Antithrombotic-associated intracerebral hemorrhage (ICH) is associated with high rates of morbidity and mortality. Rapid and effective antithrombotic reversal is critical for mitigating risk of hemorrhage expansion and neurological deterioration. This review provides an overview of the most recent advances in emergency antithrombotic reversal in ICH. Rapid coagulopathy reversal within the first 60-90min of hospital presentation may limit massive ICH expansion and improve outcomes. Current data suggests reversal of vitamin K antagonists with intravenous vitamin K and 4-factor prothrombin complex concentrates (4f-PCC), reversal of dabigatran with idarucizumab, and reversal or direct oral factor Xa inhibitors with either 4f-PCC or andexanet-alfa. While platelet transfusion is not suggested for antiplatelet-associated ICH, DDAVP may be reasonable, and a new reversal agent is under development for ticagrelor. Rapid reversal of antithrombotic-associated coagulopathy in the context of ICH may prevent ICH expansion and improve neurological outcomes.

To review the pathophysiology, clinical presentation, evaluation methods, and current treatment strategies of nocturnal hypokinesia and early morning OFF in Parkinson's disease. A comprehensive literature search was conducted using PubMed, ScienceDirect, and the Cochrane Library for relevant treatment strategies. We identified 31 clinical trials. Pharmacologic treatments include standard and sustained-release levodopa, dopamine agonists (rotigotine, ropinirol, pramipexole, and apomorphine), MAO-B inhibitors (rasagiline, safinamide), COMT inhibitors (opicapone), and rescue therapies like inhaled or dispersible levodopa or apomorphine injection. We propose a tiered treatment algorithm based on disease stage and symptom severity. Non-pharmacological treatment is recommended in all stages. For mild, disturbing symptoms in early PD, inhaled or dispersible levodopa or apomorphine injection are advised. In moderate to advanced stages, treatment options include long-acting dopamine agonists, MAO-B inhibitors, sustained-release levodopa, or COMT inhibitors selected based on factors such as daytime motor symptoms, and non-motor symptoms.

This article aims to summarize the key evidence supporting the use of non-invasive neuromodulation devices in the treatment of various headache disorders in adults and children. Over the last decade, different modalities have emerged for the non-invasive management of various headache disorders, with increasing evidence in recent years demonstrating their safety and efficacy in the treatment of migraine and trigeminal autonomic cephalgias, as well as other headache disorders. These devices include external trigeminal nerve stimulation (eTNS), transcutaneous electrical nerve stimulator (TENS), single-pulse transcranial magnetic stimulation (sTMS), non-invasive vagus nerve stimulation (nVNS), remote electrical neuromodulation (REN), and external concurrent trigeminal and occipital nerve neurostimulation (eCOT-NS). These non-pharmacologic options for the management of headache are safe, have evidence to support their use, and they are a particularly appealing option for patients vulnerable to the side effects of pharmacologic treatments or those who are looking to avoid them.

This article reviews recent literature on the association between migraine and trauma, particularly adverse childhood experiences (ACEs). It makes recommendations for research and clinical practice. ACEs are prevalent and associated with lifetime morbidity and mortality. Observational studies have elucidated the association between migraine and ACEs. Emerging literature highlights a dose-dependent relationship between incident migraine and ACEs. ACEs have been linked with migraine-related outcomes in both children and adolescents as well as adults. However, the mechanisms linking ACEs to migraine remain poorly understood. Principles of, and approaches to, trauma-informed care in other populations can be drawn from, expanded, and extended to the context of migraine. We highlight the need for trauma-informed clinical care. We provide specific suggestions for how clinicians can integrate trauma-informed approaches in their clinical practice to improve patient outcomes. Finally, we make recommendations on how the field can advance research.

Infections as a risk factor for stroke remain an underrecognized issue within the medical community although this link was identified for more than 60 years. Preceding infections acting as triggers or even causal factors for ischemic and hemorrhagic stroke were assessed notably for tropical infections. Since the COVID 19 pandemic, the interest for all kind of infectious agents (bacteria, viruses, fungi, parasitosis) is becoming an emerging concern worldwide. Surprisingly, this risk is addressed only in classification of causes concerning young adults and children. In addition, the seasonality of meteorological conditions (temperature, humidity, rain patterns) probably obscured the underlying causes such as epidemic infections and air pollution peaks (which can act in synergy, notably for respiratory infections). Greater recognition of infection-related stroke risk is essential, especially given the potential for increased incidence driven by global warming, the availability of biomarkers for risk assessment, and the opportunities improving preventive and therapeutic strategies.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia notable for its association with the later development of diseases with pathological α-synuclein deposition, including Parkinson's Disease (PD), Dementia with Lewy Bodies (DLB), and Multiple System Atrophy (MSA). The goal of this review is to summarize the recent advances in characterizing the clinical deficits, neuroimaging characteristics, and biomarker assay development of individuals with RBD. Clinical research indicates that many people with RBD are presenting to clinical attention for reasons other than dream enactment behavior. They experience deficits in neuropsychiatric, autonomic, and motor domains and co-presentation of these features with RBD predict a faster rate of phenoconversion to PD, DLB, or MSA. RBD is considered a prodromal synucleinopathy with early abnormalities in α-synuclein protein pathways, together with inflammation and mitochondrial dysfunction being recognized as key pathophysiological mechanisms. Seed amplification assays for α-synuclein in various tissue types hold tremendous promise for antemortem diagnosis. RBD is clearly an at-risk population for neurodegenerative disease with well-defined measures that can refine enrollment and better target prodromal populations for interventional clinical trials. The first neuroprotective trials are underway.

A subset of patients with headache disorders presents with a dyscapnic state typically clinically symptomatic chronic respiratory alkalosis (CSCRA). CSCRA is well described as an important factor in increased neuromuscular irritability and reduces tissue oxygen delivery through reduction of cerebral blood flow (vasospasm) and left shift of the oxygen-hemoglobin dissociation curve, as well as increasing metabolic tissue oxygen demand all thought to be important factors in headache disorders. Novel testing paradigms that allow assessment of hypoxemia / orthodeoxia-platypnea include hypoxic echocardiography with bubble contrast to diagnose clinically significant right to left shunts (RLS). RLS (commonly through a patent foramen ovale (PFO)) is associated with migraine, particularly migraine with aura. We evaluate patients with an in-depth acid base analysis (including arterial blood gas analysis, comprehensive metabolic profile and urinalysis) and then pursue diagnostic evaluation of potential causative factors. Common causes of CSCRA include sleep disordered breathing, RLS (anatomic and capillary shunting), post-concussive states as well as post-viral or postoperative derangements of acid base status and associated with altered autonomic function. A focused diagnostic approach to discern the root cause for CSCRA may uncover treatable causes such as hypoxemia secondary to RLS or lung disease, sleep disorders and diaphragmatic dysfunction. The time-limited intervention with carbonic anhydrase to normalize acid base status and tissue carbon dioxide stores, as well as rehabilitation measures to normalize breathing patterns serve to normalize the acid base status, reduce neuromuscular irritability and reduce symptoms including headache.

Systemic therapy is particularly important for patients with recurrent or incompletely gross-total resected ependymoma. This study focuses on summarizing the systemic therapeutic strategies including molecular targeted therapy, immunotherapy and conventional chemotherapy in recent years, with a view to bringing more advanced treatment options to patients with ependymoma. In studies of systemic therapy for ependymoma, chemotherapy, although controversial, remains effective in patients with recurrent ependymoma. In targeted therapy, tyrosine kinase inhibitors, epigenetic agents and PARP inhibitors have shown promising antitumor activity in preclinical studies and some clinical trials. In immunotherapy, strategies such as immunological checkpoint inhibitors and CAR T cells therapy have shown potential therapeutic value in specific patient populations. Chemotherapy remains an important option for patients with recurrent ependymoma, and recent studies have revealed the great potential of targeted therapy and immunotherapy, suggesting that further in-depth studies on the optimization and combined application of targeted drugs and immunotherapy strategies, etc., can be conducted in the future.

The frontal cortex plays a key role in many functions considered to be relevant for consciousness. Furthermore, altered consciousness appears to exist in those with disorders that disrupt or damage frontal areas and/or networks. This article reviews recent research discussing the impact of frontal disorders on consciousness. Many theories of consciousness have been developed over the last century to help explain the neural correlates of consciousness. Some theories argue that the frontal cortex is necessary for consciousness, while others argue that posterior cortical regions are critical for consciousness. The Memory Theory of Consciousness argues that consciousness requires modality-specific localization throughout the brain. We argue that frontal disorders do not abolish consciousness but they may disrupt conscious abilities such as sustained attention, working memory, problem-solving, complex thought, executive function, response inhibition, decision-making, and goal-oriented behavior. Understanding the role of the frontal cortex in consciousness has significant scientific, clinical, and societal implications.

This review provides a comprehensive overview of the multidisciplinary management strategies available for intracranial meningiomas, with a focus on novel therapies. With the 2021 WHO classification of tumors of the Central Nervous System (CNS) came the introduction of molecular alterations impacting meningioma grading. As with other central nervous system tumors, the medical management of meningiomas is moving in the direction of targeted therapies. However, meningiomas display significant heterogeneity in their natural history and management options for advanced or recurrent tumor types are lacking. Meningioma management has advanced with refined surgical techniques, radiotherapy strategies, and emerging systemic therapies. Maximal safe resection remains the mainstay of treatment; however, several clinical challenges and unanswered questions persist. Ongoing investigations into targeted therapies and immunotherapies offer promising avenues, particularly for high-grade and recurrent cases.