Clinical Neurology and Neurosurgery最新文献

Incidence and outcomes of unplanned escalation-of-care complications for patients with traumatic brain injury 外伤性脑损伤患者意外护理升级并发症的发生率和结局

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-05-01 Epub Date: 2026-02-09 DOI: 10.1016/j.clineuro.2026.109341

Vikas N. Vattipally , S. Farzad Maroufi , Mazin Elshareif , Patrick Kramer , Jacob Jo , Jose I. Suarez , Joseph V. Sakran , Elliott R. Haut , Judy Huang , Chetan Bettegowda , Tej D. Azad

Introduction

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality, and unplanned escalation-of-care complications such as intubations, intensive care unit (ICU) transfers, and operating room (OR) visits may reflect both injury severity and gaps in triage. Although linked to adverse outcomes in general trauma populations, they remain poorly characterized in TBI. The objective of this study was to define the frequency, co-occurrence, and consequences of these unplanned complications.

Methods

We conducted a retrospective cohort study of adults with blunt TBI in the ACS TQIP database (2017–2022). Exposures were unplanned ICU admission, intubation, and OR visit, examined individually and cumulatively. Outcomes included hospital length of stay (LOS), discharge disposition, and inpatient mortality. Descriptive analyses characterized complication frequency and overlap, spline models assessed risk across presenting Glasgow Coma Scale (GCS), and regression models evaluated associations with complication burden and mortality among surgically-managed patients.

Results

Among 132,984 patients (median age, 63 years), 3.5 % experienced at least one unplanned complication. Rates were higher among surgically-managed patients, and intubation with ICU transfer was the most common combination. The probability of unplanned complications followed a non-linear relationship with GCS, peaking in the moderate range (10−12) and consistently higher among surgical patients. Increasing complication burden was associated with longer LOS and lower rates of favorable discharge. In adjusted models, unplanned intubations strongly predicted mortality (OR 1.80; 95 % CI, 1.43–2.27), unplanned ICU transfers were associated with lower mortality (OR 0.57; 95 % CI, 0.42–0.76), and unplanned OR visits showed no significant association.

Conclusions

Unplanned escalation-of-care complications are uncommon but clinically meaningful in TBI, disproportionately affecting surgically-managed patients. These complications carry distinct prognostic significance, with intubation signaling high mortality risk, ICU transfer associated with lower risk, and higher complication burden linked to longer stays and poorer discharge outcomes. These unplanned complications represent reproducible indicators of acute instability and potential targets for improved triage and quality improvement.

外伤性脑损伤（TBI）是发病率和死亡率的主要原因，而意外的护理升级并发症，如插管、重症监护病房（ICU）转移和手术室（OR）就诊，可能反映了损伤的严重程度和分诊的差距。尽管与一般创伤人群的不良后果有关，但它们在TBI中的特征仍然很差。本研究的目的是确定这些意外并发症的频率、发生率和后果。方法对ACS TQIP数据库（2017-2022）中的成人钝性脑损伤患者进行回顾性队列研究。暴露包括非计划的ICU入院、插管和手术室就诊，单独和累积检查。结果包括住院时间（LOS）、出院处置和住院死亡率。描述性分析描述了并发症的频率和重叠，样条模型评估了呈现格拉斯哥昏迷量表（GCS）的风险，回归模型评估了手术治疗患者并发症负担和死亡率的相关性。结果132,984例患者（中位年龄63岁）中，有3.5 %的患者出现了至少一种计划外并发症。手术治疗的患者发生率更高，插管和ICU转移是最常见的组合。意外并发症的概率与GCS呈非线性关系，在中等范围内（10 - 12）达到峰值，在手术患者中一直较高。并发症负担的增加与较长的LOS和较低的良好出院率有关。在调整后的模型中，计划外插管与死亡率有很强的相关性（OR 1.80; 95 % CI, 1.43-2.27），计划外ICU转移与较低的死亡率相关（OR 0.57; 95 % CI, 0.42-0.76），计划外手术室就诊无显著相关性。结论非计划的护理升级并发症在TBI中并不常见，但具有临床意义，对手术治疗的患者影响不成比例。这些并发症具有明显的预后意义，插管表明死亡率高，ICU转移风险较低，并发症负担较高，住院时间较长，出院结果较差。这些计划外并发症是急性不稳定的可重复指标，也是改进分诊和质量改进的潜在目标。

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引用次数: 0

Prediction of occluded-side M1 vessel diameter using pre-procedural magnetic resonance angiography 术前磁共振血管造影预测闭塞侧M1血管直径

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-05-01 Epub Date: 2026-02-11 DOI: 10.1016/j.clineuro.2026.109345

Takaaki Kitano, Hiroyuki Ikeda , Hidenobu Hata, Natsuki Akaike, Mai Tanimura, Yasunori Yokochi, Takuya Osuki, Ryosuke Kaneko, Minami Uezato, Masanori Kinosada, Yoshitaka Kurosaki, Masaki Chin

Purpose

To determine whether the occluded-side M1 vessel diameter on post-procedural digital subtraction angiography (DSA) can be predicted from that on pre-procedural magnetic resonance angiography (MRA) and its usefulness for aspiration catheter selection.

Methods

We retrospectively analyzed 41 cases of M1 occlusion undergoing mechanical thrombectomy with successful recanalization and pre- and post-procedural MRA at our institution between January 2020 and December 2024. The relationship between the catheter-to-vessel ratio (CVR), calculated from aspiration catheter’s outer diameter and occluded-side M1 vessel diameter on pre-procedural MRA, and first-pass effect was assessed.

Results

The mean occluded-side M1 vessel diameter was 2.2 ± 0.3 mm on pre-procedural MRA and 2.4 ± 0.4 mm on post-procedural DSA; the latter showed a strong correlation with the former (r = 0.925, p < 0.001), and the regression equation was as follows: occluded-side M1 vessel diameter on post-procedural DSA (mm) = 0.19 + 1.025 × occluded-side M1 vessel diameter on pre-procedural MRA (mm) (R² = 0.856). The occluded-side M1 vessel diameter on post-procedural DSA approximated from the mean occluded-side M1 vessel diameter on pre-procedural MRA was pre-procedural MRA measurement + 0.2 mm. First-pass effect was achieved in 66.7 % of cases with CVR ≥ 0.80 and in 25.0 % of cases with CVR < 0.80 (p = 0.049).

Conclusion

When treating M1 occlusion, adding 0.2 mm to the occluded-side M1 vessel diameter on pre-procedural MRA measurement allows prediction of the actual M1 vessel diameter. Selecting an aspiration catheter with CVR ≥ 0.80 may help achieve first-pass effect.

目的探讨术前磁共振血管造影（MRA）与术后数字减影血管造影（DSA）对M1闭塞侧血管直径的预测价值及其对抽吸导管选择的指导意义。方法回顾性分析2020年1月至2024年12月在我院行机械取栓术并成功再通的41例M1闭塞患者的术前和术后MRA。通过术前MRA上抽吸导管外径和闭塞侧M1血管直径计算导管血管比（CVR）与首过效果的关系进行评估。结果闭塞侧M1血管平均内径术前MRA为2.2 ± 0.3 mm，术后DSA为2.4 ± 0.4 mm；与前者后者显示很强的相关性(r = 0.925,p & lt; 0.001),回归方程是如下:occluded-side M1在术后DSA血管直径(毫米)= 0.19  + 1.025  × occluded-side M1容器直径在pre-procedural MRA(毫米)(r²= 0.856)。术后DSA上闭塞侧M1血管直径由术前MRA平均闭塞侧M1血管直径近似为术前MRA测量+ 0.2 mm。CVR≥ 0.80的66.7 %和CVR <； 0.80的25.0 %达到一过效果（p = 0.049）。结论在治疗M1闭塞时，术前MRA测量闭塞侧M1血管直径增加0.2 mm可以预测实际M1血管直径。选择CVR≥ 0.80的抽吸导管有助于达到首过效果。

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引用次数: 0

Neuroimaging correlates of cognitive stages in Parkinson's disease: A multimodal MRI study 帕金森病认知阶段的神经影像学相关性：一项多模态MRI研究

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-05-01 Epub Date: 2026-02-10 DOI: 10.1016/j.clineuro.2026.109343

Hannah L. Combs , Sarah R. Heilbronner , Stephen R. McCauley , Christof Karmonik , Elizabeth Wilde , Michele K. York

Objective

Cognitive impairment in Parkinson’s disease (PD) ranges from mild executive deficits to dementia. This exploratory study aimed to characterize neuroanatomical correlates of cognitive subtypes to improve understanding of disease-related cognitive heterogeneity. Structural and diffusion-weighted MRI were used to examine preliminary patterns of brain–behavior relationships across PD cognitive stages.

Methods

38 patients with PD and 10 healthy controls underwent neuropsychological testing, structural MRI, and diffusion-weighted imaging (dMRI). Patients with PD were classified as cognitively intact (PDi), mild cognitive impairment (PD-MCI), or dementia (PDD) using Movement Disorder Society guidelines. Volumetric and dMRI analyses focused on hippocampal volume and white matter integrity in key tracts.

Results

Volumetric analyses revealed smaller hippocampi in PDD (Left M = 3.71 cm³, Right M = 3.69 cm³) compared to PD-MCI and PDi (p < .03). Patients with PDD had significantly larger lateral ventricles (Left M = 21.17 cm³, p = .05). dMRI analyses showed reduced fractional anisotropy (FA) in the left posterior limb of the internal capsule (p = .002) and increased apparent diffusion coefficient (ADC) in the same region (p = .003). These findings reflect stage-related correlates of cognitive impairment rather than predictive markers of future decline. Cognitive domains correlated with FA and ADC values in the internal capsule and splenium.

Conclusions

Present findings revealed isolated regions of volume loss and white matter abnormalities in patients with PDD as compared to other cognitive subtypes. Hippocampal atrophy and white matter disruption were observed in patients with PDD and should be interpreted as correlates of advanced cognitive impairment rather than predictive biomarkers. Longitudinal studies are needed to determine whether these imaging features track or precede cognitive decline.

目的帕金森病（PD）的认知障碍从轻度执行功能障碍到痴呆不等。本探索性研究旨在描述认知亚型的神经解剖学相关性，以提高对疾病相关认知异质性的理解。结构和扩散加权MRI用于检查PD认知阶段脑行为关系的初步模式。方法对38例PD患者和10例健康对照者进行神经心理测试、结构MRI和弥散加权成像（dMRI）。根据运动障碍学会的指南，PD患者被分为认知完整（PDi）、轻度认知障碍（PD- mci）或痴呆（PDD）。体积和dMRI分析侧重于海马体体积和关键束白质完整性。结果体积分析显示，与PD-MCI和PDi相比，PDD的海马体积较小（左M = 3.71 cm³，右M = 3.69 cm³）（p <； .03）。PDD患者侧脑室明显增大（左M = 21.17 cm³，p = .05）。dMRI分析显示左后肢内囊的分数各向异性（FA）降低（p = .002），同一区域的表观扩散系数（ADC）增加（p = .003）。这些发现反映了认知障碍的阶段相关性，而不是未来衰退的预测标志。认知域与内囊和脾FA和ADC值相关。结论目前的研究结果显示，与其他认知亚型相比，PDD患者存在孤立的体积损失和白质异常区域。在PDD患者中观察到海马萎缩和白质破坏，应被解释为晚期认知障碍的相关因素，而不是预测性生物标志物。需要纵向研究来确定这些影像学特征是否跟踪或先于认知衰退。

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引用次数: 0

Baseline characteristics of patients recruited to the mannitol for cerebral oedema after acute intracerebral haemorrhage (MACE-ICH) trial 急性脑出血（MACE-ICH）试验后甘露醇治疗脑水肿患者的基线特征

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-05-01 Epub Date: 2026-02-12 DOI: 10.1016/j.clineuro.2026.109342

Kailash Krishnan , Emma Grace , Lisa Woodhouse , Christine Roffe , Jesse Dawson , Timothy J. England , David W. Hewson , Rob A. Dineen , Zhe Kang Law , Stefan Pszczolkowski , Keenan Wells , Amanda Buck , Jennifer Craig , Diane Havard , Mary J. Macleod , David J. Werring , Fergus N. Doubal , Nikola Sprigg , Philip M. Bath

Background

Mannitol, an osmotic diuretic and free radical scavenger might decrease cerebral oedema after acute intracerebral haemorrhage.

Aims

The Mannitol for cerebral oedema after acute intracerebral haemorrhage trial is testing the feasibility of performing a phase II trial to define the optimal approach for a phase III trial of testing mannitol in patients with cerebral oedema or at risk of it to improve outcome.

Methods

MACE-ICH is a multicentre, prospective, randomised, open-label, blinded-endpoint outcome assessment trial. Participants presenting within 72 h of ictus were randomised to one of three groups: 1:1 g/kg 10 % single dose mannitol infusion at 10 ml/min, in addition to standard care; 1 g/kg 10 % mannitol at 10 ml/min followed by a second dose 1 g/kg repeated 24 h later (providing serum osmolality <320 mOsm/Kg and sodium<160 mmol/L), in addition to standard care or standard care alone. The trial was registered prospectively: ISRCTN15383301.

Results

46 (of planned 45) participants were recruited from 8 sites between February 2024-April 2025. Baseline characteristics: mean age 74.7 years (standard deviation 12.0); male 69 %; onset-to-randomisation 22.9 h; severity (National Institutes of Health Stroke Scale) 12.1 (8.3); blood pressure 155.3 (29.0)/78.9 (16.5) mmHg. Haematoma characteristics: lobar 58 %, mass effect 58.7 %, midline shift (34.8 %). The mean maximum haemorrhage diameter was 4.3 cm.

Conclusion

MACE-ICH successfully enroled patients with cerebral oedema after acute intracerebral haemorrhage to assess the feasibility and safety of intravenous mannitol. The trial is novel with a dose-comparative approach with assessment of single and repeated mannitol dosing regimens, addressing an important gap in clinical practice.

甘露醇是一种渗透性利尿剂和自由基清除剂，可能会减少急性脑出血后的脑水肿。目的甘露醇用于急性脑出血后脑水肿的试验正在测试进行II期试验的可行性，以确定甘露醇用于脑水肿或有脑水肿风险患者的III期试验的最佳方法，以改善结果。方法sace - ich是一项多中心、前瞻性、随机、开放标签、盲终点结局评估试验。在发作72 小时内出现的参与者被随机分为三组之一：除标准治疗外，1:1 g/kg 10 %单剂量甘露醇输注10 ml/min；1 g/kg 10 %甘尼醇，剂量为10 ml/min， 24 h后重复第二次剂量1 g/kg（提供血清渗透压320 mOsm/ kg和钠160 mmol/L），除标准护理或单独标准护理外。该试验前瞻性注册：ISRCTN15383301。结果在2024年2月至2025年4月期间从8个地点招募了46名（计划45名）参与者。基线特征：平均年龄74.7岁（标准差12.0）；男性69 %;onset-to-randomisation 22.9 h;严重程度（美国国立卫生研究院卒中量表）12.1 (8.3)；血压155.3 (29.0)/78.9 (16.5)mmHg。血肿特征：大叶58 %，肿块效应58.7 %，中线移位34.8 %。平均最大出血直径4.3 cm。结论mace - ich成功纳入急性脑出血后脑水肿患者，评估静脉注射甘露醇的可行性和安全性。该试验新颖，采用剂量比较方法评估单一和重复甘露醇给药方案，解决了临床实践中的一个重要空白。

{"title":"Baseline characteristics of patients recruited to the mannitol for cerebral oedema after acute intracerebral haemorrhage (MACE-ICH) trial","authors":"Kailash Krishnan , Emma Grace , Lisa Woodhouse , Christine Roffe , Jesse Dawson , Timothy J. England , David W. Hewson , Rob A. Dineen , Zhe Kang Law , Stefan Pszczolkowski , Keenan Wells , Amanda Buck , Jennifer Craig , Diane Havard , Mary J. Macleod , David J. Werring , Fergus N. Doubal , Nikola Sprigg , Philip M. Bath","doi":"10.1016/j.clineuro.2026.109342","DOIUrl":"10.1016/j.clineuro.2026.109342","url":null,"abstract":"<div><h3>Background</h3><div>Mannitol, an osmotic diuretic and free radical scavenger might decrease cerebral oedema after acute intracerebral haemorrhage.</div></div><div><h3>Aims</h3><div>The Mannitol for cerebral oedema after acute intracerebral haemorrhage trial is testing the feasibility of performing a phase II trial to define the optimal approach for a phase III trial of testing mannitol in patients with cerebral oedema or at risk of it to improve outcome.</div></div><div><h3>Methods</h3><div>MACE-ICH is a multicentre, prospective, randomised, open-label, blinded-endpoint outcome assessment trial. Participants presenting within 72 h of ictus were randomised to one of three groups: 1:1 g/kg 10 % single dose mannitol infusion at 10 ml/min, in addition to standard care; 1 g/kg 10 % mannitol at 10 ml/min followed by a second dose 1 g/kg repeated 24 h later (providing serum osmolality <320 mOsm/Kg and sodium<160 mmol/L), in addition to standard care or standard care alone. The trial was registered prospectively: ISRCTN15383301.</div></div><div><h3>Results</h3><div>46 (of planned 45) participants were recruited from 8 sites between February 2024-April 2025. Baseline characteristics: mean age 74.7 years (standard deviation 12.0); male 69 %; onset-to-randomisation 22.9 h; severity (National Institutes of Health Stroke Scale) 12.1 (8.3); blood pressure 155.3 (29.0)/78.9 (16.5) mmHg. Haematoma characteristics: lobar 58 %, mass effect 58.7 %, midline shift (34.8 %). The mean maximum haemorrhage diameter was 4.3 cm.</div></div><div><h3>Conclusion</h3><div>MACE-ICH successfully enroled patients with cerebral oedema after acute intracerebral haemorrhage to assess the feasibility and safety of intravenous mannitol. The trial is novel with a dose-comparative approach with assessment of single and repeated mannitol dosing regimens, addressing an important gap in clinical practice.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"264 ","pages":"Article 109342"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146161892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association between bone mineral density and spondylolisthesis: A matched case-control study using DXA 骨密度与脊柱滑脱之间的关系：一项使用DXA的匹配病例对照研究。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-04-01 Epub Date: 2026-01-16 DOI: 10.1016/j.clineuro.2026.109318

Elif Dilara Topcuoglu , Nursima Aydın , Mihrimah Kan , Burcu Narin , Ahmet Nedim Kahraman , Esin Derin Cicek

Objective

To investigate the association between dual-energy X-ray absorptiometry (DXA) T-scores (lumbar spine, total femur and femoral neck) and the presence of spondylolisthesis (SL) in a matched case-control design.

Materials and Methods

Between January 2020 and November 2024, patients who underwent lumbar magnetic resonance imaging (MRI) and DXA in the same year were retrospectively reviewed. Patients with SL were identified and matched 1:1 with controls by age, sex, and body mass index category. Group differences were assessed using t-tests and logistic regression.

Results

Of 1573 lumbar MRI scans, 173 patients with SL (mean age 69.3 ± 9.9 years, 158 women) were matched with 173 controls. Osteoporosis and osteopenia were significantly more prevalent in the SL group (p < 0.001 for both). Patients with SL had significantly lower lumbar spine (−0.85 ± 1.60 vs. −0.15 ± 1.68), femoral neck (−1.23 ± 1.08 vs. −0.84 ± 1.03), and total femur (−0.91 ± 1.16 vs. −0.40 ± 1.23) T-scores (all p < 0.001). Multivariable logistic regression confirmed that lumbar spine T-scores were independently associated with SL (OR 0.76, 95 % CI 0.58–1.00, p = 0.047), with a stronger effect in women (OR 0.61, 95 % CI 0.45–0.82, p = 0.001). Obesity was associated with higher T-scores but did not protect against SL.

Conclusion

Reduced lumbar spine T-scores are independently associated with SL, particularly in postmenopausal women, indicating that lumbar bone mineral density may be clinically relevant in this population. These findings support consideration of DXA assessment as part of preoperative evaluation in patients with SL.

目的：通过配对病例对照设计，探讨双能x线骨密度（DXA） t评分（腰椎、全股骨和股骨颈）与腰椎滑脱（SL）之间的关系。材料与方法：回顾性分析2020年1月至2024年11月期间接受腰椎磁共振成像（MRI）和DXA治疗的患者。确定SL患者并按年龄、性别和体重指数类别与对照组进行1:1匹配。采用t检验和逻辑回归评估组间差异。结果：在1573次腰椎MRI扫描中，173例SL患者（平均年龄69.3 ± 9.9岁，158名女性）与173名对照组相匹配。骨质疏松和骨质减少在SL组中更为普遍（p ）结论：腰椎t评分降低与SL独立相关，特别是绝经后妇女，表明腰椎骨密度可能与该人群临床相关。这些发现支持考虑将DXA评估作为SL患者术前评估的一部分。

{"title":"Association between bone mineral density and spondylolisthesis: A matched case-control study using DXA","authors":"Elif Dilara Topcuoglu , Nursima Aydın , Mihrimah Kan , Burcu Narin , Ahmet Nedim Kahraman , Esin Derin Cicek","doi":"10.1016/j.clineuro.2026.109318","DOIUrl":"10.1016/j.clineuro.2026.109318","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between dual-energy X-ray absorptiometry (DXA) T-scores (lumbar spine, total femur and femoral neck) and the presence of spondylolisthesis (SL) in a matched case-control design.</div></div><div><h3>Materials and Methods</h3><div>Between January 2020 and November 2024, patients who underwent lumbar magnetic resonance imaging (MRI) and DXA in the same year were retrospectively reviewed. Patients with SL were identified and matched 1:1 with controls by age, sex, and body mass index category. Group differences were assessed using t-tests and logistic regression.</div></div><div><h3>Results</h3><div>Of 1573 lumbar MRI scans, 173 patients with SL (mean age 69.3 ± 9.9 years, 158 women) were matched with 173 controls. Osteoporosis and osteopenia were significantly more prevalent in the SL group (p < 0.001 for both). Patients with SL had significantly lower lumbar spine (−0.85 ± 1.60 vs. −0.15 ± 1.68), femoral neck (−1.23 ± 1.08 vs. −0.84 ± 1.03), and total femur (−0.91 ± 1.16 vs. −0.40 ± 1.23) T-scores (all p < 0.001). Multivariable logistic regression confirmed that lumbar spine T-scores were independently associated with SL (OR 0.76, 95 % CI 0.58–1.00, p = 0.047), with a stronger effect in women (OR 0.61, 95 % CI 0.45–0.82, p = 0.001). Obesity was associated with higher T-scores but did not protect against SL.</div></div><div><h3>Conclusion</h3><div>Reduced lumbar spine T-scores are independently associated with SL, particularly in postmenopausal women, indicating that lumbar bone mineral density may be clinically relevant in this population. These findings support consideration of DXA assessment as part of preoperative evaluation in patients with SL.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109318"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing combined effects of RAI, GNRI, and Anemia on morbidity and mortality in elderly patients after subdural hematoma evacuation 评估RAI、GNRI和贫血对老年患者硬膜下血肿引流术后发病率和死亡率的联合影响。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-04-01 Epub Date: 2026-02-05 DOI: 10.1016/j.clineuro.2026.109340

Shaila D. Ghanekar , Paul Serrato , Ethan D.L. Brown , Sina Sadeghzadeh , Apratim Maity , Syed I. Khalid , Michael DiLuna , Aladine A. Elsamadicy

Background/Objectives

This study aims to assess the composite impact of frailty, malnutrition, and anemia on postoperative outcomes for elderly subdural hemorrhage (SDH) patients.

Methods

A retrospective cohort study was performed using the 2011–2023 NSQIP database. All patients > 65 years who underwent SDH evacuation were identified using CPT and ICD codes. The study population was divided based on RAI-rev frailty status, with frail patients being further subdivided based on anemia and Geriatric Nutritional Risk Index (GNRI) nutritional status. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of these health condition combinations with extended hospital length of stay (LOS), any 30-day adverse event (AE), non-routine discharge (NRD), and 30-day mortality.

Results

Of 3136 elderly SDH patients, 610 (19.5 %) were Frail Alone (F), 712 (22.7 %) were Frail + Anemic (FA), 464 (14.8 %) were Frail + Malnourished (FM), 1226 (39.1 %) were FA + Malnourished (FAM), and 124 (4.0 %) were Not Frail (NF). RAI-rev was a risk factor for extended LOS (aOR: 1.03, 95 % CI: 1.01–1.06), AEs (aOR: 1.04, 95 % CI: 1.02–1.06), and mortality (aOR: 1.05, 95 % CI: 1.03–1.08). GNRI was a predictor of decreased odds of extended LOS (aOR: 0.98, 95 % CI: 0.97–0.99) and NRD (aOR: 0.98, 95 % CI: 0.97–1.00), whereas anemia only predicted AEs (aOR: 1.58, 95 % CI: 1.27–1.96). On ROC analysis, adding anemia and GNRI to RAI-rev was associated with statistically significant (p = 0.034) but modest improvements in discrimination for 30-day adverse events.

Conclusion

Our findings suggest that adding anemia and GNRI to RAI-rev is associated with a modest incremental improvement in discrimination for 30-day adverse events in elderly SDH patients.

背景/目的：本研究旨在评估虚弱、营养不良和贫血对老年硬膜下出血（SDH）患者术后预后的综合影响。方法：采用2011-2023 NSQIP数据库进行回顾性队列研究。所有bb0 65岁接受SDH疏散的患者均使用CPT和ICD代码进行识别。研究人群根据RAI-rev衰弱状态进行划分，虚弱患者根据贫血和老年营养风险指数（GNRI）营养状况进一步细分。使用受试者工作特征（ROC）和多变量分析，我们比较了这些健康状况组合与延长住院时间（LOS）、任何30天不良事件（AE）、非常规出院（NRD）和30天死亡率的判别阈值和独立关联。结果：3136例老年SDH患者中，单独虚弱(F) 610例（19.5 %），虚弱+ 贫血（FA） 712例（22.7 %），虚弱+ 营养不良（FM） 464例（14.8 %），FA + 营养不良（FAM） 1226例（39.1 %），不虚弱（NF） 124例（4.0 %）。RAI-rev是延长的LOS （aOR: 1.03, 95 % CI: 1.01-1.06）、ae （aOR: 1.04, 95 % CI: 1.02-1.06）和死亡率（aOR: 1.05, 95 % CI: 1.03-1.08）的危险因素。GNRI是延长LOS （aOR: 0.98, 95 % CI: 0.97-0.99）和NRD （aOR: 0.98, 95 % CI: 0.97-1.00）降低的预测因子，而贫血仅预测ae （aOR: 1.58, 95 % CI: 1.27-1.96）。在ROC分析中，将贫血和GNRI添加到RAI-rev中具有统计学意义（p = 0.034），但对30天不良事件的区分略有改善。结论：我们的研究结果表明，在RAI-rev中加入贫血和GNRI与老年SDH患者30天不良事件的歧视有适度的增量改善相关。

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引用次数: 0

Delayed deformation of the Neuroform Atlas Stent during follow-up: Observational findings and clinical implications 神经形态Atlas支架在随访期间的延迟变形：观察结果和临床意义。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.clineuro.2026.109320

Lee Hwangbo , Jun Kyeung Ko

Objective

The Neuroform Atlas Stent (NAS) has become one of the most widely used stents for stent-assisted coil embolization of wide-necked intracranial aneurysms, owing to its low-profile design, flexible deliverability, and compatibility with 0.017-inch microcatheters. However, data on its long-term durability are limited. The purpose of this study is to evaluate the incidence, angiographic features, and clinical significance of NAS deformation or crumpling that occurs during the follow-up period.

Methods

We retrospectively reviewed 174 patients with unruptured intracranial aneurysms who underwent NAS-assisted coiling from March 2018 to December 2024, all of whom had follow-up digital subtraction angiography. Stent deformation or crumpling was defined as a noticeable change in the position or spacing of the stent markers on unsubtracted images between the immediate post-procedural and follow-up examinations.

Results

Significant NAS deformation was observed in 7 of 174 patients (4.02 %). All aneurysms were located in the anterior circulation, with the most common site being the ophthalmic segment of the internal carotid artery. The mean aneurysm dome and neck sizes were 4.1 mm and 3.3 mm, respectively. Despite the marker changes, all aneurysms remained stable or showed progressive occlusion. In-stent stenosis of more than 30 % occurred in one patient. Antiplatelet response was adequate in almost all patients, with only one patient showing a high P2Y12 reaction unit value.

Conclusion

Stent deformation or crumpling of the NAS can occur as a rare, delayed finding. While this observational study found that this mechanical change did not compromise short-term aneurysm occlusion, its long-term clinical implications remain unclear. The thin profile of the NAS may contribute to a degree of vulnerability within the intracranial circulation until sufficient endothelialization is achieved. Long-term follow-up is necessary to clarify the clinical implications of this crumpling phenomenon.

目的：神经形态阿特拉斯支架（NAS）由于其低轮廓设计、可灵活输送、与0.017英寸微导管兼容，已成为支架辅助线圈栓塞颅内宽颈动脉瘤应用最广泛的支架之一。然而，关于其长期耐久性的数据有限。本研究的目的是评估随访期间NAS变形或皱缩的发生率、血管造影特征及临床意义。方法：回顾性分析2018年3月至2024年12月，174例未破裂的颅内动脉瘤患者行nas辅助卷曲术，所有患者均行数字减影血管造影。支架变形或皱褶被定义为在术后立即检查和随访检查之间的未减影图像上支架标记物的位置或间距的明显变化。结果：174例患者中有7例出现明显的NAS变形（4.02 %）。所有动脉瘤均位于前循环，最常见的部位是颈内动脉的眼段。动脉瘤穹窿和颈部的平均尺寸分别为4.1 mm和3.3 mm。尽管标记改变，所有动脉瘤保持稳定或表现进行性闭塞。1例患者发生超过30% %的支架内狭窄。几乎所有患者的抗血小板反应都足够，只有1例患者出现高P2Y12反应单位值。结论：NAS支架变形或皱褶是一种罕见的延迟发现。虽然这项观察性研究发现这种机械变化不会损害短期动脉瘤闭塞，但其长期临床意义尚不清楚。NAS的薄轮廓可能在颅内循环中造成一定程度的易损性，直到实现充分的内皮化。长期随访是必要的，以澄清这种皱缩现象的临床意义。

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引用次数: 0

Predictors of symptomatic intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke: A retrospective study 急性缺血性卒中血管内取栓术后症状性颅内出血的预测因素：一项回顾性研究。

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-04-01 Epub Date: 2026-01-29 DOI: 10.1016/j.clineuro.2026.109319

Wei Hong , Xiaoyu Wang , Shanshan Hu , Yuzhu Ma , Deju Yin

Background

Intracranial hemorrhage (ICH) is a serious potential complication of stroke mechanical thrombectomy (MT). We evaluated the predictors of symptomatic ICH (sICH) after MT for patients with acute ischemic stroke (AIS).

Methods

This retrospective study analyzed 170 consecutive patients with anterior circulation large vessel occlusion (LVO) undergoing MT. Outcomes were stratified as no hemorrhagic transformation (HT), asymptomatic ICH (aICH) and sICH. RAPID-processed perfusion parameters included ischemic core volume (rCBF<30 %), hypoperfusion volume (Tmax>6 s), mismatch volume, and hypoperfusion intensity ratio (HIR). Multivariable logistic regression with backward stepwise selection identified independent sICH predictors from ten candidate variables spanning clinical, laboratory, imaging and procedural domains.

Results

Among 170 patients, any ICH occurred in 67 (39.4 %), of whom 22 met sICH criteria. Platelet counts, balloon dilatation, ischemic core volume, Tmax> 6 s volume and HIR differed significantly across groups (all p < 0.05). Door-to-puncture time was longer for aICH group than no HT group (159.82 ± 64.05 vs. 131.99 ± 68.47; p < 0.05). Compared with the aICH group, the sICH group had lower platelet counts (141.82 ± 43.56 vs. 176.98 ± 72.36; p < 0.05), a larger ischemic core volume (77.50 ± 61.71 vs. 31.88 ± 34.87; p < 0.05) and higher HIR (0.64(0.45, 0.80) vs. 0.40(0.15, 0.57); p < 0.05). Multivariable analysis identified ischemic core volume (OR 3.62, 95 %CI 2.16–6.67, p < 0.001) and thrombocytopenia (OR 6.53, 95 %CI 2.03–25.41, p = 0.003) as independent sICH predictors. The integrated model achieved robust discrimination (AUC 0.874, accuracy 85.6 %).

Conclusions

Ischemic core volume and thrombocytopenia independently predict sICH following MT.

背景：颅内出血（ICH）是脑卒中机械取栓术（MT）的严重潜在并发症。我们评估了急性缺血性脑卒中（AIS）患者MT后症状性脑出血（sICH）的预测因素。方法：本回顾性研究分析了170例连续接受MT治疗的前循环大血管闭塞（LVO）患者。结果分为无出血转化（HT）、无症状脑出血（aICH）和脑出血（siich）。快速处理的灌注参数包括缺血核心体积（rCBF6 s）、失配体积和低灌注强度比（HIR）。采用反向逐步选择的多变量逻辑回归从临床、实验室、影像和程序领域的10个候选变量中确定了独立的siich预测因子。结果：170例患者中有67例（39.4 %）发生脑出血，其中22例符合脑出血标准。血小板计数、球囊扩张、缺血性核体积、Tmax> 6 s体积和HIR在各组间差异显著（均p ）结论：缺血性核体积和血小板减少独立预测MT后siich。

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引用次数: 0

Evaluating long-term outcomes of endovascular revascularization in symptomatic chronic internal carotid artery occlusion: A multicenter cohort study 评估有症状的慢性颈内动脉闭塞的血管内重建术的长期结果：一项多中心队列研究

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-04-01 Epub Date: 2025-10-12 DOI: 10.1016/j.clineuro.2025.109135

Xiaoliang Yin , Xiaodong Chen , Jiachun Liu , Junjie Wang , Jun Lu , Qi Peng , Yiling Cai , Xiaogang Li , Yu Fu , Xumin Pan , Wei Guo , Ying Liu , Huishu Yuan , Haibo Wu , Jun Yang , Daming Wang

Objectives

Chronic internal carotid artery occlusion (CICAO) poses a considerable risk for stroke. While endovascular revascularization holds promise as a potential therapy, its real-world efficacy, safety, and long-term outcomes remain underexplored. This study aims to assess the effectiveness, safety, and long-term outcomes of endovascular revascularization in symptomatic CICAO patients refractory to medical therapy.

Materials and methods

A retrospective cohort study was conducted to collect clinical and surgical data from CICAO patients meeting the inclusion criteria for endovascular revascularization therapy. Patients were categorized into groups based on the success or failure of revascularization procedures. Follow-up assessments were undertaken to ascertain patients' prognoses and survival outcomes. Logistic multivariate analysis was employed to identify risk factors associated with primary and secondary outcome events. COX proportional hazard regression was used to compare the risk ratios of these events between the two groups.

Results

The study included 59 patients undergoing 62 procedures with a 75.81 % success rate for revascularization. Perioperative complications were 6.45 %, and the average follow-up duration was 36.53 ± 3.92 months. In the successful revascularization group, the primary endpoint event rate was 6.52 %, contrasting with 23.08 % in the non-revascularization group. Carotid artery occlusion and diabetes emerged as independent risk factors for primary endpoint events. A significant difference was observed between the two groups in both primary endpoint (RR 0.16, [95 %CI, 0.03–0.84]) and total endpoint event rates (RR 0.27, [95 %CI, 0.08–0.96])

Conclusions

Failure of revascularization may be associated with an increased risk of recurrent cerebrovascular events in patients with CICAO, while successful endovascular revascularization appears to be linked to a lower incidence of such events. However, these results should be interpreted with caution due the relatively small sample size.

目的慢性颈内动脉闭塞（CICAO）具有相当大的卒中风险。虽然血管内血管重建术有望成为一种潜在的治疗方法，但其实际疗效、安全性和长期结果仍未得到充分探讨。本研究旨在评估对药物治疗难治性症状性CICAO患者进行血管内血运重建术的有效性、安全性和长期预后。材料与方法回顾性队列研究，收集符合血管内血管重建术纳入标准的CICAO患者的临床和手术资料。患者根据血运重建手术的成功或失败进行分组。进行随访评估以确定患者的预后和生存结果。采用Logistic多变量分析确定与主要和次要结局事件相关的危险因素。采用COX比例风险回归比较两组间这些事件的风险比。结果59例患者接受62次手术，血运重建成功率为75.81 %。围手术期并发症发生率为6.45 %，平均随访时间36.53 ± 3.92个月。血运重建术成功组的主要终点事件发生率为6.52 %，而非血运重建术组的主要终点事件发生率为23.08 %。颈动脉闭塞和糖尿病成为主要终点事件的独立危险因素。两组在主要终点（RR = 0.16,[95 %CI, 0.03-0.84]）和总终点事件发生率（RR = 0.27,[95 %CI, 0.08-0.96]）上均有显著差异。结论：血管重建术失败可能与CICAO患者脑血管事件复发风险增加有关，而血管内血管重建术成功则与此类事件发生率降低有关。然而，由于样本量相对较小，这些结果应该谨慎解释。

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引用次数: 0

Association between anesthetic administration and mortality in patients with hemorrhagic stroke: Analysis of the MIMIC-IV database 出血性卒中患者麻醉给药与死亡率的关系：MIMIC-IV数据库分析

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI: 10.1016/j.clineuro.2026.109321

Mengyao Wang , Ju Gao , Shunyan Lin , Yaqun Li , Tianfeng Huang

Objective

Anesthetic drugs are used in patients with hemorrhagic stroke (HS). We explored the impact of anesthetics on in-hospital mortality in patients with HS using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.

Methods

Eligible patients with HS who were treated between 2008 and 2019 were selected from the MIMIC-IV (version 3.1) database. The Chi-squared test and Wilcoxon’s test were performed to compare the differences between deceased and surviving patients. Then, least absolute shrinkage and selection operator and multivariate logistic regression analyses were employed to identify variables associated with mortality, after which a nomogram was constructed to predict in-hospital mortality. The performance of this nomogram was assessed by receiver operating characteristic curve analysis.

Results

In total, 1541 patients were included, including 270 deceased patients (17.5 %) and 1271 surviving patients (82.5 %). Meanwhile, 970 (62.9 %) patients received anesthetics. The use of rocuronium (regression coefficient [β] = 1.033; odds ratio [OR] = 2.809; 95 % confidence interval [CI] = 1.054–7.357; P = 0.037) or morphine (β = 1.894; OR = 6.644; 95 % CI = 4.443–10.079; P < 0.001) was identified as a risk factor for in-hospital mortality in patients with HS. A nomogram was constructed using the statistically significant variables, and its area under curve was 0.924, indicating its high predictive accuracy for in-hospital mortality.

Conclusion

A significant percentage of patients with HS received anesthetics. The use of rocuronium and morphine was associated with an increased mortality risk. A nomogram including anesthetic administration could accurately predict in-hospital mortality in patients with HS.

目的麻醉药物用于出血性脑卒中（HS）患者。我们利用重症监护医疗信息市场IV （MIMIC-IV）数据库探讨了麻醉药对HS患者住院死亡率的影响。方法从MIMIC-IV（3.1版）数据库中选择2008 - 2019年治疗的符合条件的HS患者。采用卡方检验和Wilcoxon检验比较死亡和存活患者之间的差异。然后，采用最小绝对收缩、选择算子和多变量逻辑回归分析来识别与死亡率相关的变量，然后构建nomogram来预测住院死亡率。通过受试者工作特征曲线分析来评价该nomogram的性能。结果共纳入1541例患者，其中死亡患者270例（17.5% %），存活患者1271例（82.5 %）。同时，970例（62.9 %）患者接受了麻醉。使用罗库溴铵（回归系数[β] = 1.033；优势比[OR] = 2.809； 95 %置信区间[CI] = 1.054-7.357; P = 0.037）或吗啡（β = 1.894; OR = 6.644; 95 % CI = 4.443-10.079; P <； 0.001）被确定为HS患者院内死亡的危险因素。采用具有统计学意义的变量构建nomogram，其曲线下面积为0.924，表明其对院内死亡率的预测准确率较高。结论HS患者接受麻醉的比例较高。罗库溴铵和吗啡的使用与死亡风险增加有关。包括麻醉给药在内的心电图可以准确预测HS患者的住院死亡率。

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引用次数: 0