JNS.jpgThe March issue of the Journal of the Neurological Sciences Vol 398 is now available online.


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Issue highlights

Cephalosporin neurotoxicity: An overlooked cause of toxic-metabolic encephalopathy

Consider the following case: A 75-year-old woman with a history of chronic renal failure is admitted to the hospital for shortness of breath. She is diagnosed with pneumonia and started on ceftriaxone. Three days later, she is disoriented, speaking "ragtime," and has intermittent myoclonus. The on-call neurologist is asked to evaluate the patient for the cause of her "altered mental status."

Cerebrovascular reactivity in subjects with migraine: Age paradox?

Migraine, and especially migraine with aura, is a recognized risk factor for stroke; however, the mechanisms underlying the association between migraine and stroke are unclear. Notably, previous studies found that the contribution of migraine to the risk of stroke is more significant in younger women compared with the older ones and in women with active migraine compared with those with past history of migraine, suggesting the presence of a migraine-specific factor increasing the risk of stroke.

Serum magnesium level and hematoma expansion in patients with intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is a devastating subtype of stroke that results in significant rates of mortality and morbidities. The initial hematoma volume, hematoma expansion (HE), blood pressure (BP), and coagulopathy are considered strong predictors of clinical outcomes and mortality. Low serum magnesium (Mg++) levels have been shown to be associated with larger initial hematoma and greater HE.

Coagulopathy, platelet dysfunction, high BP, and increased inflammatory response might form the mechanistic link between low serum Mg++ levels, larger hematoma size and greater HE. However, randomized clinical trials administering intravenous Mg++ have shown no benefit over placebo in ICH patients. The confounding effect of hypocalcemia and a delay in Mg++ trafficking across the blood-brain barrier might explain the futile results for intravenous Mg++ therapy.

In the current review, we will discuss the evidence regarding the possible role of low serum Mg++ level on HE in acute ICH.

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Intracerebral hemorrhage outcome: A comprehensive update

Non-traumatic intracerebral hemorrhage (ICH) is associated with a significant global burden of disease, and despite being proportionally less frequent than ischemic stroke, in 2010 it was associated with greater worldwide disability-adjusted life years lost.

The focus of outcome assessment after ICH has been mortality in most studies, because of the high early case fatality which reaches 40% in some population-based studies. The most robust and consistent predictors of early mortality include age, severity of neurological impairment, hemorrhage volume and antithrombotic therapy at the time of the event.

Long-term outcome assessment is multifaceted and includes not only mortality and functional outcome, but also patient self-assessment of the health-related quality of life, occurrence of cognitive impairment, psychiatric disorders, epileptic seizures, recurrent ICH and subsequent thromboembolic events. Several scores which predict mortality and functional outcome after ICH have been validated and are useful in the daily clinical practice, however they must be used in combination with the clinical judgment for individualized patients.

Management of patients with ICH both in the acute and chronic phases, requires health care professionals to have a comprehensive and updated perspective on outcome, which informs decisions that are needed to be taken together with the patient and next of kin.

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