Volume 8 Issue 10, October 2012

Controversy exists over the treatment of brain arteriovenous malformations. A recent study suggests that, irrespective of clinical presentation, invasive treatment has no benefit over conservative management with regard to risk of seizure. Whether eradication is superior to medical management alone for those with seizures, headache and/or haemorrhage remains unsettled.

High platelet reactivity persists in many patients receiving antiplatelet therapy for secondary prevention of ischaemic stroke. Patient-tailored antiplatelet therapy, guided by platelet function tests, is an appealing approach for prevention of recurrent vascular events. However, a recent study has demonstrated that this strategy is associated with worse clinical outcomes.

The introduction of recombinant tissue-type plasminogen activator (tPA) revolutionized stroke treatment, but experimental studies have suggested potential toxic effects of this molecule on various components of the CNS. Two new studies have added further insight into the complex CNS effects of tPA following traumatic brain injury and brain ischaemia.

The understanding and treatment of medulloblastoma, the most common childhood malignant brain tumour, is rapidly evolving. Three complementary deep-sequencing studies that were recently published in Nature add to our knowledge of this disease, further refine risk stratification, and identify potential druggable targets.

One of the main challenges associated with diagnosis of Alzheimer disease (AD) is the identification and validation of blood-based biomarkers. Three recent studies describe different approaches to blood-based biomarker research in AD, and provide hope for a simple, minimally invasive means of diagnosis.

Megalencephaly syndromes are a spectrum of severe developmental neurological disorders associated with brain overgrowth. Two recent studies highlight the pathogenic role of somatic mutations in genes of the mTOR signalling pathway in the brains of patients with these conditions, providing hope for development of new treatments.

Treatments for the hereditary optic neuropathies, including Leber hereditary optic neuropathy and dominant optic atrophy, are limited. In this Review, Nancy Newman summarizes the natural history of hereditary optic neuropathies, and the role of mitochondrial dysfunction in their pathogenesis. She highlights recent advances in the treatment of these disorders, and indicates how insights into the hereditary optic neuropathies could have therapeutic implications for other disorders of presumed mitochondrial dysfunction.

Sepsis-associated encephalopathy (SAE) is a clinical syndrome that is associated with diffuse brain dysfunction and is secondary to infection in the body. Severity of SAE ranges from mild delirium to deep coma, and mortality reaches almost 70% in severe cases. In this Review, Gofton and Young provide an overview of the epidemiology and clinical presentation of SAE. They discuss current evidence relating to the pathophysiology and prognosis of SAE, and present a diagnostic approach and management strategy for patients with the disease.

Around half of all stroke survivors exhibit spatial neglect—a failure to report, respond to or orientate to contralesional stimuli. Current therapeutic approaches for spatial neglect focus largely on visual perceptual processing, but many patients respond poorly to such approaches because their main impairments lie in spatial motor 'aiming' function. Here, Barrett et al. highlight a promising alternative approach—prism adaptation treatment—that specifically targets spatial motor deficits.

Cranial radiation therapy (CRT) is commonly used to treat brain tumours but, in paediatric patients, this therapeutic strategy can lead to subsequent neurocognitive impairment. Padovani et al. discuss both the mechanisms underlying the effect of CRT on cognitive function and factors that can affect outcome. New approaches to correct or avoid CRT-induced neurotoxicity are also considered.