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CLINICAL, NEUROIMMUNOLOGIC, AND CSF INVESTIGATIONS IN Purchase access. For assistance, please contact: AAN Members (800) 879-1960 or (612) 928-6000 (International) Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) Sign Up. Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here. ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE, AND THE RISK OF Objective: Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. This study aims is to investigate the links between kidney function, kidney function decline and dementia incidence. Methods: We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis NUTRITIONAL STATUS IS A PROGNOSTIC FACTOR FOR SURVIVAL IN Objective: To evaluate the occurrence of malnutrition in patients with ALS, to assess the relation of malnutrition to the neurologic deficit, and to determine the impact of nutritional status on patient survival. Background: Although ALS may be associated with significant malnutrition, the relative impact on patient survival has not yet been well established. Methods: In a prospective 7-month PEARLS & OY-STERS: ANGIOPLASTY AND STENTING AS NEW Pearls & Oy-sters: Angioplasty and Stenting as New Treatment Method for Cough Headache With Stenotic Internal Jugular Vein: Case Report With 12-Month Follow-up A PHASE 1, MULTIPLE-DOSE STUDY OF ELEZANUMAB (ABT-555) IN Objective: The current study evaluated multiple doses of elezanumab to determine its safety and tolerability in patients with relapsing forms of MS. Background: Elezanumab is a fully humanized monoclonal antibody directed against repulsive guidance molecule A (RGMa). Studies in patients with multiple sclerosis (MS) demonstrate RGMa upregulation, which inhibits axonal growth and myelination THE FINAL MONTH OF LIFE IN PATIENTS WITH ALS Objective: To study the health care experiences and palliative care needs of patients with ALS in their final month of life. Methods: Caregivers of decedent patients with ALS completed a single survey focused on the final month of life. They reported the patients’ physical and emotional symptoms, preferences for end-of-life care, completion of advance directives, and preparation for death. GENERALIZED MYOCLONUS IN COVID-19 Objective To report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus. Methods Patient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain. Results Three patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus NEUROLOGY® RESIDENT & FELLOW SECTION CLINICAL REASONING Clinical Reasoning in Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section. The new Clinical Reasoning Book edited by Aaron Berkowitz, Sashank Prasad and Mitchell Elkind available as a FREE pdf download or on the Neurology app for the iPadand Android
CLINICAL, NEUROIMMUNOLOGIC, AND CSF INVESTIGATIONS IN Purchase access. For assistance, please contact: AAN Members (800) 879-1960 or (612) 928-6000 (International) Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) Sign Up. Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here. ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE, AND THE RISK OF Objective: Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. This study aims is to investigate the links between kidney function, kidney function decline and dementia incidence. Methods: We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis NUTRITIONAL STATUS IS A PROGNOSTIC FACTOR FOR SURVIVAL IN Objective: To evaluate the occurrence of malnutrition in patients with ALS, to assess the relation of malnutrition to the neurologic deficit, and to determine the impact of nutritional status on patient survival. Background: Although ALS may be associated with significant malnutrition, the relative impact on patient survival has not yet been well established. Methods: In a prospective 7-month PEARLS & OY-STERS: ANGIOPLASTY AND STENTING AS NEW Pearls & Oy-sters: Angioplasty and Stenting as New Treatment Method for Cough Headache With Stenotic Internal Jugular Vein: Case Report With 12-Month Follow-up A PHASE 1, MULTIPLE-DOSE STUDY OF ELEZANUMAB (ABT-555) IN Objective: The current study evaluated multiple doses of elezanumab to determine its safety and tolerability in patients with relapsing forms of MS. Background: Elezanumab is a fully humanized monoclonal antibody directed against repulsive guidance molecule A (RGMa). Studies in patients with multiple sclerosis (MS) demonstrate RGMa upregulation, which inhibits axonal growth and myelination THE FINAL MONTH OF LIFE IN PATIENTS WITH ALS Objective: To study the health care experiences and palliative care needs of patients with ALS in their final month of life. Methods: Caregivers of decedent patients with ALS completed a single survey focused on the final month of life. They reported the patients’ physical and emotional symptoms, preferences for end-of-life care, completion of advance directives, and preparation for death. THE IMPACT OF COVID-19 ON DEVELOPING NEUROLOGIC DISORDERS One of the greatest challenges of treating a new virus is the lack of information about it. When little is known about a virus, patients affected by it, as well as their families, are left with uncertainty. In an article appearing in this issue of Neurology® , Dr. Frontera and her team aimed to determine how often patients hospitalized with coronavirus disease 2019 (COVID-19) developed newTABLE OF CONTENTS
Karine Eid, Øivind Fredvik Torkildsen, Jan Aarseth, Heidi Øyen Flemmen, Trygve Holmøy, Åslaug Rudjord Lorentzen, Kjell-Morten Myhr, Trond Riise, Cecilia Simonsen, Cecilie Fredvik Torkildsen, Stig Wergeland, Johannes Sverre Willumsen, Nina Øksendal, Nils Erik Gilhus, Marte-Helene Bjørk LONG-TERM OUTCOMES (15 YEARS) AFTER SUBTHALAMIC NUCLEUS Objective: To evaluate the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson disease (PD) patients on motor complications beyond 15 years after surgery. Methods: Data about motor complications, quality of life (QoL), activities of daily living, the UPDRS motor scores, dopaminergic treatment, stimulation parameters, and side effects of STN-DBS were DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other DIAGNOSING MRI-NEGATIVE AUTOIMMUNE DISEASES The diagnosis of MS requires demonstration of disease dissemination in space and time and is based on diagnostic criteria such as the recently revised McDonald criteria.1 With their 2001 revision, the McDonald criteria formally have included MRI in the diagnostic workup of patients with suspected MS.2 Since then, the relevance of MRI for diagnosis and disease monitoring has further increased DIZZINESS AS A SIGN OF STROKEABOUT STROKE Dizziness as a sign of stroke. About stroke. Dizziness is a common medical complaint. It “is the third most common medical symptom reported in general medical clinics and accounts for about 3%–5% of visits across care settings. In the United States, this translates to 10 million ambulatory visits per year because of dizziness, withroughly
THE SYNDROME OF ACUTE SENSORY NEUROPATHY We followed 42 patients with clinically defined pure sensory neuropathy of acute or subacute onset for 2 to 35 years. The symptoms began in the upper limbs in 23 patients, in the lower limbs in 13, symmetrically in all 4 limbs in 4, and the face was 1st affected in 2. For 19 patients, the symptoms began asymmetrically. Electrophysiologic testing typically showed absence of sensory A RETROSPECTIVE STUDY EVALUATING THE USE OF ANTI Objective: To examine the use of oral/transdermal anti-parkinsonian medications in advanced Parkinson’s disease (APD) patients who have a history of or current treatment with deep brain stimulation (DBS), and are receiving levodopa-carbidopa intestinal gel (LCIG). Background: As PD progresses, oral drug regimens may become inadequate for symptom control. FIVE UNAPPROVED DRUGS FOUND IN COGNITIVE ENHANCEMENT Objective To identify the presence of unapproved pharmaceutical drugs in over-the-counter dietary supplements marketed to improve memory and cognitive function. Methods Supplements were identified by searching 2 supplement databases for products labeled as containing omberacetam, aniracetam, phenylpiracetam, or oxiracetam, 4 drugs not approved for human use in the United States. NEUROPATHOLOGY, AND COGNITIVE DECLINE Views & Reviews 1080 Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review W. Liang, Y. AMERICAN ACADEMY OF NEUROLOGY JOURNALSNEUROLOGYCLINICAL PRACTICEGENETICSNEUROIMMUNOLOGY & NEUROINFLAMMATIONCOVID-19 Neurology ® Neuroimmunology & Neuroinflammation. CLINICAL/SCIENTIFIC NOTES | Autoimmune Diseases. Reversible Cerebral Vasculopathy, Transverse Myelitis, and Active Systemic Lupus Erythematosus in Aquaporin-4 Antibody–Positive. ARTICLE |Multiple Sclerosis. Incidence and Impact of COVID-19 in MS: A Survey From a Barcelona MSUnit.
NEUROLOGIC SYNDROMES RELATED TO ANTI-GAD65 Objective Antibodies against glutamic acid decarboxylase 65 (anti-GAD65) are associated with a number of neurologic syndromes. However, their pathogenic role is controversial. Our objective was to describe clinical and paraclinical characteristics of anti-GAD65 patients and analyze their response to immunotherapy. Methods Retrospectively, we studied patients (n = 56) with positive anti-GAD65 PAIN IN GUILLAIN-BARRÉ SYNDROME Background: Pain in Guillain-Barré syndrome (GBS) may be pronounced and is often overlooked. Objectives: To obtain detailed information about pain in GBS and its clinical variants. Methods: This was a prospective cohort study in 156 patients with GBS (including 18 patients with Miller Fisher syndrome ). We assessed the location, type, and intensity of pain using questionnaires at MEMORY LOSS AFTER STROKE Memory loss commonly occurs as a result of the loss of nerve cells in the brain. When memory loss is so severe that it interferes with normal daily functioning, it is called dementia. People with dementia may have difficulty learning new things or remembering names of people they just met. They may get lost in places that were previously very familiar or have trouble finding words. THE FINAL MONTH OF LIFE IN PATIENTS WITH ALS Objective: To study the health care experiences and palliative care needs of patients with ALS in their final month of life. Methods: Caregivers of decedent patients with ALS completed a single survey focused on the final month of life. They reported the patients’ physical and emotional symptoms, preferences for end-of-life care, completion of advance directives, and preparation for death. NUTRITIONAL STATUS IS A PROGNOSTIC FACTOR FOR SURVIVAL IN Objective: To evaluate the occurrence of malnutrition in patients with ALS, to assess the relation of malnutrition to the neurologic deficit, and to determine the impact of nutritional status on patient survival. Background: Although ALS may be associated with significant malnutrition, the relative impact on patient survival has not yet been well established. Methods: In a prospective 7-month DIZZINESS AS A SIGN OF STROKEABOUT STROKE Dizziness as a sign of stroke. About stroke. Dizziness is a common medical complaint. It “is the third most common medical symptom reported in general medical clinics and accounts for about 3%–5% of visits across care settings. In the United States, this translates to 10 million ambulatory visits per year because of dizziness, withroughly
VITAMIN B6 TOXICITY REVISITED: A CASE OF REVERSIBLE Objective: To present the salient features, and reversibility of pyridoxine (vitamin B6) induced peripheral neuropathy, in conjunction with its electrodiagnostic correlate. Background: B-Complex vitamins are essential for functioning of the nervous system, and supplementation is generally well tolerated. Although rare, excess pyridoxine can lead to paradoxical neurotoxicity— resulting in FRONTOTEMPORAL DEMENTIA VERSUS ALZHEIMER'S DISEASE Frontotemporal dementia (FTD) is a common neurodegenerative dementia that can be difficult to distinguish clinically from Alzheimer's disease (AD).The differential distribution of pathology in FTD and AD predicts the presence of differential cognitive features on mental status examination. We compared 39 FTD patients with 101 AD patients on the Consortium to Establish a Registry in AD MIGRAINE IN POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME Objective: Headache characteristics were prospectively studied in 41 consecutive patients with postural orthostatic tachycardia syndrome (POTS). Background: POTS, the most prevalent form of orthostatic intolerance, is a heterogeneous disorder that is associated with a number of symptoms, including headache. The prevalence and clinical features of headache and how it relates to clinical AMERICAN ACADEMY OF NEUROLOGY JOURNALSNEUROLOGYCLINICAL PRACTICEGENETICSNEUROIMMUNOLOGY & NEUROINFLAMMATIONCOVID-19 Neurology ® Neuroimmunology & Neuroinflammation. CLINICAL/SCIENTIFIC NOTES | Autoimmune Diseases. Reversible Cerebral Vasculopathy, Transverse Myelitis, and Active Systemic Lupus Erythematosus in Aquaporin-4 Antibody–Positive. ARTICLE |Multiple Sclerosis. Incidence and Impact of COVID-19 in MS: A Survey From a Barcelona MSUnit.
NEUROLOGIC SYNDROMES RELATED TO ANTI-GAD65 Objective Antibodies against glutamic acid decarboxylase 65 (anti-GAD65) are associated with a number of neurologic syndromes. However, their pathogenic role is controversial. Our objective was to describe clinical and paraclinical characteristics of anti-GAD65 patients and analyze their response to immunotherapy. Methods Retrospectively, we studied patients (n = 56) with positive anti-GAD65 PAIN IN GUILLAIN-BARRÉ SYNDROME Background: Pain in Guillain-Barré syndrome (GBS) may be pronounced and is often overlooked. Objectives: To obtain detailed information about pain in GBS and its clinical variants. Methods: This was a prospective cohort study in 156 patients with GBS (including 18 patients with Miller Fisher syndrome ). We assessed the location, type, and intensity of pain using questionnaires at MEMORY LOSS AFTER STROKE Memory loss commonly occurs as a result of the loss of nerve cells in the brain. When memory loss is so severe that it interferes with normal daily functioning, it is called dementia. People with dementia may have difficulty learning new things or remembering names of people they just met. They may get lost in places that were previously very familiar or have trouble finding words. THE FINAL MONTH OF LIFE IN PATIENTS WITH ALS Objective: To study the health care experiences and palliative care needs of patients with ALS in their final month of life. Methods: Caregivers of decedent patients with ALS completed a single survey focused on the final month of life. They reported the patients’ physical and emotional symptoms, preferences for end-of-life care, completion of advance directives, and preparation for death. NUTRITIONAL STATUS IS A PROGNOSTIC FACTOR FOR SURVIVAL IN Objective: To evaluate the occurrence of malnutrition in patients with ALS, to assess the relation of malnutrition to the neurologic deficit, and to determine the impact of nutritional status on patient survival. Background: Although ALS may be associated with significant malnutrition, the relative impact on patient survival has not yet been well established. Methods: In a prospective 7-month DIZZINESS AS A SIGN OF STROKEABOUT STROKE Dizziness as a sign of stroke. About stroke. Dizziness is a common medical complaint. It “is the third most common medical symptom reported in general medical clinics and accounts for about 3%–5% of visits across care settings. In the United States, this translates to 10 million ambulatory visits per year because of dizziness, withroughly
VITAMIN B6 TOXICITY REVISITED: A CASE OF REVERSIBLE Objective: To present the salient features, and reversibility of pyridoxine (vitamin B6) induced peripheral neuropathy, in conjunction with its electrodiagnostic correlate. Background: B-Complex vitamins are essential for functioning of the nervous system, and supplementation is generally well tolerated. Although rare, excess pyridoxine can lead to paradoxical neurotoxicity— resulting in FRONTOTEMPORAL DEMENTIA VERSUS ALZHEIMER'S DISEASE Frontotemporal dementia (FTD) is a common neurodegenerative dementia that can be difficult to distinguish clinically from Alzheimer's disease (AD).The differential distribution of pathology in FTD and AD predicts the presence of differential cognitive features on mental status examination. We compared 39 FTD patients with 101 AD patients on the Consortium to Establish a Registry in AD MIGRAINE IN POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME Objective: Headache characteristics were prospectively studied in 41 consecutive patients with postural orthostatic tachycardia syndrome (POTS). Background: POTS, the most prevalent form of orthostatic intolerance, is a heterogeneous disorder that is associated with a number of symptoms, including headache. The prevalence and clinical features of headache and how it relates to clinical AMERICAN ACADEMY OF NEUROLOGY JOURNALS Dr. Jeff Ratliff discusses primary care management for acute sciatica and physical therapy referrals with Dr. Julie Fritz. Dr. Andy Southerland talks with Dr. Amrou Sarraj about direct endovascular thrombectomy in patients with large vessel occlusions. NEUROLOGY | THE MOST WIDELY READ AND HIGHLY CITED PEER Automated, Quantitative Pupillometry in the Critically Ill: A Systematic Review of the Literature. Petra Opic, Stephan Rüegg, Stephan Marsch, et al. May 27, 2021. Video NeuroImages. Treatment of Painless Legs and Moving Toes Syndrome Associated With Multiple System Atrophy With Levodopa. Takeya Araki, Tatsuya Mukai, Takehisa Araki.TABLE OF CONTENTS
Karine Eid, Øivind Fredvik Torkildsen, Jan Aarseth, Heidi Øyen Flemmen, Trygve Holmøy, Åslaug Rudjord Lorentzen, Kjell-Morten Myhr, Trond Riise, Cecilia Simonsen, Cecilie Fredvik Torkildsen, Stig Wergeland, Johannes Sverre Willumsen, Nina Øksendal, Nils Erik Gilhus, Marte-Helene Bjørk WELCOME TO NEUROLOGY: GENETICS The powers of human genetics and genetic technologies have transformed the complexities of neurology and neuroscience at the basic, translational, and now also the clinical level. We have left an era of black and white views of causative genetic variation and are entering a period of more than 50 shades of grey, fascinated with DNA variants that increase or decrease risk, epigenetic DIZZINESS AS A SIGN OF STROKEABOUT STROKE Dizziness as a sign of stroke. About stroke. Dizziness is a common medical complaint. It “is the third most common medical symptom reported in general medical clinics and accounts for about 3%–5% of visits across care settings. In the United States, this translates to 10 million ambulatory visits per year because of dizziness, withroughly
ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent FRONTOTEMPORAL DEMENTIA VERSUS ALZHEIMER'S DISEASE Frontotemporal dementia (FTD) is a common neurodegenerative dementia that can be difficult to distinguish clinically from Alzheimer's disease (AD).The differential distribution of pathology in FTD and AD predicts the presence of differential cognitive features on mental status examination. We compared 39 FTD patients with 101 AD patients on the Consortium to Establish a Registry in AD SEIZURES AFTER BLEEDING INTO THE BRAIN In their article, “Electrographic seizures and periodic discharges after intracerebral hemorrhage,” Dr. Claassen and colleagues discuss several important issues that affect people who have bleeding into the brain (Neurology 2007;69:1356–1365). They used a retrospective review to study problems associated with bleeding within the brain. SYNAPTIC EFFECTS OF CANNABINOIDS The discovery of (−)-Δ9-tetrahydrocannabinol (Δ9 THC) as the main psychoactive ingredient in cannabis (marijuana), the cloning of the cannabinoid receptors CB1R and CB2R, and the identification of the endocannabinoids as their endogenous ligands has stimulated extensive research on the role of the cannabinoid system in synaptic regulation in the CNS. The 2 major endocannabinoids in the A PROPOSED CLINICAL CLASSIFICATION AND A DIAGNOSTIC Purpose of Review This review proposes a clinical classification for congenital ataxias based on clinical features, neuroimaging, and course of the disease. Recent Findings Congenital ataxias are an unusual group of neurologic disorders, with heterogeneous clinical and genetic presentation. Typical clinical features of congenital ataxias include variable degrees of motor developmental delay NEUROLOGY® RESIDENT & FELLOW SECTION CLINICAL REASONING Clinical Reasoning in Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section. The new Clinical Reasoning Book edited by Aaron Berkowitz, Sashank Prasad and Mitchell Elkind available as a FREE pdf download or on the Neurology app for the iPadand Android
DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE, AND THE RISK OF Objective: Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. This study aims is to investigate the links between kidney function, kidney function decline and dementia incidence. Methods: We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent THE SYNDROME OF ACUTE SENSORY NEUROPATHY We followed 42 patients with clinically defined pure sensory neuropathy of acute or subacute onset for 2 to 35 years. The symptoms began in the upper limbs in 23 patients, in the lower limbs in 13, symmetrically in all 4 limbs in 4, and the face was 1st affected in 2. For 19 patients, the symptoms began asymmetrically. Electrophysiologic testing typically showed absence of sensory A PHASE 1, MULTIPLE-DOSE STUDY OF ELEZANUMAB (ABT-555) IN Objective: The current study evaluated multiple doses of elezanumab to determine its safety and tolerability in patients with relapsing forms of MS. Background: Elezanumab is a fully humanized monoclonal antibody directed against repulsive guidance molecule A (RGMa). Studies in patients with multiple sclerosis (MS) demonstrate RGMa upregulation, which inhibits axonal growth and myelination TEACHING VIDEO NEUROIMAGES: JAW CLONUS IN AMYOTROPHIC We present a case of amyotrophic lateral sclerosis (ALS) in a middle-aged woman who presented with a 2-year history of dysarthria and dysphagia. On examination, she had spastic dysarthria, jaw clonus (video 1), hyperreflexia, and fasciculations involving the tongue, trunk, and extremities. Jaw clonus is an upper motor sign that localizes to the dysfunction of corticobulbar fibers cranial to STROKE INCIDENCE IN YOUNG ADULTS ACCORDING TO AGE, SUBTYPE Objective To investigate incidence of stroke and its subtypes in young adults, according to sex and age, and to study trends over time. Methods We established a nationwide cohort through linkage of national registries (hospital discharge, cause of death, and population register) with patients aged 18–50 years and those ≥50 years with first-ever ischemic stroke, intracerebral hemorrhage, orZOSTER SINE HERPETE
Varicella zoster virus (VZV) is an exclusively human neurotropic herpesvirus that causes varicella (chickenpox) during primary infection, after which the virus becomes latent in cranial nerve, dorsal root, and autonomic ganglia along the entire neuraxis.1 Decades later, virus may reactivate to cause herpes zoster (shingles), an extremely painful vesicular skin rash confined to one or more NEW EVIDENCE FOR REDUCED LEG OXYGEN LEVELS IN RESTLESS Changes in dopamine may be linked to low levels of iron in the brain and body along with poor iron transport into the brain and changes in brain dopamine receptors. 1. However, there is new evidence for problems with blood flow and leg oxygen levels in RLS/WED. These changes involve the cells of the blood vessel walls, or endothelium. NEUROLOGY® RESIDENT & FELLOW SECTION CLINICAL REASONING Clinical Reasoning in Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section. The new Clinical Reasoning Book edited by Aaron Berkowitz, Sashank Prasad and Mitchell Elkind available as a FREE pdf download or on the Neurology app for the iPadand Android
DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE, AND THE RISK OF Objective: Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. This study aims is to investigate the links between kidney function, kidney function decline and dementia incidence. Methods: We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent THE SYNDROME OF ACUTE SENSORY NEUROPATHY We followed 42 patients with clinically defined pure sensory neuropathy of acute or subacute onset for 2 to 35 years. The symptoms began in the upper limbs in 23 patients, in the lower limbs in 13, symmetrically in all 4 limbs in 4, and the face was 1st affected in 2. For 19 patients, the symptoms began asymmetrically. Electrophysiologic testing typically showed absence of sensory A PHASE 1, MULTIPLE-DOSE STUDY OF ELEZANUMAB (ABT-555) IN Objective: The current study evaluated multiple doses of elezanumab to determine its safety and tolerability in patients with relapsing forms of MS. Background: Elezanumab is a fully humanized monoclonal antibody directed against repulsive guidance molecule A (RGMa). Studies in patients with multiple sclerosis (MS) demonstrate RGMa upregulation, which inhibits axonal growth and myelination TEACHING VIDEO NEUROIMAGES: JAW CLONUS IN AMYOTROPHIC We present a case of amyotrophic lateral sclerosis (ALS) in a middle-aged woman who presented with a 2-year history of dysarthria and dysphagia. On examination, she had spastic dysarthria, jaw clonus (video 1), hyperreflexia, and fasciculations involving the tongue, trunk, and extremities. Jaw clonus is an upper motor sign that localizes to the dysfunction of corticobulbar fibers cranial to STROKE INCIDENCE IN YOUNG ADULTS ACCORDING TO AGE, SUBTYPE Objective To investigate incidence of stroke and its subtypes in young adults, according to sex and age, and to study trends over time. Methods We established a nationwide cohort through linkage of national registries (hospital discharge, cause of death, and population register) with patients aged 18–50 years and those ≥50 years with first-ever ischemic stroke, intracerebral hemorrhage, orZOSTER SINE HERPETE
Varicella zoster virus (VZV) is an exclusively human neurotropic herpesvirus that causes varicella (chickenpox) during primary infection, after which the virus becomes latent in cranial nerve, dorsal root, and autonomic ganglia along the entire neuraxis.1 Decades later, virus may reactivate to cause herpes zoster (shingles), an extremely painful vesicular skin rash confined to one or more NEW EVIDENCE FOR REDUCED LEG OXYGEN LEVELS IN RESTLESS Changes in dopamine may be linked to low levels of iron in the brain and body along with poor iron transport into the brain and changes in brain dopamine receptors. 1. However, there is new evidence for problems with blood flow and leg oxygen levels in RLS/WED. These changes involve the cells of the blood vessel walls, or endothelium. CRANIAL NEUROPATHIES AND COVID-19 The coronavirus disease 2019 (COVID-19) global pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. Like its predecessors, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 binds to angiotensin converting enzyme 2 (ACE2) receptors to facilitate tissue GENERALIZED MYOCLONUS IN COVID-19 Objective To report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus. Methods Patient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain. Results Three patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus CATEGORIES OF THE RESIDENT AND FELLOW SECTION Categories of the Resident and Fellow Section. This information must be used in conjunction with all policies and specifications outlined in the Author Center. The Resident & Fellow Section (RFS) publishes papers that further the education of medical students, residents, fellows, and other trainees. Papers in the RFS are relevant totrainees
SHORTCOMINGS OF RAPID CLINICAL INFORMATION DISSEMINATION The coronavirus disease 2019 (COVID-19) pandemic has led to an acceleration of clinical information dissemination to unprecedented speeds, a phenomenon only partially explained by formal efforts of the scientific community. These have ranged from the establishment of open-source platforms for review of article preprints to the elimination of journal paywalls for COVID-19–related publications.TABLE OF CONTENTS
Karine Eid, Øivind Fredvik Torkildsen, Jan Aarseth, Heidi Øyen Flemmen, Trygve Holmøy, Åslaug Rudjord Lorentzen, Kjell-Morten Myhr, Trond Riise, Cecilia Simonsen, Cecilie Fredvik Torkildsen, Stig Wergeland, Johannes Sverre Willumsen, Nina Øksendal, Nils Erik Gilhus, Marte-Helene Bjørk DIAGNOSING MRI-NEGATIVE AUTOIMMUNE DISEASES The diagnosis of MS requires demonstration of disease dissemination in space and time and is based on diagnostic criteria such as the recently revised McDonald criteria.1 With their 2001 revision, the McDonald criteria formally have included MRI in the diagnostic workup of patients with suspected MS.2 Since then, the relevance of MRI for diagnosis and disease monitoring has further increased LOG IN | NEUROLOGY CLINICAL PRACTICE For assistance, please contact: AAN Members (800) 879-1960 or (612) 928-6000 (International) Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) SOCIOECONOMIC AND GEOGRAPHIC DISPARITIES IN IDIOPATHIC Objective To identify relationships between idiopathic intracranial hypertension (IIH) and socioeconomic determinants of health, such as low-income status and proximity to healthy food. Methods This retrospective case–control study of adult female neuro-ophthalmology patients from one institution identified 223 women with and 4,783women without IIH.
WERNEKINCK COMMISSURE SYNDROME For assistance, please contact: AAN Members (800) 879-1960 or (612) 928-6000 (International) Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) NEUROPATHOLOGY, AND COGNITIVE DECLINE Views & Reviews 1080 Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review W. Liang, Y. NEUROLOGY | THE MOST WIDELY READ AND HIGHLY CITED PEERLOG INLATEST ARTICLESCURRENT ISSUEPAST ISSUESRESIDENTS & FELLOWS Automated, Quantitative Pupillometry in the Critically Ill: A Systematic Review of the Literature. Petra Opic, Stephan Rüegg, Stephan Marsch, et al. May 27, 2021. Video NeuroImages. Treatment of Painless Legs and Moving Toes Syndrome Associated With Multiple System Atrophy With Levodopa. Takeya Araki, Tatsuya Mukai, Takehisa Araki. NEUROLOGY® RESIDENT & FELLOW SECTION CLINICAL REASONING Clinical Reasoning in Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section. The new Clinical Reasoning Book edited by Aaron Berkowitz, Sashank Prasad and Mitchell Elkind available as a FREE pdf download or on the Neurology app for the iPadand Android
TEMPORAL CORRELATION OF CSF AND NEUROIMAGING IN THE Objective: Temporal correlations between CSF and neuroimaging (PET and MRI) measures of amyloid, tau, and neurodegeneration were evaluated in relation to Alzheimer disease (AD) progression. Methods: Three hundred seventy-one cognitively unimpaired and impaired participants enrolled in longitudinal studies of AD had both CSF (amyloid-β42, phosphorylated tau181, total tau, and WELCOME TO NEUROLOGY: GENETICS The mission of Neurology® Genetics is the publication of high-quality original contributions that elucidate the role of genetic and epigenetic variation in diseases of the central and peripheral nervous systems. The journal will publish original articles in all areas of neurogenetics, including rare and common genetic variation, genotype-phenotype correlations, outlier phenotypes as a result ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other PAIN IN GUILLAIN-BARRÉ SYNDROME Background: Pain in Guillain-Barré syndrome (GBS) may be pronounced and is often overlooked. Objectives: To obtain detailed information about pain in GBS and its clinical variants. Methods: This was a prospective cohort study in 156 patients with GBS (including 18 patients with Miller Fisher syndrome ). We assessed the location, type, and intensity of pain using questionnaires at MEMORY LOSS AFTER STROKE Memory loss commonly occurs as a result of the loss of nerve cells in the brain. When memory loss is so severe that it interferes with normal daily functioning, it is called dementia. People with dementia may have difficulty learning new things or remembering names of people they just met. They may get lost in places that were previously very familiar or have trouble finding words. VITAMIN B6 TOXICITY REVISITED: A CASE OF REVERSIBLE Objective: To present the salient features, and reversibility of pyridoxine (vitamin B6) induced peripheral neuropathy, in conjunction with its electrodiagnostic correlate. Background: B-Complex vitamins are essential for functioning of the nervous system, and supplementation is generally well tolerated. Although rare, excess pyridoxine can lead to paradoxical neurotoxicity— resulting in THE FINAL MONTH OF LIFE IN PATIENTS WITH ALS Objective: To study the health care experiences and palliative care needs of patients with ALS in their final month of life. Methods: Caregivers of decedent patients with ALS completed a single survey focused on the final month of life. They reported the patients’ physical and emotional symptoms, preferences for end-of-life care, completion of advance directives, and preparation for death. NEUROLOGY | THE MOST WIDELY READ AND HIGHLY CITED PEERLOG INLATEST ARTICLESCURRENT ISSUEPAST ISSUESRESIDENTS & FELLOWS Automated, Quantitative Pupillometry in the Critically Ill: A Systematic Review of the Literature. Petra Opic, Stephan Rüegg, Stephan Marsch, et al. May 27, 2021. Video NeuroImages. Treatment of Painless Legs and Moving Toes Syndrome Associated With Multiple System Atrophy With Levodopa. Takeya Araki, Tatsuya Mukai, Takehisa Araki. NEUROLOGY® RESIDENT & FELLOW SECTION CLINICAL REASONING Clinical Reasoning in Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section. The new Clinical Reasoning Book edited by Aaron Berkowitz, Sashank Prasad and Mitchell Elkind available as a FREE pdf download or on the Neurology app for the iPadand Android
TEMPORAL CORRELATION OF CSF AND NEUROIMAGING IN THE Objective: Temporal correlations between CSF and neuroimaging (PET and MRI) measures of amyloid, tau, and neurodegeneration were evaluated in relation to Alzheimer disease (AD) progression. Methods: Three hundred seventy-one cognitively unimpaired and impaired participants enrolled in longitudinal studies of AD had both CSF (amyloid-β42, phosphorylated tau181, total tau, and WELCOME TO NEUROLOGY: GENETICS The mission of Neurology® Genetics is the publication of high-quality original contributions that elucidate the role of genetic and epigenetic variation in diseases of the central and peripheral nervous systems. The journal will publish original articles in all areas of neurogenetics, including rare and common genetic variation, genotype-phenotype correlations, outlier phenotypes as a result ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other PAIN IN GUILLAIN-BARRÉ SYNDROME Background: Pain in Guillain-Barré syndrome (GBS) may be pronounced and is often overlooked. Objectives: To obtain detailed information about pain in GBS and its clinical variants. Methods: This was a prospective cohort study in 156 patients with GBS (including 18 patients with Miller Fisher syndrome ). We assessed the location, type, and intensity of pain using questionnaires at MEMORY LOSS AFTER STROKE Memory loss commonly occurs as a result of the loss of nerve cells in the brain. When memory loss is so severe that it interferes with normal daily functioning, it is called dementia. People with dementia may have difficulty learning new things or remembering names of people they just met. They may get lost in places that were previously very familiar or have trouble finding words. VITAMIN B6 TOXICITY REVISITED: A CASE OF REVERSIBLE Objective: To present the salient features, and reversibility of pyridoxine (vitamin B6) induced peripheral neuropathy, in conjunction with its electrodiagnostic correlate. Background: B-Complex vitamins are essential for functioning of the nervous system, and supplementation is generally well tolerated. Although rare, excess pyridoxine can lead to paradoxical neurotoxicity— resulting in THE FINAL MONTH OF LIFE IN PATIENTS WITH ALS Objective: To study the health care experiences and palliative care needs of patients with ALS in their final month of life. Methods: Caregivers of decedent patients with ALS completed a single survey focused on the final month of life. They reported the patients’ physical and emotional symptoms, preferences for end-of-life care, completion of advance directives, and preparation for death. AMERICAN ACADEMY OF NEUROLOGY JOURNALS This month's replay of past episodes showcases a selection of interviews on updates in Alzheimer's disease diagnostics and the impact of future therapies, featuring Drs. Michael Weiner, Randall Bateman, Erik Musiek, Joseph Therriault, and Yvette Sheline. NEUROLOGY | THE MOST WIDELY READ AND HIGHLY CITED PEER Automated, Quantitative Pupillometry in the Critically Ill: A Systematic Review of the Literature. Petra Opic, Stephan Rüegg, Stephan Marsch, et al. May 27, 2021. Video NeuroImages. Treatment of Painless Legs and Moving Toes Syndrome Associated With Multiple System Atrophy With Levodopa. Takeya Araki, Tatsuya Mukai, Takehisa Araki.TABLE OF CONTENTS
Karine Eid, Øivind Fredvik Torkildsen, Jan Aarseth, Heidi Øyen Flemmen, Trygve Holmøy, Åslaug Rudjord Lorentzen, Kjell-Morten Myhr, Trond Riise, Cecilia Simonsen, Cecilie Fredvik Torkildsen, Stig Wergeland, Johannes Sverre Willumsen, Nina Øksendal, Nils Erik Gilhus, Marte-Helene Bjørk SHORTCOMINGS OF RAPID CLINICAL INFORMATION DISSEMINATION The coronavirus disease 2019 (COVID-19) pandemic has led to an acceleration of clinical information dissemination to unprecedented speeds, a phenomenon only partially explained by formal efforts of the scientific community. These have ranged from the establishment of open-source platforms for review of article preprints to the elimination of journal paywalls for COVID-19–related publications. DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other THE BRAIN AND THE KIDNEY CONNECTION Patients with chronic kidney disease (CKD) exhibit tremendously high levels of symptomatic and occult cerebrovascular disease and associated inflammatory factors, homocysteine, anemia, hypertension, and diabetes.1–4 As these risk factors overshadow aging and nonvascular factors, patients with CKD represent a potential model of accelerated vascular cognitive impairment.4 The ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent DIZZINESS AS A SIGN OF STROKEABOUT STROKE Dizziness as a sign of stroke. About stroke. Dizziness is a common medical complaint. It “is the third most common medical symptom reported in general medical clinics and accounts for about 3%–5% of visits across care settings. In the United States, this translates to 10 million ambulatory visits per year because of dizziness, withroughly
DIAGNOSING MRI-NEGATIVE AUTOIMMUNE DISEASES The diagnosis of MS requires demonstration of disease dissemination in space and time and is based on diagnostic criteria such as the recently revised McDonald criteria.1 With their 2001 revision, the McDonald criteria formally have included MRI in the diagnostic workup of patients with suspected MS.2 Since then, the relevance of MRI for diagnosis and disease monitoring has further increased CAFFEINE AND PARKINSON DISEASE Most cases of Parkinson disease (PD) over age 50 are sporadic, and twin studies strongly suggest a predominance of environmental over genetic etiologies.1 However, few factors have been found consistently in epidemiologic studies to have major effects, protective in all cases: smoking, urate,2 and caffeine consumption.3 The protective effect of caffeine (found not only in coffee, but also NEUROLOGY® RESIDENT & FELLOW SECTION CLINICAL REASONING Clinical Reasoning in Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section. The new Clinical Reasoning Book edited by Aaron Berkowitz, Sashank Prasad and Mitchell Elkind available as a FREE pdf download or on the Neurology app for the iPadand Android
DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE, AND THE RISK OF Objective: Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. This study aims is to investigate the links between kidney function, kidney function decline and dementia incidence. Methods: We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent THE SYNDROME OF ACUTE SENSORY NEUROPATHY We followed 42 patients with clinically defined pure sensory neuropathy of acute or subacute onset for 2 to 35 years. The symptoms began in the upper limbs in 23 patients, in the lower limbs in 13, symmetrically in all 4 limbs in 4, and the face was 1st affected in 2. For 19 patients, the symptoms began asymmetrically. Electrophysiologic testing typically showed absence of sensory A PHASE 1, MULTIPLE-DOSE STUDY OF ELEZANUMAB (ABT-555) IN Objective: The current study evaluated multiple doses of elezanumab to determine its safety and tolerability in patients with relapsing forms of MS. Background: Elezanumab is a fully humanized monoclonal antibody directed against repulsive guidance molecule A (RGMa). Studies in patients with multiple sclerosis (MS) demonstrate RGMa upregulation, which inhibits axonal growth and myelination TEACHING VIDEO NEUROIMAGES: JAW CLONUS IN AMYOTROPHIC We present a case of amyotrophic lateral sclerosis (ALS) in a middle-aged woman who presented with a 2-year history of dysarthria and dysphagia. On examination, she had spastic dysarthria, jaw clonus (video 1), hyperreflexia, and fasciculations involving the tongue, trunk, and extremities. Jaw clonus is an upper motor sign that localizes to the dysfunction of corticobulbar fibers cranial to STROKE INCIDENCE IN YOUNG ADULTS ACCORDING TO AGE, SUBTYPE Objective To investigate incidence of stroke and its subtypes in young adults, according to sex and age, and to study trends over time. Methods We established a nationwide cohort through linkage of national registries (hospital discharge, cause of death, and population register) with patients aged 18–50 years and those ≥50 years with first-ever ischemic stroke, intracerebral hemorrhage, orZOSTER SINE HERPETE
Varicella zoster virus (VZV) is an exclusively human neurotropic herpesvirus that causes varicella (chickenpox) during primary infection, after which the virus becomes latent in cranial nerve, dorsal root, and autonomic ganglia along the entire neuraxis.1 Decades later, virus may reactivate to cause herpes zoster (shingles), an extremely painful vesicular skin rash confined to one or more NEW EVIDENCE FOR REDUCED LEG OXYGEN LEVELS IN RESTLESS Changes in dopamine may be linked to low levels of iron in the brain and body along with poor iron transport into the brain and changes in brain dopamine receptors. 1. However, there is new evidence for problems with blood flow and leg oxygen levels in RLS/WED. These changes involve the cells of the blood vessel walls, or endothelium. NEUROLOGY® RESIDENT & FELLOW SECTION CLINICAL REASONING Clinical Reasoning in Neurology: A Case-Based Approach Cases from the Neurology® Resident & Fellow Section. The new Clinical Reasoning Book edited by Aaron Berkowitz, Sashank Prasad and Mitchell Elkind available as a FREE pdf download or on the Neurology app for the iPadand Android
DIFFERENTIAL DIAGNOSIS OF MULTIPLE SCLEROSIS A diagnosis of multiple sclerosis (MS) requires not only the demonstration of CNS lesions disseminated in time and space but also the active exclusion of alternative diagnoses.1 This requirement for “no better explanation” represents a substantial challenge given the varied clinical manifestations of MS, and the absence of a diagnostic test that readily distinguishes MS from other KIDNEY FUNCTION, KIDNEY FUNCTION DECLINE, AND THE RISK OF Objective: Community-based reports regarding the association between the estimated glomerular filtration rate (eGFR) and dementia risk show conflicting results. This study aims is to investigate the links between kidney function, kidney function decline and dementia incidence. Methods: We analyzed the association of eGFR with the risk of dementia (defined as a new dementia diagnosis ETHICAL ISSUES IN STROKE MANAGEMENT A variety of ethical issues may arise in the management of patients with stroke.1 The adequacy of informed consent may be questioned in the incapacitated patient with acute stroke for whom IV alteplase administration is planned despite the absence of a lawful surrogate decision maker. The decision-making capacity of a patient with a recent dominant hemispheric infarction causing nonfluent THE SYNDROME OF ACUTE SENSORY NEUROPATHY We followed 42 patients with clinically defined pure sensory neuropathy of acute or subacute onset for 2 to 35 years. The symptoms began in the upper limbs in 23 patients, in the lower limbs in 13, symmetrically in all 4 limbs in 4, and the face was 1st affected in 2. For 19 patients, the symptoms began asymmetrically. Electrophysiologic testing typically showed absence of sensory A PHASE 1, MULTIPLE-DOSE STUDY OF ELEZANUMAB (ABT-555) IN Objective: The current study evaluated multiple doses of elezanumab to determine its safety and tolerability in patients with relapsing forms of MS. Background: Elezanumab is a fully humanized monoclonal antibody directed against repulsive guidance molecule A (RGMa). Studies in patients with multiple sclerosis (MS) demonstrate RGMa upregulation, which inhibits axonal growth and myelination TEACHING VIDEO NEUROIMAGES: JAW CLONUS IN AMYOTROPHIC We present a case of amyotrophic lateral sclerosis (ALS) in a middle-aged woman who presented with a 2-year history of dysarthria and dysphagia. On examination, she had spastic dysarthria, jaw clonus (video 1), hyperreflexia, and fasciculations involving the tongue, trunk, and extremities. Jaw clonus is an upper motor sign that localizes to the dysfunction of corticobulbar fibers cranial to STROKE INCIDENCE IN YOUNG ADULTS ACCORDING TO AGE, SUBTYPE Objective To investigate incidence of stroke and its subtypes in young adults, according to sex and age, and to study trends over time. Methods We established a nationwide cohort through linkage of national registries (hospital discharge, cause of death, and population register) with patients aged 18–50 years and those ≥50 years with first-ever ischemic stroke, intracerebral hemorrhage, orZOSTER SINE HERPETE
Varicella zoster virus (VZV) is an exclusively human neurotropic herpesvirus that causes varicella (chickenpox) during primary infection, after which the virus becomes latent in cranial nerve, dorsal root, and autonomic ganglia along the entire neuraxis.1 Decades later, virus may reactivate to cause herpes zoster (shingles), an extremely painful vesicular skin rash confined to one or more NEW EVIDENCE FOR REDUCED LEG OXYGEN LEVELS IN RESTLESS Changes in dopamine may be linked to low levels of iron in the brain and body along with poor iron transport into the brain and changes in brain dopamine receptors. 1. However, there is new evidence for problems with blood flow and leg oxygen levels in RLS/WED. These changes involve the cells of the blood vessel walls, or endothelium. CRANIAL NEUROPATHIES AND COVID-19 The coronavirus disease 2019 (COVID-19) global pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. Like its predecessors, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 binds to angiotensin converting enzyme 2 (ACE2) receptors to facilitate tissue GENERALIZED MYOCLONUS IN COVID-19 Objective To report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus. Methods Patient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain. Results Three patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus CATEGORIES OF THE RESIDENT AND FELLOW SECTION Categories of the Resident and Fellow Section. This information must be used in conjunction with all policies and specifications outlined in the Author Center. The Resident & Fellow Section (RFS) publishes papers that further the education of medical students, residents, fellows, and other trainees. Papers in the RFS are relevant totrainees
SHORTCOMINGS OF RAPID CLINICAL INFORMATION DISSEMINATION The coronavirus disease 2019 (COVID-19) pandemic has led to an acceleration of clinical information dissemination to unprecedented speeds, a phenomenon only partially explained by formal efforts of the scientific community. These have ranged from the establishment of open-source platforms for review of article preprints to the elimination of journal paywalls for COVID-19–related publications.TABLE OF CONTENTS
Karine Eid, Øivind Fredvik Torkildsen, Jan Aarseth, Heidi Øyen Flemmen, Trygve Holmøy, Åslaug Rudjord Lorentzen, Kjell-Morten Myhr, Trond Riise, Cecilia Simonsen, Cecilie Fredvik Torkildsen, Stig Wergeland, Johannes Sverre Willumsen, Nina Øksendal, Nils Erik Gilhus, Marte-Helene Bjørk DIAGNOSING MRI-NEGATIVE AUTOIMMUNE DISEASES The diagnosis of MS requires demonstration of disease dissemination in space and time and is based on diagnostic criteria such as the recently revised McDonald criteria.1 With their 2001 revision, the McDonald criteria formally have included MRI in the diagnostic workup of patients with suspected MS.2 Since then, the relevance of MRI for diagnosis and disease monitoring has further increased A RETROSPECTIVE STUDY EVALUATING THE USE OF ANTI Objective: To examine the use of oral/transdermal anti-parkinsonian medications in advanced Parkinson’s disease (APD) patients who have a history of or current treatment with deep brain stimulation (DBS), and are receiving levodopa-carbidopa intestinal gel (LCIG). Background: As PD progresses, oral drug regimens may become inadequate for symptom control. SOCIOECONOMIC AND GEOGRAPHIC DISPARITIES IN IDIOPATHIC Objective To identify relationships between idiopathic intracranial hypertension (IIH) and socioeconomic determinants of health, such as low-income status and proximity to healthy food. Methods This retrospective case–control study of adult female neuro-ophthalmology patients from one institution identified 223 women with and 4,783women without IIH.
WERNEKINCK COMMISSURE SYNDROME For assistance, please contact: AAN Members (800) 879-1960 or (612) 928-6000 (International) Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) NEUROPATHOLOGY, AND COGNITIVE DECLINE Views & Reviews 1080 Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review W. Liang, Y. Skip to main content UNIVERSAL NAVIGATION* AAN.com
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EFFORTS BY THE JOURNAL TO PROMOTE PERSPECTIVES OF EQUITY, DIVERSITY, AND INCLUSION AND ADDRESS DISPARITIESFEATURED ARTICLES
NEUROLOGY®
ARTICLE | Multiple sclerosis Comparative effectiveness of teriflunomide vs dimethyl fumarate inmultiple sclerosis
ARTICLE | Parkinson disease Effect of polygenic load on striatal dopaminergic deterioration inParkinson disease
ARTICLE | Parkinson disease Impulse control disorders in Parkinson disease and RBD: A longitudinalstudy of severity
MEDICAL HYPOTHESIS | Myoclonus Spinal cord α-synuclein deposition associated with myoclonus inpatients with MSA-C
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NEUROLOGY® CLINICAL PRACTICE REVIEW |Parkinsonism “Pseudo-syndromes” associated with Parkinson disease, dementia, apathy, anxiety, and depression REVIEW | Bioterrorism Therapy for acute nerve agent poisoning: An updateRESEARCH |Epilepsy
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RECENT SURVEY RESULTS Explore results on an interactive world map * Topic: "When do you suspect autoimmune encephalitis and what is the role of antibody testing?" * Topic: "How do you treat epilepsy in pregnancy?" * Topic: "How do you treat neuromyelitis optica?" * Topic: "What is your diagnostic evaluation of cryptogenic stroke?" What is Practice Current? __*
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Impulse control disorders in Parkinson disease and RBD: A longitudinalstudy of severity
Dr. Jason Crowell talks with Dr. Michele Hu and Dr. David Okai about their longitudinal study of the severity of impulse control disorders in Parkinson disease and RBD August 13, 2019 Issue Neurology, Journal, podcast__ Listen26:26
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_NEUROLOGY_ PATIENT PAGES Critical reviews of ground-breaking discoveries in neurological research written especially for patients and their familiesTOPICS
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