Articles in 2009

Thrombolytic therapy is often used to treat arterial ischemic stroke in children, despite lack of FDA approval in this age group. The International Pediatric Stroke Study investigators have assessed the extent and nature of recombinant tissue plasminogen activator use in children in their registry, and have compared their findings with previously published case reports.

The ABCD system uses clinical features identifiable in primary or emergency care to reliably predict the risk of stroke in the acute phase following a transient ischemic attack. Further study is required to establish both the effectiveness of a refined system that includes carotid and brain imaging, and how such a refined system should be implemented in clinical practice.

Volunteer work in developing countries can be extremely rewarding for neurologists, from both a professional and a personal perspective. Sidney Rosenberg has worked extensively as a volunteer neurologist in hospitals in India, Cambodia and Botswana, and in this article he provides a personal account of his experiences.

Estimates of the incidence of cognitive dysfunction following ischemic stroke vary considerably in the medical literature. New research suggests that cognitive dysfunction might occur more frequently than was previously thought, emphasizing the importance of assessing such dysfunction beyond the standard deficits measured on most stroke severity scales.

Chinese investigators performed a well-designed, randomized trial to investigate the efficacy of true Chinese acupuncture compared with two different sham acupuncture approaches for the treatment of acute migraine attacks. Real acupuncture was superior to sham acupuncture, but the absolute pain relief was minimal.

Frontotemporal lobar degeneration often presents with distinct language impairments that are associated with different distributions of cortical atrophy. Two studies have now demonstrated that these clinical syndromes are associated with highly characteristic patterns of cortical thinning. Specific cortical atrophy profiles do not, however, seem to reliably predict histologically distinct frontotemporal lobar degeneration variants.

Chik et al. describe the case of a woman who developed a severe 'thunderclap' headache, followed by generalized tonic–clonic seizures, shortly after giving birth. A head CT scan revealed a subarachnoid hemorrhage, and an angiogram showed areas of vasoconstriction in the cerebral arteries that were consistent with a diagnosis of postpartum cerebral angiopathy.

The incidence of Parkinson disease (PD) increases with age, so age-related conditions are expected to feature prominently among the comorbidities associated with this disease. In this article, Nanhoe-Mahabier et al. explore a possible link between PD and cerebrovascular disease, discussing the pathophysiological mechanisms that could underlie such a relationship, and considering how comorbid cerebrovascular disease might affect the clinical presentation of PD.

Chronic kidney disease is a serious global health problem, and almost all patients with severe forms of the disease develop neurological complications, which can include cognitive impairment, cerebrovascular disease and peripheral neuropathies. Krishnan and Kiernan review the clinical features and pathophysiology of the most common neurological complications of chronic kidney disease, and highlight the currently available treatment options.

Clinical overlap between the various types of neurodegenerative parkinsonism, particularly in the early stages of disease, can make differential diagnosis problematic. Biological fluid biomarker assays are being explored as adjunctive tests to aid the diagnostic work-up of patients with neurodegenerative parkinsonism, and in this article Eller and Williams cast a critical eye over the currently available cerebrospinal fluid, plasma and urine biomarkers.

Thrombolytic therapy is an effective treatment for ischemic stroke, but only when delivered within a short period after the onset of the condition. Delay in patients being admitted to hospital is one of the main reasons why the therapeutic window is often missed. This Review examines the factors that affect prehospital delay, and describes strategies designed to overcome the problem.

Sudden unexpected death in epilepsy most frequently occurs in people with chronic epilepsy, and seems to be a seizure-related event. In this article, Surges et al. review the incidence of sudden unexpected death in epilepsy and the risk factors associated with this condition, before exploring the pathological mechanisms related to chronic epilepsy that could lead to sudden death.

Bipolar disorders are recurrent mood disturbances involving periods of depression and mania. Eric Taylor discusses the management of bipolar disorders in children and adolescents, including potential differential diagnoses and the results of treatment trials in these age groups. He also outlines the distinction between classic bipolar disorders and brief emotional outbursts.

Individuals over the age of 80 years account for 30% of the total number of people with ischemic stroke. Nevertheless, elderly patients are more likely to receive suboptimal care than are younger individuals. In this Review, Derex and Nighoghossian examine the effectiveness of thrombolysis therapy, stroke-unit care, and early rehabilitation in elderly patients with stroke.