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Abstract Introduction Comprehensive treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major clinical challenge. The current therapy gold standard is aciclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains around 20% and a majority of survivors suffer from severe disability. Experimental research and recent retrospective clinical observations suggest a favourable therapy response to adjuvant dexamethasone. Currently there is no randomized clinical trial evidence, however, to support the routine use of adjuvant corticosteroid treatment in HSVE. Methods The German trial of Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE) studied the effect of adjuvant dexamethasone versus placebo on top of standard aciclovir treatment in adult patients aged 18 up to 85 years with proven HSVE in German academic centers of Neurology in a randomized and double blind fashion. The trial was open from November 2007 to December 2012. The initially planned sample size was 372 patients with the option to increase to up to 450 patients after the second interim analysis. The primary endpoint was a binary functional outcome after 6 months assessed using the modified Rankin scale (mRS 0–2 vs. 3–6). Secondary endpoints included mortality after 6 and 12 months, functional outcome after 6 months measured with the Glasgow outcome scale (GOS), functional outcome after 12 months measured with mRS and GOS, quality of life as measured with the EuroQol 5D instrument after 6 and 12 months, neuropsychological testing after 6 months, cranial magnetic resonance imaging findings after 6 months, seizures up to day of discharge or at the latest at day 30, and after 6 and 12 months. Results The trial was stopped prematurely for slow recruitment after 41 patients had been randomized, 21 of them treated with dexamethasone and 20 with placebo. No difference was observed in the primary endpoint. In the full analysis set (n = 19 in each group), 12 patients in each treatment arm achieved a mRS of 0–2. Similarly, we did not observe significant differences in the secondary endpoints (GOS, mRS, quality of life, neuropsychological testing). Conclusion GACHE being prematurely terminated demonstrated challenges encountered performing randomized, placebo-controlled trials in rare life threatening neurological diseases. Based upon our trial results the use of adjuvant steroids in addition to antiviral treatment remains experimental and is at the decision of the individual treating physician. Unfortunately, the small number of study participants does not allow firm conclusions. Trial registration EudraCT-Nr. 2005–003201-81.

We report a 73-year-old patient with giant cell arteritis who presented with right arm paresis and dysarthria. Vasculitis of the vertebral arteries induced multiple ischemic cerebral lesions in the vertebrobasilar territory, ultimately leading to death despite intensive immunosuppressive therapy. This case illustrates that prompt relief from symptoms of giant cell arteritis upon steroid treatment does not correspond to a remission of the vasculitic process itself. Clinicians should therefore be aware of the possible occult involvement of the vertebral or other major arteries. [ABSTRACT FROM AUTHOR]

Zusammenfassung Trotz über 100 Stroke Units in Deutschland besteht in ländlichen Gebieten derzeit keine ausreichende stationäre Schlaganfallversorgung. Ziel des ?Telemedizinischen Pilotprojektes zur integrierten Schlaganfallversorung (TEMPiS)? ist daher eine flächendeckende Qualitätsförderung der Schlaganfallbehandlung in Südostbayern. Die 12 beteiligten Kooperationskliniken mit neu eingerichteten spezialisierten Schlaganfallstationen sind mittels Breitbandvideokonferenz und digitaler Bildübertragung telemedizinisch mit den Schlaganfallzentren in München-Harlaching und Regensburg vernetzt. Über die rund um die Uhr verfügbaren Telekonsultationen mit Patientenuntersuchung vor der Kamera kann die Beurteilung diagnostischer Fragestellungen und Festlegung des weiteren Prozederes gemeinsam erfolgen. Zur Evaluation der Effizienz werden in einer kontrollierten Vergleichsanalyse 5 repräsentative TEMPiS-Kooperationskliniken mit 5 Krankenhäusern entsprechender Größe, Ausstattung und Versorgungsregion verglichen. Für ca. ein Jahr werden in diesen Kliniken alle Schlaganfallpatienten prospektiv dokumentiert und neben Schlaganfallschweregrad und epidemiologischen Parametern die Behandlungsdaten festgehalten. Nach 3 bzw. 12 Monaten werden der primäre Endpunkt Tod/institutionalisierte Pflege sowie die funktionellen Outcome-Parameter modified Rankin Scale, Barthel-Index und EQ-5D erhoben. Der Patienteneinschluss hat im Juli 2003 begonnen. [ABSTRACT FROM AUTHOR]

Fibromyalgia (FM) is a disorder of unknown aetiology, characterized by chronic widespread pain, stiffness and sleep disturbances. In addition, patients frequently complain of memory and attention deficits. Accumulating evidence suggests that FM is associated with CNS dysfunction and with an altered brain morphology. However, few studies have specifically investigated neuropsychological issues in patients suffering from FM. We therefore sought to determine whether neuropsychological deficits found in FM patients may be correlated with changes in local brain morphology specifically in the frontal, temporal or cingulate cortices. Twenty FM patients underwent extensive testing for potential neuropsychological deficits, which demonstrated significantly reduced working memory and impaired non-verbal long-term memory (limited to free recall condition) in comparison with normative data from age- and education-matched control groups. Voxel-based morphometry (VBM) was used to evaluate for potential correlations between test results and local brain morphology. Performance on non-verbal working memory was positively correlated with grey matter values in the left dorsolateral prefrontal cortex, whereas performance on verbal working memory (digit backward) was positively correlated with grey matter values in the supplementary motor cortex. On the other hand, pain scores were negatively correlated with grey matter values in the medial frontal gyrus. White matter analyses revealed comparable correlations for verbal working memory and pain scores in the medial frontal and prefrontal cortex and in the anterior cingulate cortex. Our data suggest that, in addition to chronic pain, FM patients suffer from neurocognitive deficits that correlate with local brain morphology in the frontal lobe and anterior cingulate gyrus, which may be interpreted to indicate structural correlates of pain–cognition interaction. [ABSTRACT FROM AUTHOR]