Author response: Effects of orthostatic hypotension on cognition in Parkinson disease
We thank Guaraldi et al. for their comment on our article,1 and for drawing our attention to their work assessing cognitive function in patients with peripheral autonomic disorders, pure autonomic failure (PAF), and autoimmune autonomic neuropathy.2 The results in their study are similar to our results in Parkinson disease (PD),2 and to data we reported earlier on reversible cognitive impairment in individuals with orthostatic hypotension (OH) due to the peripheral disorder autoimmune autonomicganglionopathy.3 Cognitive changes in all of these studies are most significant in the domains of attention and executive functioni...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Centi, J., Freeman, R., Gibbons, C. H., Neargarder, S., Canova, A. O., Cronin-Golomb, A. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Effects of orthostatic hypotension on cognition in Parkinson disease
We read with interest the article by Centi et al.,1 which investigated the relation between orthostatic hypotension (OH) and posture-mediated cognitive impairment in 18 patients with idiopathic Parkinson disease (PD) with OH (PDOH) and 19 patients with PD without OH and 18 controls.1 The authors demonstrated that, during upright posture, PDOH exhibited a transient wider range of deficits in executive function, memory, and visuospatial function in excess of those found in PD without OH. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Guaraldi, P., Poda, R., Calandra-Buonaura, G., Solieri, L., Sambati, L., Gallassi, R., Cortelli, P. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Author response: Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
We appreciate Drs. Gutierrez and Lekic's emphasis on the time-course analysis of dual antiplatelet therapy (DAPT) by intracranial arterial stenosis (ICAS) in their comments on our article.1 Only 1,089 patients were included in the imaging substudy.2 In patients with ICAS, 19 (8.2%), 3 (1.3%), and 0 ischemic strokes in the DAPT group (n = 231) vs 25 (10.0%), 6 (2.4%), and 0 in the aspirin alone group (n = 250), and 4 (1.7%), 0, and 2 (0.9%) bleeding in the DAPT group vs 1 (0.4%), 0, and 0 in the aspirin alone group, occurred at the first, second, and third week, respectively. In patients without ICAS, 11 (3.7%), 1 (0.3%), a...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Pan, Y., Wang, Y., Wang, Y. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
We read with interest the article by Pan et al.,1 which reported that the use of dual antiplatelet therapy (DAPT) showed an early benefit, compared to aspirin alone, for secondary ischemic stroke prevention after a minor stroke or TIA. The absolute risk reduction in the first week after the indexed event was 4.5%.1 The authors previously reported a nonsignificant absolute risk reduction in recurrent ischemic stroke of 2.3% with DAPT compared to aspirin alone in Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) participants with intracranial arterial stenosis (ICAS) over the 90-day fo...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Gutierrez, J., Lekic, T. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Editors' Note
: In "Risks and benefits of clopidogrel–aspirin in minor stroke or TIA: Time course analysis of CHANCE," authors Pan et al. compared the use of dual antiplatelet therapy (DAPT) with aspirin alone for secondary stroke prevention in patients after a minor stroke or TIA. Drs. Gutierrez and Lekic point out that DAPT appeared to have a greater benefit than aspirin alone in patients with intracranial arterial stenosis (ICAS) in the first 2 weeks and ask the authors to provide a time-course analysis for the risk of ischemic stroke and hemorrhage by ICAS status. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Alcauskas, M., Galetta, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Systemic vasculitis with dermatomyositis, hearing loss, neuropathy, and multiorgan dysfunction
A 39-year-old woman presented with 10 months of steadily progressive weakness, myalgia, weight loss, and intermittent feet tingling. During the course of her illness, she developed refractory atrial fibrillation, left followed by right-sided hearing loss, amenorrhea, and hematuria. She had been on rituximab for years for "polyarthralgias," which was stopped at symptom onset. Examination showed severe proximal weakness and mildly decreased toe proprioception. Deltoid biopsy (figure) was diagnostic of dermatomyositis. Liver and enteric biopsies showed lymphocytosis. Suspicion for vasculitis led to sural nerve biopsy (figure)...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Dhawan, P. S., Dyck, P. J. B., Tracy, J. A., Naddaf, E. Tags: Vasculitis, Peripheral neuropathy NEUROIMAGES Source Type: research
Home for the holidays
Your hug wasn't your hug. Your
left arm didn't encircle me as tightly, and the
left side of your smile didn't arch upward
as completely. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Frey, J. Tags: Stroke in young adults, All Cerebrovascular disease/Stroke, Neglect REFLECTIONS: NEUROLOGY AND THE HUMANITIES Source Type: research
Successful motor mapping with transcranial magnetic stimulation in an infant: A case report
Accurate assessment of motor function is critical, particularly in the context of presurgical functional mapping. There are a few noninvasive tools available for preoperative motor mapping in older children and adults undergoing surgery for brain tumor or refractory epilepsy including fMRI, magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS).1,2 However, assessing motor function is challenging in very young children. Direct cortical stimulation, a standard procedure in adults, is associated with a high incidence of intraoperative seizures, and is often unsuccessful in young children.3,4 Alternately, n...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Narayana, S., Mudigoudar, B., Babajani-Feremi, A., Choudhri, A. F., Boop, F. A. Tags: All Clinical Neurology, All Pediatric, TMS, Epilepsy surgery, Cortical localization CLINICAL/SCIENTIFIC NOTES Source Type: research
Serum neurofilament light is sensitive to active cerebral small vessel disease
Conclusions:
Serum NfL is increased in patients with an RSSI and the occurrence of new CSVD-related MRI lesions, even when clinically silent. This suggests NfL as a blood biomarker for active CSVD. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Gattringer, T., Pinter, D., Enzinger, C., Seifert-Held, T., Kneihsl, M., Fandler, S., Pichler, A., Barro, C., Gröbke, S., Voortman, M., Pirpamer, L., Hofer, E., Ropele, S., Schmidt, R., Kuhle, J., Fazekas, F., Khalil, M. Tags: All Cerebrovascular disease/Stroke ARTICLE Source Type: research
Association between percent decline in serum total homocysteine and risk of first stroke
Conclusions:
Percent lowering in tHcy was significantly associated with a reduction in first stroke risk in Chinese adults with hypertension, and if further confirmed, may serve as a useful indicator for folic acid treatment efficacy on stroke prevention.
Clinicaltrials.gov identifier:
NCT00794885. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Huang, X., Li, Y., Li, P., Li, J., Bao, H., Zhang, Y., Wang, B., Sun, N., Wang, J., He, M., Yin, D., Tang, G., Chen, Y., Cui, Y., Huang, Y., Hou, F. F., Qin, X., Huo, Y., Cheng, X. Tags: Stroke prevention, All Clinical trials ARTICLE Source Type: research
Infliximab for the treatment of CNS sarcoidosis: A multi-institutional series
Conclusions:
Most patients with CNS sarcoidosis treated with infliximab exhibit favorable imaging and clinical treatment responses, including some previously refractory to other immunosuppressive treatments.
Classification of evidence:
This study provides Class IV evidence that for patients with CNS sarcoidosis infliximab is associated with favorable imaging and clinical responses. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Gelfand, J. M., Bradshaw, M. J., Stern, B. J., Clifford, D. B., Wang, Y., Cho, T. A., Koth, L. L., Hauser, S. L., Dierkhising, J., Vu, N., Sriram, S., Moses, H., Bagnato, F., Kaufmann, J. A., Ammah, D. J., Yohannes, T. H., Hamblin, M. J., Venna, N., Green Tags: All Immunology ARTICLE Source Type: research
Optimal deep brain stimulation site and target connectivity for chronic cluster headache
Conclusions:
We identify the optimal stimulation site and structural connectivity of the deep brain stimulation target for cluster headache, explicating possible mechanisms of action and disease pathophysiology. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Akram, H., Miller, S., Lagrata, S., Hariz, M., Ashburner, J., Behrens, T., Matharu, M., Zrinzo, L. Tags: Cluster headache, DWI ARTICLE Source Type: research
Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine
Conclusions:
IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the ED and should not be used as first-line therapy.
ClinicalTrials.gov identifier:
NCT02389829.
Classification of evidence:
This study provides Class I evidence that for patients in the ED with migraine, IV prochlorperazine + diphenhydramine is superior to IV hydromorphone. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Friedman, B. W., Irizarry, E., Solorzano, C., Latev, A., Rosa, K., Zias, E., Vinson, D. R., Bijur, P. E., Gallagher, E. J. Tags: Migraine, Clinical trials Randomized controlled (CONSORT agreement), Class I ARTICLE Source Type: research
Volumetric brain changes in migraineurs from the general population
Conclusions:
Migraineurs from the general population showed small volumetric brain changes, mainly in cortical areas involved in visual motion processing, compared to controls. The presence of morphologic changes regardless of the presence of migraine aura or disease activity suggests that migraines with and without aura share common pathophysiologic pathways and suggests that these changes are (partially) irreversible or might have been present throughout life. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Palm-Meinders, I. H., Arkink, E. B., Koppen, H., Amlal, S., Terwindt, G. M., Launer, L. J., van Buchem, M. A., Ferrari, M. D., Kruit, M. C. Tags: Migraine, Volumetric MRI, All Clinical Neurology, Visual processing, All Pain ARTICLE Source Type: research
Adding quantitative muscle MRI to the FSHD clinical trial toolbox
Conclusions:
We show a strong correlation between quantitative muscle MRI and clinical outcome measures. Muscle MRI is able to detect muscle pathology before clinical involvement of the leg muscles. This indicates that quantitative leg muscle MRI is a promising biomarker that captures disease severity and motor functioning and can thus be included in the FSHD trial toolbox. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Mul, K., Vincenten, S. C. C., Voermans, N. C., Lemmers, R. J. L. F., van der Vliet, P. J., van der Maarel, S. M., Padberg, G. W., Horlings, C. G. C., van Engelen, B. G. M. Tags: Outcome research, MRI, Muscle disease, Cohort studies ARTICLE Source Type: research
