Current issue of Apollo Medicine with a focus on advances in Neurosciences covers wide ranging subjects across both disciplines of neurology and
neurosurgery
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Editorial
Current issue of Apollo Medicine with a focus onadvances in Neurosciences covers wide rangingsubjects across both disciplines of neurology andneurosurgery
In Neurology section, two reviews pertain to the challenges
commonly faced by a clinician in management of acute
ischemic stroke, namely time constraints in the initiation of
intravenous thrombolysis and inability to reliably predict
outcome. Expanding the treatment window for intravenous
thrombolysis to beyond 3 h has increased the number of pa-
tients who can now avail and benefit from this treatment.
Recently published results of SITSeISTR trial are encouraging
anddemonstrateefficacyandsafetyof treatmentwithin3e4.5h
compared to treatmentwithin 3h.Additionallya smaller cohort
treated within 4.5e6 h did not have a worse outcome. But sig-
nificant observation that increase in time of stroke onset to
treatment leads to higher rates of symptomatic ICH and poorer
outcome, underscores the need for further investigation.
Natriuretic peptides have diagnostic and prognostic value
in cardiovascular disease. Currently BNP is a marker for
congestive heart failure. Emerging data shows that elevated
BNP differentiates cardio embolic stroke from other stroke
subtypes, MR pro-atrial natriuretic peptide identifies cardio
embolic strokes and is a potential independent predictor for
acute stroke functional outcome and mortality. Mechanisms
behind elevation of these peptides in the absence of con-
gestive cardiac failure require elucidation. Use of cardiac
biomarkers will help in optimizing treatment of stroke dur-
ing the acute phase and contribute to better functional
recovery.
Case report on tropical ataxic neuropathy highlights
impact of international travel on clinical practice in large
tertiary care hospitals in India and the need for increased
awareness of conditions unique to regions such as the Africa
and the middle east e that are the main source of patients
from outside India seeking medical care.
Neuromyelitis optica (NMO) has high frequency of organ
specific and non organ specific auto antibodies other than
AQP4 antibody. NMO also coexists with autoimmune disor-
ders such as SLE and Sjogren syndrome. But patients of SLE
and other auto immune disorders have NMO antibodies only
when they also have clinical features of NMO. This rare clin-
ical association described in one of the case reports provides
further insights into the pathogenesis of NMO.
Subhashni Prabhakar
Senior Consultant, Neurology Apollo Hospitals, Hyderabad, India
0976-0016/$ e see front matter
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All
rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.08.019
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