplinary clinical interviews and examinations. Additional objective assessments included clinical tests of vestibular (dynamic and static balance, vestibulo-ocular reflex testing, caloric testing), oculomotor (measurement of convergence, saccadic, and smooth pursuit eye movements), cognitive (comprehensive neuropsychological battery), and audiometric (pure tone and speech audiometry) functioning. Neuroimaging was also obtained. RESULTS: Of 24 individuals with suspected exposure identified by the US Department of State, 21 completed multidisciplinary evaluation an average of 203 days after exposure. Persistent symptoms (>3 months after exposure) were reported by these individuals including cognitive (n = 17, 81%), balance (n = 15, 71%), visual (n = 18, 86%), and auditory (n = 15, 68%) dysfunction, sleep impairment (n = 18, 86%), and headaches (n = 16, 76%). Objective findings included cognitive (n = 16, 76%), vestibular (n = 17, 81%), and oculomotor (n = 15, 71%) abnormalities. Moderate to severe sensorineural hearing loss was identified in 3 individuals. Pharmacologic intervention was required for persistent sleep dysfunction (n = 15, 71%) and headache (n = 12, 57%). Fourteen individuals (67%) were held from work at the time of multidisciplinary evaluation. Of those, 7 began graduated return to work with restrictions in place, home exercise programs, and higher-level work-focused cognitive rehabilitation. CONCLUSIONS AND RELEVANCE: In this preliminary report of a retrospective case series, persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin. These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.</description><subject>Abnormalities</subject><subject>Adult</subject><subject>Audiology</subject><subject>Audiometry</subject><subject>Balance</subject><subject>Brain</subject><subject>Brain - diagnostic imaging</subject><subject>Brain Concussion - diagnosis</subject><subject>Brain Concussion - etiology</subject><subject>Brain injury</subject><subject>Cognitive ability</subject><subject>Cuba</subject><subject>Diagnosis, Differential</subject><subject>Diplomatic facilities</subject><subject>Evaluation</subject><subject>Exposure</subject><subject>Eye injuries</subject><subject>Eye movements</subject><subject>Federal agencies</subject><subject>Female</subject><subject>Government Employees</subject><subject>Head injuries</subject><subject>Headache</subject><subject>Headache - etiology</subject><subject>Hearing loss</subject><subject>Hearing Loss, Sensorineural - diagnosis</subject><subject>Hearing Loss, Sensorineural - etiology</subject><subject>Humans</subject><subject>Impairment</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Nervous System Diseases - diagnosis</subject><subject>Nervous System Diseases - etiology</subject><subject>Nervous System Diseases - rehabilitation</subject><subject>Neuroimaging</subject><subject>Neurological disorders</subject><subject>Neurology</subject><subject>Neuropsychological Tests</subject><subject>Noise - adverse effects</subject><subject>Oculomotor coordination</subject><subject>Oculomotor Nerve Diseases - etiology</subject><subject>Online First</subject><subject>Personnel</subject><subject>Pharmacology</subject><subject>Postural Balance</subject><subject>Preliminary Communication</subject><subject>Public officials</subject><subject>Rehabilitation</subject><subject>Saccadic eye movements</subject><subject>Sensation Disorders - etiology</subject><subject>Sensory perception</subject><subject>Sleep</subject><subject>Smooth pursuit eye movements</subject><subject>Somatoform Disorders - diagnosis</subject><subject>Somatoform Disorders - etiology</subject><subject>Somatoform Disorders - rehabilitation</subject><subject>United States</subject><subject>Vestibular system</subject><subject>Vestibulo-ocular reflex</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc1r2zAYxkVZabNu1x12GIJe60yfkXwZhLRrB91W1vUsZPt1qmBLqWQHetj_Ppl0YRUCoVe_55FePQh9oGROCaGfN7a3c0aonlMl2BGaUcl1wWWp36AZIaUulNDiFL1NaUPyoFydoFNWCklyfYb-_IAxhi6sXW07_N1610Ia7OCCT3jZB7_GD_f4Ouwg-h78gO8gpuA9dPgXbEMcXCYuXYR6kmSL5di4qgNsfYPvwacQn_HdI_iQ1RY7j2_sznp7gVdjZd-h49Z2Cd6_rGfo4evV79VNcfvz-ttqeVtYwdVQVFYK3SpR5R3wptWNZEywpqlYK4gAqGgplapJRRcShAbJQDYt1MBzmdX8DH3Z-27Hqoemzo1E25ltdL2NzyZYZ16fePdo1mFnpNbTzAbnLwYxPI35h8wmjDH3mwwji5IwSRTJ1HxP1TGkFKE93ECJmeIyU1xmistMcWXBp__fdcD_5ZOBj3tg0h1OF4rTheZ_AT9WnG0</recordid><startdate>20180320</startdate><enddate>20180320</enddate><creator>Swanson, Randel L</creator><creator>Hampton, Stephen</creator><creator>Green-McKenzie, Judith</creator><creator>Diaz-Arrastia, Ramon</creator><creator>Grady, M. Sean</creator><creator>Verma, Ragini</creator><creator>Biester, Rosette</creator><creator>Duda, Diana</creator><creator>Wolf, Ronald L</creator><creator>Smith, Douglas H</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>5PM</scope></search><sort><creationdate>20180320</creationdate><title>Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba</title><author>Swanson, Randel L ; Hampton, Stephen ; Green-McKenzie, Judith ; Diaz-Arrastia, Ramon ; Grady, M. Sean ; Verma, Ragini ; Biester, Rosette ; Duda, Diana ; Wolf, Ronald L ; Smith, Douglas H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a437t-ba548f74b437e3df8d52242ddb2f404eeb19577c0b165e48e52e5dfece35772c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abnormalities</topic><topic>Adult</topic><topic>Audiology</topic><topic>Audiometry</topic><topic>Balance</topic><topic>Brain</topic><topic>Brain - diagnostic imaging</topic><topic>Brain Concussion - diagnosis</topic><topic>Brain Concussion - etiology</topic><topic>Brain injury</topic><topic>Cognitive ability</topic><topic>Cuba</topic><topic>Diagnosis, Differential</topic><topic>Diplomatic facilities</topic><topic>Evaluation</topic><topic>Exposure</topic><topic>Eye injuries</topic><topic>Eye movements</topic><topic>Federal agencies</topic><topic>Female</topic><topic>Government Employees</topic><topic>Head injuries</topic><topic>Headache</topic><topic>Headache - etiology</topic><topic>Hearing loss</topic><topic>Hearing Loss, Sensorineural - diagnosis</topic><topic>Hearing Loss, Sensorineural - etiology</topic><topic>Humans</topic><topic>Impairment</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Nervous System Diseases - diagnosis</topic><topic>Nervous System Diseases - etiology</topic><topic>Nervous System Diseases - rehabilitation</topic><topic>Neuroimaging</topic><topic>Neurological disorders</topic><topic>Neurology</topic><topic>Neuropsychological Tests</topic><topic>Noise - adverse effects</topic><topic>Oculomotor coordination</topic><topic>Oculomotor Nerve Diseases - etiology</topic><topic>Online First</topic><topic>Personnel</topic><topic>Pharmacology</topic><topic>Postural Balance</topic><topic>Preliminary Communication</topic><topic>Public officials</topic><topic>Rehabilitation</topic><topic>Saccadic eye movements</topic><topic>Sensation Disorders - etiology</topic><topic>Sensory perception</topic><topic>Sleep</topic><topic>Smooth pursuit eye movements</topic><topic>Somatoform Disorders - diagnosis</topic><topic>Somatoform Disorders - etiology</topic><topic>Somatoform Disorders - rehabilitation</topic><topic>United States</topic><topic>Vestibular system</topic><topic>Vestibulo-ocular reflex</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Swanson, Randel L</creatorcontrib><creatorcontrib>Hampton, Stephen</creatorcontrib><creatorcontrib>Green-McKenzie, Judith</creatorcontrib><creatorcontrib>Diaz-Arrastia, Ramon</creatorcontrib><creatorcontrib>Grady, M. Sean</creatorcontrib><creatorcontrib>Verma, Ragini</creatorcontrib><creatorcontrib>Biester, Rosette</creatorcontrib><creatorcontrib>Duda, Diana</creatorcontrib><creatorcontrib>Wolf, Ronald L</creatorcontrib><creatorcontrib>Smith, Douglas H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Swanson, Randel L</au><au>Hampton, Stephen</au><au>Green-McKenzie, Judith</au><au>Diaz-Arrastia, Ramon</au><au>Grady, M. Sean</au><au>Verma, Ragini</au><au>Biester, Rosette</au><au>Duda, Diana</au><au>Wolf, Ronald L</au><au>Smith, Douglas H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2018-03-20</date><risdate>2018</risdate><volume>319</volume><issue>11</issue><spage>1125</spage><epage>1133</epage><pages>1125-1133</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><abstract>IMPORTANCE: From late 2016 through August 2017, US government personnel serving on diplomatic assignment in Havana, Cuba, reported neurological symptoms associated with exposure to auditory and sensory phenomena. OBJECTIVE: To describe the neurological manifestations that followed exposure to an unknown energy source associated with auditory and sensory phenomena. DESIGN, SETTING, AND PARTICIPANTS: Preliminary results from a retrospective case series of US government personnel in Havana, Cuba. Following reported exposure to auditory and sensory phenomena in their homes or hotel rooms, the individuals reported a similar constellation of neurological symptoms resembling brain injury. These individuals were referred to an academic brain injury center for multidisciplinary evaluation and treatment. EXPOSURES: Report of experiencing audible and sensory phenomena emanating from a distinct direction (directional phenomena) associated with an undetermined source, while serving on US government assignments in Havana, Cuba, since 2016. MAIN OUTCOMES AND MEASURES: Descriptions of the exposures and symptoms were obtained from medical record review of multidisciplinary clinical interviews and examinations. Additional objective assessments included clinical tests of vestibular (dynamic and static balance, vestibulo-ocular reflex testing, caloric testing), oculomotor (measurement of convergence, saccadic, and smooth pursuit eye movements), cognitive (comprehensive neuropsychological battery), and audiometric (pure tone and speech audiometry) functioning. Neuroimaging was also obtained. RESULTS: Of 24 individuals with suspected exposure identified by the US Department of State, 21 completed multidisciplinary evaluation an average of 203 days after exposure. Persistent symptoms (>3 months after exposure) were reported by these individuals including cognitive (n = 17, 81%), balance (n = 15, 71%), visual (n = 18, 86%), and auditory (n = 15, 68%) dysfunction, sleep impairment (n = 18, 86%), and headaches (n = 16, 76%). Objective findings included cognitive (n = 16, 76%), vestibular (n = 17, 81%), and oculomotor (n = 15, 71%) abnormalities. Moderate to severe sensorineural hearing loss was identified in 3 individuals. Pharmacologic intervention was required for persistent sleep dysfunction (n = 15, 71%) and headache (n = 12, 57%). Fourteen individuals (67%) were held from work at the time of multidisciplinary evaluation. Of those, 7 began graduated return to work with restrictions in place, home exercise programs, and higher-level work-focused cognitive rehabilitation. CONCLUSIONS AND RELEVANCE: In this preliminary report of a retrospective case series, persistent cognitive, vestibular, and oculomotor dysfunction, as well as sleep impairment and headaches, were observed among US government personnel in Havana, Cuba, associated with reports of directional audible and/or sensory phenomena of unclear origin. These individuals appeared to have sustained injury to widespread brain networks without an associated history of head trauma.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>29450484</pmid><doi>10.1001/jama.2018.1742</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | JAMA : the journal of the American Medical Association, 2018-03, Vol.319 (11), p.1125-1133 |
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| source | MEDLINE; American Medical Association Journals |
| subjects | Abnormalities Adult Audiology Audiometry Balance Brain Brain - diagnostic imaging Brain Concussion - diagnosis Brain Concussion - etiology Brain injury Cognitive ability Cuba Diagnosis, Differential Diplomatic facilities Evaluation Exposure Eye injuries Eye movements Federal agencies Female Government Employees Head injuries Headache Headache - etiology Hearing loss Hearing Loss, Sensorineural - diagnosis Hearing Loss, Sensorineural - etiology Humans Impairment Male Medical imaging Middle Aged Nervous System Diseases - diagnosis Nervous System Diseases - etiology Nervous System Diseases - rehabilitation Neuroimaging Neurological disorders Neurology Neuropsychological Tests Noise - adverse effects Oculomotor coordination Oculomotor Nerve Diseases - etiology Online First Personnel Pharmacology Postural Balance Preliminary Communication Public officials Rehabilitation Saccadic eye movements Sensation Disorders - etiology Sensory perception Sleep Smooth pursuit eye movements Somatoform Disorders - diagnosis Somatoform Disorders - etiology Somatoform Disorders - rehabilitation United States Vestibular system Vestibulo-ocular reflex |
| title | Neurological Manifestations Among US Government Personnel Reporting Directional Audible and Sensory Phenomena in Havana, Cuba |
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