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July 25 Highlights

Hernán et al. reviewed the epidemiologic evidence and found that people who have been recently immunized against tetanus are 30% less likely to develop MS than unvaccinated people.

see page 212

Cognitive impairment is common in patients on chronic hemodialysis

Murray et al. measured cognitive function in a cross-sectional study of 374 hemodialysis patients 55 years. They found that 37% had severe cognitive impairment and only 13% were normal. High efficient dialysis (vs low to normal) independently increased the risk of severe cognitive impairment 1.67 times.

see page 216

Renal dysfunction and risk of ischemic stroke

Koren-Morag et al. followed 6,685 patients with chronic coronary heart disease and found that mild renal dysfunction is associated with an increased risk of incident ischemic stroke or TIA.

see page 224

The editorial by Monk and Bennett notes that these two articles and other published data suggest that even mild chronic kidney disease may confer an additional risk for stroke and TIA in patients with coronary artery disease. Commenting on the Murray et al. study, they note that this is the largest and most comprehensive study of cognitive impairment undertaken in well-dialyzed hemodialysis patients. A large number of persons on hemodialysis have unrecognized cognitive impairment that cannot be accounted for solely by vascular disease. While this high rate of cognitive impairment could reflect a referral bias of a particularly unhealthy group of patients, the lower stroke rate and hemodialysis vintage in their cohort vs that of the United States Renal Data System (all US patients on dialysis) argues against such a bias. Other dialysis modalities currently considered too expensive, such as nightly or daily hemodialysis, may ultimately prove to be cost-effective if cognitive function can be preserved.

see page 196

A double-blind, controlled study of botulinum toxin A in chronic myofascial pain

The Qerama et al. double-blind, placebo-controlled trial studied the effect of botulinum toxin A on chronic myofascial pain from muscle trigger points; they also assessed EMG activity. Although botulinum toxin A significantly reduced the EMG activity, it had no better effect that isotonic saline on either spontaneous pain or pain thresholds.

see page 241

Association of headache with obesity

Figure. Prevalence of transformed migraine according to the body mass index.

Bigal and Lipton show that the prevalence of chronic daily headache increases with body mass index. The association is specific to transformed migraine and is minimal for chronic tension type headache. These results provide further support for the hypothesis that obesity is a potentially modifiable risk factor for migraine progression.

see page 252

Men transmit MS more often to their children vs women: The Carter effect

MS is approximately twice as common among women as men. If men have greater physiologic resistance to MS, they might theoretically require stronger genetic predisposition than women to overcome this resistance. In this circumstance, men would be expected to transmit the disease more often to their children—the Carter effect. Kantarci et al. found that indeed, fathers with MS more often transmitted the disease to their children (transmitted: 18, not transmitted: 99) vs mothers with MS (transmitted: 27, not transmitted: 296).

see page 305

Electrodiagnostic findings in peripheral neuropathy in Krabbe disease

Siddiqi et al. studied neuropathy in 27 children with KD (age 1 day to 8 years). Twenty-five of 27 patients had abnormal NCS. Marked NCS abnormalities were found in a 1-day-old and two 3-week-old neonates.

see page 263

Effect of hematopoetic stem cell transplant on the PN in KD

Siddiqi et al. performed serial nerve conduction studies (NCS) in 12 KD patients after HSCT. Average follow-up was 17 months (6 months to 3 years). HSCT was followed by improvement in peripheral nerve conduction abnormalities in these patients, suggesting re-myelination of the nerves.

see page 268

The editorial by Hugo W. Moser notes that these two studies are important because of the recent development of technology for newborn screening for KD, and its impending implementation in at least one state (NY), combined with the proposal to perform hematopoietic stem cell transplantation in asymptomatic infants with KD. Patients who already show the symptoms of the most common early infantile phenotype no longer benefit from the procedure. Newborn screening, accomplished promptly with results quickly communicated, may make it possible to circumvent this limitation. However, a proportion of these asymptomatic patients will have a late-onset phenotype. The late-onset phenotypes have come to attention only relatively recently and may be more common than had been recognized. Performance of neonatal transplants in such patients would raise serious ethical issues.

see page 201

Effect of aging on prevalence and clinical features of migraine

Bigal et al. showed that with advancing age migraine remits in some individuals and gets less typical in others. In addition, the prevalence of frequent migraine (10 to 14 per month) increases, suggesting that there are both remitting and progressive subgroups of migraine sufferers.

see page 246

Does a birthday predispose to vascular events?

Saposnik et al. examined the influence of birthdays on the onset vascular events in a large population-based study. The frequency of stroke, TIA, and MI exceeds the expected number on patients’ birthdays by 27%. Birthday, a potential psychosocial stressor, increases the risk of vascular events.

see page 300

There is a Patient Page on this topic: www.neurology.org.

Stroke in arterial tortuosity syndrome

Cartwright et al. report ischemic stroke in an adolescent girl with arterial tortuosity syndrome. The authors postulate that fragmentation of the internal elastic membrane led to thrombosis and stroke.

see page 360

In the editorial discussing this case, Golomb and Fullerton review the causes of pediatric stroke, noting that while congenital heart disease and sickle cell disease account for a large proportion of childhood strokes, stroke is rarely the first presenting feature of these diseases, and thus they seldom explain a stroke in an otherwise healthy child. Vascular pathology has been increasingly implicated as an important cause: a European study identified vascular abnormalities in 78% of previously healthy children with a first ischemic stroke. They tabulate the list of vasculopathies that enter the differential.

see page 199

Related Articles

Reno-cerebrovascular disease?: The incognito kidney in cognition and stroke

Rebeca D. Monk and David A. Bennett
Neurology 2006 67: 196-198. [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