Neurology
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Should Endovascular Thrombectomy Be Performed With or Without Intravenous Alteplase?
With the widespread adoption of endovascular thrombectomy for the treatment of acute ischemic stroke caused by large vessel occlusion, a debate has raged about the role of intravenous thrombolysis. None of the clinical trials published to date have given us a clear evidence-based answer regarding the relative risks and benefits of this approach.
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Long-Term Outcome in Patients with Intracerebral and Intraventricular Hemorrhage
Intracerebral hemorrhage continues to be a major cause of mortality and long-term disability. Early in the course of this severe disease prognosis is based on early characteristics, and care may be withdrawn at an early stage. The natural history and long-term recovery of survivors is uncertain because of withdrawal of care at an early time, resulting in a “self-fulfilling prophecy.”
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Benefits and Risks of Dual Antiplatelet Therapy After Acute Ischemic Stroke or TIA
Secondary prevention of acute ischemic stroke is continuing to evolve with great interest in the use of dual antiplatelet treatment early in the course. A complicating factor has been the role of the CYP2C19 loss-of-function gene that interferes with the conversion of clopidogrel to its active antiplatelet metabolite.
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COVID-19 Vaccination in Patients with Autoimmune Neuromuscular Diseases
In a population-based, self-reporting survey of patients with immune-mediated myopathy and myasthenia gravis, the frequency of both mild and severe acute adverse events appeared to be no more frequent than in the general population. COVID-19 vaccinations are safe for this population of patients.
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Magnetic Resonance Imaging Evaluation of Perivascular Space Abnormalities in Neuromyelitis Optica
Perivascular space (PVS) abnormalities were demonstrated in two cohorts of patients with neuromyelitis optica spectrum disorder (NMOSD) as compared to healthy controls. Magnetic resonance imaging provided visualization of PVS enlargement, and quantification of reduced flow in NMOSD patients, both of which were found to be associated with disease outcomes.
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Improvement of Memory with Transcranial Electrical Brain Stimulation in Patients with Alzheimer’s Disease
The authors showed that gamma frequency transcranial alternating current stimulation targeting the precuneus in patients with Alzheimer’s disease improved measures of immediate and delayed verbal memory as well as associative memory for faces. Additionally, neurophysiological measurements of cholinergic transmission improved. Apolipoprotein E genotype and baseline cognitive performance were correlated with treatment response. Memory improvement was correlated both with increases in gamma frequency power in posterior cortical regions and spatial overlap between the modeled electric field distribution and the precuneus target site.
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Fraud Allegations Involving Alzheimer’s Disease Study Raise Concerns
In a paper published in 2006, the authors provided evidence indicating accumulation of a specific form of beta-amyloid protein was a cause of Alzheimer’s disease. However, recent accusations suggest images allegedly were altered, raising doubts about the initial conclusions. Regardless of what happened, this case has jumpstarted a conversation about instituting more preventive measures, conducting faster investigations into fraud allegations, and levying more severe consequences for researchers found guilty of misconduct.
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Treatment of Acute Vertigo
Treating acute vertigo with an antihistamine was more effective than benzodiazepines for acute symptoms. However, there was no difference between the two medications in terms of resolution within one week or one month.
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Measure Stroke Risk with Asymptomatic Severe Carotid Artery Stenosis
A community-based, retrospective, observational study of patients with asymptomatic severe carotid artery stenoses showed the crude stroke risk over five years was about 5%. Patients whose stenoses progress to high grade or start at that severity were at the highest risk for stroke.
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Health Systems Start Transition to New Approach for Treating Ischemic Stroke
Alteplase has been a mainstay to treat ischemic stroke. When given within hours of an episode, evidence has shown the clot-busting medication can improve outcomes. But what if there was a drug that could deliver similar, and possibly even better, outcomes for a subset of stroke patients without some of the logistical hurdles associated with alteplase?