NEURO

Prostate specific antigen (PSA) is regulated by steroid hormones, such as testosterone, the serum levels of which are altered in patients with Alzheimer's disease (AD).This pilot study compared serum levels of the free (f) PSA in AD and mild cognitive impairment (MCI), and control subjects, and evaluated the relationship between fPSA serum levels and disease severity and neuroimaging data. In addition, in a subgroup of AD patients, we correlated fPSA serum levels with the existing data on serum levels of amyloid-beta (Aβ), and iron-related proteins, including hepcidin and ferritin. from Journal of the Neurological Sciences https://ift.tt/2UhG00Z

We would like to thank Dr. Finsterer for his comments on our recent paper entitled “Clinical and neuroimaging features of the m.10197G>A mtDNA mutation: new case reports and expansion of the phenotype variability” [1]. Our expert colleague went through our manuscript and raised a number of questions to which we are pleased to reply. from Journal of the Neurological Sciences https://ift.tt/2G2osfp

With interest we read the article by Tolomeo et al. about three unrelated males aged 7y (patient 1), 5y (patient 2) and 4y (patient 3) respectively with Leigh syndrome due to the variant m.10197G > A in the ND3 gene [1]. We have the following comments and concerns. from Journal of the Neurological Sciences https://ift.tt/2UglgGA

In the emergency room, the most common cause of dizziness is benign paroxysmal positional vertigo (BPPV) [1]. BPPV is usually diagnosed by a characteristic nystagmus. Horizontal direction-changing apogeotropic positional nystagmus (APN) in the supine head-roll test is one such nystagmus suggestive of BPPV (horizontal semicircular canal cupulolithiasis-type) [2]. Thus, dizzy patients with APN tend to be diagnosed with BPPV when they have no other obvious neurologic symptoms. However, APN is also known to be associated with cerebellar lesions [3]. from Journal of the Neurological Sciences https://ift.tt/2FO0FiO

Preoperative prognostic nutritional index (PNI) is linked to the clinical outcome of patients with malignant tumours, however few studies have investigated its utility in predicting outcome in glioblastoma multiforme (GBM).We performed a retrospective study on adult patients with GBM in order to evaluate the impact of PNI on overall survival (OS), after adjusting for known prognostic factor (age, extent of surgery, Karnofsky performance status, radiochemotherapy).This is an Italian, multicentre, retrospective, cohort study. from Journal of the Neurological Sciences https://ift.tt/2UdRzpS

Acute cerebellitis is a well-recognized complication of varicella zoster virus (VZV) infection in children. It has been described in adults in the setting of virus reactivation with a preceding herpes zoster rash, but it is exceedingly rare in adults who are not elderly or immunocompromised, particularly in the absence of a rash. To our knowledge, there has been only one reported case of acute cerebellitis in an immunocompetent adult less than age 65 with virological confirmation of acute VZV infection. from Journal of the Neurological Sciences https://ift.tt/2FO0Bj4

from Neurology recent issues https://ift.tt/2FRkBD2

Since the introduction of the first, 4-channel ambulatory EEG (aEEG) system in the mid-1970s, 1 neurologists have had the ability to capture and study seizures in an outpatient, natural environment. These systems record and store days of EEG data, enabling evaluation of clinical events suspicious for seizures and characterization of seizure patterns in those with established epilepsy. However, the review of long, multichannel recordings is time-consuming. Therefore, from the beginning, there has been a strong demand for computer-assisted EEG review and seizure detection tools to diminish the burden of manual review of the entire raw dataset. Automated methods of ictal event detection on aEEG face daunting challenges arising not only from the high variability of seizure onset patterns but also the confounding effects of abundant artifacts picked up by scalp electrodes in a freely moving person. Decades of intense research and improvements of our computational ability have led to the de

Alzheimer disease (AD) is characterized by a long preclinical stage, in which the presence of progressively increasing AD pathology is not yet accompanied by clinical symptoms. In this preclinical stage, biomarkers of amyloid pathology and neurodegeneration have prognostic value with regard to cognitive outcome. 1,2 The newly proposed ATN classification framework aims to further refine the pathophysiology and staging of AD, by differentiating between several neurodegeneration markers (T and N). In the ATN classification, A stands for β-amyloid (Aβ) pathology (CSF or PET), T for tau pathology (CSF phosphorylated tau [p-tau] or tau PET), and N for other nonspecific biomarkers of neurodegeneration, such as hippocampal volume, CSF total tau (t-tau), and FDG-PET. The framework includes 8 possible subgroups, ranging from a group in which all biomarkers are negative (A–T–N–) to one in which all are positive (A+T+N+). This framework provides a mechanism to operationalize the recent National I

The pathologic features of Alzheimer dementia may be seeded many years before the clinical diagnosis, which suggests that risk factor modification early in life may be the best strategy for the prevention of late-onset Alzheimer disease. 1 There is literature suggesting that diet and nutritional factors can promote cognitive health in late life 2 ; however, in this issue of Neurology ®, McEvoy et al. 3 report that adherence to specific dietary patterns in early adulthood is associated with cognitive health in midlife. The authors examined diet using a validated questionnaire administered over 3 time points to assess adherence to a Mediterranean-style diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH), and the A Priori Diet Quality Score (APDQS). The study population was the large and racially diverse Coronary Artery Risk Development in Young Adults (CARDIA) study of 2,621 men and women with a mean age of 25 to 45 years at the first dietary assessment. Associations wit

In this issue of Neurology ®, Fox et al. 1 consider the important issue of how patients with multiple sclerosis (MS) perceive the risk of a variety of adverse side effects from disease-modifying therapies (DMTs) in the context of a single specific treatment benefit. An understanding of patient perceptions of risk is a crucial aspect of patient-centered care and truly shared decision making. This is and will continue to be increasingly important given the welcome expansion in treatment options that also come with increasing complexity and potential for harm. It is an area of limited previous study. 2,3 from Neurology recent issues https://ift.tt/2FOHJSm

The October 23, 2018, featured interview highlighted a special feature on how neurologists should manage in-flight neurologic emergencies while on an airplane. For our What's Trending feature of the week, you will hear a discussion on brain trauma induced by microwave radiation. from Neurology recent issues https://ift.tt/2OD6VOG

Brian C. Callaghan, MD, MS, and Kevin A. Kerber, MD, MS from Neurology recent issues https://ift.tt/2FOVyQN

Neuromuscular adverse events following cancer treatment with anti-programmed cell death protein 1 (PD-1) monoclonal antibodies are relatively rare, yet potentially fatal. We performed a systematic review to characterize the clinical presentation, diagnostic workup, and management of neuromuscular disorders (NMDs) in patients treated with nivolumab or pembrolizumab monotherapy or concurrent with other immunologic agents, such as ipilimumab. Sixty-one publications on 85 patients (mean age 66.9 years [range 34–86]; male/female 2.6:1; 59% metastatic melanoma) were identified from selected indexing databases until June 2018. Forty-eight patients had received nivolumab and 39 pembrolizumab. The mean number of PD-1 inhibitor treatment cycles prior to onset of symptoms was 3.6 (range 1–28). Symptoms included oculomotor (47%), respiratory (43%), bulbar (35%), and proximal weakness (35%), as well as muscle pain (28%). Diagnoses were categorized as myasthenia gravis (27%), neuropathy (23%), myopa

A 29-year-old woman presented with 1 year of cognitive and functional decline. She had resided in the Netherlands in the 1990s, and had no relevant family history. Twelve months prior to presentation, her family noted that she seemed apathetic. She developed daytime fatigue and was in an automobile accident attributed to sleepiness. Over 1 month, she developed difficulty with job-related tasks, episodic slurred speech, intermittent diplopia, insomnia, delusions, hallucinations, and difficulty in navigating familiar driving routes. from Neurology recent issues https://ift.tt/2FP4Jkm

Bismuth-containing ointment has been used for the dressing of wounds since World War I. 1 A popular option for burns and skin grafts, bismuth iodoform paraffin paste (BIPP) is a sterile gauze impregnated with 2 active ingredients: bismuth subnitrate and iodoform. 2 Because it does not get infected with chronic use in deep wounds, it is often left in situ for weeks. 2 BIPP is also used in maxillofacial and neurologic surgeries, where case reports have noted a rare adverse effect of toxic encephalopathy. 3 However, the literature on toxic encephalopathy caused by BIPP used for burn wounds is sparse. from Neurology recent issues https://ift.tt/2FPtCw7

In "The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging," Drs. Newton and Frith reported that when 56% of participants over age 60 consumed 480 mL of tap water 20 minutes before lying supine, they experienced significantly less systolic blood pressure drops upon standing than when they did not ingest the water. However, drinking water before transitioning from lying to standing had no significant effect on diastolic blood pressure drop or symptoms. from Neurology recent issues https://ift.tt/2OGvVVk

I read with interest the nonpharmacologic manipulations for management of orthostatic hypotension (OH) detailed by Drs. Newton and Frith. 1 Regardless of guidelines, 2 OH is clinically meaningless in the absence of regular or inevitable syncope, as systolic blood pressure (SBP), syncope, and cerebral arteriosclerosis do not necessarily run pari passu. While fall in SBP is a part of the guidelines, it is the diastolic blood pressure (DBP) that determines steady cerebral blood flow. A total of 480 mL tap water consumed within 5 minutes will neither be fully absorbed by the gastrointestinal system nor will be retained fully by the renal tubular system. No wonder only 56% of participants of a tiny cohort responded with a modest rise in SBP while DBP remained unaffected. 1 While standing cross-legged is truly enigmatic, will abdominal compression and elastic stockings improve or worsen venous return in uncomplicated hypotensive nonobese elderly? from Neurology recent issues https://if

We thank Dr. Gupta for the interest in our recent study. 1 It is incorrect to state that orthostatic hypotension (OH) is meaningless in the absence of syncope. OH results in a broad range of symptoms and can impair even simple activities of daily living. 2 from Neurology recent issues https://ift.tt/2OGvUke