Neurology
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Intravenous Tenecteplase for Stroke After 4.5 Hours Does Not Improve Outcome
Standard therapy for acute ischemic stroke is intravenous thrombolysis within 4.5 hours from onset of symptoms. Alteplase has been the standard medication, but in recent years, tenecteplase has supplanted alteplase because of its ease of administration as a single intravenous bolus and lower cost.
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Post-Traumatic Epilepsy and the Risk of Dementia
A subset of people with head injury will develop post-traumatic epilepsy (PTE). This prospective cohort study demonstrated a 4.5-fold increased risk of dementia in those with PTE compared to people without head trauma or epilepsy, and that this risk exceeds that observed in people with head trauma or epilepsy alone.
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Wildfire Smoke Exposure Is a Risk Factor for Dementia
In this large, open cohort study based on electronic health record data from 2009 to 2019 of dementia-free people older than 60 years of age, exposure to wildfire smoke resulted in an increased incidence of dementia later in life.
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Psychiatric Comorbidities in Persons with Epilepsy
In this systematic review and meta-analysis, the prevalence of most psychiatric disorders was significantly higher in persons with epilepsy than in those without epilepsy. These findings show the high burden of psychiatric comorbidities in persons with epilepsy and underscore the importance of appropriately identifying and treating psychiatric comorbidities in epilepsy patients.
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Patterns of Brain Atrophy in Memory Disorders
In this multicenter, memory clinic-based cohort targeting earliest at-risk states for dementia of Alzheimer’s type, limbic-predominant and hippocampus-sparing atrophy subtypes were identified. Limbic-predominant atrophy was linked to worse cognitive outcomes over time, including in individuals who were asymptomatic or only had subjective memory symptoms at the time of baseline imaging.
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Examination and Imaging Correlates of Visual Symptoms in Mild TBI
This study highlights measurable visual and structural changes in patients with mild traumatic brain injury (mTBI). Findings include convergence insufficiency, reduced contrast sensitivity, and occipital cortex changes, despite normal standard imaging and visual field tests. Machine learning discerned mTBI from controls with 72% accuracy, suggesting advanced diagnostics can uncover subtle abnormalities.
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Monotruncular (Monomelic) CIDP
In this study, the authors describe the clinical, electrophysiological, and radiological features of patients with multifocal chronic inflammatory demyelinating polyneuropathy (CIDP) that presented with monotruncular (monomelic) onset.
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Diagnostic Criteria for Paraneoplastic Neurologic Syndromes
This study evaluates the effectiveness of the updated 2021 Paraneoplastic Neurologic Syndromes (PNS)-CARE score in diagnosing PNS, highlighting significant improvements in sensitivity and specificity compared to the 2004 criteria, while also addressing limitations related to study design, diagnostic criteria comparison, and the need for further research in diverse patient populations.
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Epilepsy and Cardiovascular Events
This large prospective cohort study found that older adults with a lifetime history of epilepsy were more likely to experience cardiovascular events (CVEs), and that enzyme-inducing antiseizure medications (EIASMs) may account for a significant portion of this risk. The findings suggest a potential causal link between epilepsy treated with EIASMs and CVE, highlighting the need for careful medication selection in epilepsy management.
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DOACs Can Safely Be Started Early After Atrial Fibrillation-Associated Stroke
In ischemic stroke associated with atrial fibrillation, early restart of anticoagulation with apixaban one to three days after ischemic stroke, compared to late restart (seven to 14 days), there were no significant differences between the groups in the primary outcome — a composite endpoint including recurrent ischemic stroke, symptomatic intracranial hemorrhage, and systemic embolism.