Neurology News

Nicotine treatment of mild cognitive impairment
The authos of this article sought to assess the safety and efficacy of transdermal nicotine therapy on cognitive performance and clinical status in subjects with mild cognitive impairment (MCI). This study demonstrated that transdermal nicotine can be safely administered to nonsmoking subjects with MCI over 6 months with improvement in primary and secondary cognitive measures of attention, memory, and mental processing, but not in ratings of clinician-rated global impression. This authors conclude that this initial study provides evidence for nicotine-induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies.

Stroke Mimics and Intravenous Thrombolysis
The necessity for rapid administration of intravenous thrombolysis in patients with acute ischemic stroke may lead to treatment of patients with conditions mimicking stroke. This article analyzed stroke patients treated with intravenous thrombolysis in our center to characterize cases classified as stroke mimics. It was found that Stroke mimics were infrequent among intravenous thrombolysis–treated stroke patients in this cohort, and their treatment did not lead to harmful complications.

Comparative efficacy of combination drug therapy in refractory epilepsy
The authors of study retrospectively examined treatment records of developmentally disabled adults with highly refractory epilepsy to determine whether any combinations of 8 of the most commonly used antiepileptic drugs (AEDs) possessed superior efficacy. Out of the 32 most frequently used AED combinations, we found that only the combination of lamotrigine and valproate had superior efficacy, measured against both an aggregate measure of other AED regimens to which patients were exposed, and in head-to-head comparisons with other AED combinations. We also found that while use of 2 concurrent AEDs provided improved efficacy over monotherapy, use of 3 AEDs at a time provided no further benefit over two.

Depression and Risk of Stroke
A history of depression may be associated with an increased risk of stroke. This article was aimed to determine the association between depression and risk of stroke by performing a meta-analysis of prospective studies. Overall this random-effects meta-analysis of 17 prospective studies involving 206 641 participants and 6086 cases demonstrated a significant positive association between depression and subsequent risk of stroke 

Thromboysis in acute stroke shows good outcomes in prior patients with prior stroke and diabetes
Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. This article examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy. It found that Outcomes from thrombolysis are better than the controls among patients with DM, PS, or both.The authors find no statistical justification for the exclusion of these patients from receiving thrombolytic therapy.

Intrathecal daclizumab shows good signs in treatment of multiple sclerosis
It has been previously reported that daclizumab, a humanized monoclonal antibody against CD25, reduced contrast-enhancing lesions (CEL) in patients with multiple sclerosis (MS) who were suboptimal responders to interferon-β and that this response correlated with expansion of CD56bright NK cells. These data have been reproduced in a placebo-controlled multicenter trial (CHOICE study). The current study investigates whether daclizumab monotherapy reduces CEL in untreated patients with relapsing-remitting MS (RRMS) and the effects of daclizumab on the intrathecal immune system. This article found that daclizumab monotherapy inhibits formation of MS plaques in patients with RRMS and immunoregulatory NK cells may suppress activation of pathogenic immune responses directly in the CNS compartment.

Long-Term Epilepsy Meds Take Toll on Arteries
The duration of anti-epileptic monotherapy was associated with accelerated atherosclerosis, although individual drugs had different underlying mechanisms in epilepsy patients, according to a single-center study. "The duration of monotherapy with the older generation of anti-epileptic drugs (AEDs) ... is at least one of the important and contributing risk factors to the atherosclerotic process," wrote Teng-Yeow Tan, MD, from Kaohsiung Chang Gung Memorial Hospital in Kaoshiung, Taiwan, and colleagues in Epilepsia.

Is salt intake an independent risk factor of stroke mortality? 
We reported a remarkable regional difference within Japan in the incidence of end-stage renal disease. Regional differences were also well-known for salt intake, blood pressure (BP), and mortality from stroke, which remains one of the leading causes of death. Noting these regional differences, we examined mutual relationships among salt intake, BP, and stroke mortality in 12 regions of Japan. This article found that multiple regression analysis further identified salt intake as an independent factor to increase stroke mortality, but mean arterial BP was not a determinant. Compared with the four regions with lowest salt intake, odds ratios of stroke mortality adjusted by mean arterial BP were 1.04 for the intermediate four regions and 1.25 for the four regions with highest salt intake. These findings suggest that salt intake may have an adverse effect on stroke mortality independently of BP.

Symptoms and Signs of Posterior Circulation Ischemia in the New England Medical Center Posterior Circulation Registry
The authors of this study sought to evaluate the frequencies of symptoms and signs in patients with posterior circulation ischemia in a large case series of prospectively collected patients. Consecutive sample of 407 adult patients who had stroke and/or transient ischemic attacks in the posterior circulation within 6 months of study inclusion. All patients were examined by senior stroke neurologists. All patients had either computed tomography or magnetic resonance imaging of the brain as well as vascular imaging of the head and neck. The most frequent posterior circulation symptoms were dizziness (47%), unilateral limb weakness (41%), dysarthria (31%), headache (28%), and nausea or vomiting (27%). The most frequent signs were unilateral limb weakness (38%), gait ataxia (31%), unilateral limb ataxia (30%), dysarthria (28%), and nystagmus (24%). Logistic regression analysis reveals that the clinical features dysphagia, nausea or vomiting, dizziness, and Horner syndrome were positively correlated with the proximal vascular territory. Unilateral limb weakness and cranial nerve VII deficits were positively correlated with the middle territory. Limb sensory deficit, lethargy, and visual field loss were positively correlated with the distal territory.

Differences in Brain Natriuretic Peptide Value between Transient Ischemic Attack and Stroke Patients with Afib
The present study investigated clinical characteristics including plasma brain natriuretic peptide (BNP) among transient ischemic attack (TIA) and stroke patients with atrial fibrillation (AF). The plasma BNP level of the TIA group was significantly lower than that of the stroke group. The optimal cutoff level, sensitivity, and specificity of BNP levels to distinguish the TIA group from the stroke group were 120 pg/ml, 79.1 and 66.7%, respectively. Multivariate logistic regression analysis demonstrated that pre-admission warfarin use, glucose of ≤120 mg/dl and a plasma BNP of ≤120 pg/ml were independently associated with TIA. Overall this study found that in AF patients, the BNP value on admission is lower in those with TIA than in those with stroke. Thus, cardiac function may be associated with neurological severity at the onset of TIA and stroke.

No Help with high-dose vitamin D2 in relapsing-remitting multiple sclerosis
Higher latitude, lower ultraviolet exposure, and lower serum 25-hydroxyvitamin D (25OHD) correlate with higher multiple sclerosis (MS) prevalence, relapse rate, and mortality. This article evaluated the effects of high-dose vitamin D2 (D2) in MS.Adults with clinically active relapsing-remitting MS (RRMS) were randomized to 6 months' double-blind placebo-controlled high-dose vitamin D2, 6,000 IU capsules, dose adjusted empirically aiming for a serum 25OHD 130–175 nM. All received daily low-dose (1,000 IU) D2 to prevent deficiency. No significant treatment differences were detected in the primary MRI endpoints. There were 4 relapses with high-dose D2 vs none with low-dose D2.  The authors did not find a therapeutic advantage in RRMS for high-dose D2 over low-dose D2 supplementation.

Continuous Epileptiform Discharges in Patients Treated With Cefepime or Meropenem
This article sought to test the hypothesis that treatment with cefepime hydrochloride leads to higher incidence of periodic epileptiform discharges compared with treatment with other β-lactams. Overall this study showed a prevalence of electroencephalographic test results with continuous epileptiform discharges in 14 of 1120 patients receiving cefepime (1.25%) but only 3 of 1572 patients receiving meropenem (0.19%). Contrary to the results of previous case series, these electroencephalographic patterns occurred, in most cases, in patients with normal renal function. These results suggest that cefepime may be an independent risk factor for periodic epileptiform discharges, which are associated with worse outcomes. This finding could provide a partial explanation for the higher mortality rates reported in patients treated with cefepime compared with other β-lactams.

DWI-FLAIR mismatch may identify patients with acute ischaemic stroke within 4·5 h of symptom onset 
Many patients with stroke are precluded from thrombolysis treatment because the time from onset of their symptoms is unknown. We aimed to test whether a mismatch in visibility of an acute ischaemic lesion between diffusion-weighted MRI (DWI) and fluid-attenuated inversion recovery (FLAIR) MRI (DWI-FLAIR mismatch) can be used to detect patients within the recommended time window for thrombolysis. In this multicentre observational study, we analysed clinical and MRI data from patients presenting between Jan 1, 2001, and May 31, 2009, with acute stroke for whom DWI and FLAIR were done within 12 h of observed symptom onset. This article found that Patients with an acute ischaemic lesion detected with DWI but not with FLAIR imaging are likely to be within a time window for which thrombolysis is safe and effective. These findings lend support to the use of DWI-FLAIR mismatch for selection of patients in a future randomised trial of thrombolysis in patients with unknown time of symptom onset.

Randomized Trial of Oral Teriflunomide for Relapsing Multiple Sclerosis
Teriflunomide is a new oral disease-modifying therapy for relapsing forms of multiple sclerosis. This was a randomized trial involving 1088 patients with multiple sclerosis, 18 to 55 years of age, with a score of 0 to 5.5 on the Expanded Disability Status Scale and at least one relapse in the previous year or at least two relapses in the previous 2 years.  Teriflunomide reduced the annualized relapse rate with relative risk reductions of 31.2%, reduced relapse rates, disability progression (at the higher dose), and MRI evidence of disease activity, as compared with placebo.

Incidence of Transient Ischemic Attack and Early Stroke Risk: Validation of the ABCD2 Score in an Italian Population-Based Study
The importance of transient ischemic attack (TIA) lies on the short-term risk of stroke, and the ABCD2 score may improve early stroke risk prediction. However, population-based studies are still needed. We aimed to provide data on TIA incidence and to evaluate the ABCD2 predictive ability for early recurrent stroke in a population-based study. ABCD2 score was strongly associated with stroke occurrence after index TIA: the areas under the receiver operating characteristic curve at 2, 7, 30, and 90 days were, respectively, 0.85 , 0.69, 0.69, and 0.76. No patients with an ABCD2 score <4 had a stroke within the 90-day follow up period. This study adds new data on TIA incidence and prognosis and it further validates the ability of the ABCD2 score to identify patients at early risk for stroke.

Patients With Traumatic Brain Injury and the Risk of Stroke
Previous studies have identified an array of morbidities following traumatic brain injury (TBI), including certain neurological disorders. However, no direct evidence has been reported on the link between TBI and stroke. This population-based study was designed to estimate the risk of stroke during a period of 5 years following a TBI, compared with individuals who did not suffer TBI during the same period. During the 3-month follow-up period, 675 strokes (2.91%) occurred in TBI patients and in 207 patients (0.30%) in the non-TBI comparison cohort. A diagnosis of TBI was independently associated with a 10.21 (95% CI, 8.71–11.96), 4.61 (95% CI, 4.16–5.11), and 2.32 (95% CI, 2.17–2.47) times greater risk of stroke during 3-month, 1-year, and 5-year follow-up, respectively. This is the first report showing an increased risk of stroke among individuals who have sustained a TBI. We suggest a need for more intensive medical monitoring and health education following TBI, especially during the first few months and years.

Chronic divalproex sodium use and brain atrophy in Alzheimer disease
The authors evaluated the effect of the divalproex sodium formulation of valproic acid on brain volumes using MRI in people with mild to moderate Alzheimer disease (AD) and assessed for changes associated with behavioral and cognitive effects. It was found that Divalproex treatment was associated with accelerated brain volume loss over 1 year and perhaps with greater cognitive impairment. The long-term clinical effects of these changes are not known.

Early neurological outcomes according to CHADS2 score in stroke patients with non-valvular atrial fibrillation
A higher CHADS2 score or CHA2DS2-VASc score is associated with an increased risk of ischaemic stroke in patients with non-valvular atrial fibrillation (NVAF). However, there are no data regarding early neurological outcomes after stroke according to the risk levels.  In this study, a total of 649 stroke patients with NVAF were enrolled and categorized into three groups: low-risk (CHADS2 score of 0–1), moderate-risk (CHADS2 score 2–3), or high-risk group (CHADS2 score ≥4). The initial National Institutes of Health Stroke Scale (NIHSS) score was highest in high-risk group. During hospitalization, those in the high-risk group or higher CHA2DS2-VASc score had less improvement in their NIHSS score. Furthermore, early neurological deterioration (END) developed more frequently as CHADS2 score or CHA2DS2-VASc score increased. This data indicates that patients with NVAF and higher CHADS2 score or CHA2DS2-VASc score are more likely to develop severe stroke and a worse clinical course is expected in these patients after stroke presentation.

Continuous monitoring versus HOLTER ECG for detection of atrial fibrillation in patients with stroke
Detection of atrial fibrillation is of vital importance because oral anticoagulation decreases the risk of a stroke by 64%. Current standards for stroke unit treatment require continuous electrocardiogram (ECG) monitoring for at least 24 h. Additionally, a 24-h HOLTER ECG (HOLTER) should be performed in selected patients. It remains unclear whether continuous monitoring at the bedside is equivalent to HOLTER for the detection of atrial fibrillation. Furthermore, we investigate how many additional patients with paroxysmal atrial fibrillation can be identified as a result of a longer duration of continuous monitoring. In this study, use of HOLTER does not give any additional benefit in comparison with continuous monitoring with intermittent analysis by trained staff alone. The median detection time of 43 h emphasizes the importance of longer continuous monitoring.

A randomized, pilot trial of etanercept in dermatomyositis
The aims of this pilot study were to assess (1) the safety and tolerability of etanercept in dermatomyositis (DM); (2) the feasibility and safety of a forced prednisone taper; and (3) outcome measures, including those recommended by the International Myositis Assessment Clinical Study (IMACS) group. This was  a randomized, double-blind, placebo-controlled trial of etanercept (50mg subcutaneously weekly) for 52 weeks in DM subjects. Subjects were tapered off prednisone in a standardized schedule as tolerated over the initial 24 weeks of the study. Principal outcomes included adverse events, time from randomization to treatment failure (inability to wean off prednisone on schedule), and average prednisone dosage after week 24. There were no significant differences in adverse event rates between the treatment groups, although 5 etanercept-treated and 1 placebo-treated subjects developed worsening rash. All 5 subjects receiving placebo were treatment failures. In contrast, 5 of 11 subjects in the etanercept arm were successfully weaned off prednisone; the median time to treatment failure in this group was 358 days. The median of the average prednisone dosage after week 24 was 29.2mg/day in the placebo group and 1.2mg/day in the etanercept group. The findings of no major safety concerns and a steroid-sparing effect in our study suggest that further investigation of etanercept as a treatment for DM is warranted.

Dihydropyridine calcium channel blockers and the progression of parkinsonism
The purpose of this article was to test the association between dihydropyridine calcium channel blocker use and the time to important milestones of disease progression among patients with parkinsonism. Data were obtained from Ontario's health care administrative databases. Within a cohort of hypertensive individuals over the age of 65 who developed parkinsonism, the authors examined the effect of the length of exposure to less brain penetrant dihydropyridines (amlodipine) and more brain penetrant dihydropyridines (e.g. nifedipine, felodipine) on parkinsonism milestones as measured by time to requiring drug treatment for parkinsonism, nursing home admission and death. Overall they found no specific beneficial effect of treatment with brain penetrant dihydropyridines on delaying parkinsonism progression milestones. Dihydropyridine calcium channel blockers are unlikely to have a clinically significant effect on the course of parkinsonism, particularly Parkinson's disease, in the doses used to treat hypertension.

Body Mass Index and Etiology of Intracerebral Hemorrhage
Extremes of body mass index (BMI) are associated with increased incidence of intracerebral hemorrhage (ICH). Because ICH can result from different vessel pathologies, we investigated whether the effect of BMI depends on ICH etiology. The authors analyzed 384 consecutive ICH cases (188 lobar ICH and 196 deep ICH) and 388 control subjects enrolled between 2004 and 2009 in an ongoing single-center prospective study of primary ICH. ICH was categorized as lobar or deep based on CT imaging at admission. Overall it was shown that the extremes of BMI are associated with increased risk of deep ICH, but not lobar ICH, suggesting a role for BMI in the vascular pathologies underlying deep ICH, but not in pathologies such as cerebral amyloid angiopathy that cause ICH in the lobar brain regions.

IV thrombolysis and statins
The purpose of this article was to examine whether prior statin use affects outcome and intracranial hemorrhage (ICH) rates in stroke patients receiving IV thrombolysis (IVT) using a pooled observational study of 11 IVT databases, we compared outcomes between statin users and nonusers. It was shown that in stroke patients receiving IVT, prior statin use was neither an independent predictor of functional outcome nor ICH. It may be considered as an indicator of baseline characteristics that are associated with a less favorable course.

Dementia Differs in the Oldest Old
The oldest patients with Alzheimer's disease appear to have less profound changes in cognitive function and in cortical structure than patients who develop the disease at a younger age, a retrospective case-control study found. For instance, on the cognitive domain of executive function, Alzheimer's patients younger than 75 had worse standard scores, in relation to age-matched controls, than did those who were older than 80. Moreover, the younger cohort showed more thinning in the posterior cingulate cortex on MRI relative to controls than the older group (t103 = −2.94, P=0.004, Cohen d = 0.60), the researchers reported in the August 23 issue of Neurology.

Thrombolytic Treatment of Patients With Acute Ischemic Stroke Related to Underlying Arterial Dissection 
This article sought to determine the outcomes related to thrombolytic treatment of an acute ischemic stroke secondary to an arterial dissection in a large national cohort through determining the frequency of underlying arterial dissection among patients with acute ischemic stroke treated with thrombolytic treatment and associated in-hospital outcomes. Of the 47 899 patients with ischemic stroke who received thrombolytic treatment, 488 (1%) had an underlying dissection. The intracranial hemorrhage rates did not differ between patients with ischemic stroke with or without underlying dissection who received thrombolytic treatment but was associated with higher rates of moderate disability.

Simvastatin Doesn't help in treatment of Alzheimer disease
Lowering cholesterol is associated with reduced CNS amyloid deposition and increased dietary cholesterol increases amyloid accumulation in animal studies. Epidemiologic data suggest that use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) may decrease the risk of Alzheimer disease (AD) and a single-site trial suggested possible benefit in cognition with statin treatment in AD, supporting the hypothesis that statin therapy is useful in the treatment of AD. This article sought to determine if the lipid-lowering agent simvastatin slows the progression of symptoms in AD. A total of 406 individuals were randomized: 204 to simvastatin and 202 to placebo. Simvastatin lowered lipid levels but had no effect on change in ADAS-Cog score or the secondary outcome measures. There was no evidence of increased adverse events with simvastatin treatment.

Plasma tissue kallikrein level is negatively associated with incident and recurrent stroke
Tissue kallikrein (TK) cleaves kininogen to produce the potent bioactive compounds kinin and bradykinin, which lower blood pressure and protect the heart, kidneys, and blood vessels. Reduction in TK levels is associated with cardiovascular disease and diabetes in animal models. In this study, the authors investigated the association of TK levels with event-free survival over 5 years in Chinese first-ever stroke patients and found that lower plasma TK levels are independently associated with first-ever stroke and are an independent predictor of recurrence after an initial stroke

Randomized, blinded trial of weekend vs daily prednisone in Duchenne muscular dystrophy
The authors of this article performed a double-blind, randomized study comparing efficacy and safety of daily and weekend prednisone in boys with Duchenne muscular dystrophy (DMD). A total of 64 boys with DMD who were between 4 and 10 years of age were randomized at 1 of 12 centers of the Cooperative International Neuromuscular Research Group. Efficacy and safety of 2 prednisone schedules (daily 0.75 mg/kg/day and weekend 10 mg/kg/wk) were evaluated over 12 months. It was found that Weekend dosing of prednisone is equally beneficial to the standard daily dosing of prednisone. Analysis of side effect profiles demonstrated overall tolerability of both dosing regimens.

Statins after ischemic stroke of undetermined etiology in young adults
The authors investigated whether the use of statins and their effect on the risk for subsequent vascular events in young adults with ischemic stroke of undetermined etiology. In a Cox proportional hazards analysis adjusted for age, sex, dyslipidemia, hypertension, antihypertensive medication, stroke year, and propensity score, patients on a statin at any time during follow-up were less likely to experience outcome events.

Therapeutic INR confers long-term survival benefit after stroke
Patients with atrial fibrillation (AF) have better long-term outcomes after an ischemic stroke if they are on therapeutic oral anticoagulation at the time of the event, research suggests. The beneficial effect of having a therapeutic international normalized ratio (INR) at stroke onset was apparent even on inclusion of patients with hemorrhagic stroke. At 2 years after stroke, 92.3% of ischemic stroke patients with a therapeutic INR were still alive, compared with 15.4% of those with an INR lower than 2.0. Survival rates were 47.1% among patients on antiplatelet therapy and 55.3% among those not taking antithrombotic therapy.

Vascular risk factors spark rise in pregnancy-related stroke
US researchers have identified a large increase in the proportion of pregnant women who are hospitalized with stroke. The team compared US Nationwide Inpatient Sample data for two periods: 1994-1995 and 2006-2007. The rate of any type of stroke in pregnant women rose between these two periods, from 0.15 to 0.22 per 1000 deliveries, or a 47% increase. The increase was even larger among women in the postpartum period, from 0.12 to 0.22 per 1000 deliveries, or an 83% increase. These findings suggest several research directions, say Kuklina et al, including assessing the prevalence of pregnant women who require anticoagulant therapy, and gauging whether such women are managed according to current guidelines.

Age-Related Macular Degeneration and the Risk of Stroke
Age-related macular degeneration (AMD) and stroke are both frequent diseases in the elderly. A link between AMD and stroke has been suggested, because both disorders have many risk factors in common. The aim of this study was to investigate the association between AMD and stroke and the subtypes cerebral infarction and intracerebral hemorrhage in the general elderly population. This study was part of the population-based Rotterdam Study and included 6207 participants aged ≥55 years who were stroke-free at baseline (1990 to 1993). During a median follow-up of 13.6 years, 726 participants developed a stroke (397 cerebral infarction, 59 intracerebral hemorrhage, 270 unspecified). Late AMD was associated with an increased risk of any stroke due to a strong association with intracerebral hemorrhage. In contrast, late AMD was not associated with cerebral infarction. Earlier AMD stages were not associated with risk of stroke or any of its subtypes.After data analysis it was found that late AMD is strongly associated with intracerebral hemorrhage, but not with cerebral infarction, in the general elderly population.

Are narrow blood vessels to blame in MS
Despite a few well-publicized studies and many hopeful patients waiting for treatment, there is no good evidence that multiple sclerosis, or MS, is caused by a blood vessel condition, a fresh look at the medical literature finds.

Long-term outcome in posterior cerebral artery stroke
Previous studies on posterior cerebral artery (PCA) strokes focused mainly on topography and underlying pathophysiology. However, there are no data on long-term prognosis and its association with the localization of the infarct. All consecutive PCA strokes registered in the Athens Stroke Outcome Project between 01/1998 and 12/2009 were included in the analysis. The New England Posterior Circulation Registry criteria were applied to classify them in relation to topography: (i) pure PCA infarcts, including pure cortical-only and combined cortical/deep PCA infarcts (groups A and B respectively), and (ii) PCA-plus strokes, including cortical-only and combined cortical/deep PCA strokes with ≥1 concomitant infarcts outside PCA territory (groups C and D respectively). Patients were prospectively followed up to 10 years after stroke. This aritlc found that patients with pure PCA stroke have significantly lower risk of disability and long-term mortality compared to PCA strokes with coincident infarction outside the PCA territory.

Serum Insulinlike Growth Factor 1 as Possible Marker for Risk and Early Diagnosis of Parkinson Disease
The level of serum insulinlike growth factor 1 (IGF-1) is increased in idiopathic Parkinson disease (PD). This article assessed whether the (1) IGF-1 level is increased in patients with PD at the time of diagnosis, (2) increased IGF-1 level is related to impaired motor function in healthy individuals, and (3) detection of increased IGF-1 level will help to identify persons at risk for PD. The IGF-1 level was higher in patients with PD compared with healthy participants (P = .004) and inversely correlated with the UPDRS-III score.. The IGF-1 level was not related to motor function in the healthy group. However, there was no significant difference between the IGF-1 level in the at-risk subgroup vs the PD patients, and the IGF-1 level was positively correlated with the UPDRS-III score. This article shows that Serum IGF-1 monitoring may be valuable in the diagnosis of PD and for the identification of individuals with a putatively increased risk for PD.

Neonatal and delivery outcomes in women with multiple sclerosis
This article sought to determine (1) whether the risk of adverse neonatal and delivery outcomes differs between mothers with and without multiple sclerosis (MS) and (2) whether risk is differentially associated with clinical factors of MS. It was found that babies born to MS mothers did not have a significantly different mean gestational age or birth weight compared to babies born to mothers without MS. MS was not significantly associated with assisted vaginal delivery or Caesarean section. There was a slightly elevated risk of adverse delivery outcomes among MS mothers with greater levels of disability, although findings were not statistically significant. Disease duration and age at MS onset were not significantly associated with adverse outcomes. This study provides reassurance to MS patients that maternal MS is generally not associated with adverse neonatal and delivery outcomes. However, the suggestion of an increased risk with greater disability warrants further investigation; these women may require closer monitoring during pregnancy.

Hemorrhagic complications after systemic thrombolysis in acute stroke patients with abnormal baseline coagulation
As patients with abnormal baseline coagulation were excluded from the large randomized trials, the safety of intravenous thrombolysis after ischaemic stroke in this patient population remains controversial. The authors assessed the risk of symptomatic intracerebral hemorrhage (SICH) after systemic thrombolysis in patients with elevated baseline international normalized ratios (INRs) (≥1.3) or activated partial thromboplastin times (aPTT) (>37 s) using a prospectively recorded database from 2006 to 2010. An intracerebral hemorrhage leading to a deterioration of ≥4 points on the National Institutes of Health Stroke scale (NIHSS) was classified as symptomatic.  It was found that the risk of SICH following intravenous thrombolysis after ischaemic stroke does not appear to be increased in patients with abnormal baseline coagulation.

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