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Spotlight on the February 22 Issue
Merino, Jose G. MD, MPhil; Editor-in-Chief, Neurology(R)
doi : 10.1212/WNL.0000000000013280
Volume 98(8), 22 February 2022, p 299-300
Risk of Acute Ischemic Stroke in Patients 65 and Older Is Early After COVID-19 Diagnosis
Simpkins, Alexis N. MD, PhD, MSCR; Lekoubou, Alain MD, MS
doi : 10.1212/WNL.0000000000013182
Volume 98(8), 22 February 2022, p 301-302
Could Exercise Be the Answer?: Disease Modification With Long-term Regular Physical Activity in Parkinson Disease
Mak, Margaret K. Y. PhD; Schwarz, Heidi Beck MD
doi : 10.1212/WNL.0000000000013208
Volume 98(8), 22 February 2022, p 303-304
COVID-19 and Risk of Acute Ischemic Stroke Among Medicare Beneficiaries Aged 65 Years or Older: Self-Controlled Case Series Study
Yang, Quanhe PhD; Tong, Xin MPH; George, Mary G. MD; Chang, Anping MS; Merritt, Robert K. MA
doi : 10.1212/WNL.0000000000013184
Volume 98(8), 22 February 2022, p e778-e789
Findings of association between coronavirus disease 2019 (COVID-19) and stroke remain inconsistent, ranging from significant association to absence of association to less than expected ischemic stroke among hospitalized patients with COVID-19. The current study examined the association between COVID-19 and risk of acute ischemic stroke (AIS).
Prevalence and Significance of Impaired Microvascular Tissue Reperfusion Despite Macrovascular Angiographic Reperfusion (No-Reflow)
Ng, Felix C. MBBS, BMedSc, MPH; Churilov, Leonid PhD; Yassi, Nawaf PhD; Kleinig, Timothy John PhD; Thijs, Vincent PhD; Wu, Teddy PhD; Shah, Darshan MBBS; Dewey, Helen PhD; Sharma, Gagan MCA; Desmond, Patricia MD; Yan, Bernard MD; Parsons, Mark PhD; Donnan, Geoffrey MD; Davis, Stephen MD; Mitchell, Peter MMed; Campbell, Bruce PhD
doi : 10.1212/WNL.0000000000013210
Volume 98(8), 22 February 2022, p e790-e801
The relevance of impaired microvascular tissue-level reperfusion despite complete upstream macrovascular angiographic reperfusion (no-reflow) in human stroke remains controversial. We investigated the prevalence and clinical-radiologic features of this phenomenon and its associations with outcomes in 3 international randomized controlled thrombectomy trials with prespecified follow-up perfusion imaging.
Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type
Voinescu, P. Emanuela MD, PhD; Ehlert, Alexa N. MS; Bay, Camden P. PhD; Allien, Stephanie PA-C; Pennell, Page B. MD
doi : 10.1212/WNL.0000000000013056
Volume 98(8), 22 February 2022, p e802-e807
To assess whether increased seizure frequency during pregnancy and postpartum is influenced by epilepsy type, seizure location, and antiseizure medications.
Association of Head Injury With Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Cohort
Schneider, Andrea L.C. MD, PhD; Gottesman, Rebecca F. MD, PhD; Krauss, Gregory L. MD, PhD; Gugger, James MD, PharmD; Diaz-Arrastia, Ramon MD, PhD; Kucharska-Newton, Anna PhD, MPH; Huang, Juebin MD; Johnson, Emily L. MD
doi : 10.1212/WNL.0000000000013214
Volume 98(8), 22 February 2022, p e808-e817
Late-onset epilepsy (LOE; i.e., epilepsy starting in later adulthood) affects a significant number of individuals. Head injury is also a risk factor for acquired epilepsy, but the degree to which prior head injury may contribute to LOE is less well understood. Our objective was to determine the association between head injury and subsequent development of LOE.
Hidden Objective Memory Deficits Behind Subjective Memory Complaints in Patients With Temporal Lobe Epilepsy
Lemesle, Beatrice MSc*; Barbeau, Emmanuel J. PhD; Milongo Rigal, Emilie MD, MSc; Denuelle, Marie MD, MSc; Valton, Luc MD, MSc; Pariente, Jeremie MD, PhD; Curot, Jonathan MD, PhD*
doi : 10.1212/WNL.0000000000013212
Volume 98(8), 22 February 2022, p e818-e828
The aim of this work was to test the hypothesis that patients with temporal lobe epilepsy (TLE) with subjective initial memory complaints (not confirmed by an objective standard assessment) and various phenotypes also show objective very long-term memory deficit with accelerated long-term forgetting. We tested patients with TLE with 2 surprise memory tests after 3 weeks: the standard Free and Cued Selective Reminding Test (FCSRT) and Epireal, a new test specifically designed to capture more ecologic aspects of autobiographical memory.
Association of Sleep, Neuropsychological Performance, and Gray Matter Volume With Glymphatic Function in Community-Dwelling Older Adults
Siow, Tiing Yee MD; Toh, Cheng Hong MD, PhD; Hsu, Jung-Lung MD, PhD; Liu, Geng-Hao MD; Lee, Shwu-Hua MD; Chen, Ning-Hung MD; Fu, Changjui James PhD; Castillo, Mauricio MD; Fang, Ji-Tseng MD
doi : 10.1212/WNL.0000000000013215
Volume 98(8), 22 February 2022, p e829-e838
The glymphatic system, which is robustly enabled during some stages of sleep, is a fluid-transport pathway that clears cerebral waste products. Most contemporary knowledge regarding the glymphatic system is inferred from rodent experiments and human research is limited. Our objective is to explore the associations between human glymphatic function, sleep, neuropsychological performance, and cerebral gray matter volumes.
Neural Variability in the Prefrontal Cortex as a Reflection of Neural Flexibility and Stability in Patients With Parkinson Disease
Maidan, Inbal PhD; Hacham, Roni BSc; Galperin, Irina MSc; Giladi, Nir MD; Holtzer, Roee PhD; Hausdorff, Jeffrey M. PhD; Mirelman, Anat PhD
doi : 10.1212/WNL.0000000000013217
Volume 98(8), 22 February 2022, p e839-e847
Functional near-infrared spectroscopy (fNIRS) studies provide direct evidence of the important role of the prefrontal cortex (PFC) during walking in aging and Parkinson disease (PD). Most studies explored mean hemoglobin (HbO2) levels, while moment-to-moment variability measures have rarely been investigated. Variability measures can inform on flexibility, which is imperative for adaptive function. We hypothesized that patients with PD will show less variability in HbO2 signals during walking compared to healthy controls.
Association of Fecal and Plasma Levels of Short-Chain Fatty Acids With Gut Microbiota and Clinical Severity in Patients With Parkinson Disease
Chen, Szu-Ju MD; Chen, Chieh-Chang MD; Liao, Hsin-Yu MSc; Lin, Ya-Ting MSc; Wu, Yu-Wei PhD; Liou, Jyh-Ming MD, PhD; Wu, Ming-Shiang MD, PhD; Kuo, Ching-Hua PhD; Lin, Chin-Hsien MD, PhD
doi : 10.1212/WNL.0000000000013225
Volume 98(8), 22 February 2022, p e848-e858
Short-chain fatty acids (SCFAs) are gut microbial metabolites that promote the disease process in a rodent model of Parkinson disease (PD), but fecal levels of SCFAs in patients with PD are reduced. Simultaneous assessments of fecal and plasma SCFA levels, and their interrelationships with the PD disease process, are scarce. We aimed to compare fecal and plasma levels of different SCFA subtypes in patients with PD and healthy controls to delineate their interrelations and link to gut microbiota changes and clinical severity of PD.
Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease
Tsukita, Kazuto MD; Sakamaki-Tsukita, Haruhi MD; Takahashi, Ryosuke MD, PhD
doi : 10.1212/WNL.0000000000013218
Volume 98(8), 22 February 2022, p e859-e871
Owing to the lack of long-term observations or comprehensive adjustment for confounding factors, reliable conclusions regarding long-term effects of exercise and regular physical activity in Parkinson disease (PD) have yet to be drawn. Here, using data from the Parkinson's Progression Markers Initiative study that includes longitudinal and comprehensive evaluations of many clinical parameters, we examined the long-term effects of regular physical activity and exercise habits on the course of PD.
Understanding How to Strengthen the Neurology Pipeline With Insights From Undergraduate Neuroscience Students
Minen, Mia T. MD, MPH; Kaplan, Kayla; Akter, Sangida; Khanns, Dennique; Ostendorf, Tasha MS; Rheaume, Carol E. MSPH; Friedman, Steven MS; Wells, Rebecca Erwin MD, MPH
doi : 10.1212/WNL.0000000000013259
Volume 98(8), 22 February 2022, p 314-323
Despite increased neuroscience interest at the undergraduate level, a significant shortage of neurologists in the United States exists. To better understand how to generate more interest in neurology, specifically at the undergraduate level, we conducted an anonymous cross-sectional online survey comprising 1,085 undergraduates in either neuroscience courses or majoring/minoring in neuroscience from across the United States to better understand their clinical neurology experiences and perspectives. The survey quantitatively and qualitatively assessed students' clinical neurology exposure inside and outside of the classroom, research experiences, and career goals. Students were from a broad spectrum of undergraduate institutions (public research university [40.8%], liberal arts college [29.7%], and private research university [29.0%]). Most students (89.9%) were looking to pursue graduate studies; 56.9% reported wanting to be a physician, and 17.8% expressed interest in obtaining an MD/PhD. Of importance, students reported first exposure to neuroscience at age 16 years but felt that they could be exposed to neuroscience as early as 13 years. Half (50.5%) decided to major in neuroscience before college, and a quarter (25.6%) decided to major in their first year of college. Despite high interest in clinical neurology exposure, less than one-third of students had spoken with or shadowed a neurologist, and only 13.6% had interacted with clinical neurology populations. Only 20.8% of students felt volunteer and internship opportunities were sufficiently available. Qualitative results include student perspectives from those who did and did not work with a neurologist, describing how they were or were not able to obtain such opportunities. We discuss translating the survey findings into actionable results with opportunities to target the undergraduate neuroscience interest to improve the neurology pipeline. We describe existing programs that could be integrated into everyday neurology practices and new approaches to learning and training to help leverage the significant undergraduate neuroscience interest. We also raise questions for further research, including exploring (1) how students learn of neurologic conditions/expand their knowledge about additional neurologic conditions, (2) whether qualitative investigation of the experiences of neuroscience undergraduates at specific institutions might provide an additional insight, and (3) systems to maintain interest in neuroscience/neurology as students enter medical school.
Summer Picnics
Zhang, Ellen BA
doi : 10.1212/WNL.0000000000013110
Volume 98(8), 22 February 2022, p 324
Hemiparkinsonism Secondary to Giant Aneurysm
Goncalves, Ana MD; Oliveira, Joao MD; Simoes, Rita MD; Canas, Nuno MD; Vale, Jose MD
doi : 10.1212/WNL.0000000000013150
Volume 98(8), 22 February 2022, p 325-326
Resident & Fellow Rounds: February 2022
Strowd, Roy E. III MD, MEd, MS, FAAN; Editor; Aamodt, Whitley MD, MPH; Deputy Editor
doi : 10.1212/WNL.0000000000013287
Volume 98(8), 22 February 2022, p 327-329
Clinical Reasoning: A 55-Year-Old Woman With Recurrent Episodes of Aphasia and Vision Changes
Jeanneret, Valerie MD; Neill, Stewart MD; Greene, James G. MD, PHD; Groover, Olivia MD; Kase, Carlos S. MD
doi : 10.1212/WNL.0000000000013219
Volume 98(8), 22 February 2022, p 330-335
A 55-year-old woman presented with recurrent episodes of headache, vision changes, and language disturbances. Brain MRI showed multifocal white matter lesions, microhemorrhages, and enlarged perivascular spaces. After an extensive and unrevealing workup, she underwent a biopsy of brain and meninges that revealed thick and hyalinized leptomeningeal and cortical vessel walls that were strongly positive for [beta]-amyloid by immunohistochemical staining, suggestive of cerebral amyloid angiopathy (CAA). CAA can present as a spectrum of inflammatory responses to the deposition of amyloid-[beta] in the vessel walls. Her clinical presentation, radiologic, and histopathologic findings supported a diagnosis of probable CAA-related inflammation (CAA-ri). Although an uncommon entity, it is important to recognize it because most patients respond to immunosuppressive therapy.
Pearls & Oy-sters: Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest
Marzoughi, Sina MD; Marulanda, Laura MD; Ngo, Dian RPh; Chen, Tychicus MD, FRCPC
doi : 10.1212/WNL.0000000000013220
Volume 98(8), 22 February 2022, p 336-339
Teaching NeuroImage: Rapid Identification of Infectious Optic Neuritis by Next-Generation Sequencing
Huang, Ying MD; Liu, Yulu MD; Liu, Yongguang MD; Li, Qiang MD, PhD; Fu, Xuejun MD; Zou, Liangyu MD, PhD; Xu, Qianhui MD
doi : 10.1212/WNL.0000000000013213
Volume 98(8), 22 February 2022, p e872-e874
Teaching Video NeuroImage: Reflex Epilepsy: Seizures Induced by Vigorous Exercise
McLaren, John Robert MD*; Nascimento, Fabio Augusto MD*; Thiele, Elizabeth Anne MD, PhD
doi : 10.1212/WNL.0000000000013216
Volume 98(8), 22 February 2022, p e875
Seizure Worsening During Pregnancy: Who Is at Risk?
Karceski, Steven MD
doi : 10.1212/WNL.0000000000013286
Volume 98(8), 22 February 2022, p e876-e879
Editors' Note: Burden of Chronic and Acute Conditions and Symptoms in People With Epilepsy
Ganesh, Aravind MD, DPhil, FRCPC; Galetta, Steven MD
doi : 10.1212/WNL.0000000000013283
Volume 98(8), 22 February 2022, p 340
Reader Response: Burden of Chronic and Acute Conditions and Symptoms in People With Epilepsy
Garg, Divyani
doi : 10.1212/WNL.0000000000013284
Volume 98(8), 22 February 2022, p 340-341
Author Response: Burden of Chronic and Acute Conditions and Symptoms in People with Epilepsy
Bensken, Wyatt P.
doi : 10.1212/WNL.0000000000013285
Volume 98(8), 22 February 2022, p 341
Recovery and Prediction of Bimanual Hand Use After Stroke
doi : 10.1212/WNL.0000000000012717
Volume 98(8), 22 February 2022, p 341
High Prevalence of Neutralizing Antibodies After Long-term Botulinum Neurotoxin Therapy
doi : 10.1212/WNL.0000000000013258
Volume 98(8), 22 February 2022, p 341
