The prevalence of cardiovascular diseases requiring long-term oral anticoagulation (OAC) is increasing, notably the incidence and prevalence of atrial fibrillation.^1,2 The most significant complication of OAC is intracerebral hemorrhage (ICH).³ Based on OAC-induced coagulopathy, large hematoma volumes and increased rates of hematoma enlargement are characteristics of OAC-associated ICH (OAC-ICH) and contribute to an even higher mortality when compared with ischemic stroke or primary ICH.^4-7

Reliable blood biomarkers for Alzheimer’s disease (AD) are missing. We measured astroglial GFAP in patients with AD ( n = 28), frontotemporal dementia (bvFTD, n = 35), Parkinson’s disease ( n = 11), Lewy body dementias ( n = 19), and controls ( n = 34). Serum GFAP was increased in AD ( p < 0.001) and DLB/PDD ( p < 0.01), and cerebrospinal fluid GFAP was increased in all neurodegenerative diseases ( p < 0.001). Serum GFAP correlated with the Mini-Mental State Examination score ( r= –0.42, p < 0.001) and might be a follow-up marker in clinical trials. Sensitivity and specificity of serum GFAP for AD versus bvFTD was 89% and 79% and might be the first blood biomarker in the differential diagnosis of AD and bvFTD.

Objective: The therapeutic effects of 4-aminopyridine (4AP) were investigated in a randomized, double-blind, crossover trial in 10 subjects with familial episodic ataxia with nystagmus. Methods: After randomization, placebo or 4AP (5 mg 3 times daily) was administered for 2 3-month-long treatment periods separated by a 1-month-long washout period. The primary outcome measure was the number of ataxia attacks per month; the secondary outcome measures were the attack duration and patient-reported quality of life (Vestibular Disorders Activities of Daily Living Scale [VDADL]). Nonparametric tests and a random-effects model were used for statistical analysis. Results: The diagnosis of episodic ataxia type 2 (EA2) was genetically confirmed in 7 subjects. Patients receiving placebo had a median monthly attack frequency of 6.50, whereas patients taking 4AP had a frequency of 1.65 (p = 0.03). Median monthly attack duration decreased from 13.65 hours with placebo to 4.45 hours with 4AP (p = 0.08). The VDADL score decreased from 6.00 to 1.50 (p = 0.02). 4AP was well-tolerated. Conclusions: This controlled trial on EA2 and familial episodic ataxia with nystagmus demonstrated that 4AP decreases attack frequency and improves quality of life. Level of evidence: This crossover study provides Class II evidence that 4AP decreases attack frequency and improves the patient-reported quality of life in patients with episodic ataxia and related familial ataxias.

Based on an age-adjusted incidence-rate for intracerebral hemorrhage (ICH) in high-income countries for the year 2010, it was estimated that cerebellar ICH affects approximately 35 000 patients annually within the European Union and the United States.^1-3 There have not been randomized trials of treatment interventions for patients with cerebellar ICH. Since 1984, surgical hematoma evacuation has been the preferred treatment approach, specifically in patients with larger hematomas and intraventricular involvement, given increased risk for brainstem compression and herniation.^4-8 However, evidence on the association between surgical hematoma evacuation and clinical outcomes after cerebellar ICH has been limited to small observational studies.^9,10 International guidelines including the American Heart Association/American Stroke Association guideline recommend surgical hematoma evacuation for cerebellar ICH with diameter greater than 3 cm to improve outcome; however, definite evidence to validate or refute this recommendation is currently not available.^4,9,10 As a result, there is no commonly accepted management strategy for cerebellar ICH and no general agreement regarding whether, when, and how these patients should undergo surgical intervention.^8,11 The purpose of this study was to assess the association of surgical hematoma evacuation with functional outcome and mortality in patients with cerebellar ICH.

At present, the flexible endoscopic evaluation of swallowing (FEES) is one of the most commonly used methods for the objective assessment of swallowing. This multicenter trial prospectively collected data on the safety of FEES and also assessed the impact of this procedure on clinical dysphagia management. Patients were recruited in 23 hospitals in Germany and Switzerland from September 2014 to May 2017. Patient characteristics, professional affiliation of the FEES examiners (physicians or speech and language therapists), side-effects and cardiorespiratory parameters, severity of dysphagia and clinical consequences of FEES were documented. 2401 patients, mean age 69.8 (14.6) years, 42.3% women, were included in the FEES-registry. The most common main diagnosis was stroke (61%), followed by Parkinson’s disease (6.5%). FEES was well tolerated by patients. Complications were reported in 2% of examinations, were all self-limited and resolved without sequelae and showed no correlation to the endoscopist’s previous experience. In more than 50% of investigations FEES led to changes of feeding strategies, in the majority of cases an upgrade of oral diet was possible. This study confirmed that FEES, even when performed by less experienced clinicians is a safe and well tolerated procedure and significantly impacts on the patients’ clinical course. Implementation of a FEES-service in different clinical settings may improve dysphagia care. ClinicalTrials.gov NCT03037762, registered January 31st 2017.