Clinical Neurology and Neurosurgery最新文献

{"title":"Association between subthalamic nucleus volume and outcomes one year after bilateral subthalamic nucleus deep brain stimulation for Parkinson’s disease","authors":"Yilong Zheng ,&nbsp;Yi Zhan Cai ,&nbsp;Li Wei ,&nbsp;Seyed Ehsan Saffari ,&nbsp;Hwee Lan Ng ,&nbsp;Hui Ping Oh ,&nbsp;Wai-Yung Yu ,&nbsp;Louis Chew Seng Tan ,&nbsp;Wai Hoe Ng ,&nbsp;Shermyn Xiumin Neo ,&nbsp;Kai Rui Wan","doi":"10.1016/j.clineuro.2025.109305","DOIUrl":"10.1016/j.clineuro.2025.109305","url":null,"abstract":"<div><h3>Introduction</h3><div>Deep brain stimulation (DBS) is an effective adjunctive therapy for Parkinson’s disease (PD), but there are few biomarkers for the prediction of treatment response. Here, we aimed to evaluate whether subthalamic nucleus (STN) volume could serve as a biomarker for predicting treatment response to STN DBS in PD.</div></div><div><h3>Methods</h3><div>This was a retrospective study of patients who underwent bilateral STN DBS for PD between 2008 and 2021 at our center. Preoperative T2-weighted MRI scans were used to quantify STN volumes, while outcomes were evaluated using both the Hoehn and Yahr scale and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total and subcomponent scores at one-year follow-up. Univariate and multivariate linear regression analysis were applied to examine potential relationships between STN volume and clinical outcomes.</div></div><div><h3>Results</h3><div>Of 94 PD patients treated with DBS, 32 met the inclusion criteria for analysis. Our analysis revealed no significant association between STN volume and motor symptom improvement, as assessed by one-year changes in MDS-UPDRS Parts II (β=0.04; 95 % CI=-0.12–0.20; p = 0.590), III (β=0.07; 95 % CI=-0.35–0.48; p = 0.753), IV (β=-0.02; 95 % CI=-0.07–0.03; p = 0.430), and Hoehn and Yahr scale (β=0.01; 95 % CI=0.00–0.01; p = 0.136. Similarly, STN volume showed no association with MDS-UPDRS Part I total score (β=0.12; 95 % CI=-0.02–0.26; p = 0.096) for non-motor symptoms. However, we identified significant positive associations between STN volume and specific non-motor components, including the “anxious mood” (β=0.02; 95 % CI=0.00–0.04; p = 0.031) and the “pain and other sensation” (β=0.02; 95 % CI=0.00–0.04; p = 0.022) components, though these associations were not significant after adjusting for potential confounders.</div></div><div><h3>Conclusions</h3><div>In our cohort of patients who underwent bilateral STN DBS for PD, exploratory analyses revealed that larger STN volumes were significantly associated with an increased risk of developing affective symptoms approximately one year postoperatively. No significant association was observed between STN volume and improvement in motor outcomes. Further validation studies are warranted to corroborate the findings from this exploratory analysis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109305"},"PeriodicalIF":1.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882391","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}

{"title":"Hemodynamic changes during simulation of sub-maximal handgrip maneuver in small basilar tip aneurysms: A computational fluid dynamics and one-way fluid-structure interaction analysis","authors":"Felipe Ramirez-Velandia ,&nbsp;Vitor Lauar Pimenta de Figueiredo ,&nbsp;Vincenzo T.R. Loly ,&nbsp;Natalia Anna Koc ,&nbsp;Bruno Galelli Chieregatti ,&nbsp;Rafael T. Tatit ,&nbsp;Emmanuel O. Mensah ,&nbsp;Mark Rotondo ,&nbsp;João de Sá Brasil Lima ,&nbsp;Jorge Rios-Zermeno ,&nbsp;Johnny S. Sandhu ,&nbsp;Rabih G. Twak ,&nbsp;Christopher S. Ogilvy ,&nbsp;Carlos E. Baccin","doi":"10.1016/j.clineuro.2025.109304","DOIUrl":"10.1016/j.clineuro.2025.109304","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate through computational fluid dynamics (CFD) and fluid structure interaction (FSI) simulations basilar tip aneurysms (BTAs) hemodynamics at rest and during early (PLT1) and late (PLT2) phases of a sub-maximal handgrip (HG) maneuver.</div></div><div><h3>Methods</h3><div>Vascular segmentation used 3D rotational angiograms, and meshes were generated for accurate simulation. Time-averaged wall shear stress (TAWSS) at the aneurysm/parent vessel, oscillatory shear index (OSI), relative residence time (RRT), low and high shear stress area ratio (LSAR/HSAR), and wall deformation metrics (Von Mises stress, wall displacement, and strain) were calculated and compared.</div></div><div><h3>Results</h3><div>Seven patients (mean age: 60 ± 4.3 years; mean aneurysm size: 5.00 ± 1.76 mm) were included. 3 aneurysms were irregular, and 2 were ruptured. Ruptured BTAs were smaller (3.58 vs. 5.56 mm; p = 0.2009), had higher RRT (0.66 vs. 0.43 m²/N; p = 0.0276) and LSAR (5.11 % vs. 0 %; p = 0.0326). In unruptured BTAs, HG increased TAWSS (PLT1 +28.4 %, p = 0.0002; PLT2: +23.9 %, p = 0.0002), reduced RRT (PLT1 −21.7 %, p = 0.0009; PLT2: −18.6 %; p = 0.0016), increased HSAR (PLT1 +82.1 %, p = 0.0431, PLT2 +68.9 %, p = 0.0431), increased peak von Mises stress (PLT1 +18.6 %, p = 0.0223, PLT2 +31.9 %; p = 0.0087), maximum wall displacement (PLT1 +8.0 %, p = 0.0431; PLT2 +12.8 %, p = 0.0431) and maximum strain (PLT1 +7.13 %, p = 0.0201; PLT2 +11.8 %, p = 0.0043). Ruptured aneurysms showed similar trends with higher TAWSSR increases (PLT1 +31.6 %, p = 0.0225; PLT2 +28.2 %, p = 0.0391) and larger reductions in RRT (PLT1 −24.4 %, p = 0.0178; PLT2 −23.8 %, p = 0.0411).</div></div><div><h3>Conclusion</h3><div>In unruptured BTAs, PLT1 produced the greatest TAWSS increase and RRT reduction, whereas PLT2 led to maximal wall deformation. Ruptured aneurysms demonstrated greater TAWSSR increases and RRT reductions during simulation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109304"},"PeriodicalIF":1.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882389","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}

{"title":"Usefulness of T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging for follow-up evaluation after flow diverter implantation","authors":"Eisuke Tsukagoshi ,&nbsp;Hiroki Sato ,&nbsp;Takuma Maeda ,&nbsp;Tomoyoshi Kuribara ,&nbsp;Kazuki Fukumoto ,&nbsp;Takahiko Taniguchi ,&nbsp;Masataka Yoshimura ,&nbsp;Hiroki Kurita ,&nbsp;Shinya Kohyama","doi":"10.1016/j.clineuro.2025.109303","DOIUrl":"10.1016/j.clineuro.2025.109303","url":null,"abstract":"<div><h3>Background</h3><div>Digital subtraction angiography (DSA), the standard for postoperative evaluation following flow diverter (FD) implantation, is invasive and associated with potential complications. Although time-of-flight magnetic resonance angiography (TOF-MRA) is effective, normal blood flow may be misinterpreted as T1-weighted hyperintense thrombi. T1 volumetric isotropic turbo spin-echo acquisition black-blood magnetic resonance imaging (T1-VISTA-BB MRI) can differentiate thrombus from blood flow. We evaluate the utility of T1-VISTA-BB MRI for postoperative evaluation following FD implantation.</div></div><div><h3>Methods</h3><div>This retrospective study included 52 patients who underwent FD implantation alone. Scheduled DSA was performed at 6 and 12 months postoperatively. MRI examinations, including TOF-MRA and T1-VISTA-BB MRI, were defined as the most recent scans acquired within a specified time window relative to each DSA. The concordance with DSA was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were calculated for each modality.</div></div><div><h3>Results</h3><div>At 6-month, T1-VISTA-BB MRI demonstrated significantly higher specificity (T1-VISTA-BB MRI vs TOF-MRA: 97.2 vs. 77.8 %, p = 0.028) and PPV (T1-VISTA-BB MRI vs TOF-MRA: 92.3 vs. 57.9 %, p = 0.049) compared with TOF-MRA. At 12-month, no significant differences were found between the two modalities.</div></div><div><h3>Conclusions</h3><div>T1-VISTA-BB MRI demonstrated significantly higher specificity and PPV compared with TOF-MRA at 6 months following FD implantation. This finding suggests it may serve as a useful and less invasive complementary tool to DSA for early postoperative evaluation. However, this advantage was not observed at the 12-month follow-up. Further studies involving larger cohorts and longer follow-up periods are required to validate these findings.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109303"},"PeriodicalIF":1.6,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882446","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}

{"title":"Incidence, risk factors and management practices in post-viral encephalitis epilepsy: A long-term, nationwide population-based study and review of literature","authors":"Emilija Cvetkovska ,&nbsp;Bekim Adjami ,&nbsp;Bojan Boskovski ,&nbsp;Marija Babunovska ,&nbsp;Milena Stevanovic ,&nbsp;Marija Cvetanovska ,&nbsp;Igor Kuzmanovski ,&nbsp;Vineet Punia","doi":"10.1016/j.clineuro.2025.109302","DOIUrl":"10.1016/j.clineuro.2025.109302","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated the incidence, risk factors, and management of post-viral encephalitis epilepsy (PEE) in a nationwide cohort in North Macedonia. Additionally, we conducted a comprehensive literature search on PEE.</div></div><div><h3>Methods</h3><div>Data were obtained from the electronic National Health System (eNHS), encompassing all patients diagnosed with viral encephalitis (VE) in 2016. Patients with pre-existing epilepsy diagnoses were excluded. Clinical, neuroimaging, and EEG data were collected and analyzed, and participants were followed for seven years.</div></div><div><h3>Results</h3><div>Of 1660,584 individuals registered in the eNHS in 2016, 68 were confirmed to have VE (incidence: 4.1/100,000). Among these, six patients died during hospitalization, and the remaining 62 were included in the study cohort. Acute symptomatic seizures (ASyS) occurred in 39 % of patients, with focal to bilateral tonic-clonic seizures (FBTCS) being the most common seizure type. Over the seven-year follow-up period, 11 patients (18 %) developed PEE, with 73 % of cases diagnosed within the first year. Significant risk factors for PEE included ASyS, younger age, and epileptiform abnormalities on EEG. By the end of the follow-up, seven patients with PEE (64 %) remained on antiseizure medications (ASMs).</div></div><div><h3>Conclusions</h3><div>Our results confirm ASyS and highlight acute electro-clinical findings and young age as risk factors for PEE. There is a need for evidence-based clinical pathways and care protocols for patients at risk.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109302"},"PeriodicalIF":1.6,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899337","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}

{"title":"Corrigendum to: “Assessing glibenclamide’s efficacy on functional recovery in aneurysmal subarachnoid hemorrhage: A meta-analysis of randomized controlled trials”","authors":"Luciano Falcão ,&nbsp;Pedro Antonio Lopes Gomes,&nbsp;Rafael Andrade Sampaio Silva,&nbsp;Kenzo Ogasawara,&nbsp;João Victor Pereira Gonzalez,&nbsp;André Nishizima,&nbsp;Victor Arthur Ohannesian,&nbsp;Lara Souza Magalhães,&nbsp;Davi J. Fontoura Solla","doi":"10.1016/j.clineuro.2025.109294","DOIUrl":"10.1016/j.clineuro.2025.109294","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109294"},"PeriodicalIF":1.6,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882390","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}

{"title":"Redefining research productivity in neurosurgery residency applications through the predictive value of authorship order and research year engagement","authors":"Razan R. Faraj ,&nbsp;Rommi Kashlan ,&nbsp;Hithardhi Duggireddy ,&nbsp;Ryan S. Chung ,&nbsp;David J. Cote ,&nbsp;Robert G. Briggs ,&nbsp;Reem A. Dawoud ,&nbsp;Angela P. Mihalic ,&nbsp;Gabriel Zada ,&nbsp;Jonathan A. Grossberg","doi":"10.1016/j.clineuro.2025.109292","DOIUrl":"10.1016/j.clineuro.2025.109292","url":null,"abstract":"<div><h3>Objective</h3><div>With the recent change to pass/fail USMLE Step 1 assessment and increasing reliance on other metrics of applicant ability, neurosurgery residency programs face challenges in evaluating the academic potential of applicants. This study examines the relative contributions of first-author publications, research year completion, and total publication volume to match success.</div></div><div><h3>Methods</h3><div>Data were drawn from the Texas STAR (Seeking Transparency in Applications to Residency) survey between 2022 and 2025, including 2674 U.S. MD applicants and a detailed 2025 sub-cohort (n = 58) with authorship data. Logistic regression models, Chi-squared tests, and t-tests were used to examine associations between publication patterns and match outcomes. Covariates included Step 2 CK score (categorized), geographic connection, and away rotation participation.</div></div><div><h3>Results</h3><div>When mutually adjusted, first-author publication count was strongly predictive of match success (OR=2.76 per additional first-authored paper, 95 % CI: 1.82–4.67, p &lt; 0.001), while total publication count was negatively associated with matching when controlling for authorship (OR=0.64, 95 % CI: 0.46–0.84, p &lt; 0.001). Completion of a research year was associated with a significantly higher number of first-author publications (mean=3.96 vs. 2.53, p = 0.0023), but not with greater total publication volume (mean=8.04 vs. 6.41, p = 0.07). A greater number of research experiences was inversely associated with match success (OR=0.53 per experience, 95 % CI: 0.38–0.68, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>First-authored papers better predict match success than total publication count in neurosurgery residency applications. Dedicated research years appear to support meaningful productivity rather than sheer volume. These findings delineate how research experience is weighted in neurosurgery residency selection and may be helpful for medical students applying into neurosurgery.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109292"},"PeriodicalIF":1.6,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862562","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}

{"title":"Development of a stereotactic frame for neurosurgery targeting: A prospective pre-clinical study","authors":"Ahmed Abdelwahab ,&nbsp;Hasna Loulida ,&nbsp;Mohammad Mahdi Bagheri Asl ,&nbsp;Marwa Abdelrasoul ,&nbsp;Qian Chang Gallo ,&nbsp;Erick Lemon ,&nbsp;Sami Al Kasab ,&nbsp;Nathan C. Rowland ,&nbsp;Alejandro M. Spiotta ,&nbsp;Istvan Takacs","doi":"10.1016/j.clineuro.2025.109293","DOIUrl":"10.1016/j.clineuro.2025.109293","url":null,"abstract":"<div><h3>Objectives</h3><div>Current commercial stereotactic frames have several limitations and are geometrically complex. They utilize imaginary, physically unreachable reference points, and they are expensive. We designed a three-dimensional, low-cost, and easy-to-assemble frame that can both visualize and physically reach the reference point at (0, 0, 0). Our frame allows simultaneous bilateral targeting via distinct trajectories, thereby reducing operative time while providing wider facial exposure for airway protection.</div></div><div><h3>Methods</h3><div>In a prospective phantom experiment (August–October 2025), five operators each performed five passes at four radiopaque intracranial targets (100 attempts). Before every pass, the frame was physically re-zeroed to the reference point. For each attempt, we recorded the three-dimensional Euclidean target registration error (TRE) and the signed axis-specific offsets. Linear mixed-effects modelling with operator and target location as random factors, intraclass correlation, and Bland-Altman agreement were utilized for statistical analyses.</div></div><div><h3>Results</h3><div>All 100 trajectories contacted their intended target. Mean±SD TRE was 0.19 ± 0.07 mm. Every attempt fell within 1 mm of the target (100 %, 95 %CI 96.4–100 %). Axis-wise biases were negligible (Δx = 0.01 mm, Δy = -0.01 mm, Δz = -0.01 mm; all p &gt; 0.33). Bland-Altman limits of agreement were ±0.23 mm (x), ±0.24 mm (y), and ±0.24 mm (z) with no trend across the measurement range. Mixed-effects modelling attributed 12.5 % of the residual variance to operators, 7.1 % to target location, and 80.4 % to unexplained (within-trial) error; the adjusted ICC was 0.20, indicating low between-operator variability relative to total variance. Neither repetition order (p = 0.38) nor location (p = 0.08) influenced TRE. The mean setup-to-trajectory time was under 10 min per operator.</div></div><div><h3>Conclusion</h3><div>Our stereotactic system delivered reproducible, near-millimeter accuracy in phantom testing while simplifying setup, reducing operative time, and eliminating expensive software dependency. These findings justify advancing to cadaveric studies and early clinical trials to broaden access to frame-based stereotaxy for urgent procedures, such as external ventricular drain placement, across diverse healthcare environments.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109293"},"PeriodicalIF":1.6,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862522","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}

{"title":"Heart rate variability in adults with mild traumatic brain injury: a population-based cross-sectional study","authors":"Enkhjin Bat-Erdene ,&nbsp;Enkhnaran Tumurbaatar ,&nbsp;Gantsetseg Tumur-Ochir ,&nbsp;Battuvshin Lkhagvasuren ,&nbsp;Tsolmon Jadamba ,&nbsp;Hiroaki Adachi","doi":"10.1016/j.clineuro.2025.109289","DOIUrl":"10.1016/j.clineuro.2025.109289","url":null,"abstract":"<div><div>Autonomic nervous system disruptions following mild traumatic brain injury (MTBI) may play a role in elevated mortality risk. However, the relationship between MTBI-related autonomic dysfunction and mental health in the general population remains understudied. This study examined autonomic dysfunction and mental health symptoms among individuals reporting previous MTBI within a community sample. This population-based cross-sectional study was implemented among adults residing in Ulaanbaatar, Mongolia. Heart rate variability (HRV) analysis served as a non-invasive method for evaluating autonomic nervous system functioning. Mental health parameters including anxiety, depression, sleep disturbances, and quality of life were measured using validated instruments: Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and the brief version of World Health Organization Quality of Life (WHOQOL-BREF). The study enrolled 177 individuals (74 % female) averaging 39.85 ± 9.82 years. Sixteen individuals reported experiencing MTBI previously. After adjusting for age and sex, the population prevalence was 2.4 %. Elevated body temperature, increased heart rate, and higher anxiety levels were observed among MTBI-exposed participants relative to unexposed individuals, while HRV indices showed reductions. Regression analysis indicated associations between MTBI and reduced HRV measures. The results demonstrate that pNN50 and RMSSD were predicted by marital status, LF/HF ratio, and MTBI-exposed history (r2 = 0.33, P = 0.017 and r2 = 0.37, P = 0.005, respectively). In conclusion, individuals with MTBI history demonstrated reduced HRV and elevated anxiety relative to individuals without MTBI history. These findings indicate potential persistent effects of MTBI on autonomic function, mental health, and quality of life.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109289"},"PeriodicalIF":1.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839649","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}

{"title":"“Eiffel-by-night” sign in hypertrophic pachymeningitis: Clinical and radiological correlates","authors":"Daniela Ohlweiler Brescovit ,&nbsp;Leandro Tavares Lucato ,&nbsp;Luiz Henrique Martins Castro ,&nbsp;Suely Kazue Nagahashi Marie ,&nbsp;Guilherme Diogo Silva","doi":"10.1016/j.clineuro.2025.109291","DOIUrl":"10.1016/j.clineuro.2025.109291","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical significance of the “Eiffel-by-night” (EBN) sign in hypertrophic pachymeningitis, focusing on its frequency, etiological associations, and prognostic value for recurrence, which improves diagnostic workflows, facilitating earlier, targeted therapeutic interventions.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study at the Autoimmune Meningitis Outpatient Clinic at Hospital das Clínicas, Universidade de São Paulo (Brazil), from January 2024 to April 2025, including patients with HP confirmed by MRI dural thickening and enhancement, excluding infectious and neoplastic cases. Clinical, cerebrospinal fluid (CSF), and imaging data were obtained from medical records. Two independent raters assessed the presence of the EBN sign on post-contrast T1-weighted on baseline and follow-up MRIs, comparing EBN+ and EBN– groups.</div></div><div><h3>Results</h3><div>Forty-five patients fulfilled eligibility criteria; 8 (17.7 %) of whom were EBN+, mostly middle-aged women. EBN sign was more common in idiopathic HP (62.5 %), and less so in IgG4-related disease, neurosarcoidosis, and ANCA-associated vasculitis. Clinical and CSF profiles were similar between groups, except for two male EBN+ patients, with marked pleocytosis. Most EBN+ patients (75 %) had a relapsing disease course. The sign persisted in 86 % of cases on the last follow-up.</div></div><div><h3>Conclusion</h3><div>The EBN sign occurred in fewer than one-fifth of HP cases, primarily in idiopathic disease. Despite no clear clinical or CSF distinctions, its persistence correlated with frequent relapse.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109291"},"PeriodicalIF":1.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839620","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}

{"title":"A comment on cohort structure in Chiari I malformation studies","authors":"Shiva A. Nischal,&nbsp;Shaan Patel,&nbsp;Jayaratnam Jayamohan","doi":"10.1016/j.clineuro.2025.109295","DOIUrl":"10.1016/j.clineuro.2025.109295","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109295"},"PeriodicalIF":1.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839650","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}