Systemic vasculitis with dermatomyositis, hearing loss, neuropathy, and multiorgan dysfunction
A 39-year-old woman presented with 10 months of steadily progressive weakness, myalgia, weight loss, and intermittent feet tingling. During the course of her illness, she developed refractory atrial fibrillation, left followed by right-sided hearing loss, amenorrhea, and hematuria. She had been on rituximab for years for "polyarthralgias," which was stopped at symptom onset. Examination showed severe proximal weakness and mildly decreased toe proprioception. Deltoid biopsy (figure) was diagnostic of dermatomyositis. Liver and enteric biopsies showed lymphocytosis. Suspicion for vasculitis led to sural nerve biops...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Dhawan, P. S., Dyck, P. J. B., Tracy, J. A., Naddaf, E. Tags: Vasculitis, Peripheral neuropathy NEUROIMAGES Source Type: research

Home for the holidays
Your hug wasn't your hug. Your left arm didn't encircle me as tightly, and the left side of your smile didn't arch upward as completely. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Frey, J. Tags: Stroke in young adults, All Cerebrovascular disease/Stroke, Neglect REFLECTIONS: NEUROLOGY AND THE HUMANITIES Source Type: research

Successful motor mapping with transcranial magnetic stimulation in an infant: A case report
Accurate assessment of motor function is critical, particularly in the context of presurgical functional mapping. There are a few noninvasive tools available for preoperative motor mapping in older children and adults undergoing surgery for brain tumor or refractory epilepsy including fMRI, magnetoencephalography (MEG), and transcranial magnetic stimulation (TMS).1,2 However, assessing motor function is challenging in very young children. Direct cortical stimulation, a standard procedure in adults, is associated with a high incidence of intraoperative seizures, and is often unsuccessful in young children.3,4 Alternately, n...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Narayana, S., Mudigoudar, B., Babajani-Feremi, A., Choudhri, A. F., Boop, F. A. Tags: All Clinical Neurology, All Pediatric, TMS, Epilepsy surgery, Cortical localization CLINICAL/SCIENTIFIC NOTES Source Type: research

Serum neurofilament light is sensitive to active cerebral small vessel disease
Objective: To explore whether serum neurofilament light chain protein (NfL) levels are increased in patients with MRI-confirmed recent small subcortical infarcts (RSSI) compared to healthy controls and to determine the subsequent course and determinants of NfL levels in a longitudinal manner. Methods: In a prospectively collected group of symptomatic patients with an RSSI (n = 79, mean age 61 ± 11 years, 67% male), we analyzed brain MRI and serum NfL using a Single Molecule Array (Simoa) assay at baseline and at 3 and 15 months after stroke. Community-dwelling healthy age- and sex-matched individuals with comparabl...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Gattringer, T., Pinter, D., Enzinger, C., Seifert-Held, T., Kneihsl, M., Fandler, S., Pichler, A., Barro, C., Gröbke, S., Voortman, M., Pirpamer, L., Hofer, E., Ropele, S., Schmidt, R., Kuhle, J., Fazekas, F., Khalil, M. Tags: All Cerebrovascular disease/Stroke ARTICLE Source Type: research

Association between percent decline in serum total homocysteine and risk of first stroke
Conclusions: Percent lowering in tHcy was significantly associated with a reduction in first stroke risk in Chinese adults with hypertension, and if further confirmed, may serve as a useful indicator for folic acid treatment efficacy on stroke prevention. Clinicaltrials.gov identifier: NCT00794885. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Huang, X., Li, Y., Li, P., Li, J., Bao, H., Zhang, Y., Wang, B., Sun, N., Wang, J., He, M., Yin, D., Tang, G., Chen, Y., Cui, Y., Huang, Y., Hou, F. F., Qin, X., Huo, Y., Cheng, X. Tags: Stroke prevention, All Clinical trials ARTICLE Source Type: research

Infliximab for the treatment of CNS sarcoidosis: A multi-institutional series
Conclusions: Most patients with CNS sarcoidosis treated with infliximab exhibit favorable imaging and clinical treatment responses, including some previously refractory to other immunosuppressive treatments. Classification of evidence: This study provides Class IV evidence that for patients with CNS sarcoidosis infliximab is associated with favorable imaging and clinical responses. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Gelfand, J. M., Bradshaw, M. J., Stern, B. J., Clifford, D. B., Wang, Y., Cho, T. A., Koth, L. L., Hauser, S. L., Dierkhising, J., Vu, N., Sriram, S., Moses, H., Bagnato, F., Kaufmann, J. A., Ammah, D. J., Yohannes, T. H., Hamblin, M. J., Venna, N., Green Tags: All Immunology ARTICLE Source Type: research

Optimal deep brain stimulation site and target connectivity for chronic cluster headache
Conclusions: We identify the optimal stimulation site and structural connectivity of the deep brain stimulation target for cluster headache, explicating possible mechanisms of action and disease pathophysiology. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Akram, H., Miller, S., Lagrata, S., Hariz, M., Ashburner, J., Behrens, T., Matharu, M., Zrinzo, L. Tags: Cluster headache, DWI ARTICLE Source Type: research

Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine
Conclusions: IV hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the ED and should not be used as first-line therapy. ClinicalTrials.gov identifier: NCT02389829. Classification of evidence: This study provides Class I evidence that for patients in the ED with migraine, IV prochlorperazine + diphenhydramine is superior to IV hydromorphone. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Friedman, B. W., Irizarry, E., Solorzano, C., Latev, A., Rosa, K., Zias, E., Vinson, D. R., Bijur, P. E., Gallagher, E. J. Tags: Migraine, Clinical trials Randomized controlled (CONSORT agreement), Class I ARTICLE Source Type: research

Volumetric brain changes in migraineurs from the general population
Objective: To assess volumetric brain changes in migraineurs from the general population compared with controls. Methods: Structural brain changes in migraineurs from the general population-based MRI Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis (CAMERA)-2 observational cohort study were assessed by state-of-the-art voxel-based morphometry. T1-weighted MRIs of 84 migraineurs (52 with aura, 32 without aura) and 35 headache-free controls were evaluated. Regional volumes were compared voxelwise, corrected for age, sex, and total intracranial volume, with region-of-interest and whole-brain analyses. Resu...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Palm-Meinders, I. H., Arkink, E. B., Koppen, H., Amlal, S., Terwindt, G. M., Launer, L. J., van Buchem, M. A., Ferrari, M. D., Kruit, M. C. Tags: Migraine, Volumetric MRI, All Clinical Neurology, Visual processing, All Pain ARTICLE Source Type: research

Adding quantitative muscle MRI to the FSHD clinical trial toolbox
Conclusions: We show a strong correlation between quantitative muscle MRI and clinical outcome measures. Muscle MRI is able to detect muscle pathology before clinical involvement of the leg muscles. This indicates that quantitative leg muscle MRI is a promising biomarker that captures disease severity and motor functioning and can thus be included in the FSHD trial toolbox. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Mul, K., Vincenten, S. C. C., Voermans, N. C., Lemmers, R. J. L. F., van der Vliet, P. J., van der Maarel, S. M., Padberg, G. W., Horlings, C. G. C., van Engelen, B. G. M. Tags: Outcome research, MRI, Muscle disease, Cohort studies ARTICLE Source Type: research

The social and economic burden of frontotemporal degeneration
Objective: To quantify the socioeconomic burden of frontotemporal degeneration (FTD) compared to previously published data for Alzheimer disease (AD). Methods: A 250-item internet survey was administered to primary caregivers of patients with behavioral-variant FTD (bvFTD), primary progressive aphasia, FTD with motor neuron disease, corticobasal syndrome, or progressive supranuclear palsy. The survey included validated scales for disease staging, behavior, activities of daily living, caregiver burden, and health economics, as well as investigator-designed questions to capture patient and caregiver experience with FTD. Re...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Galvin, J. E., Howard, D. H., Denny, S. S., Dickinson, S., Tatton, N. Tags: Cost effectiveness/economic, Quality of life, All Cognitive Disorders/Dementia, Frontotemporal dementia ARTICLE Source Type: research

Weighting and standardization of frequencies to determine prevalence of AD imaging biomarkers
Conclusions: These prevalence estimates are important for understanding age-related trends in amyloid positivity and AD signature cortical thickness in the population, and for potentially projecting the future burden of biomarkers in elderly persons. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Roberts, R. O., Knopman, D. S., Syrjanen, J. A., Aakre, J. A., Vassilaki, M., Kremers, W. K., Mielke, M. M., Machulda, M. M., Graff-Radford, J., Geda, Y. E., Vemuri, P., Lowe, V., Jack, C. R., Petersen, R. C. Tags: MRI, PET, Alzheimer's disease, MCI (mild cognitive impairment), Prevalence studies ARTICLE Source Type: research

In vivo staging of regional amyloid deposition
Conclusions: The highly consistent regional hierarchy of PET-evidenced amyloid deposition across participants resembles neuropathologic observations and suggests a predictable regional sequence that may be used to stage an individual's progress of amyloid pathology in vivo. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Grothe, M. J., Barthel, H., Sepulcre, J., Dyrba, M., Sabri, O., Teipel, S. J., For the Alzheimer's Disease Neuroimaging Initiative Tags: PET, Alzheimer's disease ARTICLE Source Type: research

Amyloid PET scan: Staging beyond reading?
The advent of in vivo β-amyloid (Aβ) PET imaging has revolutionized the field of Alzheimer disease (AD). The opportunity to visualize, during life, one of the main neuropathologic hallmarks of the disease, i.e., Aβ deposition, has yielded considerable hope for diagnosis and treatment efficacy. From a clinical perspective, although the presence of Aβ deposition in the brain is not a sufficient criterion for AD dementia diagnosis, Aβ PET imaging is used to support or rule out the diagnosis, especially in patients with a complicated clinical course.1 Moreover, Aβ PET imaging is a powerful to...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Chetelat, G., Murray, M. E. Tags: EDITORIALS Source Type: research

The new Neurology: Redesigns, short articles for print, full articles online, and data availability policies
Readers will note sweeping changes in Neurology® as of the January 2, 2018, issue, changes that were carefully considered as the Editors reimagined the journal in the context of changes in scientific publishing in general, and supported by extensive research in readers' habits and preferences. The most notable changes occur both in print and online, for which there are new designs, the result of 2 years' work and crafting. For print, we are publishing articles in a short format, allowing a more comprehensive reading experience in a shorter time. For the online, canonical version of the journal, we are now able to accom...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Baskin, P. K., Gross, R. A. Tags: SPECIAL EDITORIALS Source Type: research

Spotlight on the November 14 issue
(Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Gross, R. A. Tags: IN FOCUS Source Type: research

Teaching Video NeuroImages: The pathologic deep abdominal reflex
A 68-year-old man presented with progressive asymmetric limb weakness and muscle wasting over 12 months. There were profuse fasciculations and hyperreflexia in the limbs and abdominal muscles (see video at Neurology.org), consistent with amyotrophic lateral sclerosis. (Source: Neurology)
Source: Neurology - November 13, 2017 Category: Neurology Authors: Kee, R., O'Gorman, C. M. Tags: Clinical neurology examination, Anterior nerve cell disease, All Education RESIDENT AND FELLOW SECTION Source Type: research

Clinical Reasoning: Prognostication after cardiac arrest: What do we really know?
A 43-year-old woman with a history of hypertension had a witnessed collapse while smoking crack cocaine. Immediate bystander cardiopulmonary resuscitation was performed for 15 minutes; total downtime was estimated at 30 minutes with return of spontaneous circulation (ROSC) achieved after defibrillation of ventricular fibrillation and a total of 5 mg IV epinephrine. Cardiac catheterization showed normal coronary vasculature. Initial neurologic examination 2 hours after fentanyl and vecuronium boluses was significant for nonreactive pupils, absent gag reflex, and no motor response to noxious stimulation, but intact...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Beekman, R. B., Greer, D. M., Brooks, D. C., Maciel, C. B. Tags: RESIDENT AND FELLOW SECTION Source Type: research

Author response: Education Research: Positive effect of scheduled faculty modeling on clerkship student bedside skills exposure and learning
We thank Dr. Sethi for his letter on our article.1 Dr. Sethi advocates for a scheduled assessment of bedside skills by a faculty member during the last week of the clerkship. Indeed, at the University of Rochester, all clerkship students participate in a faculty-observed bedside skills examination of a neurology inpatient during the final week of the clerkship. The examination is scheduled for 1 hour, during which the student is observed taking a complete history, performing a complete neurologic examination, and presenting and discussing the case with the attending physician. Feedback is provided following the examination...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Thompson Stone, R., Tollefson, T., Epstein, R., Jozefowicz, R. F., Mink, J. W. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Education Research: Positive effect of scheduled faculty modeling on clerkship student bedside skills exposure and learning
I read with interest the Education Research article by Thompson Stone et al.,1 which evaluated the effect of scheduled bedside skills modeling on the neurology clerkship of third-year medical students. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Sethi, N. K. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Author response: Evaluating the safety of {beta}-interferons in MS: A series of nested case-control studies
I thank Dr. Jongen for the interest in our article,1 and agree with the points made. While space precluded us from citing all the relevant literature in the main text of our article, interested readers can access an extensive review, including the article by Jongen et al.,2 as an appendix to our article (appendix e-1).1 The appendix includes over 100 studies and case reports related to potential adverse effects of the β-interferons and outlines the article referred to by Dr. Jongen.2 (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Tremlett, H. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Evaluating the safety of {beta}-interferons in MS: A series of nested case-control studies
In a series of case-control studies of patients with multiple sclerosis (MS), de Jong et al.1 found that exposure to β-interferons was associated with a 1.8-fold increased risk of stroke. The authors rightfully state that stroke is not well-recognized as a potential adverse event of β-interferons, referring to cases reported in 2006 and 2008.2,3 (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Jongen, P. J. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Editors' Note
: In "Evaluating the safety of β-interferons in MS: A series of nested case-control studies," de Jong et al. found that exposure to β-interferons was associated with a 1.8-fold increased risk of stroke. Commenting on the study, Dr. Jongen shares his own prospective study on adverse events in 284 patients with multiple sclerosis treated with intramuscular interferon-β-1a: one patient died from a stroke sinus thrombosis 22 months after start of treatment. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Karam, C., Griggs, R. C. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Ping-pong gaze and ocular nodding in bacterial meningitis
A 27-year-old man presented with fever, somnolence, seizure, and nuchal rigidity. CSF culture indicated Streptococcus pneumoniae, confirming the diagnosis of bacterial meningitis. Ping-pong gaze was observed initially, and then replaced by what we called ocular nodding after IV administration of diazepam (video at Neurology.org). The eyes went downward and returned to primary position slowly, smoothly, and periodically (with a cycle lasting 12–17 seconds and a pause between 2 cycles), resembling a nodding head. He became alert with free eye movement within 3 days of antibiotic treatment. Ping-pong gaze has been repor...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Wang, Y., Huang, Y.-H., Yang, S.-L. Tags: Meningitis, Clinical neurology examination, Ocular motility VIDEO NEUROIMAGES Source Type: research

Granulocytic sarcoma of the choroid plexus complicating acute leukemia
A 38-year-old patient with type 5 acute myeloid leukemia relapsed after 4 years of treatment including chemotherapy and bone marrow transplant. He underwent imaging for vertigo, with an otherwise normal neurologic examination. Brain MRI showed diffuse choroid plexus enlargement, without hydrocephalus, a rare typical image of granulocytic sarcoma (figure, A).1 The patient also had spine MRI, to explore right L5 radiculopathy, which showed signs of meningitis with radicular and diffuse epidural enhancement (figure, B). (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Apra, C., Bourdillon, P. Tags: MRI, Hematologic NEUROIMAGES Source Type: research

Anti-cytosolic 5'-nucleotidase 1A (cN1A) autoantibodies in motor neuron diseases
Inclusion body myositis (IBM) is the most common acquired muscle disease in patients older than 50 years. Asymmetric weakness and early involvement of quadriceps and forearm flexors are key clinical features. Muscle biopsy remains the gold standard diagnostic test, which has high specificity, but low sensitivity.1 In addition to the canonical pathologic features of IBM, upregulation of major histocompatibility complex class I and accumulation of various proteins (p62, SMI-31, and TDP-43) have been adopted to the 2011 European Neuromuscular Center diagnostic criteria for IBM.1 The recent identification of anti-cytosolic 5'-...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Liewluck, T. Tags: Anterior nerve cell disease, Amyotrophic lateral sclerosis, Muscle disease CLINICAL/SCIENTIFIC NOTES Source Type: research

Effect of concussion and blast exposure on symptoms after military deployment
Conclusions: There appears to be a continuum of increasing total symptoms from no exposure to blast exposure plus both current deployment concussion and past concussion. Concussion had a greater influence than blast exposure alone on the presence of postdeployment symptoms. A high blast injury score can be used to triage those exposed to explosive blasts for evaluation. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Tsao, J. W., Stentz, L. A., Rouhanian, M., Howard, R. S., Perry, B. N., Haran, F. J., Pasquina, P. F., Wolde, M., Taylor, C. E., Lizardo, R., Liu, S., Flores, E., Creason, A. H., Sher, K. Tags: Brain trauma ARTICLE Source Type: research

Subjective cognitive decline and {beta}-amyloid burden predict cognitive change in healthy elderly
Objective: To assess in a longitudinal study whether subjective cognitive decline (SCD) and brain β-amyloid (Aβ) contribute unique information to cognitive decline. Methods: One hundred thirty-six healthy elderly from the Berkeley Aging Cohort Study were followed up for a mean of 4 years. SCD and affective measures were generated from the Geriatric Depression Scale (GDS) with factor analysis on data from a larger set of 347 healthy, nondepressed (GDS
Source: Neurology - November 6, 2017 Category: Neurology Authors: Vogel, J. W., Varga Dolezalova, M., La Joie, R., Marks, S. M., Schwimmer, H. D., Landau, S. M., Jagust, W. J. Tags: PET, Memory, Alzheimer's disease, Cognitive aging ARTICLE Source Type: research

Prevalence and clinical features of neuromyelitis optica spectrum disorders in northern Japan
Conclusions: Our results showed that the prevalence of NMOSD in the Japanese population is similar to that in Caucasians. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Houzen, H., Kondo, K., Niino, M., Horiuchi, K., Takahashi, T., Nakashima, I., Tanaka, K. Tags: Multiple sclerosis, Devic's syndrome, Optic neuritis; see Neuro-ophthalmology/Optic Nerve, Transverse myelitis, Prevalence studies ARTICLE Source Type: research

Increasing prevalence of vascular risk factors in patients with stroke: A call to action
Conclusions: Despite numerous guidelines and prevention initiatives, prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in AIS increased across the 2004–2014 period. Proportion of patients with carotid stenosis, CRF, and multiple risk factors also increased. Enhanced risk factor modification strategies and implementation of evidence-based recommendations are needed for optimal stroke prevention. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Otite, F. O., Liaw, N., Khandelwal, P., Malik, A. M., Romano, J. G., Rundek, T., Sacco, R. L., Chaturvedi, S. Tags: Stroke prevention, Embolism, Prevalence studies, Risk factors in epidemiology, Infarction ARTICLE Source Type: research

Radiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis
Conclusions: One in 5 persons with periprocedural radiographic brain ischemia during CEA and CAS had strokes and TIAs. The stable ratio of stroke and TIA to radiographic ischemia suggests that MRI ischemia could serve as a surrogate measure of periprocedural risk. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Cho, S.-M., Deshpande, A., Pasupuleti, V., Hernandez, A. V., Uchino, K. Tags: MRI, All Cerebrovascular disease/Stroke ARTICLE Source Type: research

Population-based study of home-time by stroke type and correlation with modified Rankin score
Conclusions: We showed that home-time is an objective and graded indicator that is correlated with disability after stroke. It is obtainable from administrative data, applicable to different stroke types, and a valuable outcome indicator in population-based health services research. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Yu, A. Y. X., Rogers, E., Wang, M., Sajobi, T. T., Coutts, S. B., Menon, B. K., Hill, M. D., Smith, E. E. Tags: Outcome research, Medical care, Infarction, Intracerebral hemorrhage ARTICLE Source Type: research

Longitudinal CSF biomarkers in patients with early Parkinson disease and healthy controls
Conclusions: These core CSF biomarkers remained stable over 6 and 12 months in patients with early PD and HC. PD medication use may influence CSF α-syn. Novel biomarkers are needed to better profile progressive neurodegeneration in PD. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Mollenhauer, B., Caspell-Garcia, C. J., Coffey, C. S., Taylor, P., Shaw, L. M., Trojanowski, J. Q., Singleton, A., Frasier, M., Marek, K., Galasko, D., For the Parkinson's Progression Marker Initiative Tags: Outcome research, Parkinson's disease/Parkinsonism, Cohort studies ARTICLE Source Type: research

Longitudinal decline of driving safety in Parkinson disease
Objective: To longitudinally assess and predict on-road driving safety in Parkinson disease (PD). Methods: Drivers with PD (n = 67) and healthy controls (n = 110) drove a standardized route in an instrumented vehicle and were invited to return 2 years later. A professional driving expert reviewed drive data and videos to score safety errors. Results: At baseline, drivers with PD performed worse on visual, cognitive, and motor tests, and committed more road safety errors compared to controls (median PD 38.0 vs controls 30.5; p
Source: Neurology - November 6, 2017 Category: Neurology Authors: Uc, E. Y., Rizzo, M., O'Shea, A. M. J., Anderson, S. W., Dawson, J. D. Tags: Quality of life, Parkinson's disease/Parkinsonism, Neuropsychological assessment, Cohort studies ARTICLE Source Type: research

Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease
Objective: To compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement. Methods: DBS candidates with PD referred to Oregon Health & Science University underwent asleep DBS with imaging guidance. Six-month outcomes were compared to those of patients who previously underwent awake DBS by the same surgeon and center. Assessments included an "off"-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II a...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Brodsky, M. A., Anderson, S., Murchison, C., Seier, M., Wilhelm, J., Vederman, A., Burchiel, K. J. Tags: Parkinson's disease/Parkinsonism ARTICLE Source Type: research

Jessica Anne Panzer, MD, PhD (1977-2017)
Jessica Anne Panzer, MD, PhD, Assistant Professor of Neurology and Pediatrics at The Children's Hospital of Philadelphia (CHOP) and The Perelman School of Medicine at The University of Pennsylvania, died on May 13, 2017, at age 40 years, after a brief struggle with cancer. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Banwell, B., Goldberg, E. M., Ortiz-Gonzalez, X. R. Tags: IN MEMORIAM Source Type: research

Big data trends in stroke epidemiology in the United States: But are they good data?
Based on prior epidemiologic studies in the United States, approximately 80% of first-time strokes can be explained by modifiable risk factors such as hypertension, and therefore optimal control or elimination of known risk factors might prevent these strokes.1 Campaigns such as the American Heart Association (AHA) initiative, Life's Simple 7, have set ambitious goals for optimal cardiovascular and stroke risk factor control; in addition, a wealth of online resources are available for an increasingly health-conscious society.2 There are indeed some glimmers of hope. Efforts to prevent stroke, in large part from emphasis on...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Prabhakaran, S. Tags: EDITORIALS Source Type: research

To sleep or not to sleep during deep brain stimulation surgery for Parkinson disease?
In functional stereotactic neurosurgery, precise placement of lesions or deep brain stimulation (DBS) electrodes is paramount. From the beginning of the specialty, electrical stimulation of the brain target prior to lesioning, and confirmation of accuracy of targeting by postoperative imaging, have been critical.1 Two schools subsequently evolved: one using macroelectrode stimulation in the awake patient with careful on-table assessment and one using microelectrode recording (MER) to map out boundaries of the target followed by microstimulation to assess efficacy and avoid side effects. For many, the latter technique was a...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Aziz, T. Z., Hariz, M. Tags: EDITORIALS Source Type: research

Alzheimer dementia's other victim: The spouse
Editor's Note: The initial portion of this essay is an excerpt from the author's book (Before I Forget: Love, Hope, Help, and Acceptance in our Fight Against Alzheimer's. Copyright © 2016 by B. Smith, Dan Gasby, and Michael Shnayerson. Published by Harmony Books, an imprint of Penguin Random House LLC), reprinted with permission. Following this excerpt is an update from the events chronicled in the book. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Gasby, D. Tags: SPECIAL EDITORIALS Source Type: research

Spotlight on the November 7 issue
(Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Gross, R. A. Tags: IN FOCUS Source Type: research

Teaching Video NeuroImages: Upbeat and horizontal gaze-evoked nystagmus in bilateral medial medullary infarction
A 41-year-old man with progressive quadriparesis and generalized tingling sensation showed spontaneous upbeating nystagmus and horizontal gaze-evoked nystagmus (video at Neurology.org). The initial diffusion-weighted images showed an equivocal hyperintensity at midline of rostral medulla (upper row). Follow-up MRIs (lower row) showed characteristic heart appearance sign (figure). (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Lee, E.-S., Sung, K.-B., Lee, T.-K. Tags: Clinical neurology examination, Nystagmus, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Craniofacial fibrous dysplasia: Loss of vision after head trauma
A 24-year-old woman presented with blurred vision of her left eye 1 hour after a mild head trauma. Examination revealed left-sided exophthalmos and left side 20/40 vision with relative afferent pupillary defect. CT (figure 1) and MRI scan (figure 2) revealed ground-glass bone abnormalities involving the left frontal, orbital, and sphenoidal bones causing compression of the left optic nerve, all pathognomonic of fibrous dysplasia (FD). FD is a rare slowly progressive benign disorder where normal bone is replaced with abnormal fibrous tissue.1 IV methylprednisolone was given to treat supposed posttraumatic edema around the l...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Sarihan, F., Kasius, K. M. Tags: CT, All Clinical Neurology, Optic nerve, Visual loss, Brain trauma RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Sucking candy sign in Bell palsy
A 20-year-old woman presented with spontaneous onset of facial weakness. Examination revealed House-Brackmann grade IV1 right facial paresis and a contralaterally pigmented tongue (figure) from habitual sucking candy use. Contemporaneous taste loss on the anterior right tongue led her to keep the candy as far away from that area as possible—the posterior left tongue. (Source: Neurology)
Source: Neurology - November 6, 2017 Category: Neurology Authors: Armand, C. E., Robbins, M. S. Tags: Clinical neurology examination, Cranial neuropathy, All Education RESIDENT AND FELLOW SECTION Source Type: research

Clinical Reasoning: A patient with a history of encephalomyelitis and recurrent optic neuritis
A 4-year-old girl presented to an outside hospital after waking up with inability to stand or walk. She had a viral prodrome with fever for several days. Brain and spine MRIs revealed lesions in the left caudate, bilateral insular cortex, right thalamus, and right temporal cortex as well as longitudinally extensive cervical and thoracic cord lesions. Spinal fluid showed pleocytosis with 200 white blood cells (mixed neutrophils and lymphocytes), elevated CSF protein (103 mg/dL), and negative bacterial and viral cultures and PCR. Oligoclonal bands were negative. During the hospitalization, she developed encephalopathy and wa...
Source: Neurology - November 6, 2017 Category: Neurology Authors: Gutman, J. M., Levy, M., Galetta, S., Kister, I. Tags: All Pediatric, Optic neuritis; see Neuro-ophthalmology/Optic Nerve, Acute disseminated encephalomyelitis, Transverse myelitis RESIDENT AND FELLOW SECTION Source Type: research

Author response: Neuropsychiatric symptoms predict hypometabolism in preclinical Alzheimer disease
We thank Landin-Romero and Kumfor for the comments. Our regression techniques showed an association between neuropsychiatric inventory (NPI) scores and [18F]fluorodeoxyglucose (FDG) uptake in preclinical Alzheimer disease (AD).1 We did not find posterior cingulate cortex (PCC) hypermetabolism, but higher PCC-FDG uptake was found in patients with preclinical AD with higher NPI scores at baseline. We did not find hypermetabolism even when we contrasted the mean FDG uptake at the local maxima within the cluster. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Gauthier, S., Ng, K. P., Pascoal, T. A., Mathotaarachchi, S., Chung, C.-O., Benedetti, A. L., Shin, M., Kang, M. S., Li, X., Ba, M., Kandiah, N., Rosa-Neto, P. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Neuropsychiatric symptoms predict hypometabolism in preclinical Alzheimer disease
Ng et al.1 reported that Neuropsychiatric Inventory (NPI) scores predict hypometabolism in the posterior cingulate cortex (PCC) in preclinical Alzheimer disease (AD) with PCC hypermetabolism at baseline preceding hypometabolism 2 years later. Early and progressive hypometabolism/atrophy of the PCC in AD is a well-established finding,2,3 but early hypermetabolism is more difficult to reconcile with current network-based models of neurodegeneration. Whether it is suitable to classify groups according to average metabolic changes in the same regions that emerge in subsequent analyses (e.g., orbitofrontal, PCC) is unclear. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Landin-Romero, R., Kumfor, F. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Author response: Trends in dementia prevalence, incidence, and survival rate in a Japanese community
We thank Dr. Grant for the comment on our article.1 According to the data on dietary supply from the Food and Agriculture Organization of the United Nations, the consumption of meat (from 7.6 to 33.7 kg/capita/y), animal fat (from 5 to 35 kg/capita/y), and energy from animal products (from 249 to 580 kcal/capita/d) increased from 1961 to 1985 in Japan.2 As Dr. Grant pointed out, the increasing consumption of animal products was highly correlated with data on the prevalence of Alzheimer disease (AD) in Japan with a lag of 25 years (correlation coefficient = 0.92).3 In addition, a multicountry ecologic study revealed that th...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Ohara, T., Ninomiya, T. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Trends in dementia prevalence, incidence, and survival rate in a Japanese community
I read with interest the article by Ohara et al.1 regarding trends in dementia prevalence, incidence, and survival rate in a Japanese community. The findings were similar to those reported in 2012 by Dodge et al.,2 in which Alzheimer disease (AD) rates for the elderly increased from 1% in 1985 to 7% in 2008. I explained that findings were due to the nutrition transition from the traditional Japanese diet to the Western diet, heavy in meat and other animal products, with a lag of 15–25 years.3 More recently, in a multicountry study, I found that dietary animal products other than milk were strongly correlated with AD ...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Grant, W. B. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Editors' Note
: In "Trends in dementia prevalence, incidence, and survival rate in a Japanese community," the authors found an increase in Alzheimer disease (AD) prevalence in Japan between 1985 and 2012. Dr. Grant presents findings from other studies, supporting the explanation that the transition from a traditional Japanese diet to a westernized diet, replete with meat and other animal products, correlates to rising rates of AD and of cancers common in Western countries, with a lag time of several decades. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Alcauskas, M., Galetta, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Post viral upper and lower motor neuron injuries
A 20-year-old man presented with subacute dysarthria, along with bilateral facial and brachial palsy, after a febrile odynophagia. Initially brisk, his upper limb deep tendon reflexes decreased with muscle wasting concerning the C5-T1 myotomes. MRI showed bilateral prefrontal gyri and thalami lesions with anterior cervical spinal cord lesion (figures 1 and 2). Upper limb lower motor neuron involvement was confirmed by EMG. CSF analysis showed lymphocytic pleiocytosis, elevated protein, and normal glucose levels. Epstein-Barr virus (EBV) serology revealed acute infection with the presence of viral capsid antigen (VCA) ...
Source: Neurology - October 30, 2017 Category: Neurology Authors: De La Cruz, E., Metzger, A., Braquet, P., Gaillard, N., Taieb, G. Tags: Amyotrophic lateral sclerosis NEUROIMAGES Source Type: research