NEURO

Viral meningitis is an inflammation of the meninges associated with acute onset of meningeal symptoms and fever, pleocytosis of the cerebrospinal fluid, and no growth on routine bacterial culture. It is sometimes associated with viral encephalitis and meningoencephalitis. Viruses reach the central nervous system (CNS) hematogenously or in a retrograde manner from nerve endings. The viral etiology varies according to age and country. Molecular diagnostics technology has helped improve the rate of pathogen detection reducing unnecessary antibiotic use and length of hospitalization. from Journal of the Neurological Sciences http://bit.ly/2BcUJ1w

Receiving a thrombectomy to remove a blood clot up to 16 hours after stroke onset may benefit a broad range of patients. from Front page feed http://bit.ly/2MJ8tFH

A new study reveals the molecular switch that helps control the function of satiety neurons and body weight. from Neuroscience News Updates http://bit.ly/2SlYtYc

A new mouse study reveals a small cluster of interneurons in the hippocampus help the brain remember the places that matter the most. The findings could have implications for future studies of psychiatric disorders. from Neuroscience News Updates http://bit.ly/2HIQBfq

Exercise is associated with improved brain function and a decrease in cerebral blood flow in older people with mild cognitive impairment, a new study reports. from Neuroscience News Updates http://bit.ly/2SdmzVd

More than 80% of parents reported significant or moderate improvements in their child's ASD symptoms following medical cannabis treatment, a new study reports. from Neuroscience News Updates http://bit.ly/2sWplzM

Researchers report people with sleep apnea have trouble recalling details of autobiographical memories, putting them at greater risk of developing depression. from Neuroscience News Updates http://bit.ly/2MMTg6M

A new study reveals taking a short daytime nap can help to consolidate learning and memory of new foreign words. from Neuroscience News Updates http://bit.ly/2RwGJVT

Our brains are not perfect, smooth-running machines. Our physical responses to the events of the day are not consistent at all times. Intuitively, you are probably aware that you have a dip in concentration after eating. But our neurological responses fluctuate much more than just in a post-lunch slump. (January 31, 2019) Read the full article here from Brain Health Daily http://bit.ly/2To5Dsr

Heart-pumping exercise benefits the brain, improving thinking skills even in younger adults, a small study suggests. For the study, scientists tracked more than 130 adults, aged 20 to 67. The investigators found that aerobic exercise increased participants’ overall fitness as well as their so-called executive function — thinking skills that are key to reasoning, planning and problem-solving. (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2BcLGgV

The opioid epidemic is fueling a steep rise in infection-related stroke hospitalizations, according to preliminary research to be presented in Honolulu at the American Stroke Association’s International Stroke Conference 2019, a world premier meeting for researchers and clinicians dedicated to the science and treatment of cerebrovascular disease. This study will also be simultaneously published in the American Heart Association’s journal Stroke. (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2To5Agf

A mild traumatic brain injury — such as from a car crash or violent assault — may come with a higher risk of mental health problems, according to a new study. Specifically, the research ties mild traumatic brain injury to a higher risk of post-traumatic stress disorder and depression after the injury, compared with another type of traumatic injury not involving the head. (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2BdU1kF

Researchers pin down the faulty brain circuitry that drives negative symptom severity in schizophrenia and look at noninvasive methods of targeting and “repairing” this breakdown. Schizophrenia is a mental health condition with characteristic symptoms that include delusions and hallucinations. It also has numerous negative symptoms, such as flat affect (lack of emotional expression), anhedonia, monotone speech, and avoiding social interaction. (January 31, 2019) Read the full article here from Brain Health Daily http://bit.ly/2To5wx1

Researchers have identified a possible mechanism of human cognition that underlies autism spectrum disorders, or ASD. They found there was brain overconnectivity in the unimodal-subcortical connections and brain underconnectivity in the supramodal-subcortical connections for ASD individuals, as compared to the typically developing control group, suggesting a relationship between connectivity and the expression of ASD. (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2BdTYFv

Stimulants like methylphenidate (Ritalin) and mixed amphetamine salts (Adderall) have clear benefits for those with attention deficit/hyperactivity disorder (ADHD). But what about for those without ADHD: Do these drugs improve cognitive ability in otherwise healthy brains? (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2To5uFp

A large-scale genomic analysis has revealed some of the inner workings of the body clock, shedding new light on how it links to mental health and disease. The study, published in Nature Communications, suggests that being genetically programmed to rise early may lead to greater well-being and a lower risk of schizophrenia and depression. However, despite much previous speculation, the results did not reveal any strong links to diseases such as diabetes or obesity. (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2BeV04a

Here: Results from a clinical study of African-American patients with mild cognitive impairment. from Front page feed http://bit.ly/2HJnh8q

At Public Books , our editorial staff and contributors are hard at work to provide readers with thought-provoking articles. But when the workday is done, what is ... The post On Our Nightstands: January 2019 appeared first on Public Books . from Public Books http://bit.ly/2Tq2gRx

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Researchers report alterations in RNA editing play a vital role in autism spectrum disorder. from Neuroscience News Updates http://bit.ly/2SgY5dz

A new study reports lampreys are able to recover and regenerate its spinal cord for a second time after injury in the same location. from Neuroscience News Updates http://bit.ly/2t4RW6h

Using transcranial magnetic stimulation, researchers have successfully restored network function between the prefrontal cortex and cerebellum, helping to improve symptoms in those with treatment resistant schizophrenia. from Neuroscience News Updates http://bit.ly/2Timcpz

Researchers report 1 in 5 people are at risk of experiencing mental health conditions, such as PTSD or major depressive disorder, within 6 months of suffering mTBI. from Neuroscience News Updates http://bit.ly/2GbnH58

A new study reveals a direct link between altered brain activity and social deficits in ASD. from Neuroscience News Updates http://bit.ly/2FZhqdp

The world’s most common digital habit is not easy to break, even in a fit of moral outrage over the privacy risks and political divisions Facebook has created, or amid concerns about how the habit might affect emotional health. Although four in 10 Facebook users say they have taken long breaks from it, the digital platform keeps growing. A recent study found that the average user would have to be paid $1,000 to $2,000 to be pried away for a year. (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2sZ2Fic

In a breakthrough straight out of the world of science fiction, a team of researchers has used artificial intelligence (AI) to turn brain signals into computer-generated speech. The feat was accomplished with the assistance of five epilepsy patients. All had been outfitted with various types of brain electrodes as part of their seizure treatment. (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2MHLnQ2

Electronic cigarettes are often thought of as “healthier” than conventional cigarettes, but the jury’s still out on their potential health risks. Now, a new study has found a link between e-cigarette use and an increased risk of stroke and heart attacks. The study analyzed information from about 400,000 Americans who took part in a national health survey in 2016. Of these, about 66,800 reported that they regularly used e-cigarettes. (January 30, 2019) Read the full article here from Brain Health Daily http://bit.ly/2sXZnvY

Preeclampsia is a condition that can affect pregnant women, causing high blood pressure that increases the risk of major cardiac events, seizures or even death. Now experts think they may have another tool in stopping the dangerous complications related to this condition: aspirin. (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2MG53Um

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New research shows that some children with symptoms of ADHD have abnormally small volume in specific structures of the brain. This study from the Barcelona Institute for Global Health suggests that ADHD’s genetic variants differ between boys and girls with the condition. (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2ToEVQu

Living organisms are governed by an internal biological clock known as the circadian rhythm, and as the Earth rotates every 24 hours, this clock aligns with the cycle of day and night. In a new study, scientists reveal that this process has a strong link to mental health. There’s a larger chunk of the genome dedicated to body clocks than previously realized, and those genes are linked to others that determine a person’s overall state of well-being. (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2Bd6GUP

Picture an extra-lengthy, extra-thin, extra-flexible slab of greasy cheese coiling itself in multiple layers around a foot-long hot dog. Not quite the picture one usually has in mind when thinking about how our brains work, is it? But a set of fat-filled brain cells called oligodendrocytes are critical to pretty much everything the brain does — as much so, really, as the nerve cells or neurons (the hot dogs in my metaphor), that oligodendrocytes wrap their flabby protrusions around. (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2Tp7q0g

Long-term space travel affects the human brain and at least two scientists think more work must be done to characterize the risks. According to a new study published in the journal Neurology, astronauts who spend three to six months aboard the International Space Station showed signs of hydrocephalus, a buildup of cerebrospinal fluid inside the brain’s ventricles. (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2Bacajc

What makes humans human? What distinguishes us from the machines we design to perform our tasks, machines we admire for their elegant mimicry, then resent and fear? If a compelling case ... The post The Pinsetter’s Lament appeared first on Public Books . from Public Books http://bit.ly/2Utbhtc

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Pain and sleep are poor bedfellows. Among people with recurring pain from problems like back strain, arthritis, and diabetes, as many as two-thirds report having sleep problems, according to a National Sleep Foundation poll. Multiple studies have found associations between pain and poor sleep, including a study published in 2018 in the journal Frontiers in Psychiatry that suggested that the relationship is bidirectional — people report having worse pain after a poor night of sleep and people report sleeping worse when in pain. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2UvFc4h

The first and most distinct consequence of daily mild stress is an increase in rapid-eye-movement (REM) sleep, a new study in the journal PNAS reports. The research also demonstrated that this increase is associated with genes involved in cell death and survival. REM sleep, also known as paradoxical sleep, is the sleep state during which we have most of our dreams and is involved in the regulation of emotions and memory consolidation. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2DHzfLN

Investigators from Fralin Biomedical Research Institute at Virginia Tech have found a link between concussions and epilepsy development via mice models. More specifically, the team found atypical responses from brain cells known as astrocytes, which follow traumatic brain injuries (TBIs), may be the cause of epilepsy development. (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2Umu616

New research today published in the European Journal of Neurology has found that women are twice as likely to suffer from severe depression following a stroke than men. The team of researchers from King’s College London followed the progress of symptoms over five years after stroke onset in 2,313 people (1,275 men and 1,038 women). (January 29, 2019) Read the full article here from Brain Health Daily http://bit.ly/2DHzeHJ

In 2014 John Cryan, a professor at University College Cork in Ireland, attended a meeting in California about Alzheimer’s disease. He wasn’t an expert on dementia. Instead, he studied the microbiome, the trillions of microbes inside the healthy human body. Dr. Cryan and other scientists were beginning to find hints that these microbes could influence the brain and behavior. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2Up1nc7

The “choking game” — and other clearly ill-advised and dangerous internet challenges — leave many parents wondering what drives teens to take the bait and participate. Now, a new study suggests that an underlying psychological disorder may be one reason why some kids jump at online dares such as the “Bird Box” challenge, where people walk around blindfolded, and the Tide Pod challenge, daring people to eat laundry detergent. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2DIWHbD

A new treatment has been approved by the Food and Drug Administration for people with certain forms of epilepsy who continue to experience seizures despite trying several different anti-epileptic medications. The treatment, called deep brain stimulation, or DBS, was first developed to help people with Parkinson’s disease or tremor. Recent research has shown that it may also help people with epilepsy. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2Urbflz

We all know our chronological age. That’s as simple as counting the candles on your birthday cake. But do you know your biological age? This second number measures not how many years you’ve seen, but how much those years have impacted the functioning of your body and brain. Scientists calculate it a number of ways, but whatever methodology they employ, they agree chronological and biological age don’t always line up. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2DGRvVA

Clinical investigations of brain death are supposed to prove absence of cerebral perfusion. However, only limited data are available documenting intracranial pressure (ICP) and cerebral perfusion pressure (CPP) during the development of brain death. Our study presents additional data to understand the course of ICP and CPP in patients developing brain death. from Journal of the Neurological Sciences http://bit.ly/2G6UCrs

The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. from Journal of the Neurological Sciences http://bit.ly/2FXeaiH

Corticobasal syndrome (CBS) can harbor diverse pathologies, such as corticobasal degeneration (CBD) and Alzheimer's disease (AD). CSF biochemical analysis in CBS patients can confidently distinguish between an AD (CBS-AD) and a non-AD (CBS-nAD) pathology. from Journal of the Neurological Sciences http://bit.ly/2G6Uzfg

New research found over a quarter of children with treatment-refractory epilepsy sustained treatment response to CBD over four years. from Front page feed http://bit.ly/2RZvien

A new study reveals demography and the by products of industrialization are contributing to an impending Parkinson's disease pandemic. from Neuroscience News Updates http://bit.ly/2G02zj4

Researchers have developed a new system which utilizes artificial intelligence technology to turn brain signals to recognizable speech. The breakthrough could help restore a voice to those with limited, or no ability, to speak. from Neuroscience News Updates http://bit.ly/2GdPZfc

Researchers have successfully created stem cell derived brain cells which can generate oligodendrocytes, neurons and astrocytes. from Neuroscience News Updates http://bit.ly/2FVFHBd

According to a new study, those who are genetically predisposed to be early risers have a lower risk of developing psychiatric conditions, such as depression and schizophrenia, as well as having better over all health. In contrast to other studies, researchers did not find a strong link between circadian rhythm and diseases such as obesity or diabetes. from Neuroscience News Updates http://bit.ly/2G6YbOs

Using fNIRS, researchers discovered babies are able to pick out words from speech at as young as three days old. from Neuroscience News Updates http://bit.ly/2FUFfTT

Machine learning technology is helping researchers to detect the early signs of Alzheimer's, by identifying potential blood based biomarkers of the disease. Researchers say the technology has found hidden factors associated with Alzheimer's through medical data, and could help improve disease prediction. from Neuroscience News Updates http://bit.ly/2RpEqn7

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I’m standing on a foot-wide cement island in the middle of the bustling Avenida ... The post Casa Mueller’s Ghost: Displaced Afro-Caribbean History in Panama City appeared first on Public Books . from Public Books http://bit.ly/2B7deo4

Please join us in welcoming Irina Campos-Cruz, who has joined the Normal Fixel Institute for Neurological Diseases as front desk staff. from Department of Neurology http://bit.ly/2DFW1ng

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Cauliflower rice. If you haven’t already eaten some, you’ve probably seen it proliferating in grocery stores and on social media. According to this Consumer Reports article , cauliflower is the new kale , with sales rising 71 percent last year. For a growing number of carb conscious eaters, chopped or “riced” cauliflower has become a popular substitute for well… rice. Of all the cauliflower-embracing diets in vogue these days, the ketogenic or “Keto” diet is certainly top of the heap right now. This high fat, moderate protein, and low carb diet has attained celebrity fad status lately but, as you probably know, it has actually been around for nearly 100 years. The ketogenic diet has long been used in an effort to reduce seizures in children with difficult-to-treat epilepsy. The anticonvulsant effect is thought to be due to the release of ketone bodies brought about by the diet’s high fat, very low carbohydrate make up. These ketone bodies, beta-hydroxybutyrate (βHB), acetoacetat...

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Contrast sensitivity may be a result of small eye movements people may not be aware they are making, a new study reports. from Neuroscience News Updates http://bit.ly/2MEyINq

from Neurology recent issues http://bit.ly/2Wtfkrh

Single-voxel 1 H magnetic resonance spectroscopy ( 1 H MRS) is a magnetic resonance technique for quantifying certain metabolites in the brain that are differentially associated with cellular, molecular, and clinical alterations characteristic of the pathophysiologic development and progression of Alzheimer disease (AD). 1,2 Specifically, lower N -acetylaspartate to creatine ratios (NAA/Cr) have been associated with increased levels of phosphorylated tau seen in pretangle, early neuritic, and mature state neurofibrillary tangle pathology but not with the extracellular neurofibrillary "ghost" tangle tau pathology that occurs later in the disease course. 1,2 Lower NAA/Cr has also been associated with a loss of synaptic integrity measured with SV2A synaptic vesicle protein. 2 In addition, higher myo-inositol to Cr ratios (mI/Cr) are associated with increased densities of diffuse, neuritic, and cored β-amyloid plaques. 1,2 The accumulation of early tau and β-amyloid pathology...

There is a sizeable literature describing the behavioral sequelae of multiple sclerosis (MS). This has traditionally been divided into 2 broad categories, namely, disorders of cognition and emotion. Few studies have explored the relationship between them and those that have were focused predominantly on depression rather than anxiety. In general, the results show that deficits in processing speed, working memory, and executive function can arise as a consequence of depression, albeit at the more severe end of the depressive spectrum. Given that cognitive dysfunction is a common and currently intractable symptom of MS, affecting up to 70% of people and impeding employment, relationships, and leisure pursuits, 1 any condition that adds to this burden must be cause for concern. from Neurology recent issues http://bit.ly/2Wp6cnI

Almost 10% of people will experience a seizure during their lifetime, while the prevalence of epilepsy is close to 1%. 1,2 Though it can be difficult at times to diagnose, and management can be complex, epilepsy is considered by many to be an ambulatory care sensitive condition, whereby the majority of care is expected to be provided in an outpatient or office-based medical setting. 3 In fact, a large proportion of hospitalizations for ambulatory care sensitive conditions are thought to be preventable, if quality care is provided in the outpatient setting. However, epilepsy or convulsions account for nearly 4% of total hospitalizations in the United States and represent the fifth most common non-neonatal, nonmaternal cause for admission in children. 4,5 from Neurology recent issues http://bit.ly/2RjAmoJ

Most clinical trials in people with amyotrophic lateral sclerosis (ALS) have not produced successful new drugs. 1 Putative new therapies may not work to slow ALS for a number of reasons: perhaps the target is not pertinent or the drug characteristics are unacceptable (e.g., inadequate CNS penetration). If a drug is ineffective in treating ALS, it is best to declare this quickly and move on. If it looks promising, it is best to hasten development. Thus, conducting high-quality, rapid trials is a meaningful goal for ALS trialists. Yet, there are numerous challenges in ALS drug development. Perhaps chief among them is that ALS is a heterogeneous disorder. 2 This heterogeneity is most obvious to clinicians and clinical researchers as differences in location of onset, duration of diagnostic delay, and rate of ALS progression. 3 This phenotypic heterogeneity can also be threatening: it reduces statistical power, resulting in larger, longer ALS trials. Participant selection criteria are 1 ...

Gretchen Birbeck, MD, MPH from Neurology recent issues http://bit.ly/2RnrVsc

The American Academy of Neurology holds the following positions regarding brain death and its determination, and provides the following guidance to its members who encounter resistance to brain death, its determination, or requests for accommodation including continued use of organ support technology despite neurologic determination of death. from Neurology recent issues http://bit.ly/2Wp673o

Words matter. In utilizing language in a medical context, we should strive to communicate succinctly and clearly, conveying both continuity and understanding. This article seeks to put forward the error in continuing to use the term "cerebral palsy," implying a unitary disease phenomenon, when the heterogeneous nature of this entity is self-evident. In an analogous fashion to that which occurred with autism (another neurodevelopmental disability), the transition in nomenclature to "cerebral palsy spectrum disorder" is put forward for the community's consideration. from Neurology recent issues http://bit.ly/2Rnls0p

Neurosarcoidosis of the spinal cord is a rare entity that most commonly presents as meningeal disease or longitudinally extensive transverse myelitis. 1 A full comprehension of neurosarcoidosis, as well as establishing the diagnosis, remains a diagnostic and clinical challenge due to the rarity of the condition and limited available data. We describe the first case of neurosarcoidosis presenting as ventral, longitudinally extensive, transverse myelitis with a braid-like enhancement. This report adds a new MRI pattern of the disease that might be helpful in differentiation from myelitis of other etiologies. from Neurology recent issues http://bit.ly/2Wp647I

facebook.com/AANResidentsAndFellows from Neurology recent issues http://bit.ly/2Rnlqpj

A 40-year-old Caucasian woman reported 15 years of progressive lower leg and hand weakness. Weakness began asymmetrically in the legs. She had trouble standing on her toes and developed progressive bilateral foot drop, worse on the right. Over the years, she developed difficulty arising from low seats and climbing stairs. She began falling with her knees buckling bilaterally. She was a hairstylist, but stopped working about 2 years prior after the onset of weakness in her hands, including difficulty opening jars or using scissors. These symptoms progressed insidiously over the years without fluctuation. from Neurology recent issues http://bit.ly/2WqZyNK

In "Clinical Reasoning: A 56-year-old woman with acute vertigo and diplopia," Sharma et al. presented the case of a patient with a pontine infarct attributed to varicella-zoster virus reactivation in the setting of immunosuppression by bortezomib for treatment of light-chain amyloidosis. In response, Dr. Ambrose reminds neurologists that bortezomib, which is increasingly being used for antibody-mediated autoimmune diseases, including NMDAR encephalitis, can cause a pan-immunodeficiency. from Neurology recent issues http://bit.ly/2RpstOu

There are wider implications of the treatments described by Sharma et al. 1 Bortezomib works by promoting apoptosis in long-lived and short-lived plasma cells responsible for long-lived immunity. These cells produce background levels of vaccine-induced protective antibodies. Therefore, there may be reduced titers of immunoglobulins against measles, mumps, and tetanus after bortezomib treatment of systemic lupus erythematosus. 2 Bortezomib is now also considered treatment in many antibody-mediated chronic autoimmune diseases. It may provide a rapid reduction in antibody titers in treatment-refractory neurologic antibody–mediated diseases, such as NMDAR encephalitis, if standard immunotherapies are ineffective. 3 Standard immunotherapies, such as methylprednisolone, rituximab, and cyclophosphamide, do not target these long-lived and short-lived plasma cells 4 ; however, as some patients do not respond when these antibody-secreting cells are targeted, there is clearly more complexity t...

In "Clinical Reasoning: A 56-year-old woman with acute vertigo and diplopia," Sharma et al. presented the case of a patient with a pontine infarct attributed to varicella-zoster virus reactivation in the setting of immunosuppression by bortezomib for treatment of light-chain amyloidosis. In response, Dr. Ambrose reminds neurologists that bortezomib, which is increasingly being used for antibody-mediated autoimmune diseases, including NMDAR encephalitis, can cause a pan-immunodeficiency. Authors Flanagan and Sharma agree that bortezomib has broad therapeutic potential, but that the risks of administration must be acknowledged. from Neurology recent issues http://bit.ly/2RoXYbi

In "Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety," Henriksen et al. evaluated the stress of 46 physicians performing a lumbar puncture (LP) and found that novice physicians are more stressed than intermediate or expert physicians when performing LPs. In response, Dr. Sethi noted that novice physician stress when performing a LP may be due to the fact that (1) novice physicians may be overworked or sleep-deprived and (2) novice physicians may be more likely to perform LPs in suboptimal conditions, such as in a time crunch or in the emergency department. Author Henriksen agrees with Sethi that extrinsic factors can affect physician stress when performing an LP, but notes that the conditions for LP performance were identical for all 46 physicians in their study. Training may help to decrease novice physician stress when performing LPs. from Neurology recent issues http://bit.ly/2Wp5YwS

I read with interest the Henriksen et al. 1 article on physician stress levels while performing lumbar puncture (LP). They concluded that stress levels of physicians who are LP procedure novices was high before and during procedure performance as compared to physicians who are experts in this procedure. The high stress levels in LP procedure novice physicians was directly related to patient confidence in the operator and risk of post LP headache. This study fails to take into consideration many physician extrinsic factors that determine the outcome of LP. LP procedure novice physicians are most likely to be physicians in training who, many times, are performing the procedure in less than optimal conditions, such as late at night under emergent situations when time is limited, operators are overworked and sleep-deprived, and the patient is frequently in an altered mental state lying on a gurney in the emergency department. Outcomes of LP procedure under these settings are more likely t...

I thank Dr. Sethi for the comment on our article. 1 We agree with Dr. Sethi that extrinsic factors play an important role in optimizing lumbar puncture (LP) performance. In our study, we had identical settings across participants' experience levels. Most of the LP procedures were performed in outpatient clinics and none on night shifts. Furthermore, the assistant was the same in all procedures. The factors described by Dr. Sethi would have contributed to even larger differences between the novice and experts, emphasizing the need for more training of novices. from Neurology recent issues http://bit.ly/2WqZq0I

A 61-year-old man with myasthenia gravis who previously underwent post-thymectomy radiotherapy for a metastatic thymoma presented with altered mental status. Examination revealed papilledema and frontoexecutive dysfunction. from Neurology recent issues http://bit.ly/2Rn2TcQ

A 19-year-old man presented 6 months postimplantation of permanent pacemaker for complete heart block with bilateral nonfatigable symmetric ptosis, diminished levator superioris function, and symmetric ophthalmoplegia (figure 1). Funduscopy revealed bilateral pigmentary retinopathy (figure 2). Skeletal muscle biopsy revealed presence of ragged-red fibers, consistent with Kearns-Sayre syndrome. This mitochondrial disorder is characterized by the triad of onset before age 20, chronic progressive external ophthalmoplegia, and pigmentary retinopathy. Other findings can include complete heart block, cerebellar ataxia, deafness, and endocrinopathies. CSF folate levels should be measured and supplemented if low. There is no definitive treatment but annual surveillance for comorbidities is required. 1,2 from Neurology recent issues http://bit.ly/2Wp5Ptk

A 56-year-old woman on hemodialysis through left arm arteriovenous fistula presented with headache, aphasia, and gradually worsening left facial swelling (figure 1A). MRI showed left temporal intracerebral hemorrhage with arterialized veins (figure 2, A and B). Cerebral angiography revealed multiple areas of venous flow reversal suggesting venous hypertension (figure 2C). Fistulogram demonstrated chronic left cephalic vein occlusion with outflow retrograde through the left internal jugular, facial, intracranial, and then centrally through right internal jugular veins. Recanalization of the venous occlusion improved facial swelling (figure 1B). Early recognition of facial swelling may prevent intracerebral hemorrhage in patients with arteriovenous fistula. 1,2 from Neurology recent issues http://bit.ly/2RiqRWN

Researchers have developed a new method for tracing neural connections with unprecedented sensitivity. from Neuroscience News Updates http://bit.ly/2UqPLpb

Researchers report up to 7% of people living with epilepsy experience social anxiety disorder. from Neuroscience News Updates http://bit.ly/2DG5dbn

According to researchers, forming both good and bad habits depends more on how often you perform an action than the satisfaction you get from the action. from Neuroscience News Updates http://bit.ly/2RWqLt8

Researchers shed light on the endocannabinoid system and report how cannabis is helping to provide relief to many with medical problems. from Neuroscience News Updates http://bit.ly/2CPBECw

A new study reports controlling blood pressure has a measurable impact on mild cognitive impairment, a precursor of dementia. from Neuroscience News Updates http://bit.ly/2DDR4eB

Researchers report NBA players who are more skilled than their peers early in their careers remain more skilled as they age. Additionally, they have a slower decline in their performance after the peak of their careers. from Neuroscience News Updates http://bit.ly/2UpbFJ9

Researchers report sleep deprivation intensifies and prolongs pain. from Neuroscience News Updates http://bit.ly/2ToIZ3f

According to a new study, the consequence of daily stress is linked to an increase in REM sleep. Researchers report the increase is associated with genes involved in apoptosis and cell survival. The findings shed light on how stress leads to mood disorders, and how changes in sleep contribute to this. from Neuroscience News Updates http://bit.ly/2B97fiB

from Neurology : nature.com subject feeds https://go.nature.com/2FUu6T1

A new study reports children and pre-teens who are exposed to screen time in the dark an hour before sleep are more likely to have sleep disturbances, a higher risk of anxiety and may be more prone to obesity. from Neuroscience News Updates http://bit.ly/2UkIerO

Researches report higher levels of the satiety hormone CCK could decrease a person's risk of developing Alzheimer's disease. from Neuroscience News Updates http://bit.ly/2DEkOrR

You can hack your brain to form good habits – like going to the gym and eating healthily – simply by repeating actions until they stick, according to new psychological research involving the University of Warwick. Dr. Elliot Ludvig from Warwick’s Department of Psychology, with colleagues at Princeton and Brown Universities, have created a model which shows that forming good (and bad) habits depends more on how often you perform an action than on how much satisfaction you get from it. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2Ur9pBt