Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is characterized by dilated ventricles and a combination of gait impairment, cognition impairment, and loss of urinary control (urgency and incontinence). The only effective treatment for NPH is a CSF shunt; however, only a small percentage of patients ever receive it. The features of gait impairment in patients with NPH are difficult to distinguish from patients of neurodegenerative disorders with motor involvement, such as parkinsonism or dementia with Lewy bodies. CT or MRI imaging is required for the diagnosis of idiopathic normal pressure hydrocephalus. An Evans ratio of more than 0.3 indicates large ventricles, and a ratio of more than 0.33 indicates very large ventricles, but is not specific for idiopathic normal pressure hydrocephalus. The international and Japanese guidelines support shunt surgery as effective treatment of idiopathic normal pressure hydrocephalus, as does the American Academy of Neurology practice guideline. There is a need to provide longitudinal care of patients with idiopathic normal pressure hydrocephalus after shunt surgery as all symptoms respond well to shunt surgery

Giant Cell Arteritis: From Neurologist’s Perspective

Giant cell arteritis (GCA) is a granulomatous vasculitis affecting large- and medium-sized arteries in the elderly and potentially causes visual loss. In an elderly patient presenting with acute pain in the distribution of the external carotid artery (e.g., headache, scalp tenderness); polymyalgia rhematica; or acute/transient visual loss or diplopia; a possibility of GCA should be considered in one of the differential diagnosis. Urgent laboratory evaluation (e.g., ESR, CRP, platelet count), followed immediately by empiric high-dose corticosteroid therapy is warranted in patients suspected of having GCA. Although ultrasound techniques are sensitive for the diagnosis of GCA, TAB remains the best confirmatory test. Patients with GCA often require long durations of steroid therapy and steroid-related complications are common. Multidisciplinary care and the use of steroid-sparing regimens are warranted in case of relapse

Risk of Seizures after Endovascular Management of Ruptured Intracranial Aneurysms: A Systematic Review and Meta-analysis

Seizures in aneurysmal subarachnoid haemorrhage (aSAH) have been described secondary to SAH, changes in cortical function, vasospasm and as a result of treatment effects. Seizures are one of the important clinical determinants in neurological outcome of aSAH. Various studies support the notion of less risk of future seizures in endovascular treatment as compared to the microsurgical clipping, yet there is no conclusive evidence in favour or against the seizure occurrence in aSAH patients after endovascular treatment as compared to the microsurgical treatment. To carry out a systematic review and meta-analysis of the risk of seizures after endovascular management (coiling) of ruptured intracranial aneurysms. A literature search was performed in electronic database of PubMed, MEDLINE, Embase, and Scopus from inception to February 2020, using the terms Seizure, Intracranial aneurysms, embolization, with no constraints applied. Data were pooled using a random-effect model, results were abstracted as odds ratios (ORs) and 95% confidence interval (CI), and heterogeneity was reported as Chi-square. Five studies involving 3,077 patients were included in the meta-analysis. After endovascular management of aSAH, seizure risk was increased by a worse clinical severity (World Federation of Neurosurgery scale or Hunt and Hess) (OR, 3.34; 95% CI, 2.69-4.16; <0.00001), severe vasospasm (OR, 2.20; 95% CI, 1.67-2.92; <0.00001), cerebral infarction (OR, 5.19; 95% CI, 3.23-8.35; <0.00001), and cerebral edema (OR, 1.79; 95% CI, 1.37-2.34; <0.0000). Worse clinical severity, vasospasm, cerebral infarction and cerebral oedema are significant risk factors for the development of seizures after endovascular intervention in aSAH. The mechanism for this correlation is not clear