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Letter re: Efficacy and safety of brivaracetam for partial-onset seizures in 3 pooled clinical studies
We thank Dr. French1 for her Epilepsy Currents commentary on our article.2 We agree that time will tell regarding the usefulness of brivaracetam's (BRV's) addition to the antiepileptic drug (AED) armamentarium, as there is no substitute for real-world clinical experience. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Klein, P., Benbadis, S. R., Diaz, A., Moseley, B. D., Ben-Menachem, E. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Author response: Ischemic Lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage
We appreciate the comments by Drs. Lattanzi and Silvestrini on our article,1 and agree that further research is needed to better understand the complex relationship among blood pressure (BP) dysregulation, small vessel disease, and development of remote ischemic lesions in the setting of acute intracerebral hemorrhage.2 (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Kidwell, C. S., Rosand, J., Norato, G., Dixon, S., Worrall, B. B., James, M. L., Elkind, M. S. V., Flaherty, M. L., Osborne, J., Vashkevich, A., Langefeld, C. D., Moomaw, C. J., Woo, D. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Ischemic Lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage
We appreciated the article by Kidwell et al.1 that showed higher first-recorded blood pressure (BP) and greater delta mean arterial pressure are associated with the development of diffusion-weighted imaging (DWI) lesions in acute intracerebral hemorrhage (ICH). The most desirable BP target and optimal antihypertensive strategy in ICH are controversial.2 The relationship between BP and outcome is more complex than simply linear, and mechanisms other than BP reduction play a role. There is accruing evidence that not only absolute BP levels but their variation over time affect ICH prognosis.3 Besides increasing the risk of he...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Lattanzi, S., Silvestrini, M. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Editors' Note
: In "Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage," the authors concluded that acute blood pressure (BP) dysregulation in primary intracerebral hemorrhage (ICH) patients was associated with the development of diffusion-weighted imaging (DWI) lesions and, subsequently, worse outcomes. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Alcauskas, M., Galetta, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Fatigable ptosis as an initial presentation of adult-onset Leigh syndrome
A 20-year-old man presented with bilateral fatigable ptosis for 1 month. On examination, there was bilateral incomplete ptosis, which deteriorated during upward gaze and improved at rest (figure, A and B). Tests for myasthenia gravis were all negative. Brain MRI showed symmetric hyperintensities at periaqueductal gray matter on T2- and diffusion-weighted images (figure, C). CSF lactic acid was elevated. Mitochondrial genome test demonstrated a homoplasmic T9176C mutation in the MT-APT6A gene, known as pathogenic mutation of Leigh syndrome.1 In our patient, fatigable ptosis may be ascribed to the dysfunction at centrally lo...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Oh, E. H., Chae, S.-H., Cho, J.-W., Baik, S. K., Choi, S.-Y., Choi, K.-D., Choi, J.-H. Tags: MRI, Eyelids, Mitochondrial disorders NEUROIMAGES Source Type: research

Did Jules Dejerine describe AMAN at the end of the 19th century?
We describe his observations, which provide us with valuable information on the course of pathologic lesions in this disease. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Mathis, S., Magy, L., Le Masson, G., Vallat, J.-M. Tags: Autoimmune diseases, Clinical neurology history, Peripheral neuropathy, Guillain-Barre syndrome HISTORICAL NEUROLOGY Source Type: research

Genome editing technologies and their potential to treat neurologic disease
Genome editing refers to a process of making precise and permanent changes in the genetic code of cells, tissues, and whole organisms. The first step in this process is to program an enzyme called a nuclease to bind to a precise DNA sequence, whereby the enzyme will cut the DNA. This double-stranded break will in turn induce the cell to make a repair at that site, which will change the DNA sequence. The repair mechanism can be utilized to either knock out or introduce selected genes. Given how rapidly gene editing systems are influencing diverse applications in biomedical research, biotechnology, and agriculture,1 clinical...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Madigan, N. N., Staff, N. P., Windebank, A. J., Benarroch, E. E. Tags: CLINICAL IMPLICATIONS OF NEUROSCIENCE RESEARCH Source Type: research

Qualitative study of burnout, career satisfaction, and well-being among US neurologists in 2016
Conclusions: Our results further characterize burnout among US neurologists through respondents' own voices. They clarify the meaning respondents attributed to ambiguous survey questions and highlight the barriers neurologists must overcome to practice their chosen specialty, including multiple regulatory hassles and increased work hours. Erosion of professionalism by external factors was a common issue. Our findings can provide strategic direction for advocacy and programs to prevent and mitigate neurologist burnout and promote well-being and engagement. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Miyasaki, J. M., Rheaume, C., Gulya, L., Ellenstein, A., Schwarz, H. B., Vidic, T. R., Shanafelt, T. D., Cascino, T. L., Keran, C. M., Busis, N. A. Tags: Electronic medical records, Insurance, Administration ARTICLE Source Type: research

Smoking cessation and outcome after ischemic stroke or TIA
Conclusion: Cessation of cigarette smoking after an ischemic stroke or TIA was associated with significant health benefits over 4.8 years in the IRIS trial cohort. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Epstein, K. A., Viscoli, C. M., Spence, J. D., Young, L. H., Inzucchi, S. E., Gorman, M., Gerstenhaber, B., Guarino, P. D., Dixit, A., Furie, K. L., Kernan, W. N., For the IRIS Trial Investigators Tags: Stroke prevention, Prognosis, All Cerebrovascular disease/Stroke, Infarction ARTICLE Source Type: research

Serum magnesium is associated with the risk of dementia
Conclusions: Both low and high serum magnesium levels are associated with an increased risk of all-cause dementia. Our results warrant replication in other population-based studies. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Kieboom, B. C. T., Licher, S., Wolters, F. J., Ikram, M. K., Hoorn, E. J., Zietse, R., Stricker, B. H., Ikram, M. A. Tags: Electrolyte, All Cognitive Disorders/Dementia, Alzheimer's disease, Cohort studies, Incidence studies ARTICLE Source Type: research

Comparison of symptomatic and asymptomatic persons with primary age-related tauopathy
Objective: To conduct a clinicopathologic study to characterize clinical and neuropathologic features associated with cognitive impairment in participants with no neuritic amyloid plaques (primary age-related tauopathy [PART] definite) and sparse neuritic plaques (amyloid sparse). Methods: Using the National Alzheimer's Coordinating Center database, we identified 377 individuals who were PART definite (n = 170) or amyloid sparse (n = 207), clinically examined within 1 year of death, and autopsied at 1 of 26 National Institute on Aging–funded Alzheimer's Disease Centers. Factors associated with the odds of being symp...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Besser, L. M., Crary, J. F., Mock, C., Kukull, W. A. Tags: All Clinical Neurology, Prognosis, Depression, All Cognitive Disorders/Dementia, Cognitive aging ARTICLE Source Type: research

Pretreatment behavior and subsequent medication effects in childhood absence epilepsy
Conclusions: Pretreatment and ongoing behavioral problems exist in CAE. Valproic acid is associated with worse behavioral outcomes than ethosuximide or lamotrigine, further reinforcing ethosuximide as the preferred initial therapy for CAE. Clinicaltrials.gov identifier: NCT00088452. Classification of evidence: This study provides Class II evidence that for children with CAE, valproic acid is associated with worse behavioral outcomes than ethosuximide or lamotrigine. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Shinnar, R. C., Shinnar, S., Cnaan, A., Clark, P., Dlugos, D., Hirtz, D. G., Hu, F., Liu, C., Masur, D., Weiss, E. F., Glauser, T. A., For the Childhood Absence Epilepsy Study Group Tags: Clinical trials Randomized controlled (CONSORT agreement), Attention, All Pediatric, Antiepileptic drugs, Absence seizures ARTICLE Source Type: research

Variable course of Unverricht-Lundborg disease: Early prognostic factors
Conclusions: A younger age at onset, early severe myoclonus, and seizure persistence are predictors of a more severe outcome. All of these factors may be genetically determined, but the greater hyperexcitability underlying more severe seizures and myoclonus at onset may also play a role by increasing cell damage due to reduced cystatin B activity. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Canafoglia, L., Ferlazzo, E., Michelucci, R., Striano, P., Magaudda, A., Gambardella, A., Pasini, E., Belcastro, V., Riguzzi, P., Fanella, M., Granata, T., Beccaria, F., Trentini, C., Bianchi, A., Aguglia, U., Panzica, F., Franceschetti, S. Tags: Myoclonus; see Movement Disorders/myoclonus, Natural history studies (prognosis), EEG, Generalized seizures ARTICLE Source Type: research

Randomized open-label trial of dextromethorphan in Rett syndrome
Conclusions: Dextromethorphan is a potent noncompetitive antagonist of the NMDA receptor channel that is safe for use in young girls with Rett syndrome. Preliminary evidence suggests that dextromethorphan may improve some core features of Rett syndrome. Classification of evidence: This study provides Class IV evidence that dextromethorphan at various doses does not change EEG spike counts over 6 months, though precision was limited to exclude an important effect. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Smith-Hicks, C. L., Gupta, S., Ewen, J. B., Hong, M., Kratz, L., Kelley, R., Tierney, E., Vaurio, R., Bibat, G., Sanyal, A., Yenokyan, G., Brereton, N., Johnston, M. V., Naidu, S. Tags: Clinical trials Observational study (Cohort, Case control), Rett Syndrome, All Genetics ARTICLE Source Type: research

Analysis of blood-based gene expression in idiopathic Parkinson disease
Conclusions: We present a large-scale study of PD gene expression profiling. This work identifies a reliable blood-based PD signature and highlights the importance of large-scale patient cohorts in developing potential PD biomarkers. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Shamir, R., Klein, C., Amar, D., Vollstedt, E.-J., Bonin, M., Usenovic, M., Wong, Y. C., Maver, A., Poths, S., Safer, H., Corvol, J.-C., Lesage, S., Lavi, O., Deuschl, G., Kuhlenbaeumer, G., Pawlack, H., Ulitsky, I., Kasten, M., Riess, O., Brice, A., Pete Tags: All Movement Disorders, Parkinson's disease/Parkinsonism, Gene expression studies, All Genetics ARTICLE Source Type: research

Comorbidity in multiple sclerosis is associated with diagnostic delays and increased mortality
Objective: To investigate the effect of chronic comorbidity on the time of diagnosis of multiple sclerosis (MS) and on mortality in MS. Methods: We conducted a population-based, nationwide cohort study including all incident MS cases in Denmark with first MS symptom between 1980 and 2005. To investigate the time of diagnosis, we compared individuals with and without chronic comorbidity using multinomial logistic regression. To investigate mortality, we used Cox regression with time-dependent covariates, following study participants from clinical MS onset until endpoint (death) or to the end of the study, censuring at emig...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Thormann, A., Sorensen, P. S., Koch-Henriksen, N., Laursen, B., Magyari, M. Tags: Multiple sclerosis, Cohort studies ARTICLE Source Type: research

Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury
Conclusions: We demonstrate that maintaining SCPP above 50 mm Hg is a strong predictor of improved neurologic recovery following spinal cord injury. This suggests that SCPP (the difference between MAP and CSFP) can provide useful information to guide the hemodynamic management of patients with acute spinal cord injury. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Squair, J. W., Belanger, L. M., Tsang, A., Ritchie, L., Mac-Thiong, J.-M., Parent, S., Christie, S., Bailey, C., Dhall, S., Street, J., Ailon, T., Paquette, S., Dea, N., Fisher, C. G., Dvorak, M. F., West, C. R., Kwon, B. K. Tags: Clinical trials Observational study (Cohort, Case control), Spinal cord trauma; see Trauma/spinal cord trauma, Cerebrospinal Fluid ARTICLE Source Type: research

Preventing burnout increases the desirability of neurology as a career
Neurologic diseases comprise a major percentage of disease burden in the United States, and one that is predicted to increase as our population ages. The need for physicians with expertise in the recognition, diagnosis, and management of neurologic diseases also will increase. Over the next decade, the number of neurologists in the United States will grow from the current 16,000 to 18,000. However, even this number represents a predicted 20% shortfall in number of neurologists needed by 2025.1,2 Our neurology workforce therefore must increase to address this current and future need. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Khan, J., Bernat, J. L. Tags: EDITORIALS Source Type: research

Smoking cessation and secondary stroke prevention
The 7 million adult stroke survivors in the United States remain at high risk for a recurrent stroke. The increased morbidity and cost associated with recurrent stroke, in addition to the 5% to 20% yearly stroke recurrence, support the need for additional investigations into secondary stroke prevention.1,2 Stroke prevention guidelines, whether primary or secondary, focus on risk factor control of modifiable risk factors. The American Heart Association/American Stroke Association guidelines for secondary stroke prevention indicate evidence-based risk factor control, interventional approaches, and treatment options as approa...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Boehme, A. Tags: EDITORIALS Source Type: research

An improved way to predict neurologic recovery in acute spinal cord injury
In North America alone, spinal cord injury affects well over 1 million patients, with the average annual incidence expected to rise secondary to an increasing amount of falls in an aging population.1,2 Spinal cord injury (SCI) has detrimental health consequences that can frequently leave the injured patient with a lifetime of medical expenses exceeding $4 million.2 Although the current practice in treating SCI is to elevate a patient's mean arterial pressure (MAP) to 85–90 mm Hg for the first 7 days in an effort to maintain spinal cord perfusion, this treatment strategy has uncertain efficacy, as the actual spinal co...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Lyon, K. A., Huang, J. H. Tags: EDITORIALS Source Type: research

Spotlight on the October 17 issue
(Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Gross, R. A. Tags: IN FOCUS Source Type: research

Teaching Video NeuroImages: My weeping patient: Avoiding the pitfalls of a functional diagnosis
A 54-year-old man presented with symptoms of a posterior circulation stroke. A right facial palsy and horizontal right end gaze nystagmus was noted. On resolution, episodes of uncontrolled weeping without a provoking stimulus was observed (video at Neurology.org). These were initially unremitting, lasting minutes, with complete resolution after 1 month. An early consideration was of a functional neurologic disorder. Subsequent MRI brain demonstrated bilateral anterior pontine infarcts (figure). It has been hypothesized that pseudobulbar affect (PBA) results from the loss of frontal cortex input to the cerebellum during emo...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Peters, J., Vijiaratnam, N., Wijeratne, T. Tags: All Cerebrovascular disease/Stroke, All Education RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: MR neurography for the diagnosis of hypertrophic neuropathies
A 25-year-old woman presented with a 10-year history of frequent falls and deafness. Her mother had a similar neurologic picture. Examination showed peroneal amyotrophy, pes cavus, and hearing loss. Magnetic resonance (MR) neurography showed diffuse nerve enlargement in the lower limbs (figure). Genetic analysis revealed heterozygous mutation c.82T>C (p.Trp28Arg) in the PMP22 gene, defining diagnosis of Charcot-Marie-Tooth disease (CMT) type 1A. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Souza, P. V. S. d., Bortholin, T., Naylor, F. G. M., Pinto, W. B. V. d. R., Oliveira, A. S. B. Tags: MRI, Peripheral neuropathy RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Spontaneous involution of symptomatic delayed tumefactive cyst following radiosurgery for AVM
A 65-year-old woman underwent radiosurgery for a left temporal arteriovenous malformation (AVM) (figure 1A). Follow-up MRI/magnetic resonance angiography 3 years later demonstrated postradiation changes (figure 1B) and AVM resolution (figure 2). Six years posttreatment, she had progressive headaches and aphasia and a large cyst (figure 1C). Her symptoms resolved acutely without treatment. MRI 3 months later showed reduction of the cyst with mass effect resolution related to spontaneous fenestration in the ventricle (figure 1D). (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Aiello, G., Snyder, K., Brinjikji, W., Lanzino, G. Tags: MRI, Arteriovenous malformation RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Artery of Percheron thrombosis causing selective downgaze palsy
A 47-year-old man with migraines presented with sudden onset of vertical diplopia, dysarthria, right facial weakness, and downgaze palsy (figure 1). Brain MRI revealed ischemic strokes in the midbrain periaqueductal gray, bilateral thalamic–midbrain junction, and thalamus (figure 2, A–C). Gradient echo and T1 MRI showed hypointensity in the interpeduncular fossa (figure 2, D and E). No flow could be visualized in this structure on CT angiogram or catheter angiogram, demonstrating a thrombosed artery of Percheron (figure 2, F–H). Downgaze palsy, which improved 18 months later, may result from bilateral les...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Sechler, M., Singh, J., El Husseini, N. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Clinical Reasoning: A 46-year-old man with persistent hiccups, cognitive dysfunction, and imbalance
A 46-year-old, right-handed, African American man presented to the emergency department after 1 week of persistent hiccups and 3 days of nausea and vomiting. His family member also noted that he had been experiencing right-hand tremor and gait imbalance for the last 3 months. Over the 6 months prior to presentation, the patient's coworkers had noticed that he was completing his work more slowly, that he was forgetting how to perform simple tasks, and that several times he had come to work at the wrong hours. The patient had a history of HIV diagnosed 10 years earlier and reported good adherence to an antiretroviral regimen...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Lamb, C. J., Lopez Chiriboga, A. S., Sotello Aviles, D. A., Mendez, J. C., Robinson, M. T. Tags: All Infections, Encephalitis, HIV, Executive function, Assessment of cognitive disorders/dementia RESIDENT AND FELLOW SECTION Source Type: research

Increased brain-predicted aging in treated HIV disease
(Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Tags: CORRECTIONS Source Type: research

Author response: Burnout, career satisfaction, and well-being among US neurologists in 2016
We thank Bagot et al. for their comments. Burnout, career satisfaction, and well-being in neurologists who practice telemedicine is important to study as this practice model becomes more common. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Busis, N. A., Shanafelt, T. D., Keran, C. M., Levin, K. H., Schwarz, H. B., Molano, J. R., Vidic, T. R., Kass, J. S., Miyasaki, J. M., Sloan, J. A., Cascino, T. L. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
I read with interest the article on burnout among US neurologists.1 There are 2 additional factors contributing to burnout that the authors fail to address. One is the electronization of medicine. Electronization is a term used to describe the process of taking an item or process from paper-based form and electronically producing it, mainly to increase profitability and efficiency. We now have electronic health records (EHR) available on laptop, iPad, and cell phone. Patients can email physicians through the myconnect portal on the EHR, contact physicians through work email, or, in some instances, text physicians on cell p...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Sethi, N. K. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
The study by Busis et al.1 of 1,671 US neurologist survey respondents revealed that burnout was common among all neurology practice settings and subspecialties. During Dr. Cascino's 2017 Presidential Plenary Address, he presented a figure from a larger survey of US physicians in general that correlated the percentage of physicians with burnout identified by specialty with the percentage satisfied with their work–life balance.2 This graph seemed to indicate that neurology was among the specialties with the greatest degree of burnout and the least satisfaction with work–life balance.2 (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Berger, J. R. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
I heard the excellent Presidential Plenary Address by Dr. Terrence Cascino at the 2017 American Academy of Neurology (AAN) meeting. The focus of the AAN on this issue, especially early retirement, is to be applauded, but the emphasis on work–life balance and yoga is misplaced. The term burnout is demeaning to our colleagues. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Yanofsky, C. S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
Busis et al.1 investigated the prevalence and factors that contribute to burnout, career satisfaction, and well-being in US neurologists. Within the last decade, there has been growing interest in considering factors defined at multiple levels in psychological and health research; multilevel analysis emerged as a way to partly address this need by allowing simultaneous examination of group-level and individual-level factors.2 Given that doctors do not live in a social vacuum, without emotional, cognitive, and behavioral influences, but are active members of working groups with lead roles in health care organizations, a shi...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Giannouli, V. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
From a recent workforce survey, Busis et al.1 reported that 63% of neurologists in clinical practice had at least one symptom of burnout. Burnout and percentage of clinical practice time were associated with decreased professional satisfaction. However, meaningful work and job autonomy were associated with increased satisfaction. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Bagot, K. L., Cadilhac, D. A., Kim, J., Vu, M., Bladin, C. F. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Editors' Note
: In a survey of US American Academy of Neurology member neurologists who had finished training, Busis et al. found that approximately 60% had at least one symptom of burnout. Burnout was strongly associated with decreased career satisfaction, while meaningful work and job autonomy were associated with increased satisfaction. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Karam, C., Galetta, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

TIPIC syndrome
A 31-year-old woman presented with left acute cervical pain. Cervical imaging showed a large pericarotid infiltration (figure 1). A diagnosis of transient perivascular inflammation of the carotid artery (TIPIC) syndrome was made. The patient received steroids with full clinical recovery 12 days after onset. The follow-up ultrasound showed striking decrease of the perivascular infiltration, confirming the diagnosis (figure 2). (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Lecler, A., Obadia, M., Sadik, J.-C. Tags: Secondary headache disorders, MRI, Ultrasound, Other cerebrovascular disease/ Stroke NEUROIMAGES Source Type: research

Job negotiation
There are many who will find this poem Difficult to understand. And many who, thank God, Will not. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Schor, N. F. Tags: Administration REFLECTIONS: NEUROLOGY AND THE HUMANITIES Source Type: research

Swallowing-induced displacement of the carotid artery as a risk of stroke: Flip-flop phenomenon
A 70-year-old man without cerebrovascular risk factors was admitted to our hospital with amaurosis fugax of the right eye. Diffusion MRI showed an acute asymptomatic brain infarct in the right frontal lobe cortex, and carotid duplex ultrasound revealed movement of the right internal carotid artery (ICA), with a hypoechoic plaque at its origin, in contact with the hyoid bone during head rotation and swallowing (figure). (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Kinoshita, N., Saito, K., Tanaka, T., Kajimoto, K., Yamagami, H., Morita, Y., Ihara, M., Nagatsuka, K. Tags: MRI, Ultrasound, Infarction CLINICAL/SCIENTIFIC NOTES Source Type: research

Sex differences in the prevalence of genetic mutations in FTD and ALS: A meta-analysis
Conclusions: Higher female prevalence of C9orf72 hexanucleotide repeat expansions in ALS and GRN mutations in FTD suggest that sex-related risk factors might moderate C9orf72 and GRN-mediated phenotypic expression. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Curtis, A. F., Masellis, M., Hsiung, G.-Y. R., Moineddin, R., Zhang, K., Au, B., Millett, G., Mackenzie, I., Rogaeva, E., Tierney, M. C. Tags: All Clinical Neurology, Amyotrophic lateral sclerosis, Frontotemporal dementia, Gene expression studies, All epidemiology VIEWS & amp;amp; REVIEWS Source Type: research

Giuliano Vanghetti and the innovation of "cineplastic operations"
Conclusions: Vanghetti was the first to accurately perform and describe cineplastic operations for patients following an upper arm amputation. He considered the neurologic implications of the problem and, perhaps in an effort to provide more appropriate proprioceptive feedback, he intuitively applied the prostheses so that they were functionally activated by the muscles of the proximal stump. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Tropea, P., Mazzoni, A., Micera, S., Corbo, M. Tags: Quality of life, Clinical neurology history, Other trauma, Motor Control HISTORICAL NEUROLOGY Source Type: research

Quality improvement in neurology: Stroke and Stroke Rehabilitation Quality Measurement Set update
Stroke is the fifth leading cause of death in the United States and the second leading cause of disability worldwide.1,2 "On average, every 40 seconds, someone in the United States has a stroke, and someone dies of one approximately every 4 minutes."3 Each year, nearly 800,000 people experience stroke, with up to 185,000 experiencing recurrent stroke events.3 Strokes occur at any age, and risk increases with age.4 Nearly half of older stroke survivors experience moderate to severe disability.5 (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Latorre, J. G. S., Flanagan, S., Phipps, M. S., Shenoy, A. M., Bennett, A., Seidenwurm, D. Tags: All Imaging, All Cerebrovascular disease/Stroke, All Rehabilitation, All Practice Management SPECIAL ARTICLE Source Type: research

REM sleep behavior disorder is related to enteric neuropathology in Parkinson disease
Objective: To determine whether REM sleep behavior disorder (RBD) in Parkinson disease (PD) is associated with lesions and dysfunctions of the autonomic nervous system by evaluating enteric phosphorylated α-synuclein histopathology (PASH) and permeability. Methods: A total of 45 patients with PD were included in this cross-sectional study. RBD was diagnosed on the basis of a standardized clinical interview and confirmed by polysomnography. For each patient, 5 biopsies were taken at the junction between the sigmoid and descending colon during the course of a rectosigmoidoscopy. For the detection of enteric PASH, 2 co...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Leclair-Visonneau, L., Clairembault, T., Coron, E., Le Dily, S., Vavasseur, F., Dalichampt, M., Pereon, Y., Neunlist, M., Derkinderen, P. Tags: Parkinson's disease/Parkinsonism, Parasomnias ARTICLE Source Type: research

Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration
Conclusions: FTD is associated with outer retina thinning, and this thinning correlates with disease severity. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Kim, B. J., Irwin, D. J., Song, D., Daniel, E., Leveque, J. D., Raquib, A. R., Pan, W., Ying, G.-S., Aleman, T. S., Dunaief, J. L., Grossman, M. Tags: Progressive supranuclear palsy, Retina, Frontotemporal dementia ARTICLE Source Type: research

Cognitive trajectories over 4 years among HIV-infected women with optimal viral suppression
Objective: To determine whether persistent viral suppression alters cognitive trajectories among HIV-infected (HIV+) women on combination antiretroviral therapy (cART) by investigating performance longitudinally in uninfected (HIV–) and 3 groups of HIV+ women: those with consistent viral suppression after continuous cART use (VS), those without consistent virologic suppression despite continuous cART use (NVS), and those without consistent virologic suppression after intermittent cART use (Int NVS). Methods: Two hundred thirty-nine VS, 220 NVS, 172 Int NVS, and 301 HIV– women from the Women's Interagency HIV S...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Rubin, L. H., Maki, P. M., Springer, G., Benning, L., Anastos, K., Gustafson, D., Villacres, M. C., Jiang, X., Adimora, A. A., Waldrop-Valverde, D., Vance, D. E., Bolivar, H., Alden, C., Martin, E. M., Valcour, V. G., For the Women's Interagency HIV Study Tags: HIV, Neuropsychological assessment, HIV dementia, Assessment of cognitive disorders/dementia ARTICLE Source Type: research

Reversibility of the effects of natalizumab on peripheral immune cell dynamics in MS patients
Conclusions: Natalizumab's effects on peripheral immune cells and pharmacodynamic markers were reversible, with changes starting 8 weeks post last natalizumab dose; levels returned to those observed/expected in untreated patients 16 weeks post last dose. This reversibility differentiates natalizumab from MS treatments that require longer reconstitution times. Characterization of the time course of natalizumab's biological effects may help clinicians make treatment sequencing decisions. Classification of evidence: This study provides Class III evidence that the pharmacodynamic markers of natalizumab are reversed 16 weeks a...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Plavina, T., Muralidharan, K. K., Kuesters, G., Mikol, D., Evans, K., Subramanyam, M., Nestorov, I., Chen, Y., Dong, Q., Ho, P.-R., Amarante, D., Adams, A., De Seze, J., Fox, R., Gold, R., Jeffery, D., Kappos, L., Montalban, X., Weinstock-Guttman, B., Har Tags: All Demyelinating disease (CNS), Multiple sclerosis ARTICLE Source Type: research

25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort
Objective: To determine whether and to what extent vitamin D deficiency is associated with multiple sclerosis (MS) risk. Methods: We conducted a prospective nested case-control study among women in the Finnish Maternity Cohort (FMC). The FMC had 1.8 million stored serum samples taken during the pregnancies of over 800,000 women at the time of this study. Through linkages with hospital and prescription registries, we identified 1,092 women with MS diagnosed between 1983 and 2009 with at least 1 serum sample collected prior to date of MS diagnosis; ≥2 serum samples were available for 511 cases. Cases were matched to up t...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Munger, K. L., Hongell, K., Aivo, J., Soilu-Hänninen, M., Surcel, H.-M., Ascherio, A. Tags: Multiple sclerosis, Risk factors in epidemiology ARTICLE Source Type: research

Nonlinear temporal dynamics of cerebral small vessel disease: The RUN DMC study
Objective: To investigate the temporal dynamics of cerebral small vessel disease (SVD) by 3 consecutive assessments over a period of 9 years, distinguishing progression from regression. Methods: Changes in SVD markers of 276 participants of the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) cohort were assessed at 3 time points over 9 years. We assessed white matter hyperintensities (WMH) volume by semiautomatic segmentation and rated lacunes and microbleeds manually. We categorized baseline WMH severity as mild, moderate, or severe according to the modified Fazekas scale. We ...
Source: Neurology - October 9, 2017 Category: Neurology Authors: van Leijsen, E. M. C., van Uden, I. W. M., Ghafoorian, M., Bergkamp, M. I., Lohner, V., Kooijmans, E. C. M., van der Holst, H. M., Tuladhar, A. M., Norris, D. G., van Dijk, E. J., Rutten-Jacobs, L. C. A., Platel, B., Klijn, C. J. M., de Leeuw, F.-E. Tags: MRI, All Cerebrovascular disease/Stroke, Cohort studies, Risk factors in epidemiology ARTICLE Source Type: research

Outcome after stroke thrombolysis in patients >80 years treated within 3 hours vs >3-4.5 hours
Objective: To determine outcomes and risks of IV thrombolysis (IVT) in patients with acute ischemic stroke (AIS)>80 years of age within 3 hours compared to>3 to 4.5 hours recorded in the Safe Implementation of Treatment in Stroke (SITS) International Stroke Thrombolysis Registry. Methods: A total of 14,240 (year 2003–2015) patients>80 years of age with AIS were treated with IVT ≤4.5 hours of stroke onset (3,558 in>3–4.5 hours). Of these, 8,658 (2,157 in>3–4.5 hours) were treated otherwise according to the European Summary of Product Characteristics (EU SmPC) criteria for alteplase. Outc...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Ahmed, N., Lees, K. R., Ringleb, P. A., Bladin, C., Collas, D., Toni, D., Ford, G. A., And the SITS Investigators Tags: All Cerebrovascular disease/Stroke ARTICLE Source Type: research

CSF inflammatory response after intraventricular hemorrhage
Conclusions: Aseptic CSF inflammation after IVH is primarily dependent on the volume of initial bleed. Thrombolysis intensifies the inflammatory response, with no apparent detrimental effect on clinical outcome. Clinicaltrials.gov identifier: NCT00784134. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Fam, M. D., Zeineddine, H. A., Eliyas, J. K., Stadnik, A., Jesselson, M., McBee, N., Lane, K., Cao, Y., Wu, M., Zhang, L., Thompson, R. E., John, S., Ziai, W., Hanley, D. F., Awad, I. A., On behalf of the CLEAR III Trial Investigators Tags: Clinical trials Observational study (Cohort, Case control), Intracerebral hemorrhage ARTICLE Source Type: research

Relevance of supraventricular runs detected after cerebral ischemia
Objective: Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up. Methods: Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on ad...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Weber-Krüger, M., Lutz, C., Zapf, A., Stahrenberg, R., Seegers, J., Witzenhausen, J., Wasser, K., Hasenfuss, G., Gröschel, K., Wachter, R. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Clinical trials Observational study (Cohort, Case control), Cardiac ARTICLE Source Type: research

Franz Gerstenbrand, Dr med (1924-2017)
Franz Gerstenbrand was born on September 6, 1924, in Hof, North Moravia. He attended elementary and high school in Nikolsburg in Südmähren. In 1942, he was in the German armed forces, and after the Second World War he studied medicine at the University of Vienna, earning a doctorate in 1950. Under Hans Hoff, the head of the Department of Neurology of the University Hospital Vienna, he finished his specialization in neurology and psychiatry. At that time, his special interests were neurotrauma, prolonged coma after severe brain damage, spinal cord injury, and the early diagnosis of brain damage in child neurology. In 19...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Golaszewski, S. Tags: IN MEMORIAM Source Type: research