Inequities in Telemedicine Use Among Patients With Stroke and Cerebrovascular Diseases: A Tricenter Cross-sectional Study
Discussion
In our diverse cohort across 3 centers, we found differences in TM visit type by race and insurance early during the COVID-19 pandemic. These findings suggest disparities in VTM access across different stroke populations. As VTM remains an integral part of outpatient neurology practice, steps to ensure equitable access are essential. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 14, 2023 Category: Neurology Authors: Naqvi, I. A., Cohen, A. S., Kim, Y., Harris, J., Denny, M. C., Strobino, K., Bicher, N., Leite, R. A., Sadowsky, D., Adegboye, C., Okpala, N., Okpala, M., Savitz, S. I., Marshall, R. S., Sharrief, A. Tags: All Health Services Research, All Cerebrovascular disease/Stroke, Underserved populations, Health disparities Research Article Source Type: research
Clinical Biomarkers and Prediction Models for Poststroke Epilepsy: Have We Settled the Scores Yet?
In an era of time-dependent reperfusion and recanalization therapy for stroke leading to improved survival, there is a growing population at risk of poststroke epilepsy (PSE). Accumulating evidence suggests a multidirectional interaction among stroke, PSE, and dementia in stroke survivors. There is no evidence to justify prophylactic antiseizure medication (ASM) to reduce these morbidities. Although several predictive molecular biomarkers and scoring models have been proposed, they remain inadequately validated for stratifying risk and indicating who will benefit from prophylactic ASM. Studies leveraging advances in geneti...
Source: Neurology Clinical Practice - March 14, 2023 Category: Neurology Authors: Yonas, A. S., Meschia, J. F., Feyissa, A. M. Tags: Stroke in young adults, All Cerebrovascular disease/Stroke, EEG; see Epilepsy/Seizures, Screening in epidemiology, All Epilepsy/Seizures Commentary Source Type: research
Improving Sleep Health Among Refugees: A Systematic Review
Purpose of Review
Sleep disorders among refugees are common yet understudied. Interventions are difficult in resource-limited settings where most of these populations live. A systematic review of sleep disorders in refugee populations is warranted to identify prevalence, comorbidities, and the limitations of the current state of sleep health among refugees.
Recent Findings
Sleep disturbances, particularly insomnia and nightmares, occur with a higher prevalence among refugees. Diseases associated with insomnia in this population included fibromyalgia, posttraumatic stress disorder, depression, and anxiety. Risk factors inc...
Source: Neurology Clinical Practice - March 14, 2023 Category: Neurology Authors: Baskaran, A., Marogi, E., Bitar, R., Attarian, H., Saadi, A. Tags: Quality of life, All Sleep Disorders, All global neurology, Health disparities Review Source Type: research
EEG Correlates of Qualitative Hypermetabolic FDG-PET in Patients With Neurologic Disorders
Discussion
Adults admitted with acute neurologic symptoms who had hypermetabolic FDG-PET were more likely to show electrographic seizures and LPDs, but not other rhythmic or periodic EEG patterns, compared with those with hypometabolic FDG-PET. Subjects with hypermetabolic FDG-PET and LPDs were more likely to have LPDs with concurrent electrographic seizures, LPDs with a spike morphology, and LPDs +F, compared with subjects with hypometabolic FDG-PET. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 14, 2023 Category: Neurology Authors: Husari, K. S., Solnes, L., Cervenka, M. C., Venkatesan, A., Probasco, J., Ritzl, E. K., Johnson, E. L. Tags: All Imaging, All Clinical Neurology, EEG; see Epilepsy/Seizures, All Epilepsy/Seizures Research Article Source Type: research
Intracranial Hemorrhage as a Marker for Mycotic Aneurysm in Patients With Infective Endocarditis
Discussion
Patients with left-sided and right-sided endocarditis with PFO and ICH on CNS imaging were more likely to have mycotic aneurysms detected through DSA than similar patients without ICH. Routine DSA screening for mycotic aneurysms may not be required in patients with endocarditis undergoing evaluation for valve surgery who present without ICH on CNS imaging. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 10, 2023 Category: Neurology Authors: Williams, T. J., Starr, M., El-Dalati, S. Tags: CT, MRI, Bacterial infections, Embolism, Intracerebral hemorrhage Research Article Source Type: research
Rescue Epidural Saline Patch for Comatose Patients With Refractory Convexity Spontaneous Subacute Subdural Hematoma: Case Report
In this study, we report 4 cases of refractory CSSSH treated with rescue epidural saline patch, although history and imaging studies showed no evidence of SIH.
Methods
All 4 patients received a lumbar saline epidural rescue patch for consciousness impairment associated with refractory CSSSH, and one is particularly detailed. No patient had typical radiologic signs of SIH or, on the contrary, uncal herniation that could have indicated intracranial hypertension.
Results
The Glasgow Coma Scale score improved significantly in the days after application of the epidural patch in 3 patients. All patients showed an improvement o...
Source: Neurology Clinical Practice - March 10, 2023 Category: Neurology Authors: Roy, M., Welschbillig, S., Cantier, M., Chauvet, D., Bourdillon, P., Engrand, N. Tags: Low pressure syndrome, Other cerebrovascular disease/ Stroke, Coma, Critical care Clinical/Scientific Note Source Type: research
Adverse Childhood Experiences Are Associated With Seizures in Children: A Cross-sectional Analysis
Discussion
Multiple ACE exposures were individually associated with reporting a diagnosis of epilepsy or seizure disorder. An increase in cumulative ACE exposures increased odds of having current diagnosis of epilepsy or seizure disorder. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 10, 2023 Category: Neurology Authors: Anto, M., Shipley, S. C., Massey, S., Szperka, C. L. Tags: All Pediatric, Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), All Epilepsy/Seizures Research Article Source Type: research
Clinical and Radiographic Characteristics of Nocardia vs Non-Nocardia Brain Abscesses
Discussion
Patients with CNS nocardiosis were more likely to be older, have a history of diabetes or immunosuppression, or have a concomitant lung infection compared with those with non-Nocardia brain abscesses. Abscesses because of CNS nocardiosis were more likely to be multifocal, affect the infratentorial region or occipital lobe, or have a bilobed appearance. Neurosurgical specimen culture was most likely to yield a diagnosis for both Nocardia and non-Nocardia abscesses. The combination of clinical and imaging findings may suggest CNS nocardiosis and inform early initiation of targeted empiric treatment. (Source: Neuro...
Source: Neurology Clinical Practice - March 8, 2023 Category: Neurology Authors: LaHue, S. C., Guterman, E. L., Mikhail, M., Li, Y., Cha, S., Richie, M. B. Tags: MRI, Abscess, Bacterial infections Research Article Source Type: research
Isolating Neurologic Deficits in Cervical Spondylotic Myelopathy: A Case-Controlled Study, Using the NIH Toolbox Motor Battery
This study aimed to determine, for the first time, the use of the NIH Toolbox motor battery (NIHTBm) in the objective assessment of motor deficits in patients with CSM.
Methods
Patients with symptoms and MRI evidence of CSM and age-matched healthy controls (HC), with no evidence of spinal disorder or surgery were included in this case-control study based on our inclusion and exclusion criteria. We performed motor tests, dexterity, gait speed, grip strength, and balance tests, using the NIHTBm in patients with CSM and HCs. Motor impairment rates were determined in patients with CSM based on the NIHTBm scores. We determined...
Source: Neurology Clinical Practice - March 8, 2023 Category: Neurology Authors: Muhammad, F., Baha, A., Haynes, G., Shakir, H., Omini, M., Martin, M., Weber, K. A., Paliwal, M., Van Hal, M., Dickson, D., Dhaher, Y., Zhao, Y. D., Smith, Z. A. Tags: Research Article Source Type: research
Best Practice Recommendations for Stroke Vascular Imaging During Iodinated Contrast Shortage
GE Healthcare© announced on April 19, 2022, that their main factory and distributor of iodinated contrast had experienced a temporary shutdown because of COVID-19 outbreak in Shanghai, China. This, along with other supply chain issues, led to a worldwide shortage of iodinated contrast agents, Omnipaque and Visipaque. Our Comprehensive Stroke Center was confronted with the cascading effect of this iodinated contrast material shortage. We took immediate steps to revise our protocols and processes to continue to provide high-quality care to our stroke patients. A multidisciplinary working group comprised of representativ...
Source: Neurology Clinical Practice - March 3, 2023 Category: Neurology Authors: Bhole, R., Solenski, N. J., Donahue, J. H., Kellogg, R. T., Roach, N. N., Chapman, S. N., Worrall, B. B., Evans, A. J., Patel, S. H., Mukherjee, S., Park, M. S., Southerland, A. M. Tags: Decision analysis, Medical care, All Cerebrovascular disease/Stroke, All Practice Management Commentary Source Type: research
Measuring Ambulatory Racial and Ethnic Neurologic Disparities With the Axon Registry
Discussion
The large proportion of missing or unknown R/E data and low overall rate of performance on these quality measures made the relevance of small differences difficult to determine. This analysis demonstrates the feasibility of using the Axon Registry to assess neurologic disparities in outpatient care. More education and training are required on the accurate capture of R/E data in the EHR. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 1, 2023 Category: Neurology Authors: Benson, R. T., Benish, S. M., Esper, G. J., Kissela, B., Rosendale, N., Marulanda-Londono, E., Hope, O. A., Pham, T. T. A., Roe, M., Torres, A., Lien, A., Kauwe, S. K., Lundgren, K. B., Mante, A., Schierman, B., Jones, L. K. Tags: Research Article Source Type: research
Migraine Patient Care Model Preferences in a Community Practice
In this study, we aimed to inform the development of migraine care models by assessing patient preferences for types of care delivery and determining differences based on migraine frequency and disability.
Methods
We analyzed unpublished data from a cross-sectional survey of 516 randomly selected individuals with migraine within a community practice associated with Mayo Clinic, Rochester, MN.
Results
Individuals with chronic migraine, compared with those with episodic migraine, were more likely to prefer a visit with a neurologist (p = 0.0005), synchronous telephone conference with primary care provider (PCP) and neurolo...
Source: Neurology Clinical Practice - March 1, 2023 Category: Neurology Authors: Stern, J. I., Ebbert, J. O., Vierkant, R. A., Young, N. P. Tags: Quality of life, Medical care, Models of care Research Article Source Type: research
Benefits and Challenges of Pediatric-to-Adult Health Care Transition in Childhood-Onset Neurologic Conditions
Discussion
Systems that provide sufficient pediatric-to-adult HCT for individuals with childhood-onset neurologic conditions are required. Lifelong education for patients and families, training for pediatricians on HCT and neurologists on childhood-onset conditions and disabilities, and clinical practice and human resources that support patients and families are warranted. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - March 1, 2023 Category: Neurology Authors: Osako, M., Yamaoka, Y., Takeuchi, C., Fujiwara, T., Mochizuki, Y. Tags: Disability Research Article Source Type: research
Argatroban Resistance and Successful Adjunctive Anticoagulation for Cerebral Venous Sinus Thrombosis With SERPINC1 Mutation: A Case Report
We report a case of a 19-year-old man who was admitted to the hospital with sudden headache, nausea, vomiting, and eye swelling for 3 days. Brain MRI on admission showed multifocal CVST.
Results
SERPINC1 mutation (exon1, c.40delA: [p.R14Gfs*17]) combined with hereditary AT deficiency (AT activity was 50% [reference range: 80%–120%]) was detected in this patient. A high dose of anticoagulation treatment with argatroban did not improve the activated partial thromboplastin time (APTT) level to the target range (1.5–3 times over the initial baseline level) for this case. We chose adjunctive anticoagulation (argatr...
Source: Neurology Clinical Practice - March 1, 2023 Category: Neurology Authors: Ma, H., Zhang, Q., Gu, Y., Ji, X., Duan, J. Tags: MRI, Cerebral venous thrombosis, All Genetics Clinical/Scientific Note Source Type: research
Discontinuing Antiseizure Medications After Acute Symptomatic Neonatal Seizures: The Great Trepidation
The developing brain is particularly vulnerable to internal and external stressors, and it is no surprise that clinicians in the field of neonatal neurology fiercely debate the urgency of treating neonatal seizures while at the same token advocate minimizing exposure to potentially toxic antiseizure medications (ASMs). In this issue of Neurology® Clinical Practice, Carrasco et al.1 explored the evidence for early discontinuation of ASMs after acute symptomatic seizures in neonates and provide a pragmatic framework for clinicians to use in practice. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 28, 2023 Category: Neurology Authors: Anwar, T. Tags: Antiepileptic drugs, Neonatal seizures Editorial Source Type: research
