JNS.jpgThe February issue of the Journal of the Neurological Sciences Vol 409 is now available online.


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Issue highlights

The current significance of the FOUR score: A systematic review and critical analysis of the literature

The Full Outline of Un-Responsiveness Score (FOURs) is a scale for clinical assessment of consciousness that was introduced to overcome disadvantages of the widely accepted Glasgow Coma Scale (GCS).

A systematic review and critical analysis of the available literature on the clinical application of FOURs shows that even though FOURs is more complicated than GCS, its application remains quite simple and is a reliable and more detailed alternative to GCS score. However, whether it poses a clinically significant advantage in detecting patients' deterioration and outcome prediction, compared to other scaling systems, remains unclear.


Predictors of malignant cerebral edema in cerebral artery infarction: A meta-analysis

Malignant cerebral edema (MCE) is a life-threatening complication of acute cerebral stroke. To date, the focus has been on symptomatic treatment, rather than on prevention.

This study identifies high-risk patients and explores potential therapeutic approaches, and investigates the possible predictors of MCE.

Searching the MEDLINE, Embase, Cochrane, China National Knowledge Infrastructure, Wanfang Data, and VIP databases from their inception to July 2018 for cohort and case-control studies on the predictors of MCE in patients with cerebral infarction, results suggest that the risk of MCE is higher in case of severe clinical symptoms and large infarct volumes. Additionally, male sex, older age, and a history of stroke and smoking were protective factors against MCE in cerebral infarction patients.

The findings facilitate the early prediction of MCE and may contribute to potential therapeutic approaches.

Ophthalmological changes in hereditary spastic paraplegia and other genetic diseases with spastic paraplegia

Ophthalmological abnormalities may occur in specific subtypes of hereditary spastic paraplegia (HSP) and in genetic diseases that present with spastic paraplegia mimicking HSP. These ophthalmological changes may precede the motor symptoms and include pigmentary retinal degeneration, ophthalmoplegia, optic atrophy, cataracts and nystagmus. Some ophthalmological abnormalities are more prevalent in specific forms of HSP.

In this article, we review the main ophthalmological changes observed in patients with HSP and HSP-like disorders.

Considering that the diagnosis of HSP is usually difficult and complex, specific ophthalmological changes may guide the genetic testing. There are other genetic diseases such as autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS), X-linked adrenoleukodystrophy and spastic paraplegia, optic atrophy and neuropathy (SPOAN) that may mimic HSP and also may present with specific ophthalmological changes.

Timing to start anticoagulants after acute ischemic stroke with non-valvular atrial fibrillation

In a prospective observational cohort study of 120 patients with AIS/TIAs to identify timing for initiation of anticoagulation therapy in acute ischemic stroke (AIS) with non-valvular AF as regards safety and efficacy, early initiation of anticoagulation after stroke, especially in cases of large infarction, is found to be associated with significant risk of ICH. This risk is highest with warfarin and lowest with DOAC.