Clin. Transl. Neurosci., Volume 3, Issue 1 (March 2019) – 11 articles

Virchow–Robin spaces or perivascular spaces are pial-lined fluid-filled interstitial spaces recognized throughout brain parenchyma along the path of penetrating vessels. Occasionally, they may become enlarged, cause mass effect, and be mistaken for cystic neoplasms or infections. We report three cases of giant tumefactive perivascular spaces (GTPVS) incidentally found at brain magnetic resonance imaging (MRI). The lesions were multilocular cystic-appearing, isointense to cerebrospinal fluid on all pulse sequences, and did not enhance. They were located both in typical and atypical locations and in one case associated with hydrocephalus. We describe the key features of GTPVS on MRI and illustrate the need to acknowledge and promptly recognize these entities in daily practice in order to avoid unnecessary treatment. Full article

This short review focuses on clinical and therapeutic issues posed by severe osteoporotic and neoplastic insufficiency vertebral fractures and on the potential use of a new technique to obtain minimally invasive vertebral body reconstruction, augmentation, and stabilization in such severe fractures, combining two preexisting procedures. The implant of vertebral body stents is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement–stent complex. This procedure results in a 360° nonfusion form of vertebral internal fixation that may empower vertebral augmentation and potentially avoid corpectomy in challenging osteoporotic and neoplastic fractures. Full article

Genetic generalized epilepsies (GGEs) are a group of seizure syndromes that start in childhood and adolescence. Although generally viewed as benign, large-scale epidemiological studies suggest that a significant proportion of GGE patients suffer from drug-resistant seizures, cognitive impairment and social problems. This motivates further research into their pathophysiology, which is still incompletely understood. GGE is characterized clinically and on the encephalogram by seizures that seem to involve both hemispheres simultaneously – hence the idea of a ‘generalized’ process. However, findings from experimental animal studies suggest that seizures in GGE arise due to complex functional alterations within a network that involves fronto-parietal cortex and midline thalamus. In line with these results, neuroimaging studies have found metabolic changes in midline frontal and posterior parietal cortices during GGE seizures and atrophy of both frontal lobe structures and thalamus in GGE patients. Pathology of fronto-thalamic networks seems therefore to be a core feature of GGE. It is unknown how alterations of structure and function between different sites of the network influence each other. Given that the thalamus exerts widespread influence on cortical function, we hypothesized that thalamic atrophy in GGE patients would lead to functional impairment in cortical networks. To test this hypothesis, we performed a case–control study on patients with GGE and healthy controls (HCs), using computational neuroanatomical and functional connectivity techniques. Confirming our hypothesis, we found atrophy in midline thalamic regions preferentially connected to midline (pre-) frontal cortex, and correlated functional disconnection between midline frontal and posterior parietal cortex. Of note, we found increased functional connectivity between the left-sided thalamus and the left medial prefrontal cortex, and a decrease in interhemispheric functional connectivity between bilateral parietal cortex in patients compared to HCs. Taken together, our results suggest that even highly localized subcortical structural changes might lead to large-scale network effects in GGE. Full article

Introduction: Combined intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the recommended treatment options for acute ischemic stroke (AIS). It is unclear whether earlier IVT and MT management can predict complete vessel recanalization. Methods: In this single-center retrospective observational study, we included 81 consecutive subjects with proximal middle cerebral artery AIS (age 70.5 ± 14.2 years, 53% female) who had both IVT and MT. We assessed recanalization after mechanical procedure according to modified thrombolysis in cerebral infarction (TICI) score as well as the National Institute of Health Stroke Scale (NIHSS) score at 24 h. Outcomes were modified Rankin Scale (mRS) at discharge, mRS at 3 months, death at 3 months, and prevalence of intracerebral hemorrhage during hospitalization. Results: Multinomial logistic regression (χ² = 49.4, p = 0.0075, pseudo-R² = 0.26) showed that complete recanalization (TICI score = 3) was predicted by lower door-to-MT time (p = 0.014, 95% confidence interval (CI) = −0.09 to −0.01) and lower symptoms-to-IVT time (p = 0.045, 95% CI = −0.038 to −0.0004). An NIHSS score ≥ 10 at 24 h was predicted by higher baseline NIHSS (p < 0.0001) and lower TICI score (p = 0.009). Lower NIHSS at 24 h predicted a good outcome according to mRS at 3 months (p = 0.006). Similarly, higher NIHSS at 24 h was a predictor of death at 3 months (p = 0.013). Conclusions: The present study suggests that bridging therapy may improve vascular recanalization when both IVT and MT are performed earlier. Full article

Is it worthwhile still, in times of quick downloads and fake news, when people in highest administrative positions who declare not to be reading at all and that they do not need facts because they know the truth . . . is it worth to buy a book nowadays for 49£ with 563 pages and 120 mainly black and white illustrations or to lend it from a library in order to read about what happened in a Hospital and its adjacent Institute in London’s Bloomsbury over the last 160 years? [...] Full article

The Swiss Archives of Neurology and Psychiatry was founded in 1917 by Constantin von Monakow (1853–1930), the first professor of neurology at the University of Zurich and founder of the Swiss Neurological Society. The carefully bound booklets of these Archives are to be found completely in the scientific library of the Psychiatric University Hospital Burghölzli in Zürich. It is hoped that this treasure trove of knowledge will be preserved for all those interested in the history of neurology and psychiatry in its integrity. Today’s work in and on this archives allows time and again to bring out older works and to present them in the light of more modern concepts. Of medical–historical interest is also the category of obituaries, occurring in almost all issues, virtually a “Who’s Who” of neurologists and psychiatrists who have laid the foundations for our subjects. Full article

This literature review deals with the question whether neck pain (NP) constitutes a symptom or a trigger of migraine. Firstly, a short survey about some techniques for measuring NP in association and relation with migraine is presented. Secondly, the arguments about NP as a symptom or a trigger of migraine are being reviewed and compared. The main questions are the following: Which tests can be used to distinguish NP as a trigger or a symptom of migraine? Is a therapy for NP an adequate method to treat migraine? Finally, the pros and cons of NP as a symptom or as a trigger will be reviewed, and possible treatment options will be suggested. This review found that no reliable and standardized tests exist to classify NP in relation to migraine. However, there is a comparability among these studies due to the common use of migraine definition in the “International Classification of Headache Disorders”. Regarding the quality and methods, different types of studies were analyzed, for example, retrospective, prospective, and cross-sectional studies. Nevertheless, none of these types are specifically suited to show a causality between NP and migraine. In order to do this, the authors would suggest using a randomized controlled study. Another adequate study design might be a population-based case–control crossover study and calculating the population attributable risk. Furthermore, the pathophysiology of NP in migraine patients should be investigated in more detail. Besides their questionable suitability for showing a connection between NP and migraine, some studies were additionally subject to a population and selection bias. To sum up, part of the authors in the reviewed literature generate the hypothesis that NP is more often a symptom than a trigger of migraine. However, due to methodological flaws, more studies are necessary to confirm this hypothesis. Full article

We reviewed the ideas of Ivan Pavlov and his Russian forerunners (Ivan Tarkhanov and Maria Manaseina) and followers (Nikolai Rozjanskiy and Konstantin Bykov) on the functional role of sleep. This analysis led to the conclusion that the state of sleep is connected with functional operations that have not been considered in the past and are also not being investigated in present neuroscience. Thus, a real understanding of the function of sleep may only come with a new neurophysiological paradigm. Full article

More than a dozen substances are meanwhile available for the disease-modifying immunotherapy of multiple sclerosis (MS). However, for some substances, there is a clear difference between approval in Switzerland (Swissmedic) and neighboring countries (European Medicines Agency (EMA)). In addition, limitations imposed by the Swiss Federal Office of Public Health in the specialties list (SL) have significant effects on use in daily clinical practice. In the following, we present consensus recommendations, which were reviewed and agreed upon by the Scientific Advisory Board of the Swiss Multiple Sclerosis Society and the Swiss Neurological Society. We explicitly focus on practice-relevant differences in the approval of MS immunotherapies in Switzerland compared with the EMA area and discuss further limitations (SL) and their impact on the use in clinical practice. Immunotherapies with the same approval in Switzerland and the EMA area and symptomatic therapies are not discussed here. Full article

In collaboration with some of the leading headache centres in Germany, Switzerland and Austria, we have established new guidelines for the treatment of migraine attacks and the prevention of migraine. A thorough literature research of the last 10 years has been the basis of the current recommendations. At the beginning, we present therapeutic novelties, followed by a summary of all recommendations. After an introduction, we cover topics like drug therapy and practical experience, non-effective medication, migraine prevention, interventional methods, non-medicational and psychological methods for prevention and therapies without proof of efficacy. Full article

The 21st Annual Meeting of the Swiss Stroke Society held in Lausanne, Switzerland, from the 11th to 12th January 2018 at Lausanne University Hospital (CHUV) included scientific sessions about vasculitis, hyperacute stroke management, the old and polymorbid stroke patient, and cerebral aneurysms/vasospasms and inaugurated the 1st Symposium of the Swiss Stroke Nursing Network. Full article