Most dizzy strokes here had no nystagmus

The edition in brief

Acute imbalance syndrome: in 75 emergency patients with MRI-proven stroke causing vertigo, dizziness or imbalance, 58.7% had no spontaneous nystagmus and presented with postural or gait imbalance, against 38.7% with the classic acute vestibular syndrome. Imbalance-type strokes clustered in the anterior cerebellum and deep nuclei; nystagmus-type strokes in the posterior cerebellum and flocculonodular lobe. Bedside algorithms built on nystagmus would not apply to the larger group. Tenecteplase in posterior circulation stroke: five studies and 997 patients showed no difference from alteplase in functional independence (RR 1.10, 0.89–1.37), symptomatic haemorrhage or mortality, with a possible gain in ambulatory outcome (mRS 0–3, RR 1.29) and pre-thrombectomy reperfusion. Aducanumab: an exploratory analysis of phase 3 participants found those whose amyloid cleared by week 78 declined less to week 134 and after a treatment gap, with about two-thirds declining by under one point a year on the CDR Sum of Boxes. Preclinical Alzheimer's: a Lancet Neurology review sets out the ethical, accuracy and system questions raised by biomarker testing in cognitively unimpaired people while prevention trials of anti-amyloid therapy are still running.