Clinical Neurology and Neurosurgery最新文献

{"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}

{"title":"Occlusion of posterior communicating artery aneurysms with a ‘fetal’ type circulation treated with flow diversion","authors":"Kimberly Han,&nbsp;Aryan Wadhwa,&nbsp;Felipe Ramirez-Velandia,&nbsp;Alejandro Enriquez-Marulanda,&nbsp;Justin Granstein,&nbsp;Philipp Taussky,&nbsp;Christopher S. Ogilvy","doi":"10.1016/j.clineuro.2025.109290","DOIUrl":"10.1016/j.clineuro.2025.109290","url":null,"abstract":"<div><h3>Objective</h3><div>The fetal-type posterior communicating artery is a circle of Willis variant. Previous studies report lower complete occlusion rates (0–20 %) for fetal-type PComA (fPComA) aneurysms treated with flow diversion than non-fPComA aneurysms (70–75 %). This study evaluated the efficacy of Pipeline embolization devices (PED) in treating fPComA aneurysms and identified predictors of obliteration.</div></div><div><h3>Methods</h3><div>Retrospective analysis was performed on fPComA and non-fPComA aneurysms in patients treated from 2013 to 2023 with PED in the internal carotid artery covering the PComA origin. Demographic, fetal-type anatomy morphology, aneurysm characteristics, intervention technique, and outcome data (e.g., occlusion status at one year, complications, and retreatment rate) was collected. Aneurysm occlusion was assessed during angiographic follow-up. Univariate statistical analysis was performed to compare aneurysm occlusion rates.</div></div><div><h3>Results</h3><div>Among 96 patients treated for PComA aneurysms, 19 patients with a mean age of 61.6 ± 16.3 years had a fetal variant. Three patients were lost to follow-up. Flow diversion achieved complete or near-complete occlusion (&gt;90 % angiographic obliteration) in 12 fetal variant cases (75 %) at one year, matching PED-treated non-fPComA aneurysm occlusion rate (75 %). Two patients with fPComA aneurysms experienced in-stent thrombosis resulting in minor strokes without permanent deficits. Distal PED tip placement in the proximal M1 segment was significantly associated with complete fPComA aneurysm occlusion (p = 0.049).</div></div><div><h3>Conclusion</h3><div>PED treatment for fPComA aneurysms in our cohort demonstrates a 75 % occlusion rate, exceeding rates of prior studies and matching non-fPComA cases. PED placement technique was significantly associated with this high occlusion rate. These findings highlight PED as a potentially safe and effective intervention for these aneurysms.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109290"},"PeriodicalIF":1.6,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839648","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":"Predicting dementia severity changes after shunt surgery for idiopathic normal-pressure hydrocephalus: Role of the tap test and cognitive assessments","authors":"Fuyuki Koizumi ,&nbsp;Hideki Kanemoto ,&nbsp;Takashi Suehiro ,&nbsp;Shunsuke Sato ,&nbsp;Yuto Satake ,&nbsp;Daiki Taomoto ,&nbsp;Kenji Yoshiyama ,&nbsp;Koichi Hosomi ,&nbsp;Haruhiko Kishima ,&nbsp;Manabu Ikeda","doi":"10.1016/j.clineuro.2025.109288","DOIUrl":"10.1016/j.clineuro.2025.109288","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the most appropriate assessment scale and timing of the tap test for predicting improvements in dementia severity after shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH).</div></div><div><h3>Methods</h3><div>Data were extracted from an observational study that followed patients with iNPH as follows: Patients diagnosed with possible iNPH and scheduled for a tap test were enrolled. Patients diagnosed with probable iNPH by the tap test underwent shunting and followed up for 3 months after shunting. Patients with missing data in the tap test assessment items (gait speed: 3 consecutive days before tapping and 3 consecutive days after tapping; cognition: before tapping, 1 day after tapping and 1 week after tapping; and urinary dysfunction: before tapping and 1 week after tapping) or in the Clinical Dementia Rating (CDR) assessed before tapping and 3 months after shunting were excluded from this study.</div></div><div><h3>Results</h3><div>54 patients were included in the analysis. The change in CDR-Sum of Boxes (CDR-SoB) score after shunt surgery was significantly correlated with the change in Mini-Mental State Examination (MMSE) score (β = −0.417, p &lt; 0.001) and Frontal Assessment Battery (FAB) score (β = −0.379, p = 0.002) 3 months after shunt surgery after adjusting for age and sex. The change in MMSE score after shunt surgery was correlated with the change in MMSE score 1 day after tapping (β = 0.411, p = 0.001), the change in the minimum Timed Up and Go test score across repeated tests after tapping (β = −0.376, p = 0.004) and attention/concentration in Wechsler Memory Scale-Revised 1 day after tapping (β = −0.289, p = 0.024). The change in FAB score after shunt surgery was correlated with the change in the maximum FAB score across repeated tests after tapping (β = 0.523, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Combining MMSE and FAB assessments during the tap test may yield more useful information in assessing cognitive impairment than using either MMSE or FAB alone.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109288"},"PeriodicalIF":1.6,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826974","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}