Pure Autonomic Failure
Abstract Pure autonomic failure (PAF) is a rare sporadic neurodegenerative autonomic disorder characterized by slowly progressive pan autonomic failure without other features of neurologic dysfunctions. The main clinical symptoms result from neurogenic orthostatic hypotension and urinary and gastrointestinal autonomic dysfunctions. Autonomic failure in PAF is caused by neuronal degeneration of pre- and postganglionic sympathetic and parasympathetic neurons in the thoracic spinal cord and paravertebral autonomic ganglia. The presence of Lewy bodies and α-synuclein deposits in these neural structures suggests...
Source: Current Neurology and Neuroscience Reports - June 23, 2016 Category: Neuroscience Source Type: research

Alien Hand Syndrome
Abstract Alien hand syndrome (AHS) is a rare disorder of involuntary limb movement together with a sense of loss of limb ownership. It most commonly affects the hand, but can occur in the leg. The anterior (frontal, callosal) and posterior variants are recognized, with distinguishing clinical features and anatomical lesions. Initial descriptions were attributed to stroke and neurosurgical operations, but neurodegenerative causes are now recognized as most common. Structural and functional imaging and clinical studies have implicated the supplementary motor area, pre-supplementary motor area, and their network con...
Source: Current Neurology and Neuroscience Reports - June 17, 2016 Category: Neuroscience Source Type: research

The Impact of Psychoactive Drugs on Seizures and Antiepileptic Drugs
Abstract Psychiatric comorbidities are very common in patients with epilepsy, and in fact, a bidirectional relationship between epilepsy and some psychiatric disorders have been identified. However, despite their high prevalence, these comorbidities are not routinely recognized or adequately treated causing a significant burden for these patients. Atypical presentations of some of these psychiatric comorbidities in epilepsy, the concern that some psychotropic drugs may lower seizure threshold worsening frequency of seizures, possibility of many drug-drug interactions, and the negative impact of some antiepileptic...
Source: Current Neurology and Neuroscience Reports - June 17, 2016 Category: Neuroscience Source Type: research

The Utility of Cerebral Blood Flow Assessment in TBI
This article reviews the history of CBF measurements in TBI as well as the role of CBF in pathologies associated with TBI, such as cerebral autoregulation, hyperemia, and cortical spreading depression. The limitations of various CBF monitors are reviewed in order to better understand their role in TBI management. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - June 17, 2016 Category: Neuroscience Source Type: research

Cognitive and Functional Consequence of Cardiac Arrest
Abstract Cardiac arrest is associated with high morbidity and mortality. Better-quality bystander cardiopulmonary resuscitation training, cardiocerebral resuscitation principles, and intensive post-resuscitation hospital care have improved survival. However, cognitive and functional impairment after cardiac arrest remain areas of concern. Research focus has shifted beyond prognostication in the immediate post-arrest period to identification of mechanisms for long-term brain injury and implementation of promising protocols to reduce neuronal injury. These include therapeutic temperature management (TTM), as well a...
Source: Current Neurology and Neuroscience Reports - June 16, 2016 Category: Neuroscience Source Type: research

Isolated Abducens Nerve Palsy: Update on Evaluation and Diagnosis
Abstract Abducens nerve palsy is a common clinical finding in neurology practice. In many instances, the origin is obvious and management straightforward; however, the list of possible etiologies and mimics is vast and diverse and diagnostic decisions can be challenging and even controversial. This is especially true when the abducens nerve is affected in isolation, since in the current era of cost-effective medicine, it is critical to accurately diagnose etiologies that may lead to major morbidity or mortality with efficiency. Topics for highlighted updates in this review include management of isolated abducens ...
Source: Current Neurology and Neuroscience Reports - June 15, 2016 Category: Neuroscience Source Type: research

Paediatric Multiple Sclerosis: Update on Diagnostic Criteria, Imaging, Histopathology and Treatment Choices
Abstract Paediatric multiple sclerosis (MS) represents less than 5 % of the MS population, but patients with paediatric-onset disease reach permanent disability at a younger age than adult-onset patients. Accurate diagnosis at presentation and optimal long-term treatment are vital to mitigate ongoing neuroinflammation and irreversible neurodegeneration. However, it may be difficult to early differentiate paediatric MS from acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD), as they often have atypical presentation that differs from that of adult-onset MS. The purp...
Source: Current Neurology and Neuroscience Reports - June 6, 2016 Category: Neuroscience Source Type: research

Neurological Complications of Pregnancy
Abstract Physiologic alterations during pregnancy create an environment for the occurrence of disease states that are either unique to pregnancy, occur more frequently in pregnancy, or require special management considerations that may be different from the nonpregnancy state. In the realm of cerebrovascular disease, preeclampsia, eclampsia, reversible cerebral vasoconstriction syndrome, sources of cardiogenic embolization including peripartum cardiomyopathy, cerebral venous thrombosis, pituitary apoplexy, subarachnoid hemorrhage, intracerebral hemorrhage, and special considerations for anticoagulation during pre...
Source: Current Neurology and Neuroscience Reports - May 26, 2016 Category: Neuroscience Source Type: research

Facioscapulohumeral Dystrophy
Abstract Facioscapulohumeral muscular dystrophy (FSHD) is a clinically recognizable and relatively common muscular dystrophy. It is inherited mostly as an autosomal dominant disease or in a minority of cases, in a digenic pattern. The disease manifestation is variable and most likely dependent on genetic and epigenetic factors. We review the history, epidemiology, clinical presentation, and genetics of the disease, present the recently elucidated molecular pathogenesis, discuss the pathology and the possible consequence of the inflammation seen in the muscle biopsies, and consider future treatments. (Source: Curr...
Source: Current Neurology and Neuroscience Reports - May 23, 2016 Category: Neuroscience Source Type: research

Migraine: What Imaging Reveals
Abstract Although migraine symptomatology is well-defined, our understanding of migraine pathophysiology is incomplete. Structural and functional brain imaging can contribute to a greater understanding of migraine pathophysiology. Recent neuroimaging studies demonstrate that migraine is associated with structural and functional alterations of brain regions commonly implicated in pain processing. This review summarizes recent brain structural and functional imaging findings in migraine and highlights those that are associated with characteristics such as the presence or absence of aura, associated cognitive dysfun...
Source: Current Neurology and Neuroscience Reports - May 16, 2016 Category: Neuroscience Source Type: research

New Techniques and Progress in Epilepsy Surgery
Abstract While open surgical resection for medically refractory epilepsy remains the gold standard in current neurosurgical practice, modern techniques have targeted areas for improvement over open surgical resection. This review focuses on how a variety of these new techniques are attempting to address these various limitations. Stereotactic electroencephalography offers the possibility of localizing deep epileptic foci, improving upon subdural grid placement which limits localization to neocortical regions. Laser interstitial thermal therapy (LITT) and stereotactic radiosurgery can minimally or non-invasiv...
Source: Current Neurology and Neuroscience Reports - May 16, 2016 Category: Neuroscience Source Type: research

Melatonin for Sleep Disorders in Patients with Neurodegenerative Diseases
Abstract In patients with neurodegenerative diseases, sleep disorders are common; they impair the quality of life for patients and caregivers and are associated with poorer clinical outcomes. Melatonin has circadian, hypnotic, and free radical-scavenging effects, and preclinical data suggest benefits of melatonin on neurodegeneration. However, randomized, controlled trials of melatonin in patients with neurodegenerative diseases have not shown strong effects. Trials in Alzheimer’s patients demonstrate a lack of benefit on sleep quantity. Subjective measures of sleep quality are mixed, with possible symptoma...
Source: Current Neurology and Neuroscience Reports - May 14, 2016 Category: Neuroscience Source Type: research

Neurologic Complications in Treated HIV-1 Infection
Abstract Effective combination antiretroviral therapy has transformed HIV infection into a chronic disease, with HIV-infected individuals living longer and reaching older age. Neurological disease remains common in treated HIV, however, due in part to ongoing inflammation and immune activation that persist in chronic infection. In this review, we highlight recent developments in our understanding of several clinically relevant neurologic complications that can occur in HIV infection despite treatment, including HIV-associated neurocognitive disorders, symptomatic CSF escape, cerebrovascular disease, and periphera...
Source: Current Neurology and Neuroscience Reports - May 12, 2016 Category: Neuroscience Source Type: research

Muscle-Specific Receptor Tyrosine Kinase (MuSK) Myasthenia Gravis
Abstract Autoimmune myasthenia gravis (MG) is the prototypic, antibody-mediated neuromuscular disease and is characterized by a decrease in the number of functional acetylcholine receptors (AChR) within the muscle end plate zone of the neuromuscular junction (NMJ). Although the pathophysiology of AChR-mediated myasthenia gravis has been extensively studied over the last 40 years since its original description by Patrick and Lindstrom (Science 180:871–872, 1973), less is known about the much more recently described muscle-specific kinase (MuSK) antibody-mediated MG. MuSK-MG has features clinically disti...
Source: Current Neurology and Neuroscience Reports - May 12, 2016 Category: Neuroscience Source Type: research

Kleine-Levin Syndrome
This article reviews common presenting symptoms, differential diagnosis, diagnostic workup, and potential treatment options. Current updates on functional imaging studies and long-term neuropsychological studies are reviewed. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - May 2, 2016 Category: Neuroscience Source Type: research

Advances of Molecular Imaging in Epilepsy
This article reviews the development of several PET radioligands and their application in studying the molecular mechanisms of epilepsy. Over the last decade, tracers binding to serotonin and γ-aminobutyric acid (GABA) receptors have been used to delineate the location of the epileptic focus. PET studies have examined the role of opioids, cannabinoids, acetylcholine, and dopamine in modulating neuronal hyperexcitability and seizure termination. In vivo analyses of drug transporters, e.g., P-glycoprotein, have increased our understanding of pharmacoresistance that could inform new therapeutic strategies. Finally, PET ...
Source: Current Neurology and Neuroscience Reports - April 25, 2016 Category: Neuroscience Source Type: research

ALS: Recent Developments from Genetics Studies
Abstract Amyotrophic lateral sclerosis (ALS) is a fatal disorder that is characterized by a progressive degeneration of the upper and lower motor neurons. Most cases appear to be sporadic, but 5–10 % of cases have a family history of the disease. High-throughput DNA sequencing and related genomic capture tools are methodological advances which have rapidly contributed to an acceleration in the discovery of genetic risk factors for both familial and sporadic ALS. It is interesting to note that as the number of ALS genes grows, many of the proteins they encode are in shared intracellular processes. This ...
Source: Current Neurology and Neuroscience Reports - April 25, 2016 Category: Neuroscience Source Type: research

Neurologic Complications in the Intensive Care Unit
Abstract Complications involving the central and peripheral nervous system are frequently encountered in critically ill patients. All components of the neuraxis can be involved including the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles. Neurologic complications adversely impact outcome and length of stay. These complications can be related to underlying critical illness, pre-existing comorbid conditions, and commonly used and life-saving procedures and medications. Familiarity with the myriad neurologic complications that occur in the intensive care unit can facilitate their timely r...
Source: Current Neurology and Neuroscience Reports - April 20, 2016 Category: Neuroscience Source Type: research

Brain Multimodality Monitoring: Updated Perspectives
Abstract The challenges posed by acute brain injury (ABI) involve the management of the initial insult in addition to downstream inflammation, edema, and ischemia that can result in secondary brain injury (SBI). SBI is often subclinical, but can be detected through physiologic changes. These changes serve as a surrogate for tissue injury/cell death and are captured by parameters measured by various monitors that measure intracranial pressure (ICP), cerebral blood flow (CBF), brain tissue oxygenation (PbtO2), cerebral metabolism, and electrocortical activity. In the ideal setting, multimodality monitoring (MMM) in...
Source: Current Neurology and Neuroscience Reports - April 19, 2016 Category: Neuroscience Source Type: research

The Risk of Sleep Disorder Among Persons with Mild Traumatic Brain Injury
Abstract Sleep disorders and mild traumatic brain injury (mTBI) are among the most commonly occurring neurological problems clinicians encounter simultaneously. Each can cause the other, and both share common predisposing factors. An important question that remains to be addressed is whether high-risk groups can be defined. We observed an accumulation of considerable knowledge on sleep dysfunction in mTBI in recently published works. The results highlight sleep disturbances in mTBI as the product of diverse internal and external influences, acting on a genetically determined substrate. This may partially explain ...
Source: Current Neurology and Neuroscience Reports - April 14, 2016 Category: Neuroscience Source Type: research

Neurological Disorders Associated with Striatal Lesions: Classification and Diagnostic Approach
In this study, we review the clinical and radiological features of the conditions associated with MRI evidence of bilateral striatal lesions. Based on MRI findings, we have distinguished two groups of disorders: BSN and other neostriatal lesions (SL). This distinction is extremely helpful in narrowing the differential diagnosis to a small group of known conditions. The clinical picture and complementary exams will finally lead to the diagnosis. We provide an update on the etiological spectrum of BSN and propose a diagnostic flowchart for clinicians. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - April 13, 2016 Category: Neuroscience Source Type: research

Imaging Systemic Dysfunction in Parkinson’s Disease
Abstract Parkinson’s disease is now widely recognized to be a multisystem disorder affecting the brain and peripheral autonomic nerves. Extensive pathology is present in both the sympathetic and parasympathetic nervous system and the intrinsic gastrointestinal plexuses in patients. Autonomic pathology and symptoms such as constipation can predate the clinical diagnosis by years or decades. Imaging studies have contributed greatly to our understanding of Parkinson’s disease but focused primarily on imaging cerebral pathology. However, given the importance of understanding the nature, chronology, and fu...
Source: Current Neurology and Neuroscience Reports - April 12, 2016 Category: Neuroscience Source Type: research

Progressive External Ophthalmoplegia
We present an evidence-based review of the presenting neuro-ophthalmic features, differential diagnosis, diagnostic tools, systemic implications, and treatment options for isolated PEO and other PEO-associated mitochondrial syndromes. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - April 12, 2016 Category: Neuroscience Source Type: research

Sleep Disorders in Multiple Sclerosis
The objectives of this review are to summarize the latest relevant data on sleep disorders in MS and offer a helpful approach to the identification and workup of the most common sleep problems in this population. Unexplored research avenues and opportunities to address important questions at the interface of sleep and MS are also discussed. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - April 12, 2016 Category: Neuroscience Source Type: research

Clinical Outcomes after Traumatic Brain Injury
Abstract Traumatic brain injury (TBI) is a major cause of death and disability that often affects young people. After injury, the degree of recovery can be highly variable, with some people regaining near complete function while others remain severely disabled. Understanding what factors influence recovery is important for counseling patients and families in the acute period after injury and can help guide therapeutic decisions in the acute period following injury. In this review, prognostic algorithms useful for clinicians are discussed. Tools for grading patient outcomes, their role in clinical care and researc...
Source: Current Neurology and Neuroscience Reports - April 12, 2016 Category: Neuroscience Source Type: research

Neuropsychiatric Issues in Parkinson’s Disease
Abstract Cognitive and neuropsychiatric symptoms are common in Parkinson’s Disease and may surpass motor symptoms as the major factors impacting patient quality of life. The symptoms may be broadly separated into those associated with the disease process and those that represent adverse effects of treatment. Symptoms attributed to the disease arise from pathologic changes within multiple brain regions and are not restricted to dysfunction in the dopaminergic system. Mood symptoms such as depression, anxiety, and apathy are common and may precede the development of motor symptoms by years, while other neurop...
Source: Current Neurology and Neuroscience Reports - April 5, 2016 Category: Neuroscience Source Type: research

New Genetic Approaches to AD: Lessons from APOE-TOMM40 Phylogenetics
We describe novel approaches, focused on molecular phylogenetics, to finding genetic variants that predict age at LOAD onset with sufficient accuracy and precision to be useful. We highlight the discovery of a polymorphism in TOMM40 that, in addition to APOE, may improve risk prediction and review how TOMM40 genetic variants may impact the develop of LOAD independently from APOE. The analysis methods described in this review may be useful for other genetically complex human diseases. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - April 4, 2016 Category: Neuroscience Source Type: research

The Role of Nonvitamin K Antagonist Oral Anticoagulants (NOACs) in Stroke Prevention in Patients with Atrial Fibrillation
This article reviews the available data on the use of NOACs for primary and secondary stroke prevention in AF patients and describes specific patient populations to guide clinician in making the informed decision regarding appropriate use of those agents. It also addresses the use of NOACs early after acute stroke and use of thrombolysis while on NOAC. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - March 29, 2016 Category: Neuroscience Source Type: research

The Clinical Approach to Encephalitis
Abstract Encephalitis has various etiologies, but viral infections and autoimmune disorders are the most commonly identified. Clinical signs, geographical clues, and diagnostic testing—including cerebrospinal fluid abnormalities and magnetic resonance imaging abnormalities—can be helpful in identifying the cause. Certain forms of encephalitis have specific treatments; hence, establishing a diagnosis rapidly and accurately is crucial. Here, we describe the clinical approach to diagnosing several common etiologies of encephalitis as well as treatment strategies. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - March 28, 2016 Category: Neuroscience Source Type: research

Chronic Traumatic Encephalopathy and Movement Disorders: Update
Abstract Association of repetitive brain trauma with progressive neurological deterioration has been described since the 1920s. Punch drunk syndrome and dementia pugilistica (DP) were introduced first to explain symptoms in boxers, and more recently, chronic traumatic encephalopathy (CTE) has been used to describe a neurodegenerative disease in athletes and military personal with a history of multiple concussions. Although there are many similarities between DP and CTE, a number of key differences are apparent especially when comparing movement impairments. The aim of this review is to compare clinical and pathol...
Source: Current Neurology and Neuroscience Reports - March 28, 2016 Category: Neuroscience Source Type: research

Mapping the Connectome Following Traumatic Brain Injury
Abstract There is a paucity of accurate and reliable biomarkers to detect traumatic brain injury, grade its severity, and model post-traumatic brain injury (TBI) recovery. This gap could be addressed via advances in brain mapping which define injury signatures and enable tracking of post-injury trajectories at the individual level. Mapping of molecular and anatomical changes and of modifications in functional activation supports the conceptual paradigm of TBI as a disorder of large-scale neural connectivity. Imaging approaches with particular relevance are magnetic resonance techniques (diffusion weighted imaging...
Source: Current Neurology and Neuroscience Reports - March 28, 2016 Category: Neuroscience Source Type: research

Medulloblastoma: Tumor Biology and Relevance to Treatment and Prognosis Paradigm
Abstract Medulloblastoma is a malignant embryonic brain tumor arising in the posterior fossa and typically occurring in pediatric patients. Current multimodal treatment regimes have significantly improved the survival rates; however, a marked heterogeneity in therapy response is observed, and one third of all patients die within 5 years after diagnosis. Large-scale genetic and transcriptome analysis revealed four medulloblastoma subgroups (WNT, SHH, Group 3, and Group 4) associated with different demographic parameters, tumor manifestation, and clinical behavior. Future treatment protocols will integrate mol...
Source: Current Neurology and Neuroscience Reports - March 28, 2016 Category: Neuroscience Source Type: research

History, Evolution, and Importance of Emergency Endovascular Treatment of Acute Ischemic Stroke
Abstract More than 800,000 people in North America suffer a stroke each year, with ischemic stroke making up the majority of these cases. The outcomes of ischemic stroke range from complete functional and cognitive recovery to severe disability and death; outcome is strongly associated with timely reperfusion treatment. Historically, ischemic stroke has been treated with intravenous thrombolytic agents with moderate success. However, five recently published positive trials have established the efficacy of endovascular treatment in acute ischemic stroke. In this review, we will discuss the history of stroke treatm...
Source: Current Neurology and Neuroscience Reports - March 28, 2016 Category: Neuroscience Source Type: research

A Practical Approach to Autonomic Dysfunction in Patients with Headache
This article will review the pathophysiology and presence of autonomic dysfunction in headache and will provide techniques to help in headache diagnosis in patients with autonomic dysfunction. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - March 28, 2016 Category: Neuroscience Source Type: research

Managing Migraine During Pregnancy and Lactation
Abstract While over half of women with migraine report improvement during pregnancy, having a history of migraine may increase the chance of negative health outcomes. The state of pregnancy increases the risk of several dangerous secondary headache disorders, especially those associated with hypertensive disorders of pregnancy, and providers need to know the red flags to diagnose and treat emergently. Non-pharmacological migraine treatments can be instituted in advance of pregnancy as many are considered the safest options during pregnancy, but understanding the safety of medications and dietary supplements ensur...
Source: Current Neurology and Neuroscience Reports - March 21, 2016 Category: Neuroscience Source Type: research

Practice Update: Review of Anticonvulsant Therapy
Abstract Since 2010, the Food and Drug Administration has approved the use of four new anti-epilepsy drugs (AEDs) for the treatment of epilepsy in the USA: clobazam (Onfi), ezogabine (Potiga), perampanel (Fycompa), and eslicarbazepine (Aptiom) as well as two extended release formulations, topiramate ER (Qudexy XR and Trokendi) and oxcarbazepine ER (Oxtellar). This not only provides practitioners ample choice to match medication profiles to their patients’ preferences and co-morbidities better, but also challenges us to be proficient in the use of all. In addition to providing a brief overview of these new m...
Source: Current Neurology and Neuroscience Reports - March 16, 2016 Category: Neuroscience Source Type: research

The Use of Oral Disease-Modifying Therapies in Multiple Sclerosis
Abstract Three oral disease-modifying drugs—fingolimod, teriflunomide, and dimethyl fumarate (DMF)—are available for treatment of relapsing forms of multiple sclerosis (MS). All three agents were approved in the last decade, primarily on the basis of a moderate to substantial reduction in the occurrence of MS relapses and central nervous system lesion formation detected by MRI. In the trials leading to approval, the first oral disease-modifying drug, fingolimod, reduced the annualized relapse rate (ARR) from 0.40 in placebo-treated patients to 0.18 (FREEDOMS) and from 0.33 in patients treated with int...
Source: Current Neurology and Neuroscience Reports - March 5, 2016 Category: Neuroscience Source Type: research

A Review and Update on Tourette Syndrome: Where Is the Field Headed?
Abstract Tourette syndrome (TS) is a childhood onset neurologic disorder with manifestations including multiple motor and phonic tics, and in most cases a variety of behavioral comorbidities such as attention deficit hyperactivity disorder, obsessive compulsive disorder, and other impulse control disorders. Although it is considered a hereditary disorder, likely modified by environmental factors, genetic studies have yet to uncover relevant causative genes and there is no animal model that mimics the broad clinical phenomenology of TS. There has been a marked increase in the number of neurophysiological, neuroima...
Source: Current Neurology and Neuroscience Reports - March 2, 2016 Category: Neuroscience Source Type: research

Vaccines in Multiple Sclerosis
Abstract Vaccinations help prevent communicable disease. To be valuable, a vaccine’s ability to prevent disease must exceed the risk of adverse effects from administration. Many vaccines present no risk of infection as they are comprised of killed or non-infectious components while other vaccines consist of live attenuated microorganisms which carry a potential risk of infection—particularly, in patients with compromised immunity. There are several unique considerations with respect to vaccination in the multiple sclerosis (MS) population. First, there has been concern that vaccination may trigger or ...
Source: Current Neurology and Neuroscience Reports - February 27, 2016 Category: Neuroscience Source Type: research

Neurologic Complications of Commonly Used Drugs in the Hospital Setting
Abstract This chapter reviews the neurologic complications of medications administered in the hospital setting, by class, introducing both common and less common side effects. Detail is devoted to the interaction between pain, analgesia, sedation, and their residual consequences. Antimicrobials are given in nearly every hospital setting, and we review their capacity to produce neurologic sequelae with special devotion to cefepime and the antiviral treatment of human immunodeficiency virus. The management of hemorrhagic stroke has become more complex with the introduction of novel oral anticoagulants, and we provi...
Source: Current Neurology and Neuroscience Reports - February 23, 2016 Category: Neuroscience Source Type: research

The Role of Vascular Imaging in the Initial Assessment of Patients with Acute Ischemic Stroke
Abstract Over the last few years, improvement in radiological imaging and treatment has changed the management of acute ischemic stroke. We have made significant advances in not only the imaging modalities themselves but also in identifying imaging parameters that can help us predict patient outcomes with both intravascular thrombolysis and endovascular thrombectomy. In this review, we describe the added utility of baseline vascular imaging including computed tomography angiography and magnetic resonance angiography in the diagnosis and management of patients with acute ischemic stroke. We focus on information th...
Source: Current Neurology and Neuroscience Reports - February 22, 2016 Category: Neuroscience Source Type: research

Cerebral Lactate Metabolism After Traumatic Brain Injury
Abstract Cerebral energy dysfunction has emerged as an important determinant of prognosis following traumatic brain injury (TBI). A number of studies using cerebral microdialysis, positron emission tomography, and jugular bulb oximetry to explore cerebral metabolism in patients with TBI have demonstrated a critical decrease in the availability of the main energy substrate of brain cells (i.e., glucose). Energy dysfunction induces adaptations of cerebral metabolism that include the utilization of alternative energy resources that the brain constitutively has, such as lactate. Two decades of experimental and human ...
Source: Current Neurology and Neuroscience Reports - February 22, 2016 Category: Neuroscience Source Type: research

Novel Approaches to Optimization of Levodopa Therapy for Parkinson’s Disease
Abstract Levodopa (LD) is the most effective medication to treat Parkinson’s disease (PD). However, motor fluctuations and drug-induced dyskinesia compromise the long-term success of levodopa therapy in PD. These response complications are due, at least in part, to fluctuating LD plasma levels (as a result of erratic gastric emptying, variable jejunal absorption, and most importantly, the short half-life of LD) with standard levodopa formulations. Keeping levodopa concentrations as constant as possible is the target for improving the pharmacokinetics and developing new ways of LD administration. In this art...
Source: Current Neurology and Neuroscience Reports - February 22, 2016 Category: Neuroscience Source Type: research

Allergic Rhinitis and Chronic Daily Headaches: Is There a Link?
Abstract Allergic rhinitis and migraine remain on the list of the most common diseases affecting adults. Migraines and headaches due to allergic rhinitis are easily confused because the symptoms of both conditions often overlap. Both may occur with sinus headache, nasal congestion, and lacrimation and may worsen with weather changes and exposure to allergens. No precise clinical definition exists for what constitutes a sinus headache, which has always been a diagnostic dilemma. Contrary to popular belief, headache is not a typical symptom of rhinitis. Some studies have shown that up to 90 % of sinus headache...
Source: Current Neurology and Neuroscience Reports - February 22, 2016 Category: Neuroscience Source Type: research

Chronic Meningitis: Simplifying a Diagnostic Challenge
Abstract Chronic meningitis can be a diagnostic dilemma for even the most experienced clinician. Many times, the differential diagnosis is broad and encompasses autoimmune, neoplastic, and infectious etiologies. This review will focus on a general approach to chronic meningitis to simplify the diagnostic challenges many clinicians face. The article will also review the most common etiologies of chronic meningitis in some detail including clinical presentation, diagnostic testing, treatment, and outcomes. By using a case-based approach, we will focus on the key elements of clinical presentation and laboratory anal...
Source: Current Neurology and Neuroscience Reports - February 18, 2016 Category: Neuroscience Source Type: research

Neuroprotection Trials in Traumatic Brain Injury
Abstract Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide. Current treatment of acute TBI includes surgical intervention when needed, followed by supportive critical care such as optimizing cerebral perfusion, preventing pyrexia, and treating raised intracranial pressure. While effective in managing the primary injury to the brain and skull, these treatment modalities do not address the complex secondary cascades that occur at a cellular level following initial injury and greatly affect the ultimate neurologic outcome. These secondary processes involve changes in ionic flux...
Source: Current Neurology and Neuroscience Reports - February 16, 2016 Category: Neuroscience Source Type: research

Integrated Approach for Pain Management in Parkinson Disease
Abstract Pain, one of the most frequent nonmotor symptoms of Parkinson disease (PD), is recognized as an important component of the illness that adversely affects patient quality of life. The aims of this review are to summarize the current knowledge on the clinical assessment and to provide a detailed overview of the evidence-based pharmacologic and nonpharmacologic approaches to treating pain. Results of a literature search include studies investigating pain/sensory abnormalities in PD. The effects of levodopa administration, deep brain stimulation (DBS), pallidotomy, spinal cord stimulation, rehabilitation, an...
Source: Current Neurology and Neuroscience Reports - February 15, 2016 Category: Neuroscience Source Type: research

Sickle Cell Disease and Stroke: Diagnosis and Management
Abstract Both adult and pediatric patients with sickle cell disease face a higher risk of stroke than the general population. Given the different underlying pathophysiology predisposing these patients to stroke, providers should be aware of differences in guidelines for stroke management. This paper reviews diagnostic considerations and recommendations during the evaluation and acute management of patients with sickle cell disease presenting with stroke, focusing on recent updates in the literature. Given the high recurrence rate of stroke in these patients, secondary prevention and curative measures will also be...
Source: Current Neurology and Neuroscience Reports - February 12, 2016 Category: Neuroscience Source Type: research

Tumefactive Demyelinating Lesions in Multiple Sclerosis and Associated Disorders
This article reviews the recent literature on the clinical presentation; radiographic features; prognosis; and management of tumefactive demyelinating lesions in multiple sclerosis, acute demyelinating encephalomyelitis, neuromyelitis optica, and the rare variants of multiple sclerosis including Schilder’s disease, Marburg acute multiple sclerosis, and Balo’s concentric sclerosis. (Source: Current Neurology and Neuroscience Reports)
Source: Current Neurology and Neuroscience Reports - February 4, 2016 Category: Neuroscience Source Type: research

Critical Care of Brain Reperfusion
Abstract Over the last few decades, the management of acute ischemic stroke has undergone significant advancements with the introduction of intravenous thrombolysis and more recently punctuated by the success of endovascular mechanical thrombectomy trials for large vessel occlusion. These advancements have transformed the practice of neurocritical care. In this review, we present a case-based discussion of common brain reperfusion techniques with an emphasis on complication recognition and management. The article encompasses recent evidence-based recommendations as well as some of our own institutional protocols....
Source: Current Neurology and Neuroscience Reports - February 2, 2016 Category: Neuroscience Source Type: research