Volume 5 Issue 4, April 2009

The use of repeated microcatheter injections during intra-arterial procedures to treat acute stroke is associated with an increased risk of intracranial hemorrhage. The number of such injections performed should, therefore, be minimized.

MRI provides a very sensitive reflection of the histopathological changes in multiple sclerosis. Many short-term studies fail to appreciate the relationship between MRI and clinical findings, although such shortcomings might be argued to reflect a weakness of clinical measures, rather than of MRI.

Differences in the frequencies of physician and emergency-room visits and hospitalizations across socioeconomic and ethnic groups may lead to poor health outcomes in disadvantaged populations. Analyzing the causes and implementing interventions to redress such disparities is a high priority in the US, but neurology lags behind other clinical specialties in this research.

Human prion diseases are sometimes difficult to diagnose because few clinical features distinguish them reliably from other neurological disorders. A new study suggests that analysis of movement disorders might contribute to the clinical differentiation of sporadic Creutzfeldt–Jakob disease from Alzheimer disease and dementia with Lewy bodies.

Distinguishing between a first episode of multiple sclerosis and acute disseminated encephalomyelitis in children who present with an initial demyelinating event can be a clinical challenge. New brain MRI criteria that aim to differentiate these clinical presentations, and revised McDonald MRI criteria specific for the pediatric population, are both worthy of note.

Malaria is a serious public health problem in the developing world, and is also being seen increasingly in Western countries as a result of travel and immigration. Malaria is associated with a number of neurological complications, including agitation, psychosis, seizures, impaired consciousness and coma. In this article, Mishra and Newton describe these complications, discuss the underlying pathogenesis, and outline current and future management strategies.

The application of neuroimaging to headache has greatly enhanced our understanding of the pathophysiology of this syndrome. Here, Arne May describes neuroimaging as a diagnostic tool for headache and highlights the advances made with functional and structural neuroimaging in the study of primary headache syndromes such as migraine and trigeminal autonomic headaches.

Delirium is an acute neuropsychiatric syndrome, the core features of which are inattention and global cognitive dysfunction. Fong and Inouye review current clinical practice in delirium in elderly individuals, including diagnosis, treatment and outcomes. They also consider the profound impact of this syndrome on health-care utilization and costs.

Friedreich ataxia (FRDA) is the most common of the inherited ataxias, with an estimated prevalence of 3–4 cases per 100,000 individuals. There are, as yet, no robust evidence-based standards of care for FRDA. This Review article pools the expertise of FRDA specialists across Western Europe to formulate a set of guidelines for the diagnosis and treatment of this debilitating condition.