Basilar artery diameter may have an independent correlation with cerebrovascular mortality, as reported in the September Stroke. From a cohort of 466 consecutive patients with brain infarction, researchers reported 157 deaths, including 88 vascular deaths (54 patients died from stroke). An increased five-year stroke mortality was associated with basilar artery diameter, while all-cause or nonstroke vascular mortality was not. Basilar artery diameter and the height of bifurcation, but not transverse position, were associated with a higher risk of stroke mortality. The researchers noted that a diameter greater than 4.3 mm might be a marker for a high stroke mortality risk.

The potential of tandem internal carotid artery (ICA)/middle cerebral artery (MCA) occlusion to independently predict poor outcome after thrombolysis depends on the location of the clot in the MCA, according to an article in the September Stroke. Among 221 consecutive stroke patients with an acute MCA occlusion treated with IV t-PA, transcranial Doppler revealed 156 patients with a proximal MCA occlusion, 65 with a distal MCA occlusion, and 44 with tandem ICA/MCA occlusion. In patients with proximal, but not distal MCA occlusion, tandem ICA/MCA occlusion independently predicted resistance to thrombolysis, and both short- and long-term clinical outcome was worse in patients with tandem ICA/MCA occlusion than in patients with only MCA occlusion. The researchers concluded that "emergent carotid ultrasound plus transcranial Doppler examinations may improve the selection of patients for more aggressive reperfusion strategies."

In the September Cephalalgia, researchers reported a new migraine syndrome. Two adults were diagnosed with stroke-like migraine attacks after radiation therapy, or SMART syndrome, "which occurs as a delayed consequence of cerebral irradiation and consists of prolonged, unilateral, migrainous neurologic symptoms with transient, dramatic cortical gadolinium enhancement of the affected cerebral hemisphere and is sometimes punctuated by generalized seizures and ipsilateral EEG slowing," the researchers stated. While full recovery can occur in SMART syndrome, neurologic symptoms could last up to four weeks, the researchers noted. They concluded, "An appropriate evaluation should exclude alternative explanations."

While low blood pressure may be associated with a "favorable risk" of recurrent stroke, high and low poststroke blood pressure levels may correlate with greater mortality, researchers reported in the September Journal of the American Geriatrics Society. They examined 254 adults 65 and older who had a nonfatal first ischemic stroke. At a mean of 261.6 days poststroke, higher blood pressure levels were associated with a higher risk of stroke recurrence during a mean follow-up of 5.4 years. Mortality was significantly greater in patients with low or high poststroke blood pressure than in those with intermediate blood pressure. "Long-term antihypertensive trials in older stroke survivors would increase knowledge about the benefits of lowering blood pressure in this population," the investigators concluded.

Autism could be caused by platelet and vascular endothelium activation, according to a report in the August Archives of Neurology. After assessing children with autism and healthy controls, researchers found significantly higher urinary levels of markers for lipid peroxidation (isoprostane F2a-VI), platelet activation (2,3-dinor-thromboxane B2), and endothelium activation (6-keto-prostaglandin F1a) in the autism group compared with the control group. Both vascular biomarker ratios were directly correlated with lipid peroxidation levels, the researchers noted.

Children with autism spectrum disorder who have prolonged T2 in gray matter, but not white matter, may display abnormal developmental processes specific to autism, according to a report in the August 22 Neurology. Sixty children ages 2 to 4 with autism spectrum disorder, 16 children with idiopathic developmental delay, and 10 children with typical development were included for study. Compared with cortical gray matter T2 in children with typical development, gray matter T2 was prolonged in children with autism, while white matter T2 was not significantly different between the two groups. Compared with gray and white matter T2 in children having either autism or typical development, T2 was prolonged in children with developmental delay.

High rates of treatment adherence, lowering of LDL cholesterol levels, and higher rates of achieving national cholesterol guidelines may be associated with statin initiation during ischemic cerebrovascular event hospitalization, according to findings in the August Archives of Neurology. Ninety-two patients with ischemic stroke or transient ischemic attack who were not receiving a statin before hospital admission but had an indication for statin therapy were included in the study. After hospital initiation of statin therapy, there was 93% adherence, mean LDL levels dropped from 120 to 78 mg/dL, and the proportion of patients with LDL levels lower than 100 mg/dL increased from 36% to 88% at three months.

The safety of low-dose argatroban combined with IV t-PA "may be within acceptable limits," researchers reported in the August Archives of Neurology. Fifteen patients who had middle cerebral artery occlusions were studied. The mean time from symptom onset to argatroban bolus administration was 172 minutes; symptomatic intracerebral hemorrhage occurred in two patients, one of whom had parenchymal hemorrhage type 2. One death occurred, and another patient showed asymptomatic bleeding. Six patients had complete recanalization, while another four had partial recanalization. Within two hours of t-PA bolus administration, reocclusion occurred in three patients. Low-dose argatroban combined with IV t-PA’s "efficacy for producing fast and complete recanalization is promising, but a larger cohort of patients is required to confirm these preliminary observations."

A global disease process that may affect large parts of normal-appearing white and gray matter in multiple sclerosis (MS) could be worse for secondary progressive MS than for relapsing-remitting MS, according to a report in the September Radiology. Whole-brain T1 maps for 67 patients with MS and 24 healthy controls were examined. In secondary progressive MS patients, peak positions in the T1 histograms of normal-appearing white matter were significantly higher, broader, and lower than in controls. Histogram peak positions were significantly higher in patients with secondary progressive MS than in those with relapsing-remitting and primary progressive MS. At least 31% of normal-appearing white matter and 20% of normal-appearing cortical gray matter were affected in secondary progressive MS.

Drinking fruit and vegetable juices may delay Alzheimer’s disease onset, especially among patients who are at high risk for the disease, reported researchers in the September American Journal of Medicine. Nearly 2,000 participants who were without dementia from 1992 to 1994 were studied through 2001. Investigators found that those who drank juices at least three times a week had a hazard ratio of 0.24 for probable Alzheimer’s disease, while those drinking juices one to two times a week had a hazard ratio of 0.84. "This inverse association tended to be more pronounced among those with an apolipoprotein E e4 allele and those who were not physically active," noted the researchers. "These results may lead to a new avenue of inquiry in the prevention of Alzheimer’s disease."

According to a report in the August Mayo Clinic Proceedings, only 3% to 5% of women seek preventive therapy for migraine. After assessing all major studies of migraine in the past five years, investigators found that the one-year prevalence of migraine is 18% in women compared with 6% in men. The condition affects 27% of women ages 30 to 49. "The predominance of this disorder and its social, functional, and economic consequences make migraine an important issue in women’s health," the authors noted. "The hormonal milieu has a substantial effect on migraine in women. An understanding of these hormonal influences in the various stages of life in females is essential to the management and prevention of migraines."

ACTOS® (pioglitazone) may significantly reduce the risk of recurrent stroke in patients with type 2 diabetes who have high stroke risk, according to findings presented at the 2006 World Congress of Cardiology. A total of 5,238 patients with type 2 diabetes and macrovascular disease were randomized to receive pioglitazone or placebo in addition to standard care, which included routine use of antihypertensives, glucose-lowering agents, antiplatelet therapy, and lipid-modifying treatment. There was a 47% reduction in the incidence of recurrent stroke and a 28% reduction in the combined risk of death, myocardial infarction, or stroke. In patients who had never had a stroke, no effect of pioglitazone on subsequent strokes was observed.

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