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What is the duty of care owed by neurologists to the 'man on the street'? Does the ethical imperative to treat exist only in a medical emergency or after the establishment of a formal doctor–patient relationship? In this Viewpoint, Lim et al. draw on their personal experiences to explore these important questions.
The use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke has been limited by the need to administer the treatment within 3 hours of symptom onset, although recent findings indicate that this therapeutic window can be extended to 4.5 hours. In this Viewpoint, Maulaz et al. argue that the safety and efficacy of thrombolysis might be further improved by narrowing the selection criteria for this therapy.
Findings from laboratory studies have indicated that long-chain omega-3 fatty acids, which are found in abundance in fish, have neuroprotective properties against cognitive decline and dementia. As Majid et al. report in this article, however, the clinical trials conducted to date have failed to support a role for omega-3 fatty acids in the treatment of Alzheimer disease or other dementias. Ongoing clinical trials are expected to provide more-definitive answers in the next 2–3 years.
In this Review, Leone and colleagues provide comprehensive guidance on the available treatments for cluster headache, the most severe primary headache syndrome. They advise on the use of acute and preventive pharmacological agents and give the latest findings and recommendations regarding use of neurostimulation.
Posterior reversible leukoencephalopathy syndrome (PRES) is a complex disorder with many hypothesized mechanisms. Here, Bhatt and colleagues present a patient who developed PRES subsequent to administration of chemotherapy. The authors discuss in detail the potential causative mechanisms for PRES, emphasizing the need for early recognition of the syndrome and prompt withdrawal of the offending agent in affected patients
Biebl et al. describe the case of a 12-year-old boy who presented with fever, malaise and fatigue, and was diagnosed with Epstein–Barr virus (EBV) encephalitis when his cerebrospinal fluid tested positive for EBV. Despite intensive care and antiviral treatment, the patient died 1 month after the initial presentation. The authors suggest that EBV encephalitis should be considered in the differential diagnosis when a young patient presents with acute neurological illness of uncertain etiology.
