The generation of new neurons in the adult mammalian brain is well-established for the hippocampal dentate gyrus (DG). However, the role of neurogenesis in hippocampal function and cognition, how it changes in aging, and the mechanisms underlying this are yet to be elucidated in the monkey brain. To address this, we investigated adult neurogenesis in the DG of 42 rhesus monkeys (39 cognitively tested) ranging in age from young adult to the elderly. We report here that there is an age-related decline in proliferation and a delayed development of adult neuronal phenotype. Additionally, we show that many of the new neurons survive throughout the lifetime of the animal and may contribute to a modest increase in total neuron number in the granule cell layer of the DG over the adult life span. Lastly, we find that measures of decreased adult neurogenesis are only modestly predictive of age-related cognitive impairment.

No abstract

Purpose: We report our initial experience using a detachable microvascular plug system to occlude the internal carotid artery during endovascular treatment of high-flow carotid cavernous fistula. Case and Technique: An 87-year-old patient was admitted for acute-onset double vision with associated right-eye ptosis. Exam revealed a pupil-sparing, partial right third cranial nerve palsy. MRI showed a carotid cavernous fistula with high-flow drainage. Digital subtraction angiography showed a high-flow, right-sided, direct carotid cavernous fistula with flow from the proximal right internal carotid artery. The ophthalmic artery, posterior communicating artery and anterior communicating arteries supplied retrograde flow to the fistula through the internal carotid artery. Obliteration of the fistula was achieved through coil embolization in combination with proximal and distal microvascular plugs (Reverse Medical, Irvine, Calif., USA). Conclusion: The microvascular plug is a new addition to current endovascular embolization devices for the treatment of high-flow, direct carotid cavernous fistulas. This technique offers easy navigability through tortuous arteries, precise localization and immediate occlusion, which may allow shorter procedure and fluoroscopy times and increased cost-effectiveness. Larger case series are needed to support our observation.

patient reported improved strength in the right finger extensors, finger flexors, and wrist extensors (MRC grades 4, 5, and 5, respectively). These changes in strength resulted in significant improvement of his ability to type and perform manual tasks. After 3 years of follow-up, he has remained stable and continues to avoid neck flexion.The radiographic findings and clinical course argue in favor of a compressive etiology of monomelic amyotrophy in this patient. Conservative management was a moderately successful strategy even with radiologic signs of cervical cord compression.

Rational: Availability of an on-site endovascular program for large vessel stroke decreases the time to acute treatment. Since expanding our program to a Manhattan hospital in July 2009, we have seen a decreased time to treatment. We hypothesize that the expansion was associated with improved discharge outcomes in patients with anterior circulation large vessel strokes. Methods: A retrospective chart review of consecutive patients before and after the initiation of the program was conducted. Adults presenting to the hospital with an NIHSS greater than 8, within 6 hours from stroke onset, and with carotid terminus or middle cerebral artery occlusion were included. Exclusion criteria were INR or creatinine >3 and premorbid modified Rankin score (MRS) >1. Comparison was made between the groups before and after initiation of the program. Modified Rankin at discharge was set as a primary outcome. Secondary outcomes included admission-discharge delta NIHSS, discharge disposition, mortality and stroke volume on MRI or CT scan. P<0.05 was set as statistically significant. Results: 70 patients were included in the study. 30 were admitted before July 2009 and 40 after. There was no difference between patient demographics. Only 3/30 patient received endovascular treatment prior to July 2009 versus 34/40 after that. Patients admitted after availability of on-site endovascular treatment were less likely to be dependent (OR: 0.14; 95% CI: 0.019-1) or discharged other than home (OR: 0.233; 95% CI: 0.062-0.876) after adjusting for age and admission NIHSS. In addition there was a significant increase in median admission-discharge NIHSS change in patients treated after July 2009 (p=0.007). No difference between median stroke volume was observed (66 vs 57.2 cm3; p=0.8) Discussion: For every 30 minutes until reperfusion, the probability of good recovery after a large vessel stroke is decreased by about 10%. Transfer delays may impede or limit the benefit of endovascular recanalization. In the absence of strategic air transportation systems, rapid deployment of an endovascular team might decrease the time to recanalization and improve patient outcomes.