Neurology Alert – May 1, 2024

Post-Operative Delirium May Involve Altered Brain Glucose Metabolism

Post-operative delirium is a major health problem that occurs in about half of older patients who undergo surgery with general anesthesia. This prospective study from Norway of patients undergoing emergency hip repair surgery demonstrated from spinal fluid analysis that patients with delirium have abnormalities in brain glucose uptake and metabolism and have an early shift to ketosis in the spinal fluid.

Longitudinal Follow-Up of Patients with Anti-NMDA Receptor Encephalitis

In this retrospective, observational study of 38 patients with autoimmune encephalitis, using standard clinical assessment rating scales, the only predictor of poor outcome was muscle weakness at symptom onset. Most patients had long-term problems with cognitive and mood disorders.

Does Needle EMG Interfere with MR Neurography or Myography Interpretation?

In this carefully designed prospective clinical study, needle electromyography did not have any significant effect on the interpretation of magnetic resonance (MR) neurography or MR myography or alter the diagnosis.

Intravenous Tenecteplase for Stroke After 4.5 Hours Does Not Improve Outcome

The TIMELESS study was developed to evaluate the effect of treatment with tenecteplase 4.5 to 24 hours after stroke onset in patients with large artery occlusion who subsequently would go on to endovascular thrombectomy.

Endovascular Thrombectomy Is Used Much Less for Stroke Associated with Cardiac Interventions

Recent cardiac surgery is a strong contraindication to having intravenous thrombolysis for ischemic stroke. Endovascular thrombectomy, if appropriate, would be the best treatment for these patients. To obtain additional understanding of the prevalence of ischemic stroke and treatment with EVT following cardiac surgery, these investigators queried a large claims-based database.

Outcomes Are Better for Acute Stroke Patients Who Arrive Rapidly at Endovascular-Capable Centers

The SELECT2 trial was structured to identify which patients with large ischemic strokes would benefit from endovascular thrombectomy and analyzed the effect of direct arrival at a thrombectomy-capable center compared to transfer from a primary stroke center.

Rapid Reversal of Anticoagulation Reduces Mortality from Intracerebral Hemorrhage

Because the numbers of patients with primary intracerebral hemorrhage are far lower than those with ischemic stroke, it has been difficult to accumulate a large enough number of patients to clearly analyze the relationship between the time of the hemorrhage and the time to treatment. We need to answer the important question: Does rapid treatment result in a better outcome?