Neurology
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Diffusion tensor imaging (DTI) analysis was performed on patients with tuberous sclerosis complex (TSC) to investigate potential changes in normal-appearing white matter after treatment with everolimus, a mammalian target of rapamycin (mTOR) inhibitor. ⋯ Significant changes in FA and radial diffusivity were observed after treatment with everolimus in patients with TSC, suggesting that the genetic defect of TSC in the brain may be modified pharmacologically, even in normal-appearing white matter.
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Attention to quality and safety metrics is increasingly important for all physicians in practice due to mandates by governmental organizations, insurers, the public, and accreditation bodies. Neurology resident trainees need to acquire these skills, but little research in and outside of neurology provides guidance as to how to teach these important concepts. In the setting of new requirements mandating that training programs address these topics, we propose a number of strategies that can be implemented immediately in neurology residency training programs and call for increased investigation and sharing of best practices in order to adequately prepare neurology residents for the current and future environment of practice.
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Case Reports
Fatal PML associated with efalizumab therapy: insights into integrin αLβ2 in JC virus control.
Progressive multifocal leukoencephalopathy (PML) has become much more common with monoclonal antibody treatment for multiple sclerosis and other immune-mediated disorders. ⋯ From these data we propose that inhibition of peripheral and intrathecal T-cell activation and suppression of CNS effector-phase migration both characterize efalizumab-associated PML. LFA-1 may be a crucial factor in homeostatic JC virus control.
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Cerebral microbleeds are frequently found in the general elderly population and may reflect underlying vascular disease, but their role in cognitive function is unknown. ⋯ Presence of numerous microbleeds, especially in a strictly lobar location, is associated with worse performance on tests measuring cognitive function, even after adjustments for vascular risk factors and other imaging markers of small vessel disease. These results suggest an independent role for microbleed-associated vasculopathy in cognitive impairment.