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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.

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.

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.

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.

Iatrogenic Cerebral Amyloid Angiopathy-Related Inflammation

In this multicenter, retrospective case series, the authors sought to describe the co-occurrence of two rare variants of cerebral amyloid angiopathy: iatrogenic cerebral amyloid angiopathy, thought to be caused by prion-like spread of amyloid beta after seeding from neurosurgical procedures decades prior to symptom onset, and cerebral amyloid angiopathy-related inflammation, characterized by robust perivascular inflammatory response in amyloid-laden vessels. This series demonstrates that inflammation can complicate iatrogenic cerebral amyloid angiopathy, supporting a spectrum model of disease and urging multicenter study.

Vertigo and Altered Postural Perception: Overlapping Symptoms, Distinct Mechanisms

Two distinct vestibular disorders, persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM), both involve vertigo as a primary symptom. Nearly half of chronic migraine patients also experience vertigo, especially those with aura and allodynia. Since PPPD is seen as a functional maladaptation and VM is associated with cortical hyperexcitability, treatment for vertigo in these two conditions should be tailored to their unique pathophysiological mechanisms.

Progressive Encephalomyelitis with Rigidity and Myoclonus with GlyR Antibodies

This is a retrospective observational study of patients with a clinical diagnosis of progressive encephalomyelitis with rigidity and myoclonus (PERM) and glycine receptor (GlyR) antibodies identified at a specialized neuroimmunology laboratory, as well as an accompanying systematic literature review. The goal of the study was to describe the clinical features and long-term outcome of patients with GlyR antibody-mediated PERM.

Relationship Between Abnormal Amyloid-β Deposition and Regional Brain Atrophy on MRI

In a retrospective review of patients followed in the Wisconsin Alzheimer Disease Research Center, the time course of early deposition of amyloid-β correlated with regional atrophy in temporoparietal regions of interest independent of tau positivity.

Home Training for Cerebellar Ataxias: A Randomized Clinical Trial

In this randomized clinical trial comparing home high-intensity aerobic training to home balance training among individuals with cerebellar ataxias, investigators found that home high-intensity aerobic training improved ataxia symptoms, fatigue, and aerobic fitness more than dose-matched home balance training.

Detection of Atrial Fibrillation in Cryptogenic Stroke

The ANTARCTICA study is a pooled meta-analysis from multiple prospective studies of patients with ischemic stroke of varying etiologies, where loop monitoring was performed for atrial fibrillation detection. The groups were divided into cryptogenic stroke/transient ischemic attack or non-cryptogenic stroke/non-stroke. Both groups demonstrated an unadjusted rate of atrial fibrillation of about 30%.