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Recent items - Neurology

Stroke risk after TIA: DWI is only part of the answer
20/05/2013 22:42
The use of MRI to evaluate patients with TIA has increased dramatically over the last 10 years. Most studies have found a higher risk of recurrent stroke when there is evidence of restricted diffusion on brain MRI. However, much of the published wor
Economics of neurology 101: The dismal science meets the dismal prognosis
20/05/2013 22:42
In the coming decades, we are faced with a massive demographic shift: the nation as a whole is getting older, by leaps and bounds. The number of persons in the oldest demographic, ages 85 and older, is expected to expand from 5.8 million in 2010 to
Robert A. Fishman, MD (1924-2012)
20/05/2013 22:42
Robert A. Fishman, MD, former President of the American Neurological Association (1983–1984) and Editor-in-Chief of Annals of Neurology (1993–1997), died on December 4, 2012, from complications of Alzheimer disease. He was 88 years old.
MRI findings and stroke risk in TIA patients with different symptom durations
20/05/2013 22:42
Objective: To determine the frequency of acute infarction detected by diffusion-weighted imaging (DWI)-MRI and stroke risk in TIA patients with different symptom duration in a population-based study. Methods: During a 54-month period (starting Nove
Low-dose propranolol and exercise capacity in postural tachycardia syndrome: A randomized study
20/05/2013 22:42
Objective: To determine the effect of low-dose propranolol on maximal exercise capacity in patients with postural tachycardia syndrome (POTS). Methods: We compared the effect of placebo vs a single low dose of propranolol (20 mg) on peak oxygen con
8OHdG is not a biomarker for Huntington disease state or progression
20/05/2013 22:42
Objective: To evaluate plasma 8-hydroxy-deoxy-guanosine (8OHdG) levels as a potential biomarker of premanifest and early Huntington disease (HD). Methods: Personnel from 2 independent laboratories quantified 8OHdG in blinded longitudinal plasma sam
Incidence and prevalence of treated epilepsy among poor health and low-income Americans
20/05/2013 22:42
Objectives: To determine the incidence and prevalence of treated epilepsy in an adult Medicaid population. Methods: We performed a retrospective, dynamic cohort analysis using Ohio Medicaid claims data between 1992 and 2006. Individuals aged 18&nda
Cervical artery dissection: Trauma and other potential mechanical trigger events
20/05/2013 22:42
Objective: To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection (CeAD). Methods: In this observational study, the presence of and the type of PCT were systematically ascertained in CeAD patients using 2 d
Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls
20/05/2013 22:42
Objectives: We and others showed that migraineurs are at increased risk of subclinical and clinical ischemic brain lesions. Migraineurs also have a higher prevalence of frequent syncope and orthostatic intolerance, symptoms that are associated with
Nonmelanoma skin cancer is associated with reduced Alzheimer disease risk
20/05/2013 22:42
Objective: To explore the association of nonmelanoma skin cancer (NMSC) and Alzheimer disease (AD) in the Einstein Aging Study, an epidemiologic study of aging in New York City. Methods: Community-residing volunteers aged 70 years or older were ass
Interrater reliability of the new criteria for behavioral variant frontotemporal dementia
20/05/2013 22:42
Objective: To evaluate the interrater reliability of the new International Behavioural Variant FTD Criteria Consortium (FTDC) criteria for behavioral variant frontotemporal dementia (bvFTD). Methods: Twenty standardized clinical case modules were d
Background of the Sociedad Neurologica Argentina: Current state and concerns about neurologic education
20/05/2013 22:42
Neurology in Argentina emerged toward the end of the 19th century, following the origin of the specialty in Europe. Its development can be divided into 3 periods. The first is the specialty of neurology as part of internal medicine. Doctoral theses
Synaptic vesicle exocytosis: Molecular mechanisms and clinical implications
20/05/2013 22:42
Chemical synapses are the main mechanism of communication in the nervous system. At the presynaptic terminal, neurotransmitters are packaged into synaptic vesicles (SVs); when an action potential opens presynaptic voltage-gated Ca2+ channels, the ne
The coming crisis: Obtaining care for the growing burden of neurodegenerative conditions
20/05/2013 22:42
As the US population ages, the burden of neurodegenerative disorders, including Alzheimer disease and Parkinson disease, will increase substantially. However, many of these patients and their families currently do not receive neurologic care. For ex
Administration of isoflurane-controlled dyskinetic movements caused by anti-NMDAR encephalitis
20/05/2013 22:42
Common clinical features of anti-NMDAR encephalitis are psychiatric symptoms, decreased level of consciousness, seizures, autonomic dysfunction, orofacial dyskinesias, and several types of abnormal movements. The present case report addresses the ch
Midbrain neurocysticercal granuloma appearing as "face of panda"
20/05/2013 22:42
An 8-year-old girl presented with a 5-day history of double vision on attempting to look downward. Examination of her eye movements revealed weakness of bilateral superior oblique muscles, with a normal examination otherwise. The brain MRI revealed
Spotlight on the May 21 issue
20/05/2013 22:42
Clinical Reasoning: A 47-year-old man with progressive gait disturbance and stiffness in his legs
20/05/2013 22:42
A 47-year-old man presented with a 5-year history of slowly progressive gait disorder with clumsiness and unsteadiness during walking, as well as stiffness and cramping pain in his legs. He also had erectile dysfunction and nocturia. He denied senso
Teaching NeuroImages: Susceptibility-weighted MRI: First clue to DAVF complicating sinovenous thrombosis
20/05/2013 22:42
A 61-year-old man with factor V Leiden thrombophilia presented with hemorrhage and transverse sinus thrombosis (figure, A). Four years later, he developed worsening aphasia, new hemorrhage, and hemispheric edema (figure, B). Susceptibility-weighted
Teaching NeuroImages: "Pancake-like" gadolinium enhancement suggests compressive myelopathy due to spondylosis
20/05/2013 22:42
A 41-year-old man developed progressive bilateral hand weakness and spastic paraparesis. MRI demonstrated cord edema and "pancake-like" gadolinium enhancement (figure). Inflammatory/neoplastic causes were investigated and not found. He continued to
Ode Upon an Open Brain
20/05/2013 22:42
Child Neurology: Diagnosis of Lambert-Eaton myasthenic syndrome in children
20/05/2013 22:42
Objective: To report a case of Lambert-Eaton myasthenic syndrome (LEMS) in a child and review the existing literature of LEMS in children. Methods: We report a pediatric case of LEMS with the classic clinical triad of proximal weakness, autonomic d
Human culture and the future dementia epidemic: Crisis or crossroads?
14/05/2013 05:06
"Epidemics appear, and often disappear without trace, when a new culture has started . . . The history of epidemics is therefore the history of disturbances of human culture."
Traumatic brain injury impairs small-world topology
14/05/2013 05:06
Objective: We test the hypothesis that brain networks associated with cognitive function shift away from a "small-world" organization following traumatic brain injury (TBI). Methods: We investigated 20 TBI patients and 21 age-matched controls. Rest
Newly diagnosed atrial fibrillation linked to wake-up stroke and TIA: Hypothetical implications
14/05/2013 05:06
Background: Based on the higher frequency of paroxysmal atrial fibrillation during night and early morning hours, we sought to analyze the association between newly diagnosed atrial fibrillation and wake-up ischemic cerebrovascular events. Methods:
White matter microstructure deteriorates across cognitive stages in Parkinson disease
14/05/2013 05:06
Objectives: To characterize different stages of Parkinson disease (PD)-related cognitive decline using diffusion tensor imaging (DTI) and investigate potential relationships between cognition and microstructural integrity of primary white matter tra
Serotonergic loss in motor circuitries correlates with severity of action-postural tremor in PD
14/05/2013 05:06
Objective: The underlying pathophysiology of tremor in Parkinson disease (PD) is unclear; however, it is known that tremor does not appear to be as responsive to dopaminergic medication as bradykinesia or rigidity. It is suggested that serotonergic
The midbrain to pons ratio: A simple and specific MRI sign of progressive supranuclear palsy
14/05/2013 05:06
Objectives: MRI-based measurements used to diagnose progressive supranuclear palsy (PSP) typically lack pathologic verification and are not easy to use routinely. We aimed to develop in histologically proven disease a simple measure of the midbrain
Effect of 4-aminopyridine on vision in multiple sclerosis patients with optic neuropathy
14/05/2013 05:06
Objective: The objective of this randomized, double-blind, placebo-controlled, crossover study was to examine if patients with optic neuropathy would derive a therapeutic benefit from 4-aminopyridine (4-AP) treatment. Furthermore, the study was inte
Cerebellar learning distinguishes inflammatory neuropathy with and without tremor
14/05/2013 05:06
Objectives: This study aims to investigate if patients with inflammatory neuropathies and tremor have evidence of dysfunction in the cerebellum and interactions in sensorimotor cortex compared to nontremulous patients and healthy controls. Methods:
Motor neuron involvement in multisystem proteinopathy: Implications for ALS
14/05/2013 05:06
Objective: To explore the putative connection between inclusion body myopathy, Paget disease, frontotemporal dementia (IBMPFD) and motor neuron disease (MND). Methods: Clinical, genetic, and EMG characterization of 17 patients from 8 IBMPFD familie
Sensitivity and specificity of FTDC criteria for behavioral variant frontotemporal dementia
14/05/2013 05:06
Objective: We aimed to assess sensitivity and specificity of the updated criteria for behavioral variant frontotemporal dementia (bvFTD) based on a large autopsy-confirmed cohort of patients with dementia. Methods: Two hundred thirty-nine consecuti
Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden
14/05/2013 05:06
Objective: To explore whether prevalence, survival, and incidence of dementia have changed from 1987–1994 to 2001–2008 in Stockholm, Sweden. Methods: This study is based on 2 cross-sectional surveys of people aged 75 years or over condu
Sodium valproate use is associated with reduced parietal lobe thickness and brain volume
14/05/2013 05:06
Objective: We hypothesized that total brain volume, white matter volume, and lobar cortical thickness would be different in epilepsy patients. We studied valproate relative to nonvalproate by using patients with epilepsy and healthy controls. Metho
Subcortical epilepsy?
14/05/2013 05:06
In the past, the cortex has for the most part been considered to be the site of seizure origin in the different forms of epilepsy. Findings from histopathologic, electrophysiologic, and brain imaging studies now provide ample evidence demonstrating
Recurrent myoglobinuria and deranged acylcarnitines due to a mutation in the mtDNA MT-CO2 gene
14/05/2013 05:06
Mitochondrial myopathies commonly present with exercise intolerance typified by breathlessness and fatigue on exercise. In contrast, exercise-induced rhabdomyolysis and myoglobinuria occur rarely. We present a 43-year-old man with a lifelong history
Carotid dissection following a generalized tonic-clonic seizure
14/05/2013 05:06
A 37-year-old woman experienced a generalized tonic-clonic seizure. Subsequent to the seizure, the patient observed left-sided face and neck pain. A left Horner syndrome was noted on examination. An MRI and magnetic resonance angiogram revealed a le
Child Neurology: Zellweger syndrome
14/05/2013 05:06
Zellweger syndrome (ZS) is a severe manifestation of disease within the spectrum of peroxisome biogenesis disorders that includes neonatal adrenoleukodystrophy, infantile Refsum disease, and rhizomelic chondroplasia punctata. Patients with ZS presen
Clinical Reasoning: A 25-year-old man with headaches and collapse
14/05/2013 05:06
A 25-year-old Caucasian man with a history of headaches presented to the emergency room for witnessed collapse. The emergency room physician who initially evaluated the patient reported that the physical examination had normal results.
Teaching NeuroImages: T2 hyperintensities in neurofibromatosis type 1
14/05/2013 05:06
A 4-year-old boy with neurofibromatosis type 1 (NF1), an asymptomatic optic glioma, and a right basal ganglia T2-hyperintense lesion (figure, A and B) developed a left hemiparesis with hyperreflexia over the course of a year. Neuroimaging revealed a
Teaching NeuroImages: Spontaneous tension pneumo-hydrocephalus may be related to otitis media and temporal bony defect
14/05/2013 05:06
A 39-year-old woman with recurrent left otitis media presented with the sensation of fluid flowing in the head, headache, mild dyslexia, and disequilibrium for 2 weeks. She reported no head trauma and had a normal neurologic examination. Head CT (fi
Spotlight on the May 14 Issue
14/05/2013 05:06
Changes in brain organization after TBI: Evidence from functional MRI findings
14/05/2013 05:06
Traumatic brain injury (TBI) is a problem of growing public health interest with high incidence. After injury, patients are at risk for several long-term sequelae that encompass a wide array of physical and behavioral symptoms. Since conventional im
Varicella-zoster virus acute myelitis in a patient with MS treated with natalizumab
06/05/2013 23:03
We report a case of varicella-zoster virus (VZV) myelitis in a woman with relapsing-remitting multiple sclerosis (RRMS) receiving natalizumab, a humanized monoclonal antibody that induces an immunosuppression localized to the CNS.
Alzheimer's Pantoum
06/05/2013 23:03
Neon neurons
06/05/2013 23:03
(A) The image that triggered this project was an immunohistochemically stained cerebellum from chimeric mice that had received a bone marrow transplant of green fluorescent hematopoietic cells, which I enhanced with Corel Painter XII (Corel, Mountai
Brain MRI evolution of metronidazole intoxication
06/05/2013 23:03
A 64-year-old woman presented with a 6-month history of intermittent episodes of ataxia and dysarthria. She had been on metronidazole 1,500 mg daily for ulcerative colitis for 10 months. Cranial MRI 3 months before admission revealed hyperintensity
Reversion from mild cognitive impairment to normal or near-normal cognition: Risk factors and prognosis
06/05/2013 23:03
Neurologic manifestations of E coli infection-induced hemolytic-uremic syndrome in adults
06/05/2013 23:03
I commend Weissenborn et al.1 for careful serial neurologic and neuropsychological examination of 42 severely ill adults. I question whether encephalopathy or delirium is the best description. The first of 2 cardinal features of delirium on the Conf
Adjunctive dexamethasone in adults with meningococcal meningitis
06/05/2013 23:03
In the article by Heckenberg et al.,1 the authors conclude that dexamethasone did not similarly improve the unfavorable outcome in meningococcal meningitis as was seen in their previous pneumococcal cohort study.2 The difference in the incidence of
Blume's Atlas of Pediatric and Adult Electroencephalography
06/05/2013 23:03
Blume's Atlas of Pediatric and Adult Electroencephalography is a stellar addition to the armamentarium of EEG atlases currently available and stands out as a comprehensive, valuable teaching tool for the learner at any stage in his or her career. It
Treatment with statins and ischemic stroke severity: Does the dose matter?
06/05/2013 23:03
Objective: To examine the effects of pretreatment with statins at high doses (40 mg of rosuvastatin or 80 mg of any other statin) and low to moderate doses (<40 mg of rosuvastatin or <80 mg of any other statin) on ischemic stroke (IS) severity
APRONES: Neurology research and education in the Democratic Republic of the Congo
06/05/2013 23:03
The Democratic Republic of the Congo (DRC) is a large country (2,345,000 km2) located in Central Africa. Although no reliable census has been carried out for decades, the population is estimated to be 70 million, of whom about 12% live in Kinshasa,
Skin rash in meningitis and meningoencephalitis
06/05/2013 23:03
Skin rash and depigmentation are common in patients with meningitis and meningoencephalitis. Skin changes must always be evaluated in conjunction with the clinical symptoms, signs, brain imaging, and laboratory abnormalities, particularly the featur