{"title":"Bridging the Gap Between Brain Health Guidelines and Real-world Implementation.","authors":"Daniel José Correa, Justin T Jordan, Rana R Said","doi":"10.1212/cont.0000000000001579","DOIUrl":"https://doi.org/10.1212/cont.0000000000001579","url":null,"abstract":"<p><strong>Abstract: </strong>With the increase in the public's attention to all aspects of brain health, neurologists need to understand their role in raising awareness, advocating for preventive strategies, and promoting brain health for all. This article examines the literature on the physical, mental, cognitive, and social health factors in promoting optimal brain function. In addition, it reviews various modifiable risk factors for neurologic injury, including cardiovascular health, nutrition, sleep, mental health, cognitive engagement, social interaction, and brain injury prevention. In all clinical neuroscience specialties, neurologists should adopt preventive approaches that consider brain health throughout the lifespan. This strategy includes attention to the significant impact of social determinants of health on disparities in brain health and neurologic disorders, underscoring the need for targeted interventions to promote health equity. To achieve brain health equity, neurologists must integrate culturally sensitive care approaches, develop adapted assessment tools, improve professional and public educational materials, and continually innovate interventions to meet the diverse needs of our communities. Achieving brain health for all will require a collaborative multilevel approach to promote and sustain preventive brain health initiatives through individual empowerment, community-based programs, and the integration of brain health into health care policies and practices.</p>","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"31 3","pages":"865-884"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Features and Diagnosis of Normal Pressure Hydrocephalus.","authors":"Abhay R Moghekar","doi":"10.1212/CON.0000000000001576","DOIUrl":"https://doi.org/10.1212/CON.0000000000001576","url":null,"abstract":"<p><strong>Objective: </strong>This article serves as a practical guide for the assessment of patients with suspected idiopathic normal pressure hydrocephalus (NPH).</p><p><strong>Latest developments: </strong>Significant advancements in neuroimaging, biomarker identification, and neurosurgical techniques have considerably improved the diagnostic accuracy and outcomes of treatment for idiopathic NPH. The full triad of gait disturbance, cognitive impairment, and urinary incontinence is not present in all patients and is not a prerequisite to pursuing treatment. Comorbid cervical stenosis is common and may also require surgical intervention.</p><p><strong>Essential points: </strong>NPH remains a challenging clinical entity with significant overlap in presentation with other neurodegenerative disorders such as Alzheimer disease, vascular dementia, and parkinsonian syndromes, especially progressive supranuclear palsy and dementia with Lewy bodies. Gait tends to be affected first and more severely than other domains in patients with idiopathic NPH. The CSF tap test is a key diagnostic tool where both objective and subjective improvements in symptoms help identify patients likely to have a good outcome after shunt surgery.</p>","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"31 3","pages":"790-812"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension.","authors":"Aileen A Antonio","doi":"10.1212/CON.0000000000001570","DOIUrl":"https://doi.org/10.1212/CON.0000000000001570","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic intracranial hypertension (IIH) is a condition of unexplained increased intracranial pressure. This article provides an overview of the process of diagnosing IIH and summarizes health disparities and potential barriers to care facing patients with IIH.</p><p><strong>Latest developments: </strong>Population studies have shown that IIH incidence increases with the rising rates of obesity, with subsequent financial burden and potential implications for the health care system. There may be ethnic or racial differences in IIH prevalence, and the degree to which social determinants of health affect these differences requires further exploration.</p><p><strong>Essential points: </strong>IIH, a syndrome secondary to increased intracranial pressure without an underlying structural cause, can lead to disability, including blindness. Overdiagnosis of IIH has led to overutilization of health care resources. This article presents the criteria for diagnosing IIH, possible biases that may affect clinical reasoning, and approach to early referral to the appropriate clinical experts.</p>","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"31 3","pages":"709-727"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension.","authors":"Jill C Rau, Jeremy K Cutsforth-Gregory","doi":"10.1212/CON.0000000000001566","DOIUrl":"https://doi.org/10.1212/CON.0000000000001566","url":null,"abstract":"<p><strong>Objective: </strong>This article reviews the current understanding of the varied clinical presentations of spontaneous intracranial hypotension and discusses strategies and limitations in diagnosing this complex syndrome, including approaches for medical practitioners outside of specialty centers.</p><p><strong>Latest developments: </strong>Radiologic algorithms applied to brain MRI (eg, the Bern score) can help assess the probability of an underlying spinal CSF leak, but they do not replace good history-taking and clinical acumen. Brain MRI findings may evolve over time with or without leak-directed treatment. New techniques and improvements in imaging technology have led to better identification and classification of different types of spinal CSF leaks, especially CSF-venous fistulas that were reported for the first time in 2014 and now account for 50% or more of the leaks in patients without spinal extradural fluid collections. Occasionally, spontaneous intracranial hypotension is the result of preexisting intracranial hypertension causing \"blowout\" leaks.</p><p><strong>Essential points: </strong>Spontaneous intracranial hypotension is caused by leakage of CSF from the spinal dura and most often presents with orthostatic headache, frequently accompanied by neck pain and stiffness, nausea, vestibulo-auditory distortions, visual changes, and other symptoms. Spontaneous intracranial hypotension can be debilitating, and long diagnostic and treatment delays are common. In rare cases, spontaneous intracranial hypotension can have dangerous sequelae, including superficial siderosis, subdural hematoma, bibrachial amyotrophy, brain sagging dementia, and even death. Early recognition of clinical symptoms and radiologic signs is imperative for best patient outcomes.</p>","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"31 3","pages":"644-667"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"List of Abbreviations.","authors":"","doi":"10.1212/01.cont.0001118472.70428.75","DOIUrl":"https://doi.org/10.1212/01.cont.0001118472.70428.75","url":null,"abstract":"","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"31 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"SELF-ASSESSMENT AND CME.","authors":"","doi":"10.1212/cont.0000000000001583","DOIUrl":"https://doi.org/10.1212/cont.0000000000001583","url":null,"abstract":"","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"31 3","pages":"885"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Radiographic Evaluation of Normal Pressure Hydrocephalus.","authors":"Petrice Cogswell, Aaron Switzer","doi":"10.1212/CON.0000000000001577","DOIUrl":"https://doi.org/10.1212/CON.0000000000001577","url":null,"abstract":"<p><strong>Objective: </strong>Normal pressure hydrocephalus (NPH) is a clinical syndrome of a gait disorder, cognitive impairment, and urinary incontinence that also has characteristic imaging features. This article provides an overview of the radiographic evaluation and imaging features of NPH.</p><p><strong>Latest developments: </strong>Ventriculomegaly is an overarching imaging feature of NPH, although it is nonspecific. More specific imaging features have been described in association with NPH subtypes. Patients with idiopathic NPH commonly have features of ventriculomegaly, high-convexity tight sulci, and enlarged sylvian fissures. Patients with delayed-onset congenital NPH have features of marked ventriculomegaly, without extraventricular hydrocephalus, and may have stenosis or obstruction of the cerebral aqueduct. Evaluation of CSF dynamics, patterns of radiotracer uptake on positron emission tomography (PET), and patterns of brain stiffness on MR elastography can help to differentiate idiopathic NPH from secondary NPH or a neurodegenerative process.</p><p><strong>Essential points: </strong>Imaging features of disproportionately enlarged subarachnoid space hydrocephalus are important to recognize as they are part of the diagnostic criteria for idiopathic NPH and aid in differentiating NPH from a neurodegenerative process. Evaluation of CSF dynamics, patterns of fludeoxyglucose (FDG) uptake, and patterns of brain stiffness may aid in the evaluation of challenging cases that lack typical clinical and structural radiographic features.</p>","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"31 3","pages":"813-839"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}