Comment: Is virtual reality a useful adjunct to rehabilitation after spinal cord injury?
Spinal cord injury (SCI) has devastating effects on the CNS, leading to disruption of various neuromuscular, sensory, and autonomic pathways. However, the changes induced in the nervous system extend well beyond the tracts and neurons directly disrupted starting soon after the injury.1 There is substantial neural plasticity that takes place throughout the CNS, including the cortex.2 Trying to improve function and pain after a peripheral injury by intervening at the cortical level has been explored since the mid-1990s with classic mirror box therapy for phantom limb pain.3 (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Rammo, R., Schwalb, J. M. Tags: ARTICLE Source Type: research
Virtual reality improves embodiment and neuropathic pain caused by spinal cord injury
Conclusions:
The present findings show that VR exposure using multisensory stimulation differently affected leg vs body ownership, and is associated with mild analgesia with potential for SCI neurorehabilitation protocols. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Pozeg, P., Palluel, E., Ronchi, R., Solca, M., Al-Khodairy, A.-W., Jordan, X., Kassouha, A., Blanke, O. Tags: Neuropathic pain, All Spinal Cord ARTICLE Source Type: research
Female sex, early-onset hypertension, and risk of dementia
Conclusions:
Though midlife hypertension was more common in men, it was only associated with dementia risk in women. Sex differences in the timing of dementia risk factors have important implications for brain health and hypertension management. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Gilsanz, P., Mayeda, E. R., Glymour, M. M., Quesenberry, C. P., Mungas, D. M., DeCarli, C., Dean, A., Whitmer, R. A. Tags: All Cognitive Disorders/Dementia, Cohort studies, Risk factors in epidemiology ARTICLE Source Type: research
Metformin vs sulfonylurea use and risk of dementia in US veterans aged >=65 years with diabetes
Conclusions:
After accounting for confounding by indication, metformin was associated with a lower risk of subsequent dementia than sulfonylurea use in veterans <75 years of age. Further work is needed to identify which patients may benefit from metformin for the prevention of dementia. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Orkaby, A. R., Cho, K., Cormack, J., Gagnon, D. R., Driver, J. A. Tags: Endocrine, All Cognitive Disorders/Dementia, Alzheimer's disease, Vascular dementia, All epidemiology ARTICLE Source Type: research
Change in multimodal MRI markers predicts dementia risk in cerebral small vessel disease
Conclusions:
This longitudinal prospective study provides evidence that change in MRI measures including DTI, over time durations during which cognitive change is not detectable, predicts cognitive decline and progression to dementia. It supports the use of MRI measures, including DTI, as useful surrogate biomarkers to monitor disease and assess therapeutic interventions. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Zeestraten, E. A., Lawrence, A. J., Lambert, C., Benjamin, P., Brookes, R. L., Mackinnon, A. D., Morris, R. G., Barrick, T. R., Markus, H. S. Tags: MRI, DWI, Other cerebrovascular disease/ Stroke, All Cognitive Disorders/Dementia, Assessment of cognitive disorders/dementia ARTICLE Source Type: research
Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study
Conclusions:
Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Zupanic, E., von Euler, M., Kareholt, I., Contreras Escamez, B., Fastbom, J., Norrving, B., Religa, D., Kramberger, M. G., Winblad, B., Johnell, K., Eriksdotter, M., Garcia-Ptacek, S. Tags: Prognosis, All Cognitive Disorders/Dementia, Cohort studies, Infarction ARTICLE Source Type: research
Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population
Conclusions:
Subarachnoid hemorrhage occurs at younger age and from smaller IAs in patients with ADPKD and risk for de novo IAs is higher than in the general Eastern Finnish population. ADPKD should be considered as an indicator for long-term angiographic follow-up in patients with diagnosed IAs. (Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Nurmonen, H. J., Huttunen, T., Huttunen, J., Kurki, M. I., Helin, K., Koivisto, T., von und zu Fraunberg, M., Jääskeläinen, J. E., Lindgren, A. E. Tags: Stroke in young adults, Cohort studies, Subarachnoid hemorrhage, All Genetics ARTICLE Source Type: research
The beginning of precision medicine in ALS?: Treatment to fit the genes
Amyotrophic lateral sclerosis (ALS) affects approximately 1 in 400 adults of western European ancestry, making it the most common degenerative disease of the motor neuron network. ALS has a mean age at onset of 65 and 85%–90% of cases occur sporadically. Ten to fifteen percent of cases have a recognized genetic contribution, usually in known ALS gene-carrying families.1 In populations of European extraction, the commonest cause of familial ALS, accounting for up to 40% of familial cases, is the C9orf72 hexanucleotide repeat expansion.2 C9orf72 has a broader associated phenotype including frontotemporal dementia and a...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Armon, C., Hardiman, O. Tags: EDITORIALS Source Type: research
Oral antidiabetic drugs and dementia risk: Does treatment matter?
As the population ages, dementia grows as a public health problem. The rising life expectancy and the aging of the so-called baby boomer cohort translate to a substantial number of people reaching ages of high risk for age-related conditions like dementia. As a major cause of disability and dependency in elderly people, dementia puts social and economic burden on patients and their families and affects health care systems worldwide. In the absence of a cure, primary prevention will have the largest effect on the reduction of dementia occurrence.1 Thus, public health research should focus on the identification of modifiable...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Fink, A., Haenisch, B. Tags: All Cognitive Disorders/Dementia, All epidemiology EDITORIALS Source Type: research
Polycystic kidney disease and intracranial aneurysms: Some answers, but many questions remain
Unruptured intracranial aneurysms (UIA) occur in about 2%–3% of the population. Several medical conditions are associated with a UIA presence, including autosomal dominant polycystic kidney disease (ADPKD). Clinicians and patients want to know the risk of aneurysm growth, rupture, or de novo development, predictors of clinical outcomes, and the optimal initial and follow-up screening for individuals with UIA and ADPKD. Such data are unavailable. The recent American Heart Association–American Stroke Association statement on UIAs recommends that patients with familial risk and patients with conditions in which an...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Torner, J. C., Brown, R. D. Tags: EDITORIALS Source Type: research
Spotlight on the October 31 issue
(Source: Neurology)
Source: Neurology - October 30, 2017 Category: Neurology Authors: Gross, R. A. Tags: IN FOCUS Source Type: research
Virtual reality may relieve pain in patients with spinal cord injury
Body ownership is the ongoing feeling that our body and body parts belong to us, and are related to us in a different way than things in the external world. This sense of body ownership may seem trivial to us, yet our brain needs to connect sensory inputs (e.g., touch, pain, and visual information), internal inputs (from our body's internal milieu), and higher cognitive inputs like memories of our body in different events to generate the sense of ownership. For instance, hand ownership is generated by the visual input we get from our eyes that tracks its location, sensory input on its posture (known as proprioception), and...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Saadon-Grosman, N., Arzy, S. Tags: All Spinal Cord, Spinal cord trauma; see Trauma/spinal cord trauma PATIENT PAGES Source Type: research
Teaching Video NeuroImages: Hemifacial spasm due to cerebellopontine angle mass
A 21-year-old woman presented with tremor of the right eyelid that progressed in 1 year to involve the ipsilateral cheek and lip and ipsilateral hearing loss since childhood. Her lack of medical comorbidities prompted imaging that revealed a mass in the right cerebellopontine angle cistern. She underwent debulking of the mass, which resolved the tremors. Her pathology revealed pilocytic astrocytoma (figure; video at Neurology.org). Cranial nerve 7 is predisposed to injury due to its anatomic location. There are many case reports of hemifacial spasms due to mass effect.1 Imaging should be performed in otherwise healthy pati...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Guha, R., Cathcart, K., Arteaga, D. Tags: Tremor, Primary brain tumor, Adolescence RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Bilateral hypertrophic olivary degeneration following posterior circulation stroke
A 40-year-old comatose man was brought to the hospital with a history of posterior circulation stroke 4 months earlier due to hypertension. On examination, he had spastic quadriplegia, bilateral extensor plantar reflex, and palatal myoclonus. MRI revealed enlarged olives (figure 1) and chronic infarcts involving midbrain and pons (figure 2) suggestive of hypertrophic olivary degeneration seen after 4 months of insult. Hypertrophic olivary degeneration is a transsynaptic degeneration involving interconnecting fibers of inferior olivary nucleus, red nucleus, and contralateral dentate nucleus forming the 3 corners of the Guil...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Venkatesh, M., Prasad, V. R. S., Basha, S. U., Priya, G. H. J. Tags: MRI, Coma, All Cerebrovascular disease/Stroke, All Education, Infarction RESIDENT AND FELLOW SECTION Source Type: research
Clinical Reasoning: A case of ataxia, seizure, and choreoathetosis in a 34-year-old woman
A 34-year-old woman of Chinese Han descent was admitted to the neurology department after complaining of gait instability for 20 years and seizure attacks for 6 years. At age 14, she began experiencing slurred speech and unsteady gait. Meanwhile, she had learning difficulties and her academic performance was poor. Since then, her intelligence regressed gradually. At age 28, she developed recurrent generalized tonic-clonic seizures and myoclonus refractory to valproic acid and oxcarbazepine. She developed choreoathetosis at age 29. In the following years, the seizures and choreoathetosis progressively worsened. Two years la...
Source: Neurology - October 30, 2017 Category: Neurology Authors: Xiao, F., Wang, X.-f. Tags: Gait disorders/ataxia, Chorea, Myoclonus RESIDENT AND FELLOW SECTION Source Type: research
