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How to Treat Tiny Unruptured Intracranial Aneurysms
Although detection of unruptured intracranial aneurysms (UIAs) is becoming more common, many treatment or surveillance strategies are used for tiny UIAs (3 mm or smaller). Malhotra and coauthors used a decision-analytic model-based comparative effectiveness analysis using PubMed searches for key model inputs and produced 10 000 iterations simulating adult patients with incidental detection of UIAs 3 mm or smaller. The highest effectiveness in terms of quality-adjusted life-years was a strategy of no treatment and no follow-up imaging followed by infrequent repeated imaging (5-year follow-up). More aggressive strategies, including more frequent imaging or treatment (aneurysm coiling), were associated with worse outcomes. Editorial perspective is provided by Johnston.
Elevated Amyloid Status in Cognitively Normal Adults
Many clinical trials exploring the physiology of Alzheimer disease (AD) are being conducted on cognitively unimpaired persons who show an elevated amyloid biomarker, but there is no consensus on how to disclose what this means for cognitively normal participants. In a substudy of the Study of Knowledge and Reactions to Amyloid Testing, Mozersky and coauthors conducted interviews with 50 adults aged 65 to 85 years with abnormal amyloid positron emission tomography scan results 4 to 12 weeks after result disclosure and again 12 months later. Most participants understood that an “elevated” amyloid result described an increased but uncertain risk of developing AD and desired clarification of the term beyond its being a categorical result enabling trial eligibility. Future AD clinical trials and educational materials should include explanations of how and why dimensional biomarkers are converted to categories. Editorial perspective is provided by Chiong.
Seizures and Encephalitis in MOG-IgG Disease
Antibodies to myelin oligodendrocyte glycoprotein IgG (MOG-IgG) are increasingly detected in patients with non–multiple sclerosis–related demyelination, some with a neuromyelitis optics phenotype. Although seizures and encephalitis-like presentations are exceptionally rare in aquaporin 4 antibody–related neuromyelitis optics in white individuals, it has been reported in MOG-IgG disease. In this cross-sectional study from the national neuromyelitis optics clinic at the Walton Centre NHS Foundation Trust in Liverpool, England, Hamid and coauthors describe seizures in 5 of 34 patients (15%) with MOG-IgG disease. All had brain lesions and developed a relapsing disease, some causing significant disability. In contrast, only 1 of 100 patients (1.0%) with aquaporin 4 IgG disease had seizures without any encephalitic illness. Myelin oligodendrocyte glycoprotein IgG–associated disease should be considered in the differential diagnosis of autoimmune encephalitis.
Continuing Medical Education
NAFLD and Brain Volume in Healthy Middle-aged Adults
Although nonalcoholic fatty liver disease (NAFLD) is often asymptomatic, emerging evidence suggests a link between liver disorders and brain function. Weinstein and coauthors assessed the cross-sectional associations between NAFLD and brain magnetic resonance imaging measures in 766 participants of the Offspring cohort of the Framingham Study (mean [SD] age at time of imaging, 67  years). Nonalcoholic fatty liver disease was significantly associated with smaller total brain volume independent of multiple covariates. These differences in brain volume corresponded to greater than 4 years of brain aging. No associations were observed between NAFLD and white matter hyperintensities or covert brain infarcts. These findings point to a possible link between hepatic steatosis and brain aging.
Highlights. JAMA Neurol. 2018;75(1):5. doi:10.1001/jamaneurol.2017.1121
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