Neurology
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Childhood periodic syndromes are thought to be early life expressions of the genetic tendency for migraine. The objective of this study was to determine whether maternal migraine is associated with an increased risk of infant colic, because this may indicate that colic is a childhood periodic syndrome. ⋯ Maternal migraine is associated with increased risk of infant colic. Because migraine has a strong genetic underpinning, this association suggests that colic may be an early life manifestation of migraine.
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This review provides a summary of the currently available data pertaining to the interventional management of acute ischemic stroke in children. The literature is scarce and is lacking much-needed prospective trials. ⋯ The current review is limited to case series of interventional acute ischemic stroke therapy in children and the potential future of endovascular ischemic stroke therapy in this patient population. Recommendations in this review represent the opinion of the authors, based on review of the limited literature covering endovascular acute ischemic stroke therapy in children.
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Energy production for the maintenance of brain function fails rapidly with the onset of ischemia and is reinstituted with timely reperfusion. The key bioenergetic organelle, the mitochondrion, is strongly affected by a cascade of events occurring with ischemia and reperfusion. ⋯ The impact of perturbed bioenergetics on cellular homeostasis/function during and after ischemia are discussed. Because mitochondrial function can be compromised by derangements at more than one of the susceptible sites on this organelle, we propose that a combination therapy is needed for the restoration and maintenance of cellular bioenergetics after reperfusion.
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Though rarely considered in the clinical decision algorithm, issues of cost-effectiveness assume critical importance for the sustainability of a widely used therapy that entails considerable cost and has unproven benefit. Although current data are limited, we review the studies that have demonstrated via modeling that endovascular stroke treatment may generate significant future economic benefits, even if these treatments have a high price and result in relatively small initial reductions in disability. We highlight important considerations that, on the basis of the logistics and protocols of current neuroendovascular practices, should be included in future cost-effectiveness analyses of endovascular therapy for acute ischemic stroke.