Association between cortical metabolite levels and clinical manifestations of migrainous aura: an MR-spectroscopy study.

Previous studies suggest an abnormal cerebral cortical energy metabolism in migraineurs. If causally related to the pathophysiology of migraine, these abnormalities might show a dose-response relationship with the duration and severity of aura symptoms. While such a trend has been suggested in phosphorus spectroscopy (31P-MRS) studies, it has not been considered in proton spectroscopy (1H-MRS) studies and it has not been studied in cerebral white matter.

Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison.

Background: The risk of recurrent stroke is up to 10% in the week after a transient ischaemic attack (TIA) or minor stroke. Modelling studies suggest that urgent use of existing preventive treatments could reduce the risk by 80-90%, but in the absence of evidence many health-care systems make little provision. Our aim was to determine the effect of more rapid treatment after TIA and minor stroke in patients who are not admitted direct to hospital.

Substantial underestimation of the need for outpatient services for TIA and minor stroke.

Objectives: To measure the number of all transient ischaemic attack (TIAs) and minor strokes managed as outpatients, and hence, the need for 'TIA clinics' in comparison to current estimates of 20,000 TIAs annually in England, based on previous rates of incident-definite events.

Subjects: All individuals with confirmed or suspected TIA or stroke between 2002 and 2005 in a population-based study of 91,105 individuals in Oxfordshire, UK.

Outcome Measures: Numbers, rates, and risks of recurrent stroke for incident-definite TIA, any probable or definite TIA, stroke, and all referrals of suspected TIA and stroke, stratified according to inpatient versus outpatient management.

Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies.

Background: Randomised trials have shown that aspirin reduces the short-term risk of recurrent colorectal adenomas in patients with a history of adenomas or cancer, but large trials have shown no effect in primary prevention of colorectal cancer during 10 years' follow-up. However, the delay from the early development of adenoma to presentation with cancer is at least 10 years. We aimed to assess the longer-term effect of aspirin on the incidence of cancers.

Heritability of ischaemic stroke in women compared with men: a genetic epidemiological study.

Background: Ischaemic stroke is partly heritable. However, although the genetic and non-genetic factors responsible could be sex-specific, interactions between the sex of the parent affected and the sex of the proband or affected siblings are unknown. We sought to assess the relation between the sex and phenotype of affected probands and the sex of affected first-degree relatives.

Hand preference and performance in 20 pairs of monozygotic twins with discordant handedness.

The differences between right (RH) and left (LH) handers reported in the literature on fine motor tasks, has traditionally been interpreted relative to purported functioning of the cerebral hemispheres. However, conclusive evidence for performance differences which are intrinsic to handedness per se is difficult to obtain unless left and right handers are compared who are similar in their genetic and environmental background. The present study therefore, employed a monozygotic (MZ) twin design which minimizes differences in genetic variation between the two groups.

Risk of coronary and other nonstroke vascular death in relation to the presence and extent of atherosclerotic disease at the carotid bifurcation.

Background And Purpose: It has been proposed that purely unilateral carotid stenosis is due mainly to local hemodynamic factors, whereas more diffuse disease reflects a systemic as well as a local predisposition and should therefore be associated with higher rates of arterial disease in the other territories. However, few studies have tested this hypothesis.

Methods: We studied angiograms from 2741 patients with a recently symptomatic carotid stenosis from the European Carotid Surgery Trial and categorized them as showing purely unilateral disease (no convincing plaque in the contralateral carotid artery) or bilateral disease.

Underinvestigation and undertreatment of carotid disease in elderly patients with transient ischaemic attack and stroke: comparative population based study.

Objective: To identify any underinvestigation of older patients with transient ischaemic attack (TIA) and stroke.

Design: Comparative population based studies.

Setting: Routine clinical practice in all secondary care services in Oxfordshire and a nested population based study of incidence of transient ischaemic attack and stroke (the Oxford vascular study-OXVASC).

Neurologists and the threat of bioterrorism.

Neurologists are most likely to become involved in primarily diagnosing those bioterrorist attacks utilising botulinum toxin. Oral ingestion, or possibly inhalation, are likely routes of delivery. The characteristic descending paralysis starts in the extraocular and bulbar muscles, with associated autonomic features.

Symptomatic and asymptomatic carotid stenosis: how, when, and who to treat?

Carotid stenosis is an important cause of ischemic stroke. Large randomized trials of endarterectomy have shown that surgery reduces the risk of stroke in patients with recently symptomatic carotid stenosis of 50% or greater, and to a lesser extent in patients with asymptomatic carotid stenosis of 60% or greater. More recent research has gone some way in identifying which patients benefit most and when intervention is most effective.

Clinical electrophysiological characterization of the acquired neuromyotonia phenotype of autoimmune peripheral nerve hyperexcitability.

Acquired autoimmune neuromyotonia is regarded as part of the spectrum of peripheral nerve hyperexcitability disorders. We aimed to use clinical neurophysiological measurements to study the extent, distribution, and characteristics of spontaneous motor unit potentials in 11 patients with acquired neuromyotonia. Investigations revealed that most spontaneous discharges recorded were motor unit, or partial motor unit potentials of normal size.

Prediction and prevention of stroke after transient ischemic attack in the short and long term.

Over the last 5 years, a number of studies have shown the early risk of stroke following transient ischemic attack (TIA) to be of the order of 5-10% at 1 week and 10-20% at 3 months, considerably higher than previously estimated. Because these studies have been carried out in a variety of different clinical settings, their findings are likely to be generalizable. Various independent prognostic factors for this early risk of stroke have been identified and models, based on clinical features at presentation, have been derived and validated to predict risk of stroke within 7 and 90 days after TIA.

Family history of stroke does not predict risk of stroke after transient ischemic attack.

Background And Purpose: Animal models suggest a genetic contribution to cerebral susceptibility to ischemia. Family history of stroke (FHxstroke) is a risk factor for ischemic stroke, but there is significant confounding by heritability of hypertension and other intermediate phenotypes, and it is uncertain whether genetic factors have a direct independent influence on cerebral susceptibility to ischemia in man.

Methods: We related detailed FHxstroke to baseline characteristics and subsequent risk of stroke in 2 population-based incidence studies and a consecutive hospital-referred series of patients with recent transient ischemic attack (TIA).

A practical definition of conduction block in IvIg responsive multifocal motor neuropathy.

Background: Multifocal motor neuropathy with conduction block (MMN) can be mistaken for motor neurone disease or other lower motor neurone syndromes, but is treatable with intravenous immunoglobulin (IvIg). Formal electrophysiological criteria for conduction block (CB) are so stringent that substantial numbers of patients may miss out on appropriate treatment.

Methods: Electrophysiological data were collected from 10 healthy volunteers and compared to data from 10 patients who satisfied the clinical criteria for MMN and who responded to IvIg.

Anti-epileptic drugs: newly licensed and under development.

Approximately 1% of the world population (50 million people) suffers from epilepsy. Although the long-established anti-epileptic drugs allow 80% of newly diagnosed patients to remain seizure-free, many patients experience intolerable side effects the remaining 20% of patients do not respond to these drugs. There has therefore been a need for new anti-epileptic drugs, and the past decade has seen the licensing of eight new drugs worldwide, although these drugs have made little impact on the prognosis of refractory epilepsy.

A systematic comparison of the quality and volume of published data available on novel risk factors for stroke versus coronary heart disease.

Background: To identify new treatments to prevent stroke, it is important that we have reliable data on potential novel risk factors.

Methods: We studied seven novel vascular risk factors [apo-lipoprotein (b), C-reactive protein, Chlamydia pneumoniae, fibrin-D dimer, fibrinogen, Helicobacter pylori and lipoprotein (a)] and compared the amount of published data on their relations with ischaemic stroke versus acute coronary events by systematic review of all studies published up to 2003.

Results: From a total of 22,875 abstracts reviewed, 266 eligible studies were identified (167 case-control studies and 99 cohort studies).

Population-based study of delays in carotid imaging and surgery and the risk of recurrent stroke.

Background: Benefit from carotid endarterectomy is greatest when performed within 2 weeks of a presenting TIA or stroke and decreases rapidly thereafter.

Objective: To determine the delays to carotid imaging and endarterectomy in Oxfordshire, UK, and the consequences for the effectiveness of stroke prevention.

Methods: All patients undergoing carotid imaging for ischemic retinal or cerebral TIA or stroke were identified in two populations: the population of Oxfordshire, UK (n = 680,772), from April 1, 2002, to March 31, 2003, and the Oxford Vascular Study (OXVASC) subpopulation (n = 92,000) from April 1, 2002, to March 31, 2004.

A systematic review of the associations between age and sex and the operative risks of carotid endarterectomy.

Background: Randomized trials of carotid endarterectomy (CEA) for both symptomatic and asymptomatic carotid stenosis have demonstrated that benefit is decreased in women, due partly to a high operative risk, which is independent of age. However, it is uncertain whether these trial-based observations are generalisable to routine clinical practice.

Methods: We performed a systematic review of all publications reporting data on the association between age and/or sex and procedural risk of stroke and/or death following CEA from 1980 to 2004.

The dorsal raphe nucleus in schizophrenia: a post mortem study of 5-hydroxytryptamine neurones.

The 5-hydroxytryptamine (5-HT, serotonin) system has been implicated in the pathophysiology and treatment of schizophrenia. In this study, we addressed the hypothesis that a deficit of 5-HT neurones, either inherited or acquired, is central to the developmental pathology of the disorder. We examined putative 5-HT neurones of the dorsal raphe nucleus (DRN) in post mortem, formalin-fixed tissue from 15 schizophrenic patients and 20 control subjects matched for age and gender.

The need for emergency treatment of transient ischemic attack and minor stroke.

The risk of recurrent stroke following transient ischemic attack or minor stroke has recently been shown to be 5-10% at 1 week and 10-20% at 3 months, depending on study population and methods. This is considerably higher than previously estimated and current clinical guidelines reflect the need for rapid assessment although a wide variation in practice exists. Effective management of patients with transient ischemic attack or minor stroke, therefore, requires identification of individuals at the highest (and lowest) risk and initiation of appropriate secondary prevention.