Neurology
Cohort Study | Long-term changes in the size of pituitary microadenomas
3 Mar, 2023 | 13:49h | UTCSummary: The prevalence of pituitary lesions in radiologic studies is estimated to be 10% to 38.5%. However, it is unclear how frequently incidental lesions should be monitored by serial pituitary MRI. A retrospective longitudinal cohort study was conducted to evaluate changes in pituitary microadenomas over time. During the study period (from 2003 to 2021), 414 patients with pituitary microadenomas were identified, and 177 patients had more than 1 MRI. Approximately two-thirds of the microadenomas demonstrated no change or a decrease in size, while the rest exhibited a slow growth rate, indicating that less frequent monitoring could be considered safe.
Article: Long-Term Changes in the Size of Pituitary Microadenomas – Annals of Internal Medicine (link to abstract – $ for full-text)
News Release: Fewer surveillance MRIs may be appropriate for patients with incidental pituitary lesions – American College of Physicians
Commentary on Twitter
New from @harvardmed: new study suggests that less frequent pituitary #MRI surveillance for patients with incidental pituitary #microadenomas may be safe: https://t.co/w4hzk8ISQq pic.twitter.com/2MeK14SRph
— Annals of Int Med (@AnnalsofIM) February 28, 2023
Cohort Study | Association between a healthy lifestyle and memory decline in older adults
3 Mar, 2023 | 13:44h | UTCSummary: This study examined the association between a healthy lifestyle and memory decline in older adults over a 10-year period. The study included 29,072 participants aged 60 or older with normal cognition and apolipoprotein E (APOE) genotyping at baseline. Six healthy lifestyle factors were assessed: a healthy diet, regular physical exercise, active social contact, active cognitive activity, never or former smoker, and never drinking alcohol. Participants were categorized into three groups based on their lifestyle factors: favorable, average, and unfavorable. The results showed that participants in the favorable group had slower memory decline than those in the unfavorable group, even in the presence of the APOE ε4 allele. These findings have important implications for public health initiatives to protect older adults against memory decline.
Editorial: Healthy lifestyles for dementia prevention – The BMJ
News Release: Healthy lifestyle linked to slower memory decline in older adults – BMJ Newsroom
Commentary: Healthful Lifestyle May Slow Memory Loss, Even for APOE Gene Carriers – JAMA
Commentary on Twitter
A healthy lifestyle is associated with slower memory decline, even in the presence of the [high risk] APOE ε4 allele.
Most to least impactful: diet, cognitive activity, physical exercise, active social contact, never/former smoking, & never drinking.https://t.co/j21cH2wyo6 pic.twitter.com/6qgd9bJ2Gr
— Joseph C. Watso, PhD (@Joseph_Watso) January 27, 2023
Under a http://creativecommons.org/licenses/by-nc/4.0/ license
SR | Endovascular therapy vs. medical treatment for symptomatic intracranial artery stenosis
3 Mar, 2023 | 13:35h | UTC
Cohort Study | Female hormone therapy and risk of intracranial hemorrhage from cerebral cavernous malformations
2 Mar, 2023 | 13:03h | UTCSummary: The study aimed to investigate the association between female hormone therapy (oral contraception or menopausal hormone therapy) and intracranial hemorrhage in female patients with cerebral cavernous malformations (CCM) using data from 2 large prospective cohort studies. The researchers analyzed data from 722 female patients with CCM and found that female hormone therapy use was associated with an increased risk of subsequent intracranial hemorrhage. The risk was more significant among female patients aged 10-44 years using oral contraceptives (adjusted hazard ratio 2·00, 95% CI 1·26-3·17; p=0·003). These findings raise questions about the safety of female hormone therapy in patients with cerebral cavernous malformation.
Article: Female Hormone Therapy and Risk of Intracranial Hemorrhage From Cerebral Cavernous Malformations: A Multicenter Observational Cohort Study – Neurology (link to abstract – $ for full-text – you can try this link for full-text)
Cohort Study | Lifetime traumatic brain injury and cognitive domain deficits in late life
2 Mar, 2023 | 12:45h | UTCLifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study – Journal of Neurotrauma (link to abstract – you can try this link for full-text)
News Release: Three or more concussions linked with worse brain function in later life – University of Exeter
M-A | Efficacy of brief behavioral therapy for insomnia in older adults with chronic insomnia
1 Mar, 2023 | 13:55h | UTC
RCT | Effects of globus pallidus focused ultrasound ablation in Parkinson’s disease
27 Feb, 2023 | 13:02h | UTCSummary: The study evaluated the efficacy and safety of unilateral focused ultrasound ablation of the internal segment of globus pallidus in patients with Parkinson’s disease and dyskinesias or motor fluctuations. The randomized controlled trial involved 94 patients who were either assigned to undergo ultrasound ablation or a sham procedure. The study found that unilateral pallidal ultrasound ablation resulted in a higher percentage of patients who improved motor function or reduced dyskinesia than a sham procedure over a period of 3 months but was associated with adverse events. The study suggests the need for longer and larger trials to determine the effect and safety of this technique in persons with Parkinson’s disease.
Article: Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Focused ultrasound reduces physical symptoms of Parkinson’s disease – Health Imaging
Video Summary: Focused Ultrasound Ablation for Parkinson’s Disease | NEJM
Parkinson disease primer for the general practitioner
27 Feb, 2023 | 13:00h | UTCPart 1: Diagnosis – Canadian Family Physician
Part 2: Management of motor and nonmotor symptoms – Canadian Family Physician
Related:
Management of psychiatric and cognitive complications in Parkinson’s disease – The BMJ
Podcast | Parkinson’s Disease for primary care.
Cohort Study | Could regular laxative use be associated with an increased risk of dementia?
27 Feb, 2023 | 12:59h | UTCAssociation Between Regular Laxative Use and Incident Dementia in UK Biobank Participants – Neurology (link to abstract – $ for full-text)
News Release: Study: People Who Regularly Use Laxatives May Have an Increased Risk of Dementia – American Academy of Neurology
Commentary: Regular Use of Laxatives Linked to Risk for All-Cause Dementia – HealthDay
Review | Glioblastoma and other primary brain malignancies in adults
24 Feb, 2023 | 13:54h | UTCArticle: Glioblastoma and Other Primary Brain Malignancies in Adults: A Review – JAMA (free for a limited period)
Audio clinical review: Glioblastoma and Other Primary Brain Malignancies in Adults – JAMA
Commentary on Twitter
Review summarizes current evidence regarding diagnosis and treatment of primary malignant brain tumors in adults. https://t.co/pNKio61bN5
— JAMA (@JAMA_current) February 21, 2023
Review | Young-onset dementia diagnosis, management and care
24 Feb, 2023 | 13:37h | UTC
Injurious falls before, during and after dementia diagnosis: a population-based study
24 Feb, 2023 | 13:31h | UTC
Cohort Study | Pre-pregnancy migraine linked to a higher risk of adverse pregnancy outcomes
23 Feb, 2023 | 13:31h | UTCSummary: This study investigated the relationship between migraine and adverse pregnancy outcomes. Researchers examined data from the Nurses’ Health Study II, which included 30,555 pregnancies from 19,694 women. Pre-pregnancy migraine was associated with a higher risk of preterm delivery, gestational hypertension, and preeclampsia. Migraine with aura was associated with a higher preeclampsia risk than migraine without aura. However, migraine was not associated with low birth weight or gestational diabetes mellitus. The study suggests that migraine history, and to a lesser extent, migraine phenotype, could be useful in identifying women at risk of pregnancy complications. Regular aspirin use prior to pregnancy was associated with a lower risk of preterm delivery for women with migraine, but randomized trials are needed to evaluate this hypothesis.
Article: Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes – Neurology (link to abstract – $ for full-text)
News Release: Migraine associated with increased risk for pregnancy complications – Brigham and Women’s Hospital
Commentary: Prepregnancy Migraine Tied to Adverse Pregnancy Outcomes – HealthDay
Review | Brain monitoring after cardiac arrest
23 Feb, 2023 | 13:23h | UTCBrain monitoring after cardiac arrest – Current Opinion in Critical Care
Review | Diagnosis and management of patients with polyneuropathy
21 Feb, 2023 | 11:40h | UTCDiagnosis and management of patients with polyneuropathy – Canadian Medical Association Journal
Study finds low rates of antipsychotic medication discontinuation in older adults following infection-related hospitalization
20 Feb, 2023 | 12:25h | UTCSummary: The study aimed to investigate discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization and infection in older adults. The cohort study involved 5,835 patients in the US, who were aged 65 years or older, without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. The study found that only 11% of new atypical APM users and 52% of new haloperidol users discontinued the medication by 30 days after initiation. The discontinuation of haloperidol and atypical APM was less likely to occur in patients with dementia and prolonged hospitalization. The findings suggest that APM discontinuation rates following infection-related hospitalization are low, especially for atypical APM, and call for effective interventions to proactively discontinue APMs when they are no longer indicated.
M-A | General Anesthesia vs. to Non-GA in endovascular thrombectomy for ischemic stroke
20 Feb, 2023 | 12:20h | UTCSummary: The study analyzed randomized controlled trials comparing the use of general anesthesia (GA) versus non-GA techniques, such as conscious sedation or local anesthesia for endovascular thrombectomy (EVT) in patients with ischemic stroke. The meta-analysis included seven trials with a total of 980 participants, showing that GA is associated with a 9% improvement in recanalization rates and an 8.4% improvement in functional recovery compared to non-GA techniques. There was no difference in hemorrhagic complications or 3-month mortality. The study recommends that GA be the first choice for most EVT procedures in acute ischemic stroke.
Article: General Anesthesia Compared to Non-GA in Endovascular Thrombectomy for Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials – Neurology (link to abstract – $ for full-text)
Review | Neurological complications of sepsis
20 Feb, 2023 | 12:16h | UTCSummary: This article covers the latest developments in the prevention, diagnosis, and treatment of sepsis-associated encephalopathy (SAE) and ICU-acquired weakness (ICUAW). SAE diagnosis is clinical with supporting EEG and neuroimaging. Treatment involves early identification and treatment of infections and organ dysfunction. ICUAW is due to an overlap between critical illness polyneuropathy, critical illness myopathy, and muscle disuse atrophy. It affects all limbs and respiratory muscles and is associated with prolonged hospital stay, increased costs, and both short and long-term mortality. Recovery is typical in weeks or months, but severe cases may result in persistent functional impairments for ICU survivors.
Article: Neurological complications of sepsis – Current Opinion in Critical Care
Acute pain management pearls: a focused review for the hospital clinician
17 Feb, 2023 | 12:42h | UTCAcute Pain Management Pearls: A Focused Review for the Hospital Clinician – Healthcare
Guideline | Diagnosis and management of subarachnoid hemorrhage caused by a ruptured aneurysm
16 Feb, 2023 | 15:23h | UTC
M-A | Radiofrequency therapies for trigeminal neuralgia
16 Feb, 2023 | 14:51h | UTC
M-A | Efficacy of endovascular therapy for basilar and vertebral artery occlusion
16 Feb, 2023 | 14:50h | UTCRelated:
M-A | Mechanical thrombectomy in acute basilar artery stroke.
Guideline Synopsis | The use of opioids in the management of chronic pain
15 Feb, 2023 | 16:16h | UTCSummary: The VA/DoD guideline for chronic pain management recommends non-opioid treatments, such as cognitive-behavioral and physical therapy, with opioid use reserved for specific circumstances. Mental health evaluations are emphasized, along with regular treatment reassessments. Opioid use is not recommended due to small benefits outweighed by risks, but if used, buprenorphine is suggested due to a lower risk profile. Screening for mood disorders and traumatic brain injury is also advised, although evidence for risk mitigation strategies is lacking.*
Commentary: Initiation of Opioids Not Recommended for Chronic Pain – HealthDay
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
SR | Predisposing and precipitating factors associated with delirium
15 Feb, 2023 | 15:38h | UTC
Review | Anisocoria in the ED: pathophysiology, evaluation, and management
14 Feb, 2023 | 10:41h | UTCAnisocoria in the ED: Pathophysiology, Evaluation, and Management – emDocs