Notable in Neurology this week
This issue features an article that investigates sex differences in cerebrovascular pathologies seen on fluid-attenuated inversion recovery MRI in cognitively unimpaired elderly and another that details critical insights into the neurobiological manifestation of dyslexia. A featured Views & Reviews article accounts the state of the field in multiple sclerosis cognition and outlines guidelines and priorities for the field.
Articles
High-sensitive C-reactive protein and dual antiplatelet in intracranial arterial stenosis
In this subgroup analysis of the CHANCE trial, duel antiplatelet therapy (clopidogrel plus aspirin) reduced the risk of recurrent stroke in patients with intracranial arterial stenosis and nonelevated high-sensitive C-reactive protein levels, without increasing risk of hemorrhage. These findings may help clinicians assess antiplatelet efficacy and safety.
Page 260
From editorialists Tuttolomondo and Pinto: “The results of this study provide food for thought that inflammatory marker levels, as a surrogate for ongoing inflammation, may influence cerebrovascular and vascular endpoints, but only in persons with intracranial arterial stenosis.”
Page 253
Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke
In a prospective multicenter study of an ischemic stroke patient cohort, the blood marker midregional pro–atrial natriuretic peptide (MR-proANP) improved risk stratification beyond traditional factors and helped identify patients with high risk of underlying cardioembolic source. MR-proANP may facilitate selection of patients who will benefit from prolonged cardiac rhythm monitoring.
Page 261
Chronic traumatic encephalopathy in an epilepsy surgery cohort: Clinical and pathologic findings
In this study, chronic traumatic encephalopathy was identified in 1 of 10 young adult patients with drug-resistant focal epilepsy. Eight had prior head injury. Cognitive impairment was present in 8 patients. Further investigation is required to determine the importance of tau accumulation in younger patients with focal epilepsy and cognitive decline.
Page 263
The association of neurologists with headache health care utilization and costs
New federal laws incentivize high-value care, but whether value can be appropriately measured using claims data is unknown. In this study, patients with headache who visited neurologists had a transient increase in hospitalizations, costs, and medications. A claims-based risk adjustment would likely underestimate disease severity of patients seen by neurologists.
Page 269
NB: “A clue for familial mitochondrial disorder: Discovering a vintage painting,” p. 294. To check out other NeuroImages, point your browser to Neurology.org/N. At the end of the issue, check out the Resident & Fellow Clinical Reasoning article on the importance of clinical phenomenology in addition to genetic testing. This week also includes a Clinical/Scientific Note titled “An open-label trial of JAK 1/2 blockade in progressive IFIH1-associated neuroinflammation.”
- © 2018 American Academy of Neurology
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