Neurology
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Rapid Reversal of Anticoagulation Reduces Mortality from Intracerebral Hemorrhage
Because the numbers of patients with primary intracerebral hemorrhage are far lower than those with ischemic stroke, it has been difficult to accumulate a large enough number of patients to clearly analyze the relationship between the time of the hemorrhage and the time to treatment. We need to answer the important question: Does rapid treatment result in a better outcome?
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Outcomes Are Better for Acute Stroke Patients Who Arrive Rapidly at Endovascular-Capable Centers
The SELECT2 trial was structured to identify which patients with large ischemic strokes would benefit from endovascular thrombectomy and analyzed the effect of direct arrival at a thrombectomy-capable center compared to transfer from a primary stroke center.
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Endovascular Thrombectomy Is Used Much Less for Stroke Associated with Cardiac Interventions
Recent cardiac surgery is a strong contraindication to having intravenous thrombolysis for ischemic stroke. Endovascular thrombectomy, if appropriate, would be the best treatment for these patients. To obtain additional understanding of the prevalence of ischemic stroke and treatment with EVT following cardiac surgery, these investigators queried a large claims-based database.
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Intravenous Tenecteplase for Stroke After 4.5 Hours Does Not Improve Outcome
The TIMELESS study was developed to evaluate the effect of treatment with tenecteplase 4.5 to 24 hours after stroke onset in patients with large artery occlusion who subsequently would go on to endovascular thrombectomy.
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Does Needle EMG Interfere with MR Neurography or Myography Interpretation?
In this carefully designed prospective clinical study, needle electromyography did not have any significant effect on the interpretation of magnetic resonance (MR) neurography or MR myography or alter the diagnosis.
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Longitudinal Follow-Up of Patients with Anti-NMDA Receptor Encephalitis
In this retrospective, observational study of 38 patients with autoimmune encephalitis, using standard clinical assessment rating scales, the only predictor of poor outcome was muscle weakness at symptom onset. Most patients had long-term problems with cognitive and mood disorders.
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Post-Operative Delirium May Involve Altered Brain Glucose Metabolism
Post-operative delirium is a major health problem that occurs in about half of older patients who undergo surgery with general anesthesia. This prospective study from Norway of patients undergoing emergency hip repair surgery demonstrated from spinal fluid analysis that patients with delirium have abnormalities in brain glucose uptake and metabolism and have an early shift to ketosis in the spinal fluid.
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Glymphatic and Lymphatic Functions in Patients with Chronic Migraine
Patients with chronic migraine have dysfunction of their glymphatic and meningeal lymphatic systems, which may play a role in the pathogenesis of migraine.
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Comparing Patients with Early vs. Late-Onset Multiple Sclerosis
A recent retrospective study, combining data from a United Kingdom patient registry with a United Kingdom neuropathology tissue bank, showed that late-onset multiple sclerosis (MS), referring to disease onset after age 50 years, is linked with increased disability and quicker progression compared to MS onset at a younger age, and has distinct pathological features.
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MRI for the Evaluation of Inflammatory Myopathy
Magnetic resonance imaging (MRI) of large muscles is an important adjunctive diagnostic test for inflammatory myopathies, in conjunction with serum muscle enzymes and electrophysiology. MRI also can identify the highest-yielding section of muscle to target a muscle biopsy.