Neurology

To prospectively investigate the long-term relationship between body mass index (BMI) in adolescents and young adults and risk for multiple sclerosis (MS) at the population level.

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Autoimmune Encephalitis After SARS-CoV-2 Infection

Cristina Valencia Sanchez, Elitza Theel, Matthew Binnicker, Michel Toledano, Andrew McKeon

doi : 10.1212/WNL.0000000000012931

vol. 97 no. 23 e2262-e2268

Autoimmune encephalitis (AE) cases after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, but the frequency is unknown. We aimed to determine the frequency and diagnostic features of coronavirus disease 2019 (COVID-19)–related AE.

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Frequency of Neurologic Manifestations in COVID-19

Shubham Misra, Kavitha Kolappa, Manya Prasad, Divya Radhakrishnan, Kiran T. Thakur, Tom Solomon, Benedict Daniel Michael, Andrea Sylvia Winkler, Ettore Beghi, Alla Guekht, Carlos A. Pardo, Greta Karen Wood, Sherry Hsiang-Yi Chou, Ericka L. Fink, Erich Schmutzhard, Amir Kheradmand, Fan Kee Hoo, Amit Kumar, Animesh Das, Achal K. Srivastava, Ayush Agarwal, Tarun Dua, Kameshwar Prasad

doi : 10.1212/WNL.0000000000012930

vol. 97 no. 23 e2269-e2281

One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.

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Carotid Plaque Inflammation Imaged by PET and Prediction of Recurrent Stroke at 5 Years

John Joseph McCabe, Pol Camps-Renom, Nicola Giannotti, Jonathan P. McNulty, Sarah Coveney, Seán Murphy, Mary Barry, Joseph Harbison, Simon Cronin, David Williams, Gillian Horgan, Eamon Dolan, Tim Cassidy, Ciaran McDonnell, Eoin Kavanagh, Shane Foley, Seán Collins, Martin O'Connell, Alejandro Fernández-León, Raquel Delgado-Mederos, Michael Marnane, Joan Martí-Fàbregas, Peter J. Kelly

doi : 10.1212/WNL.0000000000012909

vol. 97 no. 23 e2282-e2291

To determine whether carotid plaque inflammation identified by 18F-fluorodeoxyglucose (18FDG)-PET is associated with late (5-year) recurrent stroke.

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Acute Ischemic Stroke Interventions in the United States and Racial, Socioeconomic, and Geographic Disparities

Adam de Havenon, Kevin Sheth, Karen C. Johnston, Alen Delic, Eric Stulberg, Jennifer Majersik, Mohammad Anadani, Shadi Yaghi, David Tirschwell, John Ney

doi : 10.1212/WNL.0000000000012943

vol. 97 no. 23 e2292-e2303

In patients with ischemic stroke (IS), IV alteplase (tissue plasminogen activator [tPA]) and endovascular thrombectomy (EVT) reduce long-term disability, but their utilization has not been fully optimized. Prior research has also demonstrated disparities in the use of tPA and EVT specific to sex, race/ethnicity, socioeconomic status, and geographic location. We sought to determine the utilization of tPA and EVT in the United States from 2016–2018 and if disparities in utilization persist.

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Life Expectancy in Duchenne Muscular Dystrophy

Jonathan Broomfield, Micki Hill, Michela Guglieri, Michael Crowther, Keith Abrams

doi : 10.1212/WNL.0000000000012910

vol. 97 no. 23 e2304-e2314

Duchenne muscular dystrophy (DMD) is a rare progressive disease that is often diagnosed in early childhood and leads to considerably reduced life expectancy; because of its rarity, research literature and patient numbers are limited. To fully characterize the natural history, it is crucial to obtain appropriate estimates of the life expectancy and mortality rates of patients with DMD.

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Assessment of Sacsin Turnover in Patients With ARSACS

Fabiana Longo, Daniele De Ritis, Annarita Miluzio, Davide Fraticelli, Jonathan Baets, Marina Scarlato, Filippo M. Santorelli, Stefano Biffo, Francesca Maltecca

doi : 10.1212/WNL.0000000000012962

vol. 97 no. 23 e2315-e2327

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is caused by variations in SACS gene encoding sacsin, a huge multimodular protein of unknown function. More than 200 SACS variations have been described worldwide to date. Because ARSACS presents phenotypic variability, previous empirical studies attempted to correlate the nature and position of SACS variations with the age at onset or with disease severity, although not considering the effect of the various variations on protein stability. In this work, we studied genotype-phenotype correlation in ARSACS at a functional level.

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Association of Reproductive History With Brain MRI Biomarkers of Dementia Risk in Midlife

Eva Schelbaum, Lacey Loughlin, Steven Jett, Cenai Zhang, Grace Jang, Niharika Malviya, Hollie Hristov, Silky Pahlajani, Richard Isaacson, Jonathan P. Dyke, Hooman Kamel, Roberta Diaz Brinton, Lisa Mosconi

doi : 10.1212/WNL.0000000000012941

vol. 97 no. 23 e2328-e2339

To examine associations between indicators of estrogen exposure from women's reproductive history and brain MRI biomarkers of Alzheimer disease (AD) in midlife.

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DNA Methylation and Protein Markers of Chronic Inflammation and Their Associations With Brain and Cognitive Aging

Eleanor L.S. Conole, Anna J. Stevenson, Susana Muñoz Maniega, Sarah E. Harris, Claire Green, Maria del C. Valdés Hernández, Mathew A. Harris, Mark E. Bastin, Joanna M. Wardlaw, Ian J. Deary, Veronique E. Miron, Heather C. Whalley, Riccardo E. Marioni, Simon R. Cox

doi : 10.1212/WNL.0000000000012997

vol. 97 no. 23 e2340-e2352

To investigate chronic inflammation in relation to cognitive aging by comparison of an epigenetic and serum biomarker of C-reactive protein and their associations with neuroimaging and cognitive outcomes.

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Shoulder-Tap Test for Functional Gait Disorders

Jan Coebergh, Ioanna Zimianiti, Diego Kaski

doi : 10.1212/WNL.0000000000012886

vol. 97 no. 23 1070-1071

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Antiseizure Medication Withdrawal in Seizure-Free Patients: Practice Advisory Update Summary

David Gloss, Kimberly Pargeon, Alison Pack, Jay Varma, Jacqueline A. French, Benjamin Tolchin, Dennis J. Dlugos, Mohamad A. Mikati, Cynthia Harden, on behalf of the AAN Guideline Subcommittee

doi : 10.1212/WNL.0000000000012944

vol. 97 no. 23 1072-1081

To update a 1996 American Academy of Neurology practice parameter.

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Continuous Unilateral Eye Blinking Related to Cerebellar Epilepsy in a Neonate

Bernardo Corrêa de Almeida Teixeira, Rafaela Grochoski, Carlos Alberto Mattozo, Gilliatt Hauer Queiroz Telles, Raul Martins Filho, Mara Lucia Schmitz Ferreira Santos

doi : 10.1212/WNL.0000000000012949

vol. 97 no. 23 1082-1083

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Clinical Reasoning: An Unexpected Response to Therapy in a Patient With HIV and Focal Seizures

Lorraine Chishimba, Mashina Chomba, Stanley Zimba, Tilele Mwansa, Wilmot Sinyangwe, Humphrey Kunda, Lottie Hachaambwa, Deanna Saylor

doi : 10.1212/WNL.0000000000012536

vol. 97 no. 23 1084-1089

We present the case of a 23-year-old right-handed man who presented to an emergency department in Lusaka, Zambia, with new-onset headaches and focal seizures. He was on combination antiretroviral therapy (cART) for HIV and had been started on antituberculous therapy at his local clinic 2 weeks before presentation, based on chest X-ray findings. On examination, he had subtle weakness and hyperreflexia in his left upper extremity. The remainder of the neurologic examination was normal. Brain CT scan revealed a single, ring-enhancing, heterogenous mass in the right posterior parietal lobe with marked vasogenic edema. His laboratory results revealed severe virologic and immunologic failure, and CSF analysis was unremarkable. He was empirically managed as CNS tuberculosis (TB). Two months later, his symptoms worsened, and he developed new neurologic deficits, despite adherence to cART and TB treatment. Repeat imaging subsequently revealed progression of his underlying CNS process with multiple brain abscesses present, and subsequent investigations revealed an unusual cause of these lesions. In this case, we review the differential diagnosis for space-occupying lesions in the context of poorly controlled HIV infection. In particular, we highlight the approach to these patients in resource-limited settings in the context of diagnostic limitations and highlight the importance of considering the local epidemiology of neurologic infections. Finally, this case demonstrates the need to maintain a wide differential diagnosis and a close monitoring plan for prompt reevaluation of empiric diagnoses when response to empiric therapy is unexpected.

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Clinical Reasoning: A 55-Year-Old Man With Odd Behavior and Abnormal Movements

Paul McIntosh, Burton Scott

doi : 10.1212/WNL.0000000000012663

vol. 97 no. 23 1090-1093

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Teaching NeuroImage: Starch-Iodine Test

Govert Dwarshuis, Bastiaan Ter Meulen, Cyra Leurs, Harold Suliman

doi : 10.1212/WNL.0000000000012597

vol. 97 no. 23 e2353-e2354

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Teaching Video NeuroImage: Spontaneous Upbeat-Torsional Nystagmus From Medial Medullary Infarction

David Edward Hale, Kemar Earl Green

doi : 10.1212/WNL.0000000000012659

vol. 97 no. 23 e2355-e2356

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Editors' Note: Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women

James E. Siegler, Steven Galetta

doi : 10.1212/WNL.0000000000012958

vol. 97 no. 23 1094

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Reader Response: Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women

Kazuo Abe

doi : 10.1212/WNL.0000000000012959

vol. 97 no. 23 1094-1095

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Author Response: Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women

Tian-Shin Yeh, Changzheng Yuan, Alberto Ascherio, Bernard A. Rosner, Walter C. Willett, Deborah Blacker

doi : 10.1212/WNL.0000000000012963

vol. 97 no. 23 1095

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[11C]PK11195-PET Brain Imaging of the Mitochondrial Translocator Protein in Mitochondrial Disease

doi : 10.1212/WNL.0000000000012559

vol. 97 no. 23 1096

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American Academy of Neurology Code of Professional Conduct

doi : 10.1212/WNL.0000000000012889

vol. 97 no. 23 1096

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Long-term Dietary Flavonoid Intake and Subjective Cognitive Decline in US Men and Women

doi : 10.1212/WNL.0000000000012933

vol. 97 no. 23 1096

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