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Endovascular Thrombectomy with or Without Alteplase? Get With The Guidelines.

Since 2015, endovascular thrombectomy with intravenous alteplase has been the standard of care for patients with large vessel occlusion and ischemic stroke. However, since that time, the continuing use of alteplase has been questioned by many practitioners and investigators.

Mechanical Thrombectomy with or Without Intravenous Thrombolysis?

Current stroke treatment guidelines recommend combined use of intravenous thrombolysis with alteplase prior to endovascular thrombectomy for patients with large vessel occlusion. However, there continues to be controversy surrounding this recommendation, and these investigators undertook a systematic review and meta-analysis of completed therapeutic trials to help resolve the controversy.

How Should We Manage False-Positive Myasthenia Gravis Antibody Studies?

False-positive autoantibody tests for myasthenia gravis occur in a small number of patients who undergo broad screening for autoimmune disorders affecting the peripheral and central nervous system. Careful investigation of clinical and electrophysiological features of each patient will determine the validity of these tests.

Risk Factors and Outcomes for Post-Traumatic Seizures After Moderate to Severe Traumatic Brain Injury

Using data collected from an Australian registry, a population-based cohort study identified risk factors for early post-traumatic seizures (EPS), associated morbidity and mortality, and contribution to development of post-traumatic epilepsy (PTE). EPS were associated with significant in-hospital morbidity, poorer outcomes, and increased risk of mortality at 24 months of follow-up. Patients with EPS had a higher risk of developing PTE.

Genetic Evaluation of Hereditary Spastic Paraplegia

Hereditary spastic paraplegia (HSP) refers to a group of rare, clinically heterogenous degenerative neurogenetic disorders resulting in spasticity, gait impairment, and falls as the result of a length-dependent upper motor neuron degeneration. Next-generation sequencing with multigene panels or exome analysis can confirm molecular diagnosis of approximately 30% of HSP patients. Multigene panels can identify the common causative variants, variants on rarely involved genes, and structural rearrangements.

Myositis as a Cause of Unexplained Dysphagia

A stepwise diagnostic algorithm was developed to identify potentially treatable idiopathic inflammatory myopathies in patients presenting with isolated unexplained dysphagia.

What Is the Right Dose of Immunoglobulin to Treat CIDP?

In this comparative trial of different doses of intravenous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy, higher doses appeared to result in a higher percentage of patients who improved. However, there was no control group and there were many confounding issues that make it difficult to reach a definitive conclusion around optimal dosing.

Intensive Blood Pressure Control May Augment Cerebral Blood Flow

Patients with hypertension were randomized to intensive vs. standard blood pressure control and underwent baseline and follow-up cerebral perfusion imaging. Intensive blood pressure treatment was associated with improved cerebral perfusion over time.

Polygenic Associations of Chronic Axonal Polyneuropathy

In most cases of chronic axonal polyneuropathy, no specific cause is found. Using a polygenic risk score for potential risk factors, based on whole genome sequencing, these investigators identified multiple significant risk factors, including diabetes, body mass index, alcohol intake, and vitamin B12 level.

Use of Serum Biomarkers in Determining Prognosis After Cardiac Arrest

Used in conjunction with the clinical exam and brain imaging, serum biomarkers, such as neurofilament light, can help refine the prognostication for patients who have experienced severe anoxic/ischemic brain injury after cardiac arrest.