Neurology News
Lower Dose Alteplase Shows Similar Clinical Outcomes in Middle Cerebral Artery Occlusion than Higher Dose
A study out the Journal Stroke evaluated the efficacy of 0.6 mg/kg intravenous alteplase on vascular and clinical outcomes in patients with middle cerebral artery occlusion in a postmarketing Phase IV trial of prospective cohort study design. Recanalization was noted in 51.7% on 6-hour MR angiography and 69.0% on 24-hour MR angiography. A favorable clinical outcome was achieved in 46.6% concluding the rates of recanalization and favorable outcome are comparable to that previously reported with the 0.9-mg/kg dose.
Increased tissue damage and lesion volumes in African Americans with multiple sclerosis
African American (AA) patients with multiple sclerosis (MS) have more rapid disease progression and poorer responses to disease-modifying therapies than white American (WA) patients with MS. A study out of the Journal of Neurology investigated brain MRI characteristics in AA compared to WA in a cohort of consecutive patients with MS. The study showed that African American patients showed increased tissue damage, as measured by magnetization transfer ratio, and presented higher lesion volumes compared to white Americans. The greater tissue damage and faster lesion volume accumulation may explain the rapid clinical progression in African American patients.
Antiplatelet pre-treatment increases the risk of intracranial haemorrhage in acute ischaemic stroke after intravenous thrombolysis
Pre-treatment with antiplatelet agents (AP) is present amongst 30% of acute stroke patients. Previous studies have shown conflicting results on the effect of these drugs regarding haemorrhagic transformation after thrombolytic therapy. This retrospective study of consecutive prospectively registered patients with acute ischaemic stroke treated with iv tPA in the last 5 years. Parietal Hemorrhage was observed prior in 54.5% of patients with prior Anti-Platlet (AP) therapy vs 26.9% of patients not on any therapy, concluding pre-treatment with AP is associated with an increased risk of PH after intravenous thrombolysis in patients with acute ischaemic stroke.
A score to predict early risk of recurrence after ischemic stroke
There is currently no instrument to stratify patients presenting with ischemic stroke according to early risk of recurrent stroke. We sought to develop a comprehensive prognostic score to predict 90-day risk of recurrent stroke. The 90-day risk of recurrent stroke was calculated by summing up the number of independent predictors weighted by their corresponding β-coefficients. The resultant score was called recurrence risk estimator at 90 days or RRE-90 score ( Link Here ). The RRE-90 score demonstrated adequate calibration and good discrimination, which was maintained when applied to a separate cohort of 433 patients. The model's performance was also maintained for predicting early (14-day) risk of recurrence.
Imaging Recomendations for new-onset afebrile seizures in infants
To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1–24 months) a prospective trial was conducted. It was found half of the infants had partial features to their seizures, yet evidence for primary generalized seizures was rare. The majority had more than 1 seizure upon presentation. Seizures in this age group tended to be brief, with 44% lasting less than 1 minute. EEG abnormalities were found in half. One-third of CTs were abnormal, with 9% of all CTs requiring acute medical management. Over half of MRIs were abnormal, with cerebral dysgenesis being the most common abnormality (p < 0.05). One-third of normal CTs had a subsequent abnormal MRI—only 1 resulted in altered medical management. Infantile seizures are usually brief, but commonly recurrent, and strong consideration should be made for inpatient observation. Acute imaging with CT can alter management in a small but important number of infants. Due to the superior yield, strong consideration for MRI should be given for all infants, as primary generalized seizures are rare, and there is a high rate of cerebral dysgenesis.
Strong Independent Correlation of Proteinuria With Cerebral Microbleeds in Patients With Stroke and Transient Ischemic Attack
To assess the association of proteinuria with the frequency and number of cerebral microbleeds (CMB), a harbinger of future hemorrhagic stroke, a cross sectional analysis was conducted.Of 236 patients, 72 (31%) had CMB present on gradient-echo imaging and 89 (38%) had evidence of proteinuria. In multivariable analyses with presence of CMB as the outcome, higher urinary protein, being female, history of atrial fibrillation , elevated serum homocysteine, and small-vessel disease subtype were all significantly associated with presence of CMB.
Cancer linked to Alzheimer disease but not vascular dementia
To investigate whether cancer is associated with Alzheimer disease (AD) and vascular dementia (VaD). A Cox proportional hazards models were used to test associations between prevalent dementia and risk of future cancer hospitalization, and associations between prevalent cancer and risk of subsequent dementia. It showed that in white older adults, prevalent Alzheimer disease (AD) was longitudinally associated with a reduced risk of cancer, and a history of cancer was associated with a reduced risk of AD. Together with other work showing associations between cancer and Parkinson disease, these findings suggest the possibility that cancer is linked to neurodegeneration.
