Neurology Alert – August 1, 2020
August 1, 2020
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Clinical Trials of IL-6 Inhibitors for the Treatment of Neuromyelitis Optica Spectrum Disorders
In a randomized, placebo-controlled trial of neuromyelitis optica spectrum disorder patients, satralizumab monotherapy demonstrated a decrease in relapse rate when compared to placebo. In a randomized, open-label, multicenter trial of tocilizumab vs. azathioprine, treatment with tocilizumab demonstrated a decreased risk of a relapse compared to azathioprine.
Brachial Plexopathy Localization in Patients with Cancer
Brachial plexopathy associated with cancer may involve any region of the brachial plexus and can be distinguished from radiation-induced brachial plexopathy only by the use of high-resolution magnetic resonance imaging.
Anticoagulation in Patients with Ischemic Stroke Related to Atrial Fibrillation, Following Reperfusion Therapy
Following ischemic stroke in patients with non-valvular atrial fibrillation, the timing to restart anticoagulation treatment is uncertain and controversial. In addition, there is little data available regarding timing to restart anticoagulation following reperfusion therapy with either systemic thrombolysis and/or mechanical thrombectomy.
Treatment of Central Retinal Artery Occlusion with Intravenous Thrombolysis
Central retinal artery occlusion is a serious threat to vision caused by interruption of the blood supply to the retina and leading to sudden, painless loss of vision in one eye. For 30 years there have been anecdotal reports and small case series suggesting that intravenous thrombolysis might be beneficial in this disorder, but none of the stroke treatment guidelines have incorporated thrombolysis as definitive treatment for this disorder.
Widely Used in Asia, Cilostazol Appears Effective for Long-Term Secondary Stroke Prevention
Cilostazol is a phosphodiesterase 3 inhibitor widely used in Asia for secondary stroke prevention but approved for use in North America only for symptomatic peripheral vascular disease. It has been theorized that cilostazol might be beneficial in preventing the progression of small vessel disease in the brain and, therefore, may have a secondary effect in preventing vascular dementia.
Should Patients with Ischemic Stroke and Large Vessel Occlusions Go Directly to Endovascular Thrombectomy?
Endovascular mechanical thrombectomy has become the standard treatment for patients with acute ischemic stroke caused by large vessel occlusion in both the anterior and posterior circulations. This is predicated on the ability to perform the procedure in a timely fashion or based on a mismatch between the size of infarction and brain perfusion.
Mobile Stroke Units: What Is the Best Way to Use Them?
A recent advance in ischemic stroke treatment is the mobile stroke unit, an ambulance outfitted with specialized equipment, computed tomography for brain imaging, and a specialized team with a stroke neurologist available either onboard or via telemedicine. Intravenous thrombolytics can be administered at the scene with the patient on the ambulance.
COVID-19 Infection Increases Stroke Risk by Almost Eight Times the Stroke Risk with Influenza
It is well documented that influenza epidemics are associated with an increased risk of ischemic stroke and myocardial infarction, as are all systemic inflammatory disorders. Investigators at Weill Cornell Medicine wanted to determine if coronavirus infection induced a higher risk of ischemic stroke than other viral infections, such as influenza.
Ticagrelor Added to Aspirin Reduces Long-Term Risk of Recurrent Stroke or Death After Ischemic Stroke or TIAs
The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death (THALES) study was designed to test the hypothesis that 30-day treatment with ticagrelor and aspirin would be superior to aspirin alone in reducing the risk of subsequent stroke or death in patients who had a non-cardioembolic ischemic stroke or transient ischemic attack.
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