Current issue of Apollo Medicine with a focus on advances in Neurosciences covers wide ranging subjects across both disciplines of neurology and

neurosurgery 

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Editorial

Current issue of Apollo Medicine with a focus onadvances in Neurosciences covers wide rangingsubjects across both disciplines of neurology andneurosurgery

In Neurology section, two reviews pertain to the challenges

commonly faced by a clinician in management of acute

ischemic stroke, namely time constraints in the initiation of

intravenous thrombolysis and inability to reliably predict

outcome. Expanding the treatment window for intravenous

thrombolysis to beyond 3 h has increased the number of pa-

tients who can now avail and benefit from this treatment.

Recently published results of SITSeISTR trial are encouraging

anddemonstrateefficacyandsafetyof treatmentwithin3e4.5h

compared to treatmentwithin 3h.Additionallya smaller cohort

treated within 4.5e6 h did not have a worse outcome. But sig-

nificant observation that increase in time of stroke onset to

treatment leads to higher rates of symptomatic ICH and poorer

outcome, underscores the need for further investigation.

Natriuretic peptides have diagnostic and prognostic value

in cardiovascular disease. Currently BNP is a marker for

congestive heart failure. Emerging data shows that elevated

BNP differentiates cardio embolic stroke from other stroke

subtypes, MR pro-atrial natriuretic peptide identifies cardio

embolic strokes and is a potential independent predictor for

acute stroke functional outcome and mortality. Mechanisms

behind elevation of these peptides in the absence of con-

gestive cardiac failure require elucidation. Use of cardiac

biomarkers will help in optimizing treatment of stroke dur-

ing the acute phase and contribute to better functional

recovery.

Case report on tropical ataxic neuropathy highlights

impact of international travel on clinical practice in large

tertiary care hospitals in India and the need for increased

awareness of conditions unique to regions such as the Africa

and the middle east e that are the main source of patients

from outside India seeking medical care.

Neuromyelitis optica (NMO) has high frequency of organ

specific and non organ specific auto antibodies other than

AQP4 antibody. NMO also coexists with autoimmune disor-

ders such as SLE and Sjogren syndrome. But patients of SLE

and other auto immune disorders have NMO antibodies only

when they also have clinical features of NMO. This rare clin-

ical association described in one of the case reports provides

further insights into the pathogenesis of NMO.

Subhashni Prabhakar

Senior Consultant, Neurology Apollo Hospitals, Hyderabad, India

0976-0016/$ e see front matter

Copyright ª 2013, Indraprastha Medical Corporation Ltd. All

rights reserved.

http://dx.doi.org/10.1016/j.apme.2013.08.019

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