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Volume 5  No 4 - Fall 2008

Volume 5 No 4 - Fall 2008

Table of Contents

Citicoline: Update on a Promising and Widely Available Agent for Neuroprotection and Neurorepair Treatment Update
Choline precursors promote repair and growth of cell membranes and hold promise in a variety of neurologic diseases, including ischemic and hemorrhagic stroke. Citicoline, the most well-studied choline agent precursor, is widely prescribed throughout the world and recently became available in the United States as a dietary supplement. In experimental stroke models, citicoline conferred acute neuroprotection and enhanced neuroplasticity and neurorepair in the subacute period. Although individual human stroke trials have been inconclusive, meta-analysis of 10 trials enrolling 2279 patients suggests patients receiving citicoline had substantially reduced frequencies of death and disability. Reinvestigation of citicoline with modern neuroimaging and clinical trial methods are underway and will provide more definitive information regarding the mechanistic and clinical effects of this promising neurotherapeutic agent. [Rev Neurol Dis. 2008;5(4):167-177]
Antiepileptic Drugs in Aneurysmal Subarachnoid Hemorrhage Management Update
Seizures may occur during or soon after rupture of an intracranial aneurysm. The use of antiepileptic drugs (AEDs) is a controversial issue. The overall conclusions from 2 recent studies in aneurysmal subarachnoid hemorrhage are that 1) many patients receive AEDs but should not; 2) long-term use is associated with worse outcome; and 3) short-term use is safer. Phenytoin may not be the first choice for seizure prophylaxis; newer AEDs such as levetiracetam might be more helpful in prevention and treatment of seizures. [Rev Neurol Dis. 2008;5(4):178-181]
Prevention of Sudden Death in Sleep Prevention and Management Update
Sudden death in sleep, particularly in the young, is a tragic occurrence that conjures thoughts of wrongdoing and foul play. Despite activation of powerful arousal mechanisms when a threat occurs, massive lesions, sudden insurmountable dysfunctions, or profound toxicities may lead to death. Sudden death in sleep is not always inexplicable or unavoidable, which opens a window of opportunity for its prevention. This review explores predisposing conditions and suspected risk factors of sudden death in sleep with a focus on prevention and management. [Rev Neurol Dis. 2008;5(4):182-190]
Sleep-Disordered Breathing and Stroke Management Update
Sleep and stroke have an important and fascinating interaction. Patients with sleep-disordered breathing present with cardiovascular heart disease, cognitive decline, and increased risk of stroke. Stroke adversely affects sleep and factors such as prolonged immobilization, chronic pain, nocturnal hypoxia, and depression, which can also adversely impact sleep quality. Obstructive sleep apnea (OSA), one of the most common and serious sleep disturbances, manifests itself in almost 50% of all stroke patients. Sleep apnea patients who experience a stroke may be at a greater impairment in their rehabilitation potential and have increased risk of secondary stroke and mortality. Given these factors, the practicing neurologist should possess the skills to appropriately recognize, rapidly diagnose, and properly manage stroke patients with OSA. [Rev Neurol Dis. 2008;5(4):191-198]
Stroke Meeting Review
Highlights of the 2008 International Stroke Conference, February 20-22, 2008, New Orleans, LA [Rev Neurol Dis. 2008;5(4):199-202]
A Patient With Subacute Onset of Ophthalmoplegia, Papilledema, and Proptosis Presentation
A young man presented with headache, proptosis, and asymmetric ophthalmoplegia. He was found to have a mass in an unusual area of the brain. The differential diagnosis, diagnostic testing, pathology, treatment, and prognosis of this rare tumor are discussed in detail. [Rev Neurol Dis. 2008;5(4):203-205]