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Successful Stroke Interventions in Minority Populations
Despite effective secondary stroke prevention, recurrent stroke remains disproportionally high in certain racial/ethnic minority populations. In a randomized clinical trial, Boden-Albala and coauthors tested the efficacy of a culturally tailored, skills-based educational intervention compared with standard discharge care in a multiethnic cohort of 552 patients (281 women [50.9%]; mean [SD] age, 64.6 [2.9] years) with mild/moderate stroke or transient ischemic attack. At 1-year follow-up, there was a reduction in the intervention arm compared with usual care. In secondary analyses, Hispanic participants experienced a clinically and statistically significant greater mean systolic blood pressure reduction. Skills-based strategies may be an alternative to achieve sustained vascular risk reduction and address racial/ethnic stroke disparities. Editorial perspective is provided by Kim and Thrift.
Gabapentin vs Pregabalin on Pain Intensity in Chronic Sciatica
Gabapentin (GBP) and pregabalin (PGB) are commonly used for the treatment of chronic sciatica. In a novel double-blind crossover randomized clinical trial in a single-center, tertiary referral public hospital, Robertson and coauthors randomized 18 patients (11 men [61%]) to receive GBP then PGB or vice versa for 8 weeks. Crossover followed a 1-week washout period. Gabapentin showed superiority and displayed better efficacy with decreased frequency and severity of adverse effects compared with PGB. The trial was stopped early because of the significant results, and the authors recommend patients initiate GBP first before commencement of PGB (if warranted) for chronic sciatica.
Diagnostic Criteria for Spontaneous Spinal Cord Infarction
The diagnostic criteria of spinal cord infarction (SCI) is unclear, and spontaneous SCI is often misdiagnosed as transverse myelitis. Zalewski and coauthors identified 133 patients (71 women [53.4%]; median [interquartile range] age at presentation, 60 [52-69] years) at the Mayo Clinic in Rochester, Minnesota, with spontaneous SCI and compared them with 280 controls from a database of alternative myelopathy etiologies to validate proposed diagnostic criteria for definite, probable, and possible SCI. Rapid onset of severe deficits reaching nadir at 12 hours, magnetic resonance imaging showing confirmatory and supportive findings while excluding other etiologies, and noninflammatory cerebrospinal fluid were common in most SCI cases. In the validation cohort, only 9 of 280 patients (3.2%) met criteria for possible SCI and none met criteria for probable SCI, suggesting the validation of the proposed criteria.
Continuing Medical Education
Serum Neurofilament Light Levels After Cardiac Arrest
Prognosticating long-term neurologic outcomes after cardiac arrest is an important and challenging aspect of patient management in critical care units. Using a novel, ultrasensitive assay with an automated method for quantifying serum neurofilament light (NFL) levels, Moseby-Knappe and coauthors analyzed biobank data from 717 patients (580 men [80.9%]; median [interquartile range] age, 65 [56-73] years) at 29 sites. Median serum NFL levels at 24 to 72 hours after cardiac arrest were higher in patients with poor neurologic outcomes compared with patients with good outcomes. Serum NFL levels were more sensitive than other biochemical serum markers, such as tau, neuron-specific enolase, and S100, suggesting that measurement of serum NFL levels could improve management of care for patients following cardiac arrest.
Highlights. JAMA Neurol. 2019;76(1):3. doi:10.1001/jamaneurol.2018.2966
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