- Email: [email protected]
National Stroke Association guidelines for the management of transient ischemic attacks
T
identified 48 patients with CAD (32 ICAD and 18 VAD). In Olmsted County, the average annual incidence rate for ICAD was 1.72 per 100,000 population (95% confidence interval [CI], 1.13 to 2.32) and for VAD 0.97 per 100,000 population (95% CI, 0.52 to 1.4). The average annual incidence rate for CAD was 2.6 per 100,000 population (95% CI, 1.86 to 3.33). The most frequently encountered symptoms in CAD were head or neck pain (80%), cerebral ischemia (TIA or infarct) (56%), and Horner syndrome (25%). Good outcome (defined as modified Rankin score of 0 to 2) was seen in 92% of patients. No recurrence of dissection was observed during a mean 7.8 years of followup.—Valérie Biousse
HE UPPER LIMIT OF NORMAL RECUMBENT CSF OPENING
pressure is around 20 cm CSF, although an upper limit of 25 cm is also suggested in many studies. The influence of body mass index on CSF opening pressure remains controversial. In this study, the author prospectively recorded CSF opening pressure in 242 adults who had a lumbar puncture with concomitant measurement of weight and height. The 95% reference interval for lumbar CSF opening pressure was 10 to 25 cm CSF. The authors conclude that body mass index has a small but clinically insignificant influence on CSF opening pressure, and emphasize that intracranial hypertension should be diagnosed only in patients with a CSF opening pressure greater than 25 cm CSF.—Valérie Biousse
*B. Mokri, Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; e-mail: [email protected]
*W. Whiteley, Bramwell Dott Building, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburg, EH4 2XU, United Kingdom; e-mail: [email protected]
●
National Stroke Association guidelines for the management of transient ischemic attacks. Johnston SC,* Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA, Hankey GJ, Hart RG, Levine SR, Biller J, Brown RD JR, Sacco RL, Kappelle LJ, Koudstaal PJ, Bogousslavsky J, Caplan LR, van Gijn J, Algra A, Rothwell PM, Adams HP, Albers GW. Ann Neurol 2006;60:301– 313.
●
Rosai-Dorfman disease presenting with widespread intracranial and spinal cord involvement. Kidd DP,* Revesz T, Miller NR. Neurology 2006;67:1551–1555.
R
OSAI-DORFMAN DISEASE IS ASSOCIATED WITH A HIS-
tiocytic infiltration of lymphoid tissue, but may also involve the orbit, nasopharynx, respiratory pathways, gastrointestinal tract, endocrine glands (particularly the thyroid), bone, and skin. Neurologic and ocular manifestations are rare (about 4%). In this article, the authors describe two cases with central nervous system and anterior visual pathway involvement, and review the literature regarding the ocular and neurologic manifestations of this disorder.—Valérie Biousse
T
*D. P. Kidd, Department of Clinical Neurosciences, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom; e-mail: [email protected]
*S. C. Johnston, Department of Neurology, Box 0114, University of California San Francisco, 505 Parnassus Avenue, M-798, San Francisco, CA 94143; e-mail: [email protected]
●
Incidence and outcome of cervical artery dissection: A population-based study. Lee VH, Brown RD JR, Mandrekar JN, Mokri B.* Neurology 2006;67:1809 –1812.
S
●
Individuals homozygous for the age-related macular degeneration risk-conferring variant of complement factor H have elevated levels of CRP in the choroid. Johnson PT,* Betts KE, Radeke MJ, Hageman GS, Anderson DH, Johnson LV. PNAS 2006;103:17456 –17461.
PONTANEOUS INTERNAL CAROTID ARTERY DISSECTION
is a classic cause of stroke and isolated Horner syndrome. Incidence rates for internal carotid artery dissection (ICAD) have been reported to be 2.6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery dissection (VAD) are not available. The aim of this study was to determine the incidence rate of cervical artery dissection (CAD) in a defined population. The authors used the medical record linkage system of the Rochester Epidemiology Project to identify all patients diagnosed with spontaneous ICAD and VAD for the period of 1987 to 2003 in Olmsted County, Minnesota, USA. They
544
AMERICAN JOURNAL
RANSIENT ISCHEMIC ATTACKS (TIAS), INCLUDING TRAN-
sient retinal ischemia, are common and important harbingers of subsequent stroke. This article, written by a group of experts, presents evidence-based guidelines for the management of patients with TIAs. They include up-to-date recommendations for initial management, evaluation, medical treatment, surgical treatment, and risk factor management and should be read by any physician encountering patients with TIAs.—Valérie Biousse (See comment in Comment in: Ann Neurol 2006;60: 273–274).
P
OLYMORPHISMS IN THE COMPLEMENT FACTOR H
gene (CFH) are associated with a significantly increased risk for, or protection against, the development of age-related macular degeneration (AMD). The most documented risk-conferring single-nucleotide polymorphism results in a tyrosine-to-histidine substituOF
OPHTHALMOLOGY
MARCH 2007
identified 48 patients with CAD (32 ICAD and 18 VAD). In Olmsted County, the average annual incidence rate for ICAD was 1.72 per 100,000 population (95% confidence interval [CI], 1.13 to 2.32) and for VAD 0.97 per 100,000 population (95% CI, 0.52 to 1.4). The average annual incidence rate for CAD was 2.6 per 100,000 population (95% CI, 1.86 to 3.33). The most frequently encountered symptoms in CAD were head or neck pain (80%), cerebral ischemia (TIA or infarct) (56%), and Horner syndrome (25%). Good outcome (defined as modified Rankin score of 0 to 2) was seen in 92% of patients. No recurrence of dissection was observed during a mean 7.8 years of followup.—Valérie Biousse
HE UPPER LIMIT OF NORMAL RECUMBENT CSF OPENING
pressure is around 20 cm CSF, although an upper limit of 25 cm is also suggested in many studies. The influence of body mass index on CSF opening pressure remains controversial. In this study, the author prospectively recorded CSF opening pressure in 242 adults who had a lumbar puncture with concomitant measurement of weight and height. The 95% reference interval for lumbar CSF opening pressure was 10 to 25 cm CSF. The authors conclude that body mass index has a small but clinically insignificant influence on CSF opening pressure, and emphasize that intracranial hypertension should be diagnosed only in patients with a CSF opening pressure greater than 25 cm CSF.—Valérie Biousse
*B. Mokri, Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; e-mail: [email protected]
*W. Whiteley, Bramwell Dott Building, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburg, EH4 2XU, United Kingdom; e-mail: [email protected]
●
National Stroke Association guidelines for the management of transient ischemic attacks. Johnston SC,* Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA, Hankey GJ, Hart RG, Levine SR, Biller J, Brown RD JR, Sacco RL, Kappelle LJ, Koudstaal PJ, Bogousslavsky J, Caplan LR, van Gijn J, Algra A, Rothwell PM, Adams HP, Albers GW. Ann Neurol 2006;60:301– 313.
●
Rosai-Dorfman disease presenting with widespread intracranial and spinal cord involvement. Kidd DP,* Revesz T, Miller NR. Neurology 2006;67:1551–1555.
R
OSAI-DORFMAN DISEASE IS ASSOCIATED WITH A HIS-
tiocytic infiltration of lymphoid tissue, but may also involve the orbit, nasopharynx, respiratory pathways, gastrointestinal tract, endocrine glands (particularly the thyroid), bone, and skin. Neurologic and ocular manifestations are rare (about 4%). In this article, the authors describe two cases with central nervous system and anterior visual pathway involvement, and review the literature regarding the ocular and neurologic manifestations of this disorder.—Valérie Biousse
T
*D. P. Kidd, Department of Clinical Neurosciences, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom; e-mail: [email protected]
*S. C. Johnston, Department of Neurology, Box 0114, University of California San Francisco, 505 Parnassus Avenue, M-798, San Francisco, CA 94143; e-mail: [email protected]
●
Incidence and outcome of cervical artery dissection: A population-based study. Lee VH, Brown RD JR, Mandrekar JN, Mokri B.* Neurology 2006;67:1809 –1812.
S
●
Individuals homozygous for the age-related macular degeneration risk-conferring variant of complement factor H have elevated levels of CRP in the choroid. Johnson PT,* Betts KE, Radeke MJ, Hageman GS, Anderson DH, Johnson LV. PNAS 2006;103:17456 –17461.
PONTANEOUS INTERNAL CAROTID ARTERY DISSECTION
is a classic cause of stroke and isolated Horner syndrome. Incidence rates for internal carotid artery dissection (ICAD) have been reported to be 2.6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery dissection (VAD) are not available. The aim of this study was to determine the incidence rate of cervical artery dissection (CAD) in a defined population. The authors used the medical record linkage system of the Rochester Epidemiology Project to identify all patients diagnosed with spontaneous ICAD and VAD for the period of 1987 to 2003 in Olmsted County, Minnesota, USA. They
544
AMERICAN JOURNAL
RANSIENT ISCHEMIC ATTACKS (TIAS), INCLUDING TRAN-
sient retinal ischemia, are common and important harbingers of subsequent stroke. This article, written by a group of experts, presents evidence-based guidelines for the management of patients with TIAs. They include up-to-date recommendations for initial management, evaluation, medical treatment, surgical treatment, and risk factor management and should be read by any physician encountering patients with TIAs.—Valérie Biousse (See comment in Comment in: Ann Neurol 2006;60: 273–274).
P
OLYMORPHISMS IN THE COMPLEMENT FACTOR H
gene (CFH) are associated with a significantly increased risk for, or protection against, the development of age-related macular degeneration (AMD). The most documented risk-conferring single-nucleotide polymorphism results in a tyrosine-to-histidine substituOF
OPHTHALMOLOGY
MARCH 2007