Neurology
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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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Treating Preclinical Alzheimer’s Disease
After studying an anti-amyloid antibody, solanezumab, researchers reported there was no benefit in reducing the likelihood of progression of cognitive impairment in patients with positive amyloid PET scans who started the trial cognitively unimpaired, compared to placebo.
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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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Timing of Anticoagulation Administration Following Atrial Fibrillation-Associated Stroke
A prospective, blinded, randomized study of early vs. later administration of oral anticoagulation after ischemic stroke in patients with atrial fibrillation calibrated by cerebral imaging showed no significant difference in 30-day outcomes.
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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.
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Nitrous Oxide-Induced Neuropathy
Nitrous oxide-induced neuropathy presents with a rapidly progressive sensorimotor neuropathy that may mimic Guillain-Barré syndrome. The pattern of clinical weakness and progression, as well as electrophysiological features, can help to rapidly distinguish the two disorders.