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Proceedings From the International Stroke Conference, Honolulu, February 2019

The following reviews of studies presented at the 2019 International Stroke Conference were written after my personal attendance at the presentations, followed by review of the simultaneous publications in The New England Journal of Medicine and The Lancet. All comments and opinions are solely those of this editor. — Matthew E. Fink, MD

Thinking Outside of the ‘Alpha-Synuclein Box’: A Critical Role of Tau in Lewy Body Disorders

Neocortical tau pathology was associated with worse antemortem cognition in this large study of Parkinson’s disease dementia and dementia with Lewy bodies. Regional brain variations correlated with specific cognitive domains.

Predicting the Risk of Mild Cognitive Impairment Using Imaging Biomarkers

In this population-based study, researchers used imaging biomarkers of amyloid and neuronal injury to estimate an absolute risk of mild cognitive impairment in the elderly.

Amyloid-ß Pathology Induced by Contaminated Cadaver-Derived Growth Hormone

Cadaveric pituitary-derived growth hormone that previously was known to transmit Creutzfeldt-Jakob disease (CJD) also contains ß-amyloid. Growth hormone vials from cases associated with amyloid plaques in CJD patients cause amyloid plaque formation and cerebral amyloid angiopathy when injected intracranially into mice.

Rituximab for CIDP Associated With Systemic Immune Disorders

Rituximab has been used “off label” for the treatment of primary chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with variable reports of success. These authors reported a high rate of response in patients who developed CIDP in the setting of other systemic immune-mediated disorders.

Continuous EEG Monitoring in Critically Ill Patients Is Associated With Reduced Hospital Mortality

In this retrospective cross-sectional study involving more than 7 million critically ill adult patients from the National Inpatient Sample database, researchers showed that the use of continuous electroencephalography is associated with lower in-hospital mortality.

Clinical Outcomes After Oral Anticoagulant-Associated Intracerebral Hematoma

In this meta-analysis of multiple observational studies, clinical outcomes after oral anticoagulant-associated intracerebral hematoma were similar for those associated with vitamin K antagonists or the new class of direct oral anticoagulants.

Correlation of Electromyography With Pathology in Myopathy

A detailed analysis of electromyography features showed a high correlation with muscle pathology. However, pathologic changes on muscle biopsy may be present even with a totally normal electromyogram.

Apolipoprotein E and CSF Levels in Men and Women With Alzheimer’s Disease

Apolipoprotein E epsilon 4 (APOE4) genotype, the stronger genetic risk factor for late-onset Alzheimer’s disease, negatively affects cerebrospinal levels of tau protein in a sex-dependent manner, whereby the effect of APOE4 is stronger in women than men.

Utility of Ictal Magnetoencephalography for Identifying Seizure Onset Zone

In a review of 377 magnetoencephalography (MEG) studies in epilepsy patients undergoing presurgical workup, 44 patients were found to have one or more seizures during routine recordings, lasting up to a mean of 51.2 minutes. Ictal MEG provided unique localizing data in about one-third of patients. For patients with frequent seizures or reliably induced seizures, MEG may be a useful supplemental tool for medically refractory epilepsy patients undergoing presurgical evaluation.