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Some reports suggest that psychotic features may occur in the early stages of Parkinson’s disease (PD), but sensitive tools have not been utilized. The aim was to evaluate the presence of psychotic symptoms using detailed scales and to assess the association with clinical characteristics. Healthy controls and patients within three years of PD onset were recruited. Participants were examined for psychotic symptoms using two different instruments: the Comprehensive Assessment of At-Risk Mental States (CAARMS) and a 10 question PD specific psychosis severity scale (10PDQ). In the PD group, medication use, motor and non-motor symptoms were documented. Based on CAARMS and 10PDQ scales, psychotic features were present in 39% (27/70) of patients and 4% (3/74) of controls. The prevalence of passage hallucinations and illusions was significantly higher in PD compared to the control group. The presence of PD-associated psychotic features was not significantly affected by medication, motor severity or global cognitive status. Higher prevalence of overall non-motor manifestations, REM sleep behavior disorder (RBD) and depressive symptoms was significantly associated with the manifestation of psychotic features in PD [(adjusted OR:1.3; 95% CI:1.1-1.6; p = 0.003), (adjusted OR:1.3; 95% CI:1.0-1.6; p = 0.023), and (adjusted OR:1.2; 95% CI:1.0-1.4;p = 0.026)]. Psychotic phenomena mainly of minor nature are highly common in early PD. Cumulative non-motor symptoms, RBD and depressive features are associated with the presence of psychotic symptoms in this non-demented, early-stage PD population. More studies are needed to clarify the mechanisms that contribute to the onset of psychotic features in early PD.

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ABSTRACTHyperglycemia on hospital admission is a common phenomenon in acute ischemic stroke patients and represents an independent predictor of poor clinical outcome with or without acute recanalization therapies (systemic thrombolysis or mechanical thrombectomy). Effective restoration of normoglycemia is considered to be beneficial, but conclusive evidence from randomized controlled clinical trials and specific recommendations are lacking. In addition, aggressive glucose control can be complicated by hypoglycemia leading to early neurological deterioration. We conducted a systematic literature review with the aim of addressing several questions: timing of glucose control, target range, type of insulin delivery, duration and practicability of glucose-lowering protocols. Special issues regarding mechanical thrombectomy and glycemic variability can then be investigated in future trials which are also being considered.

Nontraumatic acute convexity subarachnoid hemorrhage (cSAH) is a common manifestation of cerebral amyloid angiopathy (CAA), but has been rarely reported in patients with CAA-related inflammation (CAA-ri).1,2

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Recurrent cerebrovascular events are frequent in medically treated patients with patent foramen ovale (PFO), but it still remains unclear whether PFO is a causal or an incidental finding. Further uncertainty exists on whether the size of functional shunting could represent a potential risk factor. The aim of the present study was to evaluate if the presence of PFO is associated with an increased risk of recurrent stroke or transient ischemic attack and to investigate further if this relationship is related to the shunt size.

Fatigue in multiple sclerosis (MS) may be attributed to a variety of biological and psychological factors. Scales addressing the multidimensionality of fatigue are used in MS evaluation, although adequacy of data on their reliability and validity is questionable. The aim of the present study was to provide evidence for the validity and reliability of the Greek version of the Modified Fatigue Impact Scale (MFIS). The MFIS was translated into Greek and administered to 99 MS patients and 75 controls. Exploratory factor analysis was carried out and reliability measures were calculated. Discriminant validity was also assessed. The mean MFIS score was 33.8 (SD 17.8). Two factors (physical and cognitive) were extracted through factor analysis; a psychosocial factor was not identified. Reliability measures (intraclass correlation coefficient, Cronbach’s , Pearson’s correlation) yielded high values. Patients and nonpatients differed statistically significantly in the MFIS scores; no statistically significant differences in MFIS score according to the type of MS were observed. It can be concluded that the Greek version of MFIS is valid and reliable, although questions about the scale dimensions remain. Further modifications and cultural adaptation of the scale may help create a useful tool for screening and assessment of fatigue in MS patients.

Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia.

Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy of transcranial Doppler screening at laboratories that share the same standardized scanning protocol.

Objective:We sought to determine the prevalence, radiological characteristics, and clinical outcomes of intracerebral hemorrhage (ICH) of undetermined etiology.Methods:Systematic review and meta-analysis of studies involving patients with spontaneous ICH was conducted to assess the prevalence and clinical-radiological characteristics of undetermined ICH. Additionally, we assessed the rates for ICH secondary to hypertensive arteriopathy (HTN-A) and cerebral amyloid angiopathy (CAA). Subgroup analyses were performed based on the use of a) etiology-oriented ICH classification, b) detailed neuroimaging, and c) Boston criteria among CAA-ICH.Results:24 studies were included (n=15,828; mean age: 64.8 years, males: 60.8%). The pooled prevalence of HTN-A ICH, undetermined ICH and CAA-ICH were 50% (95%CI: 43-58%), 18% (95%CI: 13-23%), and 12% (95%CI: 7-17%; p<0.001 between subgroups). The volume of ICH was largest in CAA-ICH 24.7mL (95%CI: 19.7-29.8mL), followed by HTN-A ICH 16.2mL (95%CI: 10.9-21.5mL) and undetermined ICH 15.4mL (95%CI: 6.2-24.5mL). Among patients with undetermined ICH, the rates of short-term mortality and intraventricular hemorrhage were 33% (95%CI: 25-42%) and 38% (95%CI: 28-48%), respectively. Subgroup analysis demonstrated a higher rate of undetermined ICH among studies that did not use an etiology-oriented classification (22%; 95%CI: 15-29%). No difference was observed between studies based on the completion of detailed neuroimaging to assess the rates of undetermined ICH (p=0.62).Conclusions:The etiology of spontaneous ICH remains undetermined among one in five patients in studies using etiology-oriented classification and among one in four patients in studies that avoid using etiology-oriented classification. The short-term mortality in undetermined ICH is high despite the relatively small ICH volume. Our findings suggest the use of etiology-oriented classification to approach ICH patients (Figure).

Primary polydipsia (PP) is etiologically associated with physical factors and psychiatric disorders (“psychogenic polydipsia”). We present the case of a 28-year-old man with severe symptoms of polydipsia and polyuria. After a comprehensive physical assessment, the only finding was a lesion suggestive of pituitary microadenoma in the magnetic resonance imaging (MRI) scan of the brain. A thorough clinical and diagnostic assessment and the administration of a wide range of psychometric tools revealed no major psychiatric disorder apart from chronic anxiety and mild depressive symptoms. Our patient’s PP symptoms might be associated with a dysfunction of the thirst center, which is located closely to the neuroanatomical lesion found in the MRI scan. Given that the underlying pathophysiology of PP remains, to a large extent, unclear, we emphasize on the difficulties to distinguish between PP’s subtypes.

•In RRMS we detected no benefit from statin treatment as add-on to IFN-β.•Combination of statins with IFN-β was safe and well-tolerated.•Potential beneficial effects in SPMS, CIS and ON warrant further evaluation in future RCTs.

•Hydrocephalus is rarely reported in patients with diffuse glioma.•We describe a patient with a low-grade glioma presenting a complex phenotype initially masquerading as hydrocephalus of unknown etiology.•The exact pathophysiological mechanism underlying hydrocephalus in the setting of diffuse glioma remains to be elucidated.•Caution is advised regarding hydrocephalus of unknown etiology, reevaluation is necessary.