Intensive BP control safe in cerebral small vessel disease

Intensive blood pressure lowering is feasible and does not accelerate white matter damage or worsen outcomes in people with cerebral small vessel disease, a UK study has shown.

In the PRESERVE trial, 111 patients with MRI confirmed symptomatic lacunar infarct and confluent white matter hyperintensities and were randomized to standard  or intensive BP lowering, which achieved average changes of −15.3 and −23.1mmHg systolic BP.

Intensive blood pressure lowering was not associated with progression of white matter damage on diffusion tensor imaging or magnetic resonance imaging over 24 months follow up, according to results published in Stroke.

“This is important because BP lowering not only protects the brain but also reduces risk of cardiovascular end points in other vascular beds,” said researchers led by Professor Hugh Hugh Markus, of the Neurology Unit, University of Cambridge.

The study also showed that MRI markers were more sensitive to change over short time periods than cognitive testing in SVD.

‘Black fungus’ rhinocerebral mucormycosis in COVID-19 patients

Neurologists in India are seeing thousands of cases of coronavirus disease-associated rhinocerebral mucormycosis  – the so-called ‘black fungus’, as the country’s hospitals struggle to manage widespread outbreaks of the Kappa variant of COVID-19. A report in Lancet Respiratory Medicine says India has already seen hundreds of deaths from mucormycosis, which seems to be associated with use of corticosteroids for immunosuppression as well as diabetes.

The Indian Council of Medical Research has released guidelines for the screening, diagnosis, and management of mucormycosis in patients with COVID-1, which recommend neurologist involvement in multidisciplinary teams to manage the fungal infection.

Racial cognitive discrimination ended for American football players

The governing body for professional American football , the NFL, has dropped the use of “race-norming”, which reduced Black players’ cognitive test scores and rendered many ineligible for compensation payouts for concussion and other neurodegenerative conditions.

The practice came to light when former players had a diagnosis of dementia reversed after the NFL ordered doctors to use ‘race normed’ cognitive scores that assumed they had lower average cognitive function than white players.

Black athletes accused the NFL of racially discriminating against former players claiming from a compensation fund for people diagnosed with dementia, Parkinson’s, ALS, and other brain diseases linked to repeated head trauma.