Journal of the neurological sciences
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Mitochondrial disorders, in particular respiratory chain diseases (RCDs), present either as single organ problem or as multi-system disease. One of the most frequently affected organs in RCDs, in addition to the skeletal muscle, is the central nervous system (CNS). CNS manifestations of RCDs include epilepsy, stroke-like episodes, migraine-like headache, ataxia, spasticity, movement disorders, psychosis, demyelination, calcification, but also dementia. ⋯ Therapeutic strategies for dementia in RCDs rely on symptomatic measures. Only single patients may profit from cholinesterase inhibitors or memantine, antioxidants, vitamins, or other substitutes. Overall, cognitive decline in RCDs (mitochondrial dementia) needs to be included in the differentials of dementia.
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Hyperhomocysteinemia (hyper-Hcy) is a known risk factor for venous thrombosis, but few studies document the risk in puerperal cerebral venous thrombosis (CVT). Nutritional folate and vitamin B(12) deficiency can cause hyper-Hcy and pregnancy may contribute to this deficiency. We studied the association of plasma total homocysteine (tHcy), folate and vitamin B(12) levels with puerperal CVT through a case-control study. ⋯ Hyperhomocysteinemia is associated with an increased risk of puerperal CVT occurring in Indian women and low folate levels contribute significantly to hyper-Hcy. Regular antenatal folate and vitamin B(12) supplementation is likely to lower puerperal tHcy levels, but its clinical benefit needs to be tested by large therapeutic trials.
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Although a number of studies reported different interictal findings between migraine with aura (MA) and migraine without aura (MO), the pathophysiology of the visual aura in migraine remains unclear. ⋯ The high amplitude of the SSVEPs suggests that interictally migraine patients have abnormal excitability in the primary visual cortex, and this change in excitability may exist, at least partially, in the visual association cortex in MA.
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Review Historical Article
The pioneers of clinical neurology in South America.
The field of neurology in South America (SA) began to emerge towards the end of the nineteenth century, following the origin of the specialty in Europe. There was a consistent and long-standing admiration for European training, which led to the birth of the discipline in South America. The first steps took place almost simultaneously with European countries in Argentina, Brazil, Uruguay, Chile and Peru. ⋯ The first institute of neurology in Latin America, the Instituto Neurológico de Montevideo, was founded in 1926 under Américo Ricaldoni's direction. Seventeen years later, the Arquivos de Neuropsiquiatria from San Pablo was created, and is still in existence. Up until the present, South America has made dozens of important research contributions, the most important in the diagnosis and treatment of regional endemic diseases.
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Meta Analysis
Carotid angioplasty with or without stenting versus carotid endarterectomy for carotid artery stenosis: a meta-analysis.
Carotid angioplasty with or without stent placement (CAS) has emerged as an alternative to carotid endarterectomy (CEA) for revascularization of severe carotid artery stenosis in patients with high risk for surgery. This meta-analysis compared the efficacy and safety of both treatments from data for previous randomized trials. We did a literature search using Medline, PubMed, Cochrane database, and relevant articles for randomized trials comparing CAS with CEA. ⋯ But, there were significantly higher 30-day event rates after CAS than CEA for death or any stroke (1.37 [1.04-1.81]) by fix-effects model, accompanied with significant heterogeneity (p=0.04). Risk of cranial nerve injury was much lower in CAS than in CEA (0.12 [0.05-0.29]). Except for lower risk of cranial nerve injury, CAS is neither safer nor associated with a better short-term outcome as compared to CEA in treating carotid artery stenosis.