Articles related to Neurology

Navigate the complex world of diagnosing Chiari malformation in this insightful review of a clinical case. To understand Chiari malformation, let’s explore a clinical case. A mid-30s patient with a migraine history came to the ED with a sudden posterior headache. Accompanied by transient total body numbness, loss of coordination, and an inability to swallow with drooling, these symptoms started abruptly after violent sneezing. Although neurological symptoms faded after 20 seconds, the headache persisted. Regarding vital signs and physical examination, everything was normal. The patient had a head CT ordered. Interpreting the clinical picture and CT images with care is crucial in these cases. Even though a sudden onset headache could signify a ruptured berry aneurysm, no blood was detected on the CT cuts, minimizing that concern. Remember, an LP is seldom recommended if the CT is performed within 6 hours and hemoglobin exceeds 10 g/dL. However, the clinical presentation in this case, characterized by headache and drooling, didn’t match a typical migraine. Be mindful that many patients might loosely use the term “migraine” for any severe headache. The CT cut revealed a brainstem compressed by the cerebellum, indicative of a Chiari malformation type 1. Chiari malformation, characterized by an […]

Delve into the fascinating world of an integrated approach to brain medicine that amalgamates neurology and psychiatry, ushering a new era in patient care. Our understanding of the brain is constantly expanding. This unprecedented knowledge blurs the boundaries between neurology and psychiatry. However, an issue arises: current clinical training maintains a dichotomy stemming from 19th-century practices. This divergence is creating a shift. Neurologists, traditionally untrained in psychiatric management, find themselves treating more psychiatric patients. Likewise, new neuroscience-based precision treatments and diagnostic biomarkers demand skills beyond the psychiatric training purview. This status quo poses a significant challenge to training future doctors. We need to focus on establishing competence in whole-brain aspects and fostering subspecialized expertise. Additionally, implementing feasible and practical programs is paramount. In response, this article proposes a novel 4-year residency program. The first two years concentrate on common and urgent neurology and psychiatry aspects, followed by two years of elective subspecialty tracks. This concept mirrors internal medicine residencies and fellowships, without necessitating changes to existing departmental structures. The article further introduces ‘brain medicine’ as a fitting term for this unified practice. The name emphasizes a holistic focus on all brain aspects. Conventionally, the division between neurology and psychiatry relates […]

Unveil the potential ramifications of a pro-inflammatory diet on MS patients, especially concerning relapse rate and inflammatory brain lesions. Recent research from the University of Tasmania offers key insights into diet and MS. Essentially, a pro-inflammatory diet may boost relapse rates and inflammatory brain lesions. This highlights the potential impact of such a diet on MS patients. Notably, this diet didn’t influence disability progression or chronic inflammation lesions. MS, defined as a chronic autoimmune disease, harms nerve cells. Significantly, lifestyle modifications may enhance MS symptoms and outcomes. A diet high in fats and proteins, known as a pro-inflammatory diet, could heighten inflammation. Conversely, incorporating anti-inflammatory foods like turmeric, fiber, and beta-carotene may benefit those with inflammatory diseases. The Dietary Inflammation Index (DII), measures diet-related impacts on chronic inflammation. Importantly, higher DII scores imply elevated systemic inflammation, which correlates with increased cardiovascular disease and colorectal cancer risk. The researchers used data from 190 participants in the AusLong Study, all later diagnosed with MS. Participants completed a food frequency questionnaire, from which DII scores were computed. Importantly, for each one-unit DII increase, relapse risk rose by 18%. Strikingly, those in the highest energy-adjusted scores quartile were 2.24 times more likely to relapse. […]

Diving into intensive systolic BP treatment unveils intriguing cognitive benefits according to a secondary analysis of the SPRINT trial. The SPRINT trial has shed fresh light on the impact of intensive systolic blood pressure (SBP) treatment on cognitive health. Out of 7,918 participants, a significant majority with higher baseline risk of dementia or mild cognitive impairment (MCI) revealed marked cognitive improvements with intensive SBP treatment. This marks a leap forward in understanding SBP treatment’s role in cognitive function preservation. In the comprehensive secondary analysis, patients were meticulously followed up over a median of four years. To streamline the study, two SBP treatment targets were identified: intensive, set at less than 120 mm Hg, and standard, at less than 140 mm Hg. The data collected showcased 765 and 828 primary outcome events in intensive and standard treatment groups, respectively. Consequently, it confirmed intensive SBP treatment’s potential in reducing the risk of MCI or dementia. Digging deeper into the data, certain trends emerged. Older age, Medicare enrollment, and higher baseline serum creatinine levels correlated with a higher risk of the primary outcome. Conversely, enhanced baseline cognitive functioning and active employment status signified lower risk. Interestingly, higher baseline risk connected directly with greater […]

Dive into the intriguing findings from the PEACH trial on prophylactic levetiracetam for seizure prevention in intracerebral haemorrhage patients. The PEACH trial aimed to test prophylactic levetiracetam for seizure prevention in acute intracerebral haemorrhage (ICH) patients. Early seizures within seven days of stroke onset occur in almost 30% of patients. However, current guidelines lack strategies to manage this issue. Despite being prematurely stopped, the trial showed promise. In this double-blind, randomised, placebo-controlled trial, 50 patients received either levetiracetam or a placebo. Clinical or electrographic seizures were seen in 16% of levetiracetam patients and 43% of placebo patients within 72 hours. Interestingly, these seizures were only electrographic. Adverse events included headaches and pain, but no treatment-related deaths were reported. The findings suggest levetiracetam may prevent acute seizures in ICH patients, but larger studies are needed. Acute seizures can lead to increased morbidity and mortality. The trial found fewer seizures within 72 hours of study inclusion in the levetiracetam group. This is promising, but more research is required. This study opens avenues for further investigation. It raises questions about early detection of interictal epileptiform activity and the need for prophylactic levetiracetam. It also underscores the need to understand which factors influence seizure […]

FDA’s New Approval of Atogepant for Chronic Migraine Prevention is a Breakthrough in Migraine Management A promising breakthrough in migraine management, the FDA’s new approval of atogepant tablets, brings renewed hope for chronic migraine sufferers. According to AbbVie, this endorsement allows the use of atogepant (Qulipta) in the prevention of chronic migraines in adults. Atogepant stands out as the first oral calcitonin gene-related peptide (CGRP) receptor antagonist to receive dual approval for episodic and chronic migraines. It works by blocking CGRP, a molecule involved in transmitting pain signals. Chronic migraines, to clarify, involve enduring headaches for at least 15 days a month, with eight of those days associated with migraines. Before this, in September 2021, the FDA approved atogepant for treating episodic migraines. Patients can take the drug in 10 mg, 30 mg, and 60 mg dosages. The FDA recommends the 60 mg dose for chronic migraine patients. Peter McAllister, MD, from the New England Center for Neurology and Headache, noted that the FDA’s endorsement offers a new, convenient daily treatment for chronic migraine patients. The demonstrated efficacy and functional improvement of atogepant make it an appealing option for neurologists and headache specialists when devising treatment plans for patients. The […]