Assessment of safety and feasibility of non-invasive vagus nerve stimulation for treatment of acute stroke.

BACKGROUND: Non-invasive vagus nerve stimulation (nVNS) using a hand-held stimulator placed on the neck is an FDA-approved treatment for primary headache disorders. The safety of nVNS is unknown in stroke patients. OBJECTIVE: To assess the safety and feasibility of nVNS for the acute treatment of stroke. METHODS: TR-VENUS (clinicaltrials.gov identifier NCT03733431) was a randomized, sham-controlled, open-label, multicenter trial conducted in patients with acute ischemic stroke (IS) or intracerebral hemorrhage (ICH). Patients were randomly assigned to standard-dose nVNS, high-dose nVNS, or sham stimulation. The primary endpoint was a composite safety outcome defined as bradycardia or reduction in mean arterial blood pressure during treatment or progression of neurological or death within 24 h of treatment. The feasibility endpoints were the proportion of eligible subjects receiving nVNS within 6 h of symptom onset and the proportion completing all pre-specified treatment doses. Efficacy assessments included infarct growth from baseline to 24 h after treatment. RESULTS: Sixty-nine patients (61 IS, 8 ICH) completed the study. The composite safety outcome was achieved in 32.0% in sham and 47.7% in nVNS group (p = 0.203). Treatment was initiated in all but two randomized patients. All dosed subjects received 100% of prespecified stimulations. A non-significant reduction in infarct growth was observed in the high-dose nVNS group (184.2% in sham vs. 63.3% in high-dose nVNS; p = 0.109). CONCLUSIONS: The results of this study suggest that nVNS may be safe and feasible in the setting of acute stroke. These findings support further development of nVNS as a potential treatment for acute ischemic stroke.

Why is Alzheimer disease confused with other dementias?

Alzheimer disease (AD) is the most common cause of dementia. The cardinal manifestation of AD is progressive loss of memory. However, there are some nonamnestic presentations of AD, also called atypical AD. Symptoms of AD can sometimes start suddenly. In the presence of atypical symptoms or sudden onset, it may be difficult to distinguish AD from other dementias. We would like to discuss the confusing features of atypical AD that mimic other dementias. In this review, the literature associated with confusing features of AD, suggesting other dementia syndromes, is reviewed. In addition, a case of semantic dementia (SD) with the complaint of forgetfulness previously diagnosed as AD is presented together with clinical and radiological clues of the differential diagnosis of dementia syndromes. As in our representative SD case, a careful clinical history, a detailed mental evaluation, and neuroimaging will overcome this difficulty in diagnosis.