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Spotlight on the November 23 Issue
Merino, Jose G. MD, MPhil
doi : 10.1212/WNL.0000000000012900
Volume 97(21), 23 November 2021, p 969-970
Andexanet Alfa for Factor Xa Inhibitor-Associated Intracerebral Hemorrhage: Does a Specific Reversal Agent Justify Its Cost?
Patel, Nikhil MD; Morris, Nicholas A. MD
doi : 10.1212/WNL.0000000000012857
Volume 97(21), 23 November 2021, p 971-972
Cryptogenic Pediatric Ischemic Stroke: What's the Hole Story?
Sun, Lisa R. MD; Jordan, Lori C. MD, PhD
doi : 10.1212/WNL.0000000000012960
Volume 97(21), 23 November 2021, p 973-974
MRI, Big Data, and Artificial Intelligence: Rewards vs Risks
Ontaneda, Daniel MD, PhD; Ross, Lindsay A. MD; Hohlfeld, Reinhard MD
doi : 10.1212/WNL.0000000000012883
Volume 97(21), 23 November 2021, p 975-976
Modeling the Clinical Implications of Andexanet Alfa in Factor Xa Inhibitor-Associated Intracerebral Hemorrhage
Chuck, Carlin C. BS*; Kim, Daniel BA*; Kalagara, Roshini BA; Rex, Nathaniel BS; Madsen, Tracy E. MD, PhD; Mahmoud, Leana PharmD; Thompson, Bradford B. MD; Jones, Richard N. ScD; Furie, Karen L. MD, MPH; Reznik, Michael E. MD
doi : 10.1212/WNL.0000000000012856
Volume 97(21), 23 November 2021, p e2054-e2064
Andexanet alfa was recently approved as a reversal agent for the factor Xa inhibitors (FXais) apixaban and rivaroxaban, but its impact on long-term outcomes in FXai-associated intracerebral hemorrhage (ICH) is unknown. We aimed to explore potential clinical implications of andexanet alfa in FXai-associated ICH in this simulation study.
CSF Synaptic Biomarkers in the Preclinical Stage of Alzheimer Disease and Their Association With MRI and PET: A Cross-sectional Study
Mila-Aloma, Marta MSc; Brinkmalm, Ann PhD; Ashton, Nicholas J. PhD; Kvartsberg, Hlin PhD; Shekari, Mahnaz MSc; Operto, Gregory PhD; Salvado, Gemma MSc; Falcon, Carles PhD; Gispert, Juan Domingo PhD; Vilor-Tejedor, Natalia PhD; Arenaza-Urquijo, Eider M. MSc; Grau-Rivera, Oriol PhD; Sala-Vila, Aleix PhD; Sanchez-Benavides, Gonzalo PhD; Gonzalez-de-Echavarri, Jose Maria MD; Minguillon, Carolina PhD; Fauria, Karine PhD; Ninerola-Baizan, Aida PhD; Perissinotti, Andres MD, PhD; Kollmorgen, Gwendlyn PhD; Suridjan, Ivonne PhD; Zetterberg, Henrik MD, PhD; Molinuevo, Jose Luis MD, PhD; Blennow, Kaj MD, PhD; Suarez-Calvet, Marc MD PhD; on behalf of the ALFA Study; on behalf of the ALFA Study; Beteta, Annabella MD; Cacciaglia, Raffaele PhD; Canas, Alba MS; Deulofeu, Carme PhD; Cumplido, Irene MSc; Dominguez, Ruth MS; Emilio, Maria MS; Fuentes, Sherezade MS; Hernandez, Laura MS; Huesa, Gema PhD; Huguet, Jordi PhD; Marne, Paula MS; Mench[spacing acute]on, Tania MS; Polo, Albina MD; Pradas, Sandra MS; Soteras, Anna MS; Vilanova, Marc BSc
doi : 10.1212/WNL.0000000000012853
Volume 97(21), 23 November 2021, p e2065-e2078
To determine whether CSF synaptic biomarkers are altered in the early preclinical stage of the Alzheimer continuum and associated with Alzheimer disease (AD) risk factors, primary pathology, and neurodegeneration markers.
Association of CT-Based Hypoperfusion Index With Ischemic Core Enlargement in Patients With Medium and Large Vessel Stroke
Nomani, Ali Z. MD, MSc, FCPS; Kamtchum Tatuene, Joseph MD, MAS, MRes, FEBN; Rempel, Jeremy L. MD, FRCPC; Jeerakathil, Thomas MD, MSc, FRCPC; Winship, Ian R. BSc, PhD; Khan, Khurshid A. MD, FRCPC; Buck, Brian H. MD, FRCPC; Shuaib, Ashfaq MD, FRCPC; Jickling, Glen C. MD, MSc, FRCPC
doi : 10.1212/WNL.0000000000012855
Volume 97(21), 23 November 2021, p e2079-e2087
The rate of infarct core progression in patients with acute ischemic stroke is variable and affects outcome of reperfusion therapy. We evaluated the hypoperfusion index (HI) to estimate the initial rate of core progression in patients with medium vessel occlusion (MeVO) compared to large vessel occlusion (LVO) stroke and within a larger time frame since stroke onset.
CT Hypoperfusion-Hypodensity Mismatch to Identify Patients With Acute Ischemic Stroke Within 4.5 Hours of Symptom Onset
Sporns, Peter B. MD*; Kemmling, Andre MD*; Minnerup, Heike MD, MSc*; Meyer, Lennart MD; Krogias, Christos MD; Puetz, Volker MD; Thierfelder, Kolja MD; Duering, Marco MD; Kaiser, Daniel MD; Langner, Soenke MD; Massoth, Christina MD; Brehm, Alex MD; Rotkopf, Lukas MD; Kunz, Wolfgang G. MD; Karch, Andre MD, MSc; Fiehler, Jens MD; Heindel, Walter MD; Schramm, Peter MD; Royl, Georg MD; Wiendl, Heinz MD; Psychogios, Marios MD; Minnerup, Jens MD
doi : 10.1212/WNL.0000000000012891
Volume 97(21), 23 November 2021, p e2088-e2095
To test the hypothesis that CT hypoperfusion-hypodensity mismatch identifies patients with ischemic stroke within 4.5 hours of symptom onset.
Prevalence of Patent Foramen Ovale in a Cohort of Children With Cryptogenic Ischemic Stroke
Shih, Evelyn K. MD, PhD; Beslow, Lauren A. MD, MSCE; Natarajan, Shobha S. MD; Falkensammer, Christine B. MD; Messe, Steven R. MD*; Ichord, Rebecca N. MD*
doi : 10.1212/WNL.0000000000012892
Volume 97(21), 23 November 2021, p e2096-e2102
To determine the significance of patent foramen ovale (PFO) in childhood stroke, we compared PFO prevalence, PFO features, and stroke recurrence risk in 25 children with cryptogenic arterial ischemic stroke (AIS), 54 children with AIS from a known etiology, and 209 healthy controls.
Natural History of Facioscapulohumeral Dystrophy in Children: A 2-Year Follow-up
Dijkstra, Jildou N. MD; Goselink, Rianne J.M. MD, PhD; van Alfen, Nens MD, PhD; de Groot, Imelda J.M. MD, PhD; Pelsma, Maaike MSc; van der Stoep, Nienke PhD; Theelen, Thomas MD, PhD; van Engelen, Baziel G.M. MD, PhD; Voermans, Nicol C. MD, PhD*; Erasmus, Corrie E. MD, PhD*
doi : 10.1212/WNL.0000000000012882
Volume 97(21), 23 November 2021, p e2103-e2113
Data on the natural history of facioscapulohumeral dystrophy (FSHD) in childhood are limited and critical for improved patient care and clinical trial readiness. Our objective was to describe the disease course of FSHD in children.
Tissue 2-Hydroxyglutarate and Preoperative Seizures in Patients With Diffuse Gliomas
Ohno, Makoto MD, PhD*; Hayashi, Yoshiharu MEng*; Aikawa, Hiroaki PhD; Hayashi, Mitsuhiro MD, PhD; Miyakita, Yasuji MD, PhD; Takahashi, Masamichi MD, PhD; Matsushita, Yuko BSc; Yoshida, Akihiko MD, PhD; Satomi, Kaishi MD, PhD; Ichimura, Koichi MD, PhD; Hamada, Akinobu PhD; Narita, Yoshitaka MD, PhD
doi : 10.1212/WNL.0000000000012893
Volume 97(21), 23 November 2021, p e2114-e2123
Mutant isocitrate dehydrogenase (IDH) 1/2 gene products gain a new ability to produce D-2-hydroxyglutarate (D2HG). IDH1/2 mutations are thought to be associated with seizures owing to the structural similarity between D2HG and glutamate. However, the effects of D2HG on seizures in clinical settings are not fully understood. We sought to investigate the relationship between tissue 2-hydroxyglutarate (2HG) concentration and preoperative seizures using clinical samples.
Defining Speech Subtypes in De Novo Parkinson Disease: Response to Long-term Levodopa Therapy
Rusz, Jan PhD; Tykalova, Tereza PhD; Novotny, Michal PhD; Zogala, David PhD; Sonka, Karel DSc; Ruzicka, Evzen DSc; Dusek, Petr PhD
doi : 10.1212/WNL.0000000000012878
Volume 97(21), 23 November 2021, p e2124-e2135
Patterns of speech disorder in Parkinson disease (PD), which are highly variable across individual patients, have not been systematically studied. Our aim was to identify speech subtypes in treatment-naive patients with PD and to examine their response to long-term dopaminergic therapy.
Cerebral Venous Sinus Thrombosis and Thrombotic Events After Vector-Based COVID-19 Vaccines: A Systematic Review and Meta-analysis
Palaiodimou, Lina MD*; Stefanou, Maria-Ioanna MD*; Katsanos, Aristeidis H. MD; Aguiar de Sousa, Diana MD; Coutinho, Jonathan M. MD; Lagiou, Pagona MD; Michopoulos, Ioannis MD; Naska, Androniki PhD; Giannopoulos, Sotirios MD; Vadikolias, Konstantinos MD; Voumvourakis, Konstantinos I. MD; Papaevangelou, Vasiliki MD; Vassilakopoulos, Theodoros I. MD; Tsiodras, Sotirios MD; Tsivgoulis, Georgios MD
doi : 10.1212/WNL.0000000000012896
Volume 97(21), 23 November 2021, p e2136-e2147
There is accumulating evidence supporting an association between the thrombosis and thrombocytopenia syndrome (TTS) and adenovirus vector-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yet TTS and TTS-associated cerebral venous sinus thrombosis (CVST) remain poorly characterized. We aim to systematically evaluate the proportion of CVST among TTS cases and assess its characteristics and outcomes.
Fetal Familial Cerebral Cavernous Malformation With a Novel Heterozygous KRIT1 Variation
Cheng, Dan MD*; Shang, Xiang MBBS*; Gao, Wanli MD; Barkhof, Frederik MD, PhD; Liu, Yaou MD, PhD
doi : 10.1212/WNL.0000000000012852
Volume 97(21), 23 November 2021, p 986-988
To identify fetal familial cerebral cavernous malformation (CCM) and a novel variation.
Opportunities for Understanding MS Mechanisms and Progression With MRI Using Large-Scale Data Sharing and Artificial Intelligence
Vrenken, Hugo PhD; Jenkinson, Mark BSc, BE, DPhil; Pham, Dzung L. PhD; Guttmann, Charles R.G. MD; Pareto, Deborah PhD; Paardekooper, Michel PhD; de Sitter, Alexandra PhD; Rocca, Maria A. MD; Wottschel, Viktor PhD; Cardoso, M. Jorge PhD; Barkhof, Frederik MD, PhD; on behalf of the MAGNIMS Study Group; on behalf of the MAGNIMS Study Group; de Stefano, Nicola MD, PhD; Garriga, Jaume Sastre-; Ciccarelli, Olga MD, PhD; Enzinger, Christian MD, PhD; Filippi, Massimo MD, PhD; Gasperini, Claudio MD, PhD; Kappos, Ludwig MD, PhD; Palace, Jacqueline MD, PhD; Rovira, Alex MD, PhD; Yousry, Tarek MD, PhD
doi : 10.1212/WNL.0000000000012884
Volume 97(21), 23 November 2021, p 989-999
Patients with multiple sclerosis (MS) have heterogeneous clinical presentations, symptoms, and progression over time, making MS difficult to assess and comprehend in vivo. The combination of large-scale data sharing and artificial intelligence creates new opportunities for monitoring and understanding MS using MRI. First, development of validated MS-specific image analysis methods can be boosted by verified reference, test, and benchmark imaging data. Using detailed expert annotations, artificial intelligence algorithms can be trained on such MS-specific data. Second, understanding disease processes could be greatly advanced through shared data of large MS cohorts with clinical, demographic, and treatment information. Relevant patterns in such data that may be imperceptible to a human observer could be detected through artificial intelligence techniques. This applies from image analysis (lesions, atrophy, or functional network changes) to large multidomain datasets (imaging, cognition, clinical disability, genetics). After reviewing data sharing and artificial intelligence, we highlight 3 areas that offer strong opportunities for making advances in the next few years: crowdsourcing, personal data protection, and organized analysis challenges. Difficulties as well as specific recommendations to overcome them are discussed, in order to best leverage data sharing and artificial intelligence to improve image analysis, imaging, and the understanding of MS.
Perivascular and Subarachnoid Fluid-Attenuated Inversion Recovery Hyperintensities Related to Delayed Gadolinium Leakage After Stroke
Nistorec, Larisa MD; Renard, Dimitri MD; Parvu, Teodora MD
doi : 10.1212/WNL.0000000000012854
Volume 97(21), 23 November 2021, p 1000-1001
Clinical Reasoning: An Unusual Case of Acute Psychosis and Tetraparesis in a Young Zambian Man
Zimba, Stanley MBChB, MMED, STP; Chishimba, Lorraine MBChB; Chomba, Mashina MBChB; Saylor, Deanna MD, MHS
doi : 10.1212/WNL.0000000000012468
Volume 97(21), 23 November 2021, p 1002-1005
Pearls and Oy-sters: Symmetric Numbness and Paresthesia Due to Stroke-like Episode in an Adolescent Male With MELAS
Vassar, Rachel MD; Mehta, Nehali MD
doi : 10.1212/WNL.0000000000012611
Volume 97(21), 23 November 2021, p 1006-1008
Teaching NeuroImage: Basal Ganglia T1 Hyperintensity and SWI Signal Diabetic Striatopathy in an 18-Year-Old Man With Type 1 Diabetes Mellitus
Tencer, Jaclyn MD; Yum, Sabrina W. MD
doi : 10.1212/WNL.0000000000012489
Volume 97(21), 23 November 2021, p e2148-e2149
Teaching Video NeuroImage: An Uncommon Cause of Hearing Loss
Siddiqui, Waleed Tariq MD, MPH; Byrne, Maria MD
doi : 10.1212/WNL.0000000000012469
Volume 97(21), 23 November 2021, p e2150-e2151
Editors' Note: Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis
Lewis, Ariane MD; Galetta, Steven MD
doi : 10.1212/WNL.0000000000012897
Volume 97(21), 23 November 2021, p 1009
Reader Response: Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis
Pollak, Thomas A.; Pruss, Harald; Bechter, Karl; Najjar, Souhel; Vincent, Angela
doi : 10.1212/WNL.0000000000012898
Volume 97(21), 23 November 2021, p 1009-1010
Author Response: Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis
Dalmau, Josep; Guasp, Mar; Graus, Francesc
doi : 10.1212/WNL.0000000000012899
Volume 97(21), 23 November 2021, p 1010
