The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use.

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Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

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Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

The International Panel on MS Diagnosis presents revised diagnostic criteria for multiple sclerosis (MS). The focus remains on the objective demonstration of dissemination of lesions in both time and space. Magnetic resonance imaging is integrated with dinical and other paraclinical diagnostic methods. The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including "monosymptomatic" disease suggestive of MS, disease with a typical relapsing-remitting course, and disease with insidious progression, without clear attacks and remissions. Previously used terms such as "clinically definite" and "probable MS" are no longer recommended. The outcome of a diagnostic evaluation is either MS, "possible MS" (for those at risk for MS, but for whom diagnostic evaluation is equivocal), or "not MS."

https://www.onlinelibrary.wiley.com/doi/epdf/10.1002/ana.1032

Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the Diagnosis of Multiple Sclerosis

BackgroundNetrin-1, a secreted laminin-related protein, is known to regulate not only axonal guidance and neuronal cell migration, but also blood–brain barrier integrity and inflammation. Two preli...

Serum netrin-1 in relation to gadolinium-enhanced magnetic resonance imaging in early multiple sclerosis.

R. Bammer1, S. L. Keeling2, M. Augustin3, K.P. Pruessmann4, C. Leussler5, F. Ebner1, F. Fazekas1 1Magnetic Resonance Institute and Department of Neurology, University of Graz, Auenbruggerplatz 9, Graz, Austria; 2Department of Mathematics, University Graz, Heinrichstrase 36, Graz, Austria; 3Department of Radiology, University of Graz, Auenbruggerplatz 9, Graz, Austria ; 4Institute of Biomedical Engineering, ETH Zurich, Zurich, Switzerland; 5Philips Research Lab, Rontgenstrasse 24, Hamburg, Germany;

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Improved diffusion-weighted single-shot EPI in stroke using SENSE

Thirteen months later, in November 2002, she was referred for treatment of a carotid restenosis. The patient had been asymptomatic since the first procedure. When assessed at our institution, the patient showed a residual mild, right hemiparesis. Doppl er ultrasound revealed 80% stenosis of the left ICA and common carotid artery (CCA). There was also a high-grade left external carotid artery stenosis. The vessels of the posterior circulation appeared normal. Transcranial Doppler (TCD) studies revealed reduced left middle cerebral artery (MCA) flow velocities (VL; left MCA: VL systolic 0.8 m/s, VL diastolic 0.35 m/s; right MCA: VL systolic 1.2 m/s, VL diastolic 0.4 m/s). There was no evidence of any extraintracranial collateral vascularization or cross-flow to the left ICA territory via the circle of Willis. Brain CT revealed a parenchymal defect after ICH in the left frontoparietal region. 99 Tc HMPAO-SPECT showed reduced radionuclide tracer uptake in the left ICA territory, which further decreased after acetazolamide challenge. Selective intra-arterial angiography revealed 1 80% left CCA stenosis and 1 50% left ICA stenosis according to NASCET ( fig. 1 ). The intracerebral angiogram was normal. Uneventful carotid artery stenting (CAS) was performed. On the first day after CAS, color Doppler ultrasound revealed normal VL in the region of the The term cerebral hyperperfusion syndrome (HS) was coined by Sundt et al. [1] in 1981 to describe a rare complication of carotid endarterectomy (CEA) which may appear with severe unilateral headaches, seizures and focal symptoms related to cerebral edema or intracerebral hemorrhage (ICH) and is considered to result from a major increase in ipsilateral cerebral blood flow above the metabolic demands of the brain. Obvious risk factors include long-standing hypertension, high-grade stenosis, poor collateral blood flow and contralateral carotid occlusion [2–4] . Several mechanisms such as a paralysis of cerebral autoregulatory mechanisms, a break-down of the baroreceptor-reflex and an axon-like trigeminovascular reflex have been implicated in the pathophysiology of hyperperfusion and in the evolution of the cerebral HS [2] . Once it is associated with ICH, the prognosis tends to be poor [2, 4] . We here illustrate the obvious role of endothelial damage in the development of intracerebral bleeding with the imaging findings in a rare case of a recurrent cerebral HS.

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Recurrent Hyperperfusion Syndrome and Intracerebral Hemorrhage after Recanalization of the Extracranial Carotid Artery

Complementary morphological information is a prerequisite for the detailed analysis of cerebral SPET studies. We therefore developed a technique which allows the alignment of SPET and magnetic resonance scans by imaging identical slices using external landmarks on an individually fitted mask and subsequent two-dimensional image processing for in-plane matching. Regional analysis of tracer activities can be performed directly on the superimposed SPET and MR outline images or by tracing a region of interest on the original MR scan with a parallel display on the matched SPET image, and vice versa. Tests assessing correct in-plane alignment using MRI, inter- and intra-variability of the matching procedure, and its comparability with an objectively determined best-matching position, confirmed the feasibility, accuracy and usefulness of this procedure

Morphology-oriented analysis of cerebral SPET using matched magnetic resonance images.

Background : Holmes’ tremor is characterized by a combination of rest, postural, and kinetic tremor that is presumably caused by interruption of cerebello-thalamo-cortical and nigrostriatal pathways. Medical treatment remains unsatisfactory. Case Report : A 16-year-old girl presented with Holmes’ tremor caused by a transient midbrain abnormality on magnetic resonance imaging (MRI). To explore the discrepancy between persistent tremor and resolved MRI changes, we performed dopamine transporter single-photon emission computed tomography (DaT-SPECT) with a 123I-ioflupane that revealed nearly absent DaT binding in the right striatum. Levodopa dramatically improved the tremor. Discussion : This is only the second report of a transient midbrain MRI abnormality disrupting nigrostriatal pathways. The case highlights the sometimes limited sensitivity of morphologic imaging for identifying the functional consequences of tissue damage and confirms that DaT imaging may serve as a predictor for levodopa responsiveness in Holmes’ tremor.

/pdf/levodopa-responsive-holmes-tremor-caused-by-a-single-lf1zcl492k.pdf

Franz Fazekas

Papers

Serum netrin-1 in relation to gadolinium-enhanced magnetic resonance imaging in early multiple sclerosis.

Improved diffusion-weighted single-shot EPI in stroke using SENSE

Recurrent Hyperperfusion Syndrome and Intracerebral Hemorrhage after Recanalization of the Extracranial Carotid Artery

Morphology-oriented analysis of cerebral SPET using matched magnetic resonance images.

Levodopa-responsive Holmes' Tremor Caused by a Single Inflammatory Demyelinating Lesion.