Neurology Alert
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Repetitive Head Impacts and Chronic Traumatic Encephalopathy in Young Contact Sport Athletes
In a first of its kind study, researchers found neuropathological markers suggestive of chronic traumatic encephalopathy (CTE) pathology in 41% (n = 152) of young contact sport athletes (< 30 years of age) at autopsy. Clinical measures (obtained retrospectively via informant report) assessing for cognitive and psychiatric/behavioral dysfunction, while elevated across most measures for the entire group, did not significantly differ between brain donors with and without a CTE diagnosis. Functional impairments also were not commonly found.
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Acute Vertigo Caused by Herpes Zoster Oticus
Herpes zoster oticus (HZO) and vestibular neuritis (VN) can be difficult to distinguish, but treatments may be different. Magnetic resonance imaging may help by showing inflammatory lesions in the vestibular nuclei or the proximal portions of the eighth nerves in HZO, but not VN.
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Autoimmune Encephalitis After Herpes Simplex Virus Encephalitis
A recent study showed that about 25% of patients with herpes simplex encephalitis develop neurological symptoms three to six weeks after the infection, pointing toward an autoimmune process with different neurological and psychiatric symptoms. Anti-neuronal antibodies, such as anti-N-methyl-D-aspartate receptor antibodies, have been found in this post-viral autoimmune encephalitis presentation.
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Treatable Causes of Rapidly Progressive Dementias
Many cases of rapidly progressive dementia are caused by prion diseases and have no effective treatments. But, with the greater awareness of the presentation for autoimmune encephalitis, these disorders make up an increasing percentage of presenting cases and can be aggressively and successfully treated. The STAM3P score helps to identify potentially treatable cases of this disorder.
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Early Onset Post-Radiation Neuropathy
Biopsy studies of early onset neuropathies seen after radiation therapy consistently show evidence of microvasculitis and other signs of inflammation. Early and rapid treatment with anti-inflammatory medications may be effective in stopping the progression and speeding up recovery.
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Hepatitis E and Neuropathy
In this prospective case-control study of patents with neuralgic amyotrophy, Guillain-Barré syndrome, and Bell’s palsy, an association with acute hepatitis E infection was demonstrated only with neuralgic amyotrophy.
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Integrating Reproductive History Could Help Postmenopausal Women’s Long-Term Brain Health
Researchers observed patients with higher cumulative estrogen exposure throughout their life may be at lower risk of developing cerebral small vessel disease.
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Blood Pressure Management After Endovascular Thrombectomy: What Is the Best Number?
Approximately 50% of patients who undergo endovascular therapy for ischemic stroke still have a severe impairment or will die within 90 days. Therefore, additional interventions are being investigated to improve overall outcome. Current guidelines from the American Heart Association suggest maintaining systolic blood pressure below 180 mmHg for patients who were treated both with intravenous thrombolysis and endovascular thrombectomy. A number of centers around the world have tried different systolic blood pressure thresholds ranging from 120 mmHg to 160 mmHg. Many of these studies have been single-center or small non-randomized studies and have not been designed to get a definitive answer.
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Tenecteplase vs. Alteplase for Treatment of Acute Ischemic Stroke: It Is Time to Make the Change
Since 1996, when the U.S. Food and Drug Administration approved the use of intravenous alteplase for the treatment of acute ischemic stroke, there has been a steady increase in the adoption of both intravenous thrombolysis as well as endovascular thrombolysis and mechanical thrombectomy for the treatment of patients with acute ischemic stroke and large vessel occlusion. There now is extensive experience with the use of tenecteplase for the treatment of acute ischemic stroke. It has been shown to be equally efficacious, with a similar risk profile as alteplase.
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Radiosurgery vs. Watch-and-Wait Approach for Newly Diagnosed Vestibular Schwannoma
Vestibular schwannoma is the most common tumor of the cerebellopontine angle. There is controversy regarding the management of these benign tumors with up-front radiosurgery vs. observation, especially for those that are small- to medium-sized with minimal symptoms. Recent evidence suggests that up-front radiosurgery may reduce tumor volume at four-year follow-up.