Neurology Alert – September 1, 2023

Differentiating MELAS from Bland Ischemic Stroke: Clinicoradiologic Criteria

Stroke symptoms in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) are difficult to diagnose correctly, which leads to missed opportunities to provide MELAS-specific treatment. Delay in diagnosis also complicates efforts to investigate acute treatments for MELAS. Khasminsky et al proposed clinicoradiologic criteria based on a single-center validation study. Although there are methodological limitations, the concepts highlighted by the authors are valuable.

Treatment of Preclinical Alzheimer’s Disease

After a four-year, complex clinical trial of an anti-amyloid antibody, solanezumab, there was no benefit in reducing the likelihood of progression of cognitive impairment in patients with positive amyloid positron emission tomography scans who started the trial cognitively unimpaired vs. placebo.

Super-Refractory Status Epilepticus: Clinical Characteristics, Treatment, and Outcome

Patients with super-refractory status epilepticus (SRSE) differed from patients with first-time status epilepticus in clinical presentations and the treatment course. Although seizure control was achieved in most SRSE patients, the in-hospital mortality and the chance of severe disability at discharge were high.

Cumulative Number of Head Strikes Contributes to the Development of Chronic Traumatic Encephalopathy

Researchers recently evaluated the connection between head impact and chronic traumatic encephalopathy (CTE) in male athletes. They found the total number and severity of head impacts throughout life better predicted CTE than the number of symptomatic concussions.

Tarlov Cysts of the Lumbosacral Spine

Tarlov cysts (root sleeve cysts) are common incidental findings on magnetic resonance imaging of the lumbosacral spine. However, they rarely are correlated with electrophysiological findings or clinical symptoms. Undertake extreme care and caution before recommending surgical intervention for these common imaging abnormalities.