Neurology Alert – July 1, 2025

Treating Small Vessel PCNSV with Cyclophosphamide

In this single-center study, 26 adults with biopsy-confirmed small vessel primary central nervous system vasculitis (PCNSV) were followed for a median of 49 months. Patients receiving early treatment with cyclophosphamide within three months of immunosuppression initiation achieved remission faster than those receiving conservative initial treatment with corticosteroids, either as monotherapy or with azathioprine, mycophenolate, or methotrexate. Retrospective design, treatment selection bias, small sample size, and clinicopathologic heterogeneity limit therapeutic inferences and highlight the need for prospective trials.

Rituximab to Prevent Relapse in Anti-NMDAR Antibody-Mediated Encephalitis

This long-term follow-up study of 67 patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis demonstrated that initial treatment with rituximab was associated with a longer time before a relapse occurred.

Use of IV Tenecteplase Prior to Thrombectomy in Stroke

In patients with acute ischemic stroke arriving at a thrombectomy-ready hospital within 4.5 hours of stroke onset, the combination of treatment with intravenous tenecteplase followed by mechanical thrombectomy resulted in superior outcomes compared to thrombectomy alone.

Epilepsy in Frontotemporal Dementia

This Finnish case-control study explores the relationship between frontotemporal dementia (FTD) and epilepsy, revealing that individuals with FTD have a higher prevalence of epilepsy compared to those with Alzheimer’s disease (AD) and healthy controls. The findings suggest that epilepsy may precede FTD diagnosis and is more common in FTD than previously recognized, highlighting the need for broader research and clinical awareness of this comorbidity.

Post-Traumatic Headaches: Common and Complicated

The brain’s ability to modulate pain influences the development and persistence of post-traumatic headache (PTH). Functional magnetic resonance imaging (fMRI) studies in people with PTH show higher pain-induced brain activation in specific regions, such as the postcentral gyrus, superior temporal gyrus, and ventral striatum, as compared to healthy controls. Over 16 weeks of observation, progressive normalization in pain-induced brain activation was seen in the PTH group with headache improvement, with persistently elevated activation in the non-improvement PTH group.