Neurology
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Ethics Consults Focus on the Criteria Used to Determine Death
Some families simply need more time to process strong emotional reactions and grief. Establishing trust can help resolve these cases. Particularly in critical care, it is important from the moment that clinicians meet a family to start to build a good therapeutic relationship with them.
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Treating Psychotic Symptoms Among Alzheimer’s Disease Patients
In a meta-analysis of several large treatment trials of patients with Alzheimer’s disease, Parkinson’s disease, and dementia with Lewy bodies, cholinesterase inhibitors demonstrated a small but statistically significant benefit in alleviating psychotic symptoms.
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Lawsuits Allege Delays, Failure to Treat with Mechanical Thrombectomy
Malpractice claims involving intravenous thrombolytic therapy to treat acute ischemic stroke patients are more likely to allege failure to treat than to allege complications related to therapy. A group of researchers wanted to know if the same was true regarding mechanical thrombectomy.
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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.