Neurology Alert

• A Randomized Trial of Shunting for Idiopathic Normal-Pressure Hydrocephalus

  In this randomized, double-blind, placebo-controlled trial, investigators demonstrated that ventriculoperitoneal shunt surgery produces a clinically meaningful improvement in gait (but not in cognition or urinary symptoms) at three months in carefully selected patients with idiopathic normal-pressure hydrocephalus.

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• The IMPACT Tool Helps Guide Management of Incidental Meningiomas

  In a large international, multicenter, retrospective cohort, the imaging-based IMPACT tool accurately predicted progression risk of incidental meningiomas and effectively stratified patients into low-, medium-, and high-risk groups at initial diagnosis.

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• A Potential Treatment for Progressive Multifocal Leukoencephalopathy

  Fingolimod-associated progressive multifocal leukoencephalopathy in a 67-year-old woman with secondary progressive multiple sclerosis (MS) was treated off-label with tenofovir alafenamide fumarate (TAF), resulting in rapid radiologic improvement and clearance of John Cunningham virus (JCV) from cerebrospinal fluid. Although MS activity emerged after fingolimod withdrawal, TAF was well tolerated and the close temporal association with JCV clearance suggests a potential antiviral effect warranting further study.

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• Carotid Artery Stenting: The New Treatment Standard for Asymptomatic Carotid Stenosis?

  CREST-2 demonstrates that, in asymptomatic carotid stenosis, carotid artery stenting modestly reduced four-year stroke risk compared with intensive medical management, whereas carotid endarterectomy did not.

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