0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Month in Archives of Neurology |

This Month in Archives of Neurology FREE

Arch Neurol. 2007;64(6):780-781. doi:10.1001/archneur.64.6.780.
Text Size: A A A
Published online

CONSENT FOR INTRAVENOUS THROMBOLYSIS IN ACUTE STROKE

White-Bateman and colleagues indicate that intravenous thrombolysis with recombinant tissue plasminogen activator is the standard of care for the treatment of acute ischemic stroke within 3 hours after stroke onset. They point out that there is no standardized method to estimate capacity of patients who have had acute stroke and empirical data for this particular patient population are scarce. The authors review the elements of informed consent, the legal standards for competence that a thrombolysis candidate must meet to consent to treatment, and recommendations for assessing capacity to give direct informed consent.

NEUROPROTECTION: CHALLENGES AND OPPORTUNITIES

Faden and Stoica review the emerging field of neuroprotection. The ability of pharmacological agents to limit secondary biochemical damage and cell death has been well established in numerous animal models of stroke, head injury, and spinal cord injury, yet the results of such neuroprotective treatment strategies in human injury have been disappointing. Both the critical problems and potential solutions are reviewed with emphasis on recent experimental and clinical work.

SAFETY, TOLERABILITY, AND PHARMACOKINETICS OF HIGH-DOSE IDEBENONE IN PATIENTS WITH FRIEDREICH ATAXIA

Di Prospero and colleagues, in an open-label, phase 1A, dose-escalation trial followed by an open-label, 1-month, phase 1B trial, determined the safety, tolerability, and pharmacokinetics of increasing doses of idebenone in subjects with Friedreich ataxia (FA). They report that higher doses of idebenone lead to a proportional increase in plasma levels up to 55 mg/kg per day and that high-dose idebenone is well tolerated by patients with FA. These findings are essential to planning efficacy trials of high-dose idebenone in FA and other degenerative diseases in which oxidative damage has been implicated.

PSYCHIATRIC AND COGNITIVE DIFFICULTIES AS INDICATORS OF JUVENILE HUNTINGTON DISEASE ONSET IN 29 PATIENTS

Ribaï and colleagues evaluated the clinical and genetic features of juvenile Huntington disease. The most remarkable signs at onset were severe psychiatric and cognitive disturbances (19 of 29 cases, 65.5%). This led to misdiagnosis or diagnosis delay, especially in cases without a family history of Huntington disease. Editorial comment is provided by Kevin Biglan, MD, MPH, and Ira Shoulson, MD.

RISK FACTORS FOR THE DEVELOPMENT OF PEDAL EDEMA IN PATIENTS USING PRAMIPEXOLE

The risk factors for pedal edema among patients with Parkinson disease using pramipexole therapy were studied by Kleiner-Fisman and Fisman. Two hundred thirty-seven patients received pramipexole hydrochloride and met criteria for inclusion in the analysis. Of these, 38 (16%) developed pedal edema (Figure). A history of coronary artery disease or diabetes was a strong risk factor for the development of edema.

Place holder to copy figure label and caption
Figure.

Outcome of pedal edema in 38 patients who developed edema while taking pramipexole hydrochloride.

Graphic Jump Location

ACCURACY OF THE CLINICAL EVALUATION FOR FRONTOTEMPORAL DEMENTIA

Mendez et al indicate that consensus criteria for frontotemporal dementia (FTD) and neuropsychological measures were insensitive for FTD. However, they emphasize that neuroimaging, particularly functional brain scans, greatly increased the sensitivity of detecting FTD. The clinical diagnosis of FTD needs to combine neuropsychiatric features with single-photon emission computed tomography or positron emission tomography while following the changes on neuropsychological tests.

INFLAMMATORY CYTOKINE GENE POLYMORPHISMS INCREASE RISK OF PARKINSON DISEASE

Wahner and colleagues found a greater than 2-fold increased risk of Parkinson disease among carriers of the homozygous variant genotype of interleukin-1B-511 and the homozygous variant genotype of tumor necrosis factor α and a nearly 3-fold increased risk among carriers of the homozygous variant genotype for either or both polymorphisms.

CLINICAL, MAGNETIC RESONANCE IMAGING, AND GENETIC STUDY OF 5 ITALIAN FAMILIES WITH CEREBRAL CAVERNOUS MALFORMATION

A comprehensive evaluation of clinical, magnetic resonance imaging, and genetic analysis was conducted by Battistini and colleagues in 5 Italian families affected with cerebral cavernous malformations (CCMs). Three novel and 2 previously described mutations were found in the gene KRITI. The families included 33 KRITI mutation carriers and 57.6% of them were asymptomatic. Magnetic resonance imaging examination showed CCM lesions in 82.4% of symptom-free mutation carriers. These data emphasize both the importance of magnetic resonance imaging in the diagnosis of CCMs and the potential for DNA-based diagnosis to identify subjects at risk.

APPLICATION OF AUTOMATED MEDIAL TEMPORAL LOBE ATROPHY SCALE TO ALZHEIMER DISEASE

An automated intensity-based measure of medial temporal atrophy in Alzheimer disease was compared with existing volumetric and visually based methods by Ridha et al. The Automated Medial Temporal Lobe Atrophy Scale (ATLAS) is a simple medial temporal atrophy measure, which has the additional advantage of being able to track Alzheimer disease progression on serial imaging.

DAYTIME HYPOXEMIA, SLEEP-DISORDERED BREATHING, AND LARYNGOPHARYNGEAL FINDINGS IN MULTIPLE SYSTEM ATROPHY

The mechanism underlying nocturnal sudden death in patients with multiple system atrophy remains unclear. Shimohata et al studied the mechanism of sleep-disordered breathing in multiple system atrophy. They report a decrease in arterial oxygen pressure and an increase in alveolar-arterial oxygen gradient significantly correlated with disease duration. Polysomnography demonstrated Cheyne-Stokes respiration in 3 of 20 patients (15%). Vocal cord abductor paralysis was also noted. Laryngoscopy showed 11 patients (55%) had upper airway obstruction. These findings contribute to impaired respiration and sudden death in patients with multiple system atrophy.

NEUROPSYCHOLOGICAL MEASURES IN NORMAL INDIVIDUALS THAT PREDICT SUBSEQUENT COGNITIVE DECLINE

Blacker and colleagues used detailed and comprehensive neuropsychological measures among normal persons to predict subsequent cognitive decline. They report that episodic memory performance predicts time to progression to mild impairment. Tests of both episodic memory and executive function are predictors of time to progression from mild impairment to a clinical diagnosis of Alzheimer disease.

DEFORMATION-BASED MORPHOMETRY AND BRAIN ATROPHY IN FRONTOTEMPORAL DEMENTIA

Cardenas and colleagues compared deformation-based maps of local anatomical size between patients with frontotemporal dementia (FTD) and healthy subjects to identify regions of the brain involved in FTD. They confirm frontal and anterior temporal gray matter atrophy in FTD. They observed white matter loss, thalamic atrophy, and midbrain atrophy that are consistent with pathological findings in late-stage FTD.

Figures

Place holder to copy figure label and caption
Figure.

Outcome of pedal edema in 38 patients who developed edema while taking pramipexole hydrochloride.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

215 Views
0 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs