May is Stroke Awareness Month: Know the Signs!

David Langer, MD

A stroke is an injury to the brain caused by the obstruction of blood flow to a brain artery-usually by a blood clot or a direct bleed into the brain itself. It can be due to weakness in the vessel wall commonly caused by high blood pressure or cerebral aneurysm.

Stroke is the third leading cause of death and the number one cause of disability in the United States. Stroke or "brain attack" can occur in all ages and nearly one quarter of strokes occurs in people under age 65.

The warning signs of stroke include motor weakness, sensory change (i.e. numbness or tingling of the face, arm or leg), speech difficulty or visual disturbance. Pain is present only in patients with the hemorrhagic form of stroke (a bleed in the brain) which represents only 15 percent of all strokes.

For the most part, the treatment of hemorrhagic stroke remains conservative with therapeutic options to reverse brain injury being very limited. Treatment is surgical only when a blood clot in the brain becomes life threatening. Surgery or catheter-based neurointerventional procedures are often used in patients who suffer bleeds from cerebral aneurysms to prevent a second hemorrhage.

Neurointerventional treatments are becoming more common in treating patients with ischemic stroke-strokes caused by vessel blockage. Along with intravenous clot-busting drugs (called tPA), intra-arterial delivery of these same drugs, as well as new technologies such as intravascular suction catheters and sophisticated mechanical devices, are increasingly being used for patients who either fail medical therapy or who present outside the three-hour time window reserved for the administration of intravenous tPA. Full Post - to Detail View

Nicotine Patch May Help Memory Impairment

Marc Gordon, MD

Nicotine patches may ease mild cognitive impairment, according to a new study in the journal Neurology. Study participants showed improved attention plus improvements in secondary measures of attention, memory and thought-processing speed. But the research did not demonstrate a significant difference between nicotine and placebo on overall improvement.

The study was conducted with 74 non-smokers with amnestic mild cognitive impairment, who were randomly assigned to receive either nicotine patches or placebo patches for six months. Amnestic mild cognitive impairment is characterized by measurable impairment in memory without obvious functional disability. It may represent an intermediate stage between normal aging and mild Alzheimer's dementia. Alzheimer’s is associated with a deficiency of a neurotransmitter called acetylcholine, which sends signals between nerve cells by binding to specific receptors. Nicotine has the ability to bind to and activate some of these receptors.

The nicotine-treated group experienced weight loss, more adverse events and more discontinuations due to adverse events, but there were no severe adverse events, and overall, the nicotine patch appeared to be safe and relatively well-tolerated by the participants.

While these results are encouraging and justify further research into the potential therapeutic use of nicotine in mild cognitive impairment, it is important to bear in mind that this is a small, preliminary study. Full Post - to Detail View

Can Lower Body Mass Index Be an Early Sign for Alzheimer’s Disease?

Marc Gordon, MD

Obesity, a disease in itself, is a well known cause of other diseases. Midlife obesity, in particular, has been linked with an increased risk of late-life dementia and Alzheimer's disease. Interestingly, patients who have dementia due to Alzheimer's disease are actually more likely to be underweight.

The cause of this association has been unclear. It has been speculated that loss of body mass may be the result of dementia. This makes sense because dementia sufferers may simply be forgetting to eat. Or the inherent decrease in physical activity associated with dementia leads to loss of muscle mass. There is also the possibility that anti-Alzheimer’s medications has adverse effects on appetite.

However, according to a recent study published in Neurology, the authors were able to demonstrate a correlation between lower body mass index (BMI) and the presence of biomarkers suggestive of Alzheimer’s disease pathology on brain imaging and in cerebrospinal fluid. These patients had normal cognition or mild cognitive impairment (MCI).  Lower BMI in these subjects cannot be explained as a consequence of dementia since they do not have the disease. This leads researchers to suggest that there may be systemic changes in appetite or metabolism as an early manifestation of the disease process.  


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Headaches after Pediatric Traumatic Brain Injury

Noah Rosen, MD

More than half a million children in the United States sustain a traumatic brain injury (TBI) every year. In a recent study published by Pediatrics, researchers analyzed the prevalence of headaches three and 12 months after mild and moderate or severe TBI in children ages 5 to 17. Three months after a mild TBI, 43 percent of children reported headache, compared to 37 percent of children who had a moderate to severe TBI, and 26 percent of children in the control group. The risk of headache was highest in adolescents and in girls. The researchers concluded that the response to and recovery from TBI is different for children, adolescents and adults and that between boys and girls, there is a difference in symptoms and recovery from TBI.
This study is very important for several reasons. First of all, headaches in adolescents and teenagers are often ignored by parents and teachers until it has progressed to the point of disability. This study suggests early awareness and intervention. Secondly, headache disorders during this developmental period can have long term effects because teenagers can miss fundamental information in school that they will have difficulty catching up later. Lastly, undiagnosed post traumatic headache may increase risk for further damage if the teenager continues to play sports without addressing the issue.
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5 Ways Migraine Sufferers Can Keep Their Holidays Jolly

Noah Rosen, MD

From dealing with the endless lines while gift-shopping to burning the candle at both ends trying to attend all of the holiday parties, this time of year can be anything but jolly for migraine sufferers.

During the holiday season, we tend to sleep less, eat more and exercise less frequently – a bad combination that can trigger attacks in migraine sufferers. The good news is, you can prevent severe episodes of migraine by following this advice:
● Don’t skip meals. Empty stomachs can trigger headaches, so keep a regular and healthy eating schedule.

● Avoid common food triggers for migraine. Avoid things like ripe cheese, processed meat that include nitrates and chocolate.

● Maintain a regular sleep schedule. Stick to a regular sleep pattern by going to bed and waking up at the same time, even on the weekends. Lack of sleep can bring on migraines.

● Drink in moderation—if at all. Alternate alcoholic drinks with glasses of water and avoid red wine, since it contains an amino acid, which is a common migraine trigger.

● Shop early or online. The worst scenario for a migraine sufferer is to go shopping during peak time when the stores are hectic and hot. Try shopping earlier in the day to avoid the crowds and longer lines. Or better yet, shop online from the convenience of your own home.

Don’t forget about yourself.  With all of the holiday stress and busier than usual schedules, don’t forget to take time out for yourself and do whatever makes you happy--even if that means alone time or buying something for yourself.

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