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April 25 Highlights

Hand et al. evaluated 82 patients with a broad range of stroke severities. The authors found that diffusion imaging (DWI) lesion characteristics did not predict functional outcome beyond key clinical variables (age, stroke severity). Hence, DWI is unlikely to reduce sample sizes in acute stroke trials assessing functional outcome.

see page 1159

The editorial by Barber and Powers notes that accurate outcome prediction is helpful for discussions with patients and caregivers and in applying predictive models to the design and analysis of acute stroke treatment trials. MR DWI appears to be a less than ideal predictor of outcome following stroke. DWI is unlikely to reduce sample sizes for clinical trials in unselected stroke populations or to provide insight into the biologic effects of therapy.

see page 1138

Statin undertreatment among recent stroke survivors

Ovbiagele et al. evaluated the frequency of statin use and achievement of national guideline target lipid goals among recent ischemic stroke survivors (in the VISP study), and found that less than half of guideline-eligible high vascular risk patients with ischemic stroke were treated according to recommended lipid goals.

see page 1164

The editorial by Elkind and Benesch notes that it is possible that patients in this study ultimately did attain lower LDL levels than these numbers indicate. Moreover, there are no data on how many patients could not tolerate statins because of side effects, nor follow-up data on levels achieved over time. Nonetheless, these VISP data may reflect poor adherence to lipid guidelines among neurologists and others involved in stroke care, and are particularly worrisome as it is likely that those caring for patients in clinical trials have the most knowledge and experience in following vascular disease guidelines. They conclude that neurologists can no longer afford to leave preventive treatment of such patients to others.

see page 1140

Hyperdense artery sign on CT scan and thrombolysis

Qureshi et al. found that IV thrombolysis significantly increased the rates of favorable outcomes at 90 days without any modifying effect of hyperdense artery sign on initial CT scans among 616 patients with ischemic stroke. Thus IV thrombolysis may be beneficial in this subgroup of patients.

see page 1171

Hematoma growth related to outcome after ICH

Davis et al. performed a meta-analysis of 218 placebo-treated patients with intracerebral hemorrhage. Hematoma growth (72.9% < 3 hours) independently determined mortality and functional disability, additional to baseline prognostic indicators such as age, level of consciousness, and hematoma volume.

see page 1175

Functional effects of deep brain stimulation in PD

Grafton et al. found that effective unilateral stimulation of the subthalamic nucleus in six patients with PD led to normalization of task-specific alterations of activity in motor areas and widespread reductions in compensatory overactivity.

see page 1192

The editorial by Hershey and Mink discusses the use of functional imaging studies to study physiologic mechanisms of DBS. They review challenges facing the interpretation of functional imaging studies.

see page 1142

Long-term effect of selegiline on progression of PD

Pålhagen et al. followed 140 patients with PD for 7 years in a double-blind study. Patients were initially treated with either selegiline or placebo. Later, when disability required, selegiline and placebo were replaced with levodopa. Selegiline significantly slowed the progression of disease disability and other signs and symptoms of PD.

see page 1200

A three-protein biomarker panel for the diagnosis of ALS

Pasinetti et al. identified a panel of three proteins whose content in the CSF is able to identify patients with ALS with 91% sensitivity and 97% specificity. A validation study confirmed that this biologic model correctly distinguishes patients with ALS from cases with peripheral neuropathy and healthy control subjects.

see page 1218

Mycophenolate in dermatomyositis: Opportunistic infections

Rowin et al. treated 10 patients with dermatomyositis with mycophenolate and corticosteroids. Although the combination was efficacious in 6/10, three patients developed opportunistic infections, leading to death in one.

see page 1245

SPECT imaging of annexin V in AD

Lampl et al. performed SPECT using radiolabeled annexin V, a marker of phosphatidylserine expression. Four of five patients with AD had multifocal cortical annexin V uptake, while all seven non-AD and six control patients had a normal SPECT.

see page 1253

ICAM-1 polymorphism and risk for cervical artery dissection

Longoni et al. describe an association between a SNP affecting the ICAM-1 gene and spontaneous cervical artery dissection, suggesting the possible involvement of inflammation in the pathogenesis of the disorder.

see page 1273

Impaired cholinergic activity in FTDP with tau mutation

In a PET study using ¹¹C-labeled N-methylpiperidin-4-yl acetate, Hirano et al. demonstrated decreased choline acetyltransferase (AChE) activity indicative of cholinergic impairment in two patients with FTDP-17 carrying the N279K tau mutation.

see page 1276

Related Articles

MR DWI does not substitute for stroke severity scores in predicting stroke outcome

Philip A. Barber and William Powers
Neurology 2006 66: 1138-1139. [Full Text] [PDF]

This Article Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles