Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology No comments yet
Increased diffusivity in acute multiple sclerosis lesions predicts risk of black hole No comments yet
NEURONAL VOLTAGE-GATED CALCIUM CHANNELS: BRIEF OVERVIEW OF THEIR FUNCTION AND CLINICAL IMPLICATIONS IN NEUROLOGY No comments yet
CLICK-EVOKED VESTIBULO-OCULAR REFLEX DISTINGUISHES POSTERIOR FROM SUPERIOR CANAL DEHISCENCE No comments yet
Challenge of the unknown: A systematic review of acute encephalitis in non-outbreak situations No comments yet
Background: The threat of emerging infections and recognition of novel immune-mediated forms of encephalitis has raised the profile of this condition in recent years. Incidence is poorly defined and most cases have an unknown cause. There is currently much interest in identification of new microbial agents of encephalitis, but no work has investigated systematically reasons for lack of pathogen identification in studies.
Methods: We systematically reviewed published literature on incidence and etiology of encephalitis in non-outbreak settings and explored possible explanations for the large number of cases of unknown etiology.
Results: Annual incidence ranged from 0.07 to 12.6 cases per 100,000 population with an evident decrease over time (p = 0.01). The proportion of cases with unknown etiology was high across studies (>50% in 26 of 41 studies), with strong evidence of heterogeneity in study findings (p < 0.001). Our meta-regression identified study period, setting, and subsyndrome to be the main contributors to between-study variation, rather than methodologic factors such as study design, case definitions, sample types, and testing strategies.
Conclusions: Our findings support the hypothesis that new and emerging infectious agents, or new forms of immune-mediated encephalitis, may be responsible for cases currently of unknown cause and encourage the ongoing global effort to identify these. Our review highlights research areas that might lead to a better understanding of the causes of encephalitis and ultimately reduce the morbidity and mortality associated with this devastating condition.
Hydrocephalus in adults with community-acquired bacterial meningitis No comments yet
Objective: To evaluate the occurrence, treatment, and outcome of hydrocephalus complicating community-acquired bacterial meningitis in adults.
Methods: Case series from a prospective nationwide cohort study from Dutch hospitals from 2006 to 2009.
Results: Hydrocephalus was diagnosed in 26 of 577 episodes (5%) and was classified as communicating hydrocephalus in all but 1 patient. The majority of patients (69%) presented with hydrocephalus on admission. Most common causative bacteria were Streptococcus pneumoniae (in 14 patients, 54%) and Listeria monocytogenes (in 4 patients, 15%). Thirteen patients died (50%) and 18 had an unfavorable outcome (69%). Hydrocephalus was an independent predictor of death in a multivariate analysis (odds ratio 7.81, 95% confidence interval 2.91–20.8). Six patients underwent an intervention: 2 patients (8%) had serial lumbar punctures; 4 patients (15%) underwent external ventricular CSF catheter placement. Median time from diagnosis of hydrocephalus to CSF shunting was 12 hours (range 0–4 days). All patients who underwent CSF shunting died or had a poor outcome.
Conclusions: Hydrocephalus complicates community-acquired bacterial meningitis in 5% of adult cases and is associated with high fatality rates. A minority of patients underwent neurosurgery and outcome was uniformly poor in these patients.
Safety and efficacy of natalizumab in children with multiple sclerosis No comments yet
Objective: To describe the effect of natalizumab in the treatment of subjects with active multiple sclerosis (MS) treated before the age of 18 years.
Methods: Nineteen pediatric subjects with MS (mean age 14.6 ± 2.2 years, mean number of attacks 5.2 ± 1.9 during the pretreatment phase of 27.7 ± 19.7 months, median pretreatment Expanded Disability Status Scale score [EDSS] 2.5, range 1.0–5.0) were treated with natalizumab at the dose of 300 mg every 28 days. After treatment initiation, patients were reassessed clinically every month; brain MRI was performed at baseline and every 6 months.
Results: Patients received a median number of 15 infusions (range 6–26). A transient reversible worsening of preexisting symptoms occurred in 1 subject during and following the first infusion. All the patients remained relapse-free during the whole follow-up. The median EDSS decreased from 2.5 to 2.0 at the last visit (p < 0.001). EDSS remained stable in 5 cases, decreased by at least 0.5 point in 6 cases, and decreased by at least 1 point in 8 cases. At baseline, the mean number of gadolinium-enhancing lesions was 4.1 (range 1–20). During the follow-up, no gadolinium-enhancing lesions were detected (p = 0.008); 3 patients developed new T2-visible lesions at month 6 scan but the overall number of T2 lesions remained stable during the subsequent follow-up. Transient and mild side effects occurred in 8 patients.
Conclusions: Natalizumab was well-tolerated in all subjects. A strong suppression of disease activity was observed in all subjects during the follow-up.
Classification of evidence: This study provides Class IV evidence that natalizumab, 300 mg IV once every 28 days, decreased EDSS scores in pediatric patients with MS over a mean treatment period of 15.2 months.