Commentary: Early screening parameters for dysphagia in acute ischemic stroke

We read with great interest the article by Henke et al. (1) aimed to identify early assessable predictors of dysphagia in the acute phase of ischemic stroke. A multivariate logistic regression analysis revealed higher age, male gender, and higher stroke severity [as assessed by NIH stroke scale (NIHSS)] to be independent predictor of poststroke dysphagia. Moreover, ROC analysis showed that in the acute phase of stroke NIHSS score of 4.5 was the best cut-off between dysphagic and non-dysphagic patients. This research field certainly has a remarkable clinical interest, because it may lead to individuate those acute stroke patients who may benefit from a more detailed assessment of their swallow function (i.e., using fiberoptic endoscopic evaluation of swallowing or videofluoroscopy). However, an NIHSS cut-off for dysphagia of 4.5, by excluding only stroke patients with a very mild deficit, is probably of limited clinical usefulness. In other words, since the majority of stroke is of moderate-severe degree, it appears to be of little help in detecting only those patients who may benefit from a more detailed assessment of their swallowing function

Letter by toscano et al regarding article. association of leukoaraiosis with convalescent rehabilitation outcome in patients with ischemic stroke

Given the aforementioned link between leukoaraiosis and swallowing impairment, and the burden of poststroke dysphagia on rehabilitation outcome, it could be of some interest to analyze the relationships between leukoaraiosis, recovery, and dysphagia in your large population

Did Going North Give Us Migraine? An Evolutionary Approach on Understanding Latitudinal Differences in Migraine Epidemiology

This commentary discusses a recent publication by evolutionary biologists with strong implications for migraine experts. The Authors showed that a gene polymorphism associated with migraine gave our ancestors an evolutionary advantage when colonizing northern, and thus colder, territories. They then highlight that the prevalence of migraine may differ among countries because of climatic adaptation. These results may prove useful in planning both epidemiological and physiological studies in the field of migraine

Alice in wonderland syndrome. a clinical and pathophysiological review

Alice in Wonderland Syndrome (AIWS) is a perceptual disorder, principally involving visual and somesthetic integration, firstly reported by Todd, on the literary suggestion of the strange experiences described by Lewis Carroll in Alice in Wonderland books. Symptoms may comprise among others aschematia and dysmetropsia. This syndrome has many different etiologies; however EBV infection is the most common cause in children, while migraine affects more commonly adults. Many data support a strict relationship between migraine and AIWS, which could be considered in many patients as an aura or a migraine equivalent, particularly in children. Nevertheless, AIWS seems to have anatomical correlates. According to neuroimaging, temporoparietal- occipital carrefour (TPO-C) is a key region for developing many of AIWS symptoms. The final part of this review aims to find the relationship between AIWS symptoms, presenting a pathophysiological model. In brief, AIWS symptoms depend on an alteration of TPO-C where visual-spatial and somatosensory information are integrated. Alterations in these brain regions may cause the cooccurrence of dysmetropsia and disorders of body schema. In our opinion, the association of other symptoms reported in literature could vary depending on different etiologies and the lack of clear diagnostic criteria