Journal of the neurological sciences
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Cortical and subcortical atrophy occurs in multiple sclerosis (MS) and relates to clinical outcomes. FreeSurfer, a voxel-based automated software for brain reconstruction was used to investigate the extent of subcortical and cortical atrophy in 71 MS and 17 clinically isolated syndrome (CIS) patients, and 38 normal controls (NC), and to relate group differences to disease type and severity. Segmentation was performed on 3D SPGR T1-weighted MRI 1.5T images. ⋯ NC. Subcortical and cortical atrophy correlated with higher disability as measured by EDSS. This study confirmed selective deep gray matter atrophy (mostly thalamic), revealed cerebellum WM atrophy from the earliest clinical stages, and showed that cortical thinning advances with disease progression.
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Stroke centers and intravenous tissue plasminogen activators (tPA) are effective management for acute ischemic stroke. This study aimed to analyze stroke center characteristics on the administration of thrombolytic therapy. A national survey of stroke centers in academic medical centers and regional teaching hospitals in Taiwan was conducted. ⋯ The frequency of thrombolytic therapy administration significantly correlated with stroke center criteria (Spearman's rho=0.731, P<0.001). Multivariate analysis showed routine intravenous tPA protocol in the emergency room (odds ratio=4.6, P=0.042) and supervision by the stroke center director (odds ratio=3.7, P=0.031) significantly influenced the administration of thrombolytic therapy. Well-organized stroke centers, routine use of thrombolytic therapy protocols in the emergency room, and guidance by a stroke center director are important for enhancing thrombolytic therapy in patients with acute ischemic stroke.
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Fluoroquinolones has been rarely associated with exacerbation of myasthenia gravis (MG). We present a case of MG following a treatment with prulifloxacin, a new broad-spectrum oral fluoroquinolone. Fluoroquinolones of any generation may interfere with neuromuscular transmission and should be avoided in patients with MG.
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Randomized Controlled Trial
Longitudinal one-year study of levels and stoichiometry of neurofilament heavy and light chain concentrations in CSF in patients with multiple system atrophy.
Two cerebrospinal fluid (CSF) biomarkers specific for neurodegeneration have recently emerged - the neurofilament light (NfL, 68 kDa) and heavy (NfH, 190-210 kDa) chains. This study investigated whether the CSF NfH and NfL levels or their stoichiometric relationship changed over time in a neuroprotective treatment trial. ⋯ These results indicate that CSF levels of both NfL and NfH on their own are not useful markers of disease progression in MSA, at least over a 12-month period. Future work is needed to elucidate whether the CSF stoichiometry and dynamics of Nf subunits in individual patients are a feature of the underlying pathology and of diagnostic or prognostic value.
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Celecoxib is a potent anti-inflammatory drug with a safety profile that has been well-demonstrated in several human diseases and is reported to have beneficial effects in a rat model of intracerebral hemorrhage (ICH). We investigated the efficacy and safety of celecoxib treatment in patients with primary ICH. We retrospectively collected clinical data of patients admitted within 48 h after the onset of primary ICH. ⋯ The incidences of adverse events during the admission were not different between the groups. These results suggest that celecoxib may be safe and efficacious in patients with primary ICH. To confirm this notion, a large-sized prospective study should be performed.