Neurology
Anticoagulation reduced stroke and bleeding composite in atrial fibrillation at intermediate risk
A randomised trial supports the class IIa recommendation for a CHA2DS2-VASc score of 1 in men or 2 in women; repeat thrombolysis within 90 days looks feasible in a small case series; and consensus guidance puts function before sedation in Alzheimer agitation.
Atorvastatin in over-70s cut cardiovascular events by 30% but did not extend disability-free survival
STAREE settles one half of the statin question in older adults; a Korean registry shows recurrence after artery dissection is concentrated in the first week; and higher p-tau217 went with worse cognition in late-onset epilepsy.
Raised serum GFAP was linked to near-term MS progression without relapses
Two cohorts of 2,329 people with MS tie serum GFAP to near-term progression independent of relapse activity; psychosocial stress carried a 27% higher risk of first stroke across 84 studies; and dementia prevalence in South and Southeast Asia appears to be climbing.
Factor XIa inhibition cut recurrent stroke by a quarter without a significant rise in bleeding
A meta-analysis of three trials (14,239 patients) found adding a factor XIa inhibitor to antiplatelets after non-cardioembolic stroke or TIA reduced stroke recurrence. Also: lamotrigine levels fall by two-thirds in pregnancy, lecanemab's plasma biomarker signature, AI for LVO on plain CT, and atogepant against topiramate.
In 15,900 pregnancies on antiseizure drugs, topiramate and polytherapy were linked to the smallest babies, lamotrigine to the least effect
EURAP adds fetal growth to the malformation and neurodevelopment data that shape preconception choices. Also: dementia follows TIA far more often than stroke does, stroke incidence in young adults nearly doubled over 27 years, the AAN's evidence review for migraine prevention, cholinesterase inhibitors in Lewy body dementia with bradycardia, and a carbamazepine recall.
Intensive blood pressure lowering after ICH cuts recurrent haemorrhage by more than half
An individual-patient meta-analysis of 2944 ICH survivors found intensive blood pressure control reduced recurrent stroke by 38%, driven by fewer repeat bleeds, with benefit visible within about six months. Also: the AAN/AHS migraine prevention guideline, a weekly self-injected complement inhibitor in myasthenia, and tirofiban in branch atheromatous disease.
HINTS works only in the right patient: continuous dizziness with nystagmus at rest
A JAMA Neurology review sets out when the bedside test is valid and when it misleads. Also: halving LDL after stroke, antithrombotics during thrombectomy for tandem lesions, and whether levodopa causes freezing of gait.
Thrombolysis out to 24 hours works on imaging selection — and triples symptomatic bleeding
A meta-analysis of 4,944 patients quantifies both sides of the extended thrombolysis window, a Bayesian synthesis puts neurocysticercosis behind a quarter of seizures in endemic regions, and an MC1R variant carried by most Europeans marks faster Parkinson's progression.
A recent stroke need not block thrombolysis, and CHA2DS2-VASc 1 gets its first randomised answer
Pooled individual-patient data on repeated thrombolysis found no symptomatic haemorrhage; a Korean trial randomised intermediate-risk atrial fibrillation to anticoagulation or nothing; and a half-million-person cohort points at carbon monoxide behind the smoking-Parkinson association.
After a dissection, almost all the recurrence happens in the first week
A Korean registry of 711 dissections puts 17.4% of one-year recurrences inside seven days and identifies the double lumen as the early-risk morphology; a small trial shrinks intracranial stenosis with alirocumab; and the 2024 McDonald criteria meet the clinics that must apply them.
Thrombolysis before thrombectomy may help only the larger infarcts
A BRIDGE-TNK post hoc analysis finds tenecteplase benefit confined to ASPECTS under 8, with a mortality signal above it; TEMPO-2 finds no subgroup of minor stroke that benefits; and failing to lower neurofilament in year one predicts relapse even in patients looking stable.
Factor XIa inhibition cuts recurrent stroke by a quarter without a bleeding penalty, and lamotrigine levels fall by two-thirds by 32 weeks
A meta-analysis of three randomised trials puts numbers on factor XIa inhibitors added to antiplatelet therapy after noncardioembolic stroke; a 947-woman cohort quantifies how far antiseizure drug concentrations fall in pregnancy, drug by drug; carbamazepine tablets are recalled for manufacturing deviations; and atogepant beats topiramate head to head on both tolerability and efficacy.
Polytherapy in pregnancy was associated with 50% more small-for-gestational-age babies in a 15,893-birth registry
EURAP adds fetal growth to the counselling list for antiseizure drugs, the AAN–AHS review grades the evidence for every migraine preventive, and serum GFAP tracked progression independent of relapses in two MS cohorts.
Intensive blood pressure lowering after intracerebral haemorrhage cut recurrent stroke by about a third
Individual data from four trials show the benefit comes mainly from fewer repeat bleeds, within about six months. Also: new AAN/AHS migraine prevention guidance, antiseizure drug choice with DOACs, tirofiban in branch atheromatous disease and a weekly complement inhibitor for myasthenia.
Depression in cerebral amyloid angiopathy is fifteen times more likely, and it tracks the cortex
A two-site study finds depressive symptoms in CAA are common, correlate with siderosis and cortical thinning, and mediate part of the cognitive deficit. Plus what plasma p-tau217 timing really predicts, and a marker of reperfusion injury after thrombectomy.
Thrombolysis out to 24 hours buys function and costs bleeds, and levodopa is cleared of causing freezing
Fourteen trials and 4,944 patients: imaging-selected thrombolysis beyond 4.5 hours raises excellent outcomes (OR 1.43) and symptomatic haemorrhage (OR 2.51). Meanwhile two cohorts totalling 27,000 patients find the levodopa-freezing association disappears once disease duration and severity are accounted for.
APOE changes what a plasma p-tau217 result means, and distal occlusions get their own syndrome
Genotype modifies both the risk and the timing that a p-tau217 concentration predicts; menopausal hormone therapy tracks with less Alzheimer pathology at autopsy; autoimmune disease clusters in the two years before myasthenia; and ASTCT regrades immune effector cell neurotoxicity.
Prognosis at the first attack in MS, and a brain-age score that helps only before impairment
Eight outcomes predicted from the first demyelinating event in 1,288 patients, brain-predicted age tested against visual rating, demyelination quantified in cervical myelopathy, and network disruption that forecasts seizure recurrence years after surgery.
An MMSE cutoff is deciding who gets anti-amyloid therapy, and it is the wrong instrument
Most patients with atypical Alzheimer's disease fail eligibility on a bedside score rather than on disease stage; a pigmentation gene marks faster Parkinson's progression; and chronic subdural haematoma moves beyond the burr hole.
Tailoring blood pressure to the patient during thrombectomy did not help
DETERMINE randomised 433 patients to a mean arterial pressure held within 10% of their own pre-procedure value, or the standard 140–180 mmHg systolic band, and found no difference at 90 days. Plus low-dose ticagrelor against clopidogrel for early deterioration, cannabinoids in dementia, a second carbamazepine recall, and middle meningeal artery embolisation.
Steroids in herpes encephalitis: still no signal, either way
A pooled analysis finds no benefit and no clear harm from adjunctive corticosteroids in HSV encephalitis, on 209 patients in total. Plus exhaled carbon monoxide and Parkinson's risk, how the AChR antibody assay changes the answer, a carbamazepine recall, and the AAN's updated evidence on migraine prevention.
Lamotrigine levels fall by two-thirds by the third trimester, and treating amyloid neuropathy early beats treating it well
A 947-woman Chinese cohort quantifies how far each antiseizure drug drops in pregnancy, CSF amyloid tracks the severity of cerebral amyloid angiopathy better than microbleed counts, and plasma p-tau217 explains part of the cognitive decline in late-onset unexplained epilepsy.
Anticoagulation earns its place at CHA2DS2-VASc 1, and cholinesterase inhibitors stop being off-limits in Lewy body dementia
A Korean randomised trial tests the guideline's weakest recommendation and finds in favour of treating, a Lancet Neurology review dismantles the cardiac argument for withholding donepezil in dementia with Lewy bodies, and the 2024 McDonald criteria are examined as an intervention rather than a document.
Blood pressure control after intracerebral haemorrhage cuts recurrence by a third
RECAP-ICH pooled individual data from 2,944 survivors of spontaneous intracerebral haemorrhage: an 11 mmHg systolic difference cut recurrent stroke by 38% and recurrent haemorrhage by 61%, with benefit measurable within six months. Plus atogepant beats topiramate head to head, and topiramate in pregnancy carries a growth cost.
After intracerebral haemorrhage, blood pressure control is the treatment
Pooled patient-level data show intensive blood pressure lowering cuts recurrent stroke by 38% after intracerebral haemorrhage, atogepant beats topiramate head-to-head for migraine prevention, and topiramate in pregnancy costs nearly 12 birthweight centiles.