Neurology Alert
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Nitrous Oxide-Induced Neuropathy
Nitrous oxide-induced neuropathy presents with a rapidly progressive sensorimotor neuropathy that may mimic Guillain-Barré syndrome. The pattern of clinical weakness and progression, as well as electrophysiological features, can help to rapidly distinguish the two disorders.
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Comparison of the Efficacy of Rituximab vs. Ocrelizumab in the Treatment of Relapsing Multiple Sclerosis
Rituximab is an anti-CD20 chimeric monoclonal antibody used off-label to treat multiple sclerosis (MS). Ocrelizumab is a humanized monoclonal anti-CD20 monoclonal antibody that is Food and Drug Administration-approved for the treatment of MS. In this observational cohort study, the authors were not able to demonstrate noninferiority of rituximab compared to ocrelizumab because of a significantly lower relapse rate in the ocrelizumab-treated group.
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Statins Might Lower Risk of Recurrent Stroke
Patients in Denmark who suffered an intracerebral hemorrhage and were taking cholesterol-lowering medication were less likely to experience another stroke.
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Differentiating MELAS from Bland Ischemic Stroke: Clinicoradiologic Criteria
Stroke symptoms in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) are difficult to diagnose correctly, which leads to missed opportunities to provide MELAS-specific treatment. Delay in diagnosis also complicates efforts to investigate acute treatments for MELAS. Khasminsky et al proposed clinicoradiologic criteria based on a single-center validation study. Although there are methodological limitations, the concepts highlighted by the authors are valuable.
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Treatment of Preclinical Alzheimer’s Disease
After a four-year, complex clinical trial of an anti-amyloid antibody, solanezumab, there was no benefit in reducing the likelihood of progression of cognitive impairment in patients with positive amyloid positron emission tomography scans who started the trial cognitively unimpaired vs. placebo.
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Super-Refractory Status Epilepticus: Clinical Characteristics, Treatment, and Outcome
Patients with super-refractory status epilepticus (SRSE) differed from patients with first-time status epilepticus in clinical presentations and the treatment course. Although seizure control was achieved in most SRSE patients, the in-hospital mortality and the chance of severe disability at discharge were high.
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Cumulative Number of Head Strikes Contributes to the Development of Chronic Traumatic Encephalopathy
Researchers recently evaluated the connection between head impact and chronic traumatic encephalopathy (CTE) in male athletes. They found the total number and severity of head impacts throughout life better predicted CTE than the number of symptomatic concussions.
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Tarlov Cysts of the Lumbosacral Spine
Tarlov cysts (root sleeve cysts) are common incidental findings on magnetic resonance imaging of the lumbosacral spine. However, they rarely are correlated with electrophysiological findings or clinical symptoms. Undertake extreme care and caution before recommending surgical intervention for these common imaging abnormalities.
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Incident Dementia Cases Connected to Long-Term Air Pollution Exposure
Researchers reported fine particulate matter from agriculture and open fires to be especially harmful.
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Disease-Modifying Therapy After Natalizumab Discontinuation in Patients with Relapsing Multiple Sclerosis
In this retrospective cohort study, the investigators found that, when compared to fingolimod and dimethyl fumarate, ocrelizumab use was associated with significantly lower annualized relapse rate and treatment discontinuation. There were no significant differences in outcomes between fingolimod and dimethyl fumarate use. Ocrelizumab use was associated with a lower rate of disability accumulation when compared to fingolimod.