Neurology
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Multicenter Study Clinical Trial
HIV neuropathy natural history cohort study: assessment measures and risk factors.
Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) infection. Risk factors for DSP have not been adequately defined in the era of highly active antiretroviral therapy. ⋯ In this cohort of advanced human immunodeficiency virus (HIV)-infected subjects, distal sensory polyneuropathy was common and relatively stable over 48 weeks. Previously established risk factors, including CD4 cell count, plasma HIV RNA, and use of dideoxynucleoside antiretrovirals were not predictive of the progression of distal sensory polyneuropathy (DSP). Distal epidermal denervation was associated with worsening of DSP. As compared with the Total Neuropathy Score, the brief peripheral neuropathy screen had relatively low sensitivity and high specificity for the diagnosis of DSP.
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Comparative Study
Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population.
There is scant information on secular trends in the incidence and survival of ischemic stroke subtypes. ⋯ These data suggest that, in the Japanese population, the incidence of lacunar infarction steadily declined for the last 40 years. The improvement of hypertension control and decreasing prevalence of smoking might be responsible for this trend.
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Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is difficult to predict. The authors studied the relation between several parameters of brain perfusion at admission and development of DCI. ⋯ Delayed cerebral ischemia (DCI) is related to perfusion asymmetry on admission CT perfusion (CTP). The cerebral blood flow ratio (comparing contralateral regions of interest) seems the best prognosticator for development of DCI. Further studies are needed to investigate the additional value of CTP to other prognosticators for DCI and to validate the chosen threshold values.
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The authors previously proposed diagnostic criteria for neuromyelitis optica (NMO) that facilitate its distinction from prototypic multiple sclerosis (MS). However, some patients with otherwise typical NMO have additional symptoms not attributable to optic nerve or spinal cord inflammation or have MS-like brain MRI lesions. Furthermore, some patients are misclassified as NMO by the authors' earlier proposed criteria despite having a subsequent course indistinguishable from prototypic MS. A serum autoantibody marker, NMO-IgG, is highly specific for NMO. The authors propose revised NMO diagnostic criteria that incorporate NMO-IgG status. ⋯ The authors propose revised diagnostic criteria for definite neuromyelitis optica (NMO) that require optic neuritis, myelitis, and at least two of three supportive criteria: MRI evidence of a contiguous spinal cord lesion 3 or more segments in length, onset brain MRI nondiagnostic for multiple sclerosis, or NMO-IgG seropositivity. CNS involvement beyond the optic nerves and spinal cord is compatible with NMO.