Use of the drug aprotinin has been found to reduce the risk of stroke by 47% in patients undergoing coronary artery bypass graft surgery, according to a study in the Journal of Thoracic and Cardiovascular Surgery. Researchers evaluated data from 35 studies examining coronary artery bypass graft surgery and found that aprotinin reduced the need for blood transfusions—which have been associated with an increased risk of stroke—by 39%. In addition, they stated that the use of aprotinin could prevent 10 strokes in every 1,000 coronary artery bypass graft surgery patients.

Survivors of severe heart attacks may have difficulty with some learning tasks, according to a study in the October European Journal of Neuroscience. Researchers said that mice that underwent surgically induced heart attacks had more difficulty learning a new spatial task than did healthy mice. Before undergoing surgery, the mice navigated a water maze in search of a platform. After surgery, the mice navigated the same maze and had no problems locating the platform; however, when it was moved from its original position, the mice in the cardiac arrest group had difficulty learning the platform’s new location and swam an average of 2 m more than did the healthy mice. The researchers found that the mice in the cardiac arrest group had an 18% decrease in dendritic spine density in the hippocampus compared with the healthy mice. They suspect this decrease “may have had a direct effect on the performance of the cardiac arrest group.”

The American Academy of Neurology has developed a new guideline for the treatment of postherpetic neuralgia, according to an article in the September 28 Neurology. “This guideline will help direct patients and their physicians to the treatments that will bring the most effective relief to postherpetic neuralgia,” said Richard M. Dubinsky, MD, MPH, a coauthor of the guideline. Tricyclic antidepressants, gabapentin, the lidocaine patch, and opioids were found to be effective in reducing pain. However, acupuncture, morphine, laser treatments,vitamin E, benzydamine cream, dextromethorphan, epidural methylprednisolone, iontophoresis of vincristine, lorazepam, zimelidine, aspirin cream, and capsaicin were not beneficial in treating postherpetic neuralgia.

Estrogen has been found to boost CD4+CD25 cells, as well as the regulatory protein FoxP3, which are essential to fighting multiple sclerosis (MS) and other autoimmune diseases, according to a study in the Journal of Immunology. Researchers found that CD4+CD25+ cells protected mice against autoimmune encephalomyelitis, a model for human MS. They also found that the effects of estrogen on CD4+CD25+ cells actually simulate the effects of estrogen during pregnancy, supporting the long-held belief that pregnancy is the best treatment for MS. The researchers said that understanding how estrogen boosts CD4+CD25+ cells to fight MS may lead to the development of “estrogen-like” drugs that could increase the amount of cells without the negative side effects of estrogen.

Patients who experience medical or neurological complications, such as pneumonia or brain swelling, following a stroke are at a greater risk of dying in the hospital, according to research in the September 13 Archives of Internal Medicine. Investigators studied data from 13,440 ischemic stroke patients to determine factors that predict risk of death after stroke. Of the 13,440 patients, 4.9% died in the hospital. The investigators found that pneumonia caused the most deaths (31.2%) among the stroke patients. They found that among women, older age, severity of stroke, and atrial fibrillation were independent predictors for dying in the hospital. Among men, previous stroke, in addition to the factors identified for women, had a significant negative influence on stroke outcomes.

Autistic boys with language impairment have Broca’s area asymmetry similar to that of non-autistic boys who suffer from specific language impairment (SLI), according to a study in the October 11 Annals of Neurology. Researchers compared the MRI results of autistic boys with and without language impairment, boys with SLI, and normally developing boys. They found that in both boys with SLI and autistic boys with language impairment, Broca’s area asymmetry between the right and left hemispheres was reversed, whereas autistic boys without language impairment and normally developing boys had typical asymmetry. The researchers said, “If we can subdivide individuals based on some objective measures—for example, neurocognitive, genetic, or neuroimaging tests—then we may be able to more selectively and effectively treat people with debilitating neurodevelopmental disorders like autism or SLI.”

Higher homocysteine levels may be associated with changes in deep brain tissue in middle-aged men, according to an article in the September Archives of Neurology. After comparing blood samples, MRI results, and cognitive test results among 196 men and 189 women between the ages of 60 and 64, researchers found that homocysteine levels in men were related to changes in deep white matter hyperintensities in the brain. They said, “Total homocysteine level is independently related to leukoaraiosis [deep white matter hyperintensities] in middle-aged men, and this may be functionally relevant in the form of mild cognitive impairment.” Contrary to previous studies, no relationship was found between homocysteine levels and brain atrophy. The researchers suspect this may be due to the fact that the current study involved younger subjects than those in previous studies, indicating that the effect of homocysteine levels on the brain may not manifest until age 70 or later.

Initial treatment of giant cell arteritis using high doses of intravenous methylprednisolone was effective in controlling the disease and shortening the length of treatment, according to findings from a randomized, double-blind, placebo-controlled study presented at the American College of Rheumatology Annual Scientific Meeting. Treatment with intravenous methylprednisolone allowed a more rapid reduction in dosage of prednisone and helped delay recurrence of symptoms. Twenty-seven patients with giant cell arteritis participated in the study; all received oral prednisone. Fourteen of these patients received intravenous methylprednisolone, and 13 received placebo. Researchers said that during the first 34 weeks of the study, 10 of the 14 patients who received intravenous methylprednisolone were able to reduce their doses of prednisone to 5 mg or less per day, compared with two of the 13 patients in the placebo group.

In vivo administration of a recombinant adeno-associated virus (rAAV) type 2 vector into the liver reverses the progression of lysosomal storage in the brain, according to an article in the September Molecular Therapy. Researchers conducted two studies involving rats with mucopolysaccharidosis type VII (Sly syndrome) to test the effect of the rAAV vector and to analyze time to improvement. They said that after a single dose of rAAV vector, there was “a reduction of lysosomal storage in every organ analyzed at two months postinjection.” The investigators also commented, “In the long term, we have the potential to apply this type of therapy to a majority of the lysosomal storage disorders and even other disorders.”

MRI may be an alternative to CT in detecting bleeding in the brain in patients showing signs of stroke, according to the October 20 JAMA. Researchers examined 200 patients in order to compare the accuracy of MRI versus CT scans in detecting acute bleeding in the brain. MRI and CT scans were performed within six hours of the onset of stroke symptoms. The researchers ended their study when they discovered that MRI was detecting bleeding that was not shown on CT. They found that in diagnosing any type of bleeding, MRI identified 71 positive patients, while CT identified only 29 positive patients. In addition, MRI, but not CT, detected chronic bleeding in 49 patients.

People with left temporal lobe epilepsy are more likely to have learning disabilities, according to a study in the August Epilepsia. Patients with either left temporal lobe epilepsy or right temporal lobe epilepsy were evaluated using tests that assessed reading comprehension, written language, and calculation. Results indicated that 75% of patients with left temporal lobe epilepsy had one or more learning disabilities, compared with only 10% of patients with right temporal lobe epilepsy. In addition, those with left temporal lobe epilepsy were more likely to have academic problems, such as a history of special education, repeating a grade, or disrupted educational progress.

A one-year follow-up study revealed that epilepsy patients who underwent selective amygdalohippocampectomy had a significant decline in verbal memory, according to the August Epilepsia. A total of 115 patients were included in the study. At the three-month follow-up, verbal memory loss was seen in patients who had the surgery performed on either the left or the right temporal lobe. Researchers initially attributed the memory loss to a possible temporary effect of the surgery. However, at the 12-month follow-up, 30% to 50% of patients who had had surgery on the left temporal lobe did not show signs of improvement in verbal memory, while patients who had had surgery on the right temporal lobe did show improvement. The researchers said that it is unclear to what extent selective amygdalohippocampectomy “can lead to significant declines in memory functions, which memory functions are at risk of becoming impaired, and which determinants of outcome can be discerned.”

A ketogenic diet can be successfully implemented on an outpatient basis in children, suggested a recent study in the September Pediatric Neurology. Investigators reviewed the medical records of 37 patients who underwent a ketogenic diet on an outpatient basis and 17 patients who underwent the diet on an inpatient basis. No differences were found in long-term seizure control or mental improvement between the two groups. However, the investigators found that the benefits of outpatient treatment included improved acceptability and ability to maintain and comply with the diet. The investigators added that additional benefits included fewer days of lost work for parents while the diet was initiated and more comfort for the child.

NR