Pub Date : 2024-08-10DOI: 10.1016/j.clineuro.2024.108501
Purpose
Interventional stroke therapy has become standard treatment for patients with acute ischemic strokes. Complete reperfusion (eTICI 3) portrays the best possible technical outcome. The purpose of this study was to determine possible predictors for an unfavorable neurological long-term outcome (mRS 3–6) despite achieving the best possible treatment success.
Methods
We evaluated 122 patients with stroke in the anterior circulation and complete reperfusion after mechanical thrombectomy (MT) between May 2010 and March 2020. We performed a binary logistic regression analysis with patient baseline data, stroke severity, comorbidities, premedication and treatment information as independent variables.
Results
50 of the 122 patients included in our study showed a poor clinical outcome after 90 days (41 %). Multivariable logistic regression analysis showed that older age (p = 0.033), higher admission NIHSS (p=0.009), lower admission ASPECTS (p=0.005), a pre-existing cardiovascular disease (p=0.017), and multiple passes for complete reperfusion (p=0.030) had an independent impact on unfavorable outcome.
Conclusions
Older age, higher NIHSS upon admission, lower ASPECTS upon admission, cardiovascular comorbidities and multiple passes for complete reperfusion are predictors for poor neurological long-term outcome despite complete reperfusion.
{"title":"Unfavorable neurological long-term outcome despite eTICI 3 – What are the predictors?","authors":"","doi":"10.1016/j.clineuro.2024.108501","DOIUrl":"10.1016/j.clineuro.2024.108501","url":null,"abstract":"<div><h3>Purpose</h3><p>Interventional stroke therapy has become standard treatment for patients with acute ischemic strokes. Complete reperfusion (eTICI 3) portrays the best possible technical outcome. The purpose of this study was to determine possible predictors for an unfavorable neurological long-term outcome (mRS 3–6) despite achieving the best possible treatment success.</p></div><div><h3>Methods</h3><p>We evaluated 122 patients with stroke in the anterior circulation and complete reperfusion after mechanical thrombectomy (MT) between May 2010 and March 2020. We performed a binary logistic regression analysis with patient baseline data, stroke severity, comorbidities, premedication and treatment information as independent variables.</p></div><div><h3>Results</h3><p>50 of the 122 patients included in our study showed a poor clinical outcome after 90 days (41 %). Multivariable logistic regression analysis showed that older age (p = 0.033), higher admission NIHSS (p=0.009), lower admission ASPECTS (p=0.005), a pre-existing cardiovascular disease (p=0.017), and multiple passes for complete reperfusion (p=0.030) had an independent impact on unfavorable outcome.</p></div><div><h3>Conclusions</h3><p>Older age, higher NIHSS upon admission, lower ASPECTS upon admission, cardiovascular comorbidities and multiple passes for complete reperfusion are predictors for poor neurological long-term outcome despite complete reperfusion.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0303846724003883/pdfft?md5=e77283af8f7f17386cb1a059b0f827a4&pid=1-s2.0-S0303846724003883-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.clineuro.2024.108503
Objective
Cerebral infarction treatments are most effective if used early after stroke symptoms occur. Also, early detection is crucial for delaying and improving cognitive impairment. This study investigated the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (Non-HDL-C/HDL-C), which reflects the entire burden of the cholesterol transported in atherogenic lipoproteins, and the level of β-amyloid 1-42 (Aβ-1-42), a major component of cerebrovascular amyloid deposits, in peripheral blood and cognitive dysfunction secondary to cerebral infarction.
Methods
A total of 83 patients with cerebral infarction admitted to Bozhou People's Hospital between June 2019 and June 2022 were assessed. The patients were divided into two groups based on their Mini-Mental State Scale (MMSE) scores: cognitive dysfunction group (n = 30) and non-cognitive dysfunction group (n = 53). In addition, a control group comprising 34 patients with transient cerebral insufficiency or cerebrovascular stenosis was selected. The groups were compared in terms of various clinical factors, including gender, age, hypertension, hyperlipidemia, lipid indexes, Non-HDL-C/HDL-C, and Aβ1-42 levels. Logistic regression analysis was used to identify the risk factors associated with cognitive dysfunction.
Results
The results showed that hypertensive patients with cognitive dysfunction secondary to cerebral infarction had a higher proportion of frontal lobe, temporal lobe, and thalamus involvement and lower scores on the MMSE compared to the non-cognitive impairment group and control group (p < 0.05). Additionally, the levels of homocysteine (HCY), Non-HDL-C/HDL-C, and Aβ1-42 in peripheral blood were significantly higher in hypertensive patients with cognitive dysfunction compared to the other two groups (all p < 0.05) and were identified as risk factors for cognitive dysfunction secondary to cerebral infarction. Peripheral blood levels of Non-HDL-C/HDL-C and Aβ1-42 are risk factors for secondary cognitive dysfunction following a cerebral infarction.
Conclusion
These data have important clinical implications for understanding the mechanisms underlying cognitive dysfunction in individuals with cerebrovascular disorders, potentially leading to new early interventions for preventing or treating such diseases.
{"title":"Correlation between Non-HDL-C/HDL-C and Aβ1-42 levels in cerebral infarction-related cognitive dysfunction","authors":"","doi":"10.1016/j.clineuro.2024.108503","DOIUrl":"10.1016/j.clineuro.2024.108503","url":null,"abstract":"<div><h3>Objective</h3><p>Cerebral infarction treatments are most effective if used early after stroke symptoms occur. Also, early detection is crucial for delaying and improving cognitive impairment. This study investigated the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (Non-HDL-C/HDL-C), which reflects the entire burden of the cholesterol transported in atherogenic lipoproteins, and the level of β-amyloid 1-42 (Aβ-1-42), a major component of cerebrovascular amyloid deposits, in peripheral blood and cognitive dysfunction secondary to cerebral infarction.</p></div><div><h3>Methods</h3><p>A total of 83 patients with cerebral infarction admitted to Bozhou People's Hospital between June 2019 and June 2022 were assessed. The patients were divided into two groups based on their Mini-Mental State Scale (MMSE) scores: cognitive dysfunction group (n = 30) and non-cognitive dysfunction group (n = 53). In addition, a control group comprising 34 patients with transient cerebral insufficiency or cerebrovascular stenosis was selected. The groups were compared in terms of various clinical factors, including gender, age, hypertension, hyperlipidemia, lipid indexes, Non-HDL-C/HDL-C, and Aβ1-42 levels. Logistic regression analysis was used to identify the risk factors associated with cognitive dysfunction.</p></div><div><h3>Results</h3><p>The results showed that hypertensive patients with cognitive dysfunction secondary to cerebral infarction had a higher proportion of frontal lobe, temporal lobe, and thalamus involvement and lower scores on the MMSE compared to the non-cognitive impairment group and control group (<em>p</em> < 0.05). Additionally, the levels of homocysteine (HCY), Non-HDL-C/HDL-C, and Aβ1-42 in peripheral blood were significantly higher in hypertensive patients with cognitive dysfunction compared to the other two groups (all <em>p</em> < 0.05) and were identified as risk factors for cognitive dysfunction secondary to cerebral infarction. Peripheral blood levels of Non-HDL-C/HDL-C and Aβ1-42 are risk factors for secondary cognitive dysfunction following a cerebral infarction.</p></div><div><h3>Conclusion</h3><p>These data have important clinical implications for understanding the mechanisms underlying cognitive dysfunction in individuals with cerebrovascular disorders, potentially leading to new early interventions for preventing or treating such diseases.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0303846724003901/pdfft?md5=17da7ddabdc77a12f6c627a379db6c2c&pid=1-s2.0-S0303846724003901-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.clineuro.2024.108461
Background
Achieving safe, maximal tumor resection in gliomas can be challenging due to the tumor’s intricate relationship with surrounding structures. Tubular retractors offer a minimally invasive approach, preserving functional pathways and reducing complications. To assess their efficacy and safety, we conducted a systematic review and meta-analysis.
Methods
A search across databases identified 26 studies meeting inclusion criteria, encompassing 106 patients with various glioma types and tumor locations.
Results
Among 26 eligible studies, 15 provided sufficient data on 106 patients (median age: 50.5 years). Glioblastoma multiforme constituted 52.4 % of tumors, followed by IDH-mutant astrocytomas at 31.0 %. Tumor locations varied, with intraventricular and thalamic involvement in 16.3 % (16/98) of cases, followed by temporal (12.2 %), frontal and occipital (each 8.16 %), basal ganglia (8.16 %), parietal (7.14 %), optic pathway (2.04 %), and caudate nucleus (1.02 %) involvement. VyCor and Brainpath retractors were most used (22.6 % and 21.7 %, respectively). Tubular retractors were often combined with the exoscope (35.9 %). Gross total resection (GTR) was achieved in 69.4 % of cases, near-total resection (NTR) in 5.1 %, and subtotal resection/partial resection (STR/PR) in 25.5 %. Mean extent of resection (EOR) significantly differed between GTR and STR/NTR/PR groups (p<0.001). Postoperative complications included visual deficits (6.38 %), hemiparesis or weakness (2.13 %), multiple complications (1.06 %), and other unspecified complications (3.19 %).
Conclusion
Tubular retractors are a valuable intraoperative adjunct and component of the surgical armamentarium for glioma surgery allowing bimanual operative techniques to manage hemostasis directly with excellent surgical outcomes and an acceptable complication profile.
{"title":"Evaluating the impact of tubular retractors in glioma surgery: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.clineuro.2024.108461","DOIUrl":"10.1016/j.clineuro.2024.108461","url":null,"abstract":"<div><h3>Background</h3><p>Achieving safe, maximal tumor resection in gliomas can be challenging due to the tumor’s intricate relationship with surrounding structures. Tubular retractors offer a minimally invasive approach, preserving functional pathways and reducing complications. To assess their efficacy and safety, we conducted a systematic review and meta-analysis.</p></div><div><h3>Methods</h3><p>A search across databases identified 26 studies meeting inclusion criteria, encompassing 106 patients with various glioma types and tumor locations.</p></div><div><h3>Results</h3><p>Among 26 eligible studies, 15 provided sufficient data on 106 patients (median age: 50.5 years). Glioblastoma multiforme constituted 52.4 % of tumors, followed by IDH-mutant astrocytomas at 31.0 %. Tumor locations varied, with intraventricular and thalamic involvement in 16.3 % (16/98) of cases, followed by temporal (12.2 %), frontal and occipital (each 8.16 %), basal ganglia (8.16 %), parietal (7.14 %), optic pathway (2.04 %), and caudate nucleus (1.02 %) involvement. VyCor and Brainpath retractors were most used (22.6 % and 21.7 %, respectively). Tubular retractors were often combined with the exoscope (35.9 %). Gross total resection (GTR) was achieved in 69.4 % of cases, near-total resection (NTR) in 5.1 %, and subtotal resection/partial resection (STR/PR) in 25.5 %. Mean extent of resection (EOR) significantly differed between GTR and STR/NTR/PR groups (p<0.001). Postoperative complications included visual deficits (6.38 %), hemiparesis or weakness (2.13 %), multiple complications (1.06 %), and other unspecified complications (3.19 %).</p></div><div><h3>Conclusion</h3><p>Tubular retractors are a valuable intraoperative adjunct and component of the surgical armamentarium for glioma surgery allowing bimanual operative techniques to manage hemostasis directly with excellent surgical outcomes and an acceptable complication profile.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916287","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}
Pub Date : 2024-08-08DOI: 10.1016/j.clineuro.2024.108493
Objective
Early morning OFF (EMO) is one of the first motor complications to manifest and frequently signals the onset of additional motor complications in Parkinson’s Disease (PD). Although EOM are frequently observed in patients with PD and many caregivers must help with their motor inability, the treatment is still unsatisfactory. The majority of research that has been conducted on the wearing-off state of patients with PD has focused on daytime symptoms; evening and early morning symptoms have received much less attention.This study aimed to review the clinical perspectives of current therapies for EMO.
Materials and methods
We reviewed the searching relevant publications from the key words such as morning off. A total of 456 publications were identified and we reviewed 21 clinical trials as well as other relevant clinical studies and reviews.
Results
EMO are frequently disregarded or undervalued, which could have resulted in unintentional risks, inadequate management, and an increased burden of care. Oral medication is still the primary medical intervention for EMO. However, new developments in non-oral medications and advanced formulations aim to reduce the delay in experiencing the benefits of oral levodopa due to gastrointestinal problems.
Conclusions
The current therapies for EMO could be helpful in selecting a limited practical treatment. Advancements in non-oral medications and oral formulations hold promise for improving efficacy in EMO.
{"title":"Early-morning OFF in Parkinson’s disease: A systematic literature review and current therapeutics","authors":"","doi":"10.1016/j.clineuro.2024.108493","DOIUrl":"10.1016/j.clineuro.2024.108493","url":null,"abstract":"<div><h3>Objective</h3><p>Early morning OFF (EMO) is one of the first motor complications to manifest and frequently signals the onset of additional motor complications in Parkinson’s Disease (PD). Although EOM are frequently observed in patients with PD and many caregivers must help with their motor inability, the treatment is still unsatisfactory. The majority of research that has been conducted on the wearing-off state of patients with PD has focused on daytime symptoms; evening and early morning symptoms have received much less attention.This study aimed to review the clinical perspectives of current therapies for EMO.</p></div><div><h3>Materials and methods</h3><p>We reviewed the searching relevant publications from the key words such as morning off. A total of 456 publications were identified and we reviewed 21 clinical trials as well as other relevant clinical studies and reviews.</p></div><div><h3>Results</h3><p>EMO are frequently disregarded or undervalued, which could have resulted in unintentional risks, inadequate management, and an increased burden of care. Oral medication is still the primary medical intervention for EMO. However, new developments in non-oral medications and advanced formulations aim to reduce the delay in experiencing the benefits of oral levodopa due to gastrointestinal problems.</p></div><div><h3>Conclusions</h3><p>The current therapies for EMO could be helpful in selecting a limited practical treatment. Advancements in non-oral medications and oral formulations hold promise for improving efficacy in EMO.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044837","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}
Pub Date : 2024-08-06DOI: 10.1016/j.clineuro.2024.108475
Introduction
The transition from fingolimod (FIN) to siponimod (SIP) for Multiple Sclerosis (MS) treatment in the occurrence of Secondary Progressive Multiple Sclerosis (SPMS) diagnosis has increasingly attracted considerable interest in the recent literature.
Methods
We evaluated the efficacy and safety of a direct switch from FIN to SIP in nine MS patients who had switched directly from FIN to SIP due to SPMS diagnosis at the Multiple Sclerosis Center of the University Hospital Policlinico of Bari.
Results and Conclusion
Real-world results from our cohort demonstrated that the direct switch from FIN to SIP in patients transitioning in SP course is associated with clinical and disability progression stability, with a favorable safety profile.
导言：在最近的文献中，从芬戈莫德（FIN）过渡到西波尼莫德（SIP）用于多发性硬化症（MS）治疗，并确诊为继发性进展型多发性硬化症（SPMS）的研究越来越受到广泛关注。我们对巴里大学波利克利尼科医院多发性硬化症中心因确诊为继发性进展性多发性硬化症而直接从 FIN 转为 SIP 的 9 名多发性硬化症患者进行了疗效和安全性评估。结果与结论我们队列的实际结果表明，继发性进展性多发性硬化症患者直接从 FIN 转为 SIP 与临床和残疾进展的稳定性有关，同时具有良好的安全性。
{"title":"Siponimod from fingolimod direct switch in patients transitioning in secondary progressive multiple sclerosis: A single center case series","authors":"","doi":"10.1016/j.clineuro.2024.108475","DOIUrl":"10.1016/j.clineuro.2024.108475","url":null,"abstract":"<div><h3>Introduction</h3><p>The transition from fingolimod (FIN) to siponimod (SIP) for Multiple Sclerosis (MS) treatment in the occurrence of Secondary Progressive Multiple Sclerosis (SPMS) diagnosis has increasingly attracted considerable interest in the recent literature.</p></div><div><h3>Methods</h3><p>We evaluated the efficacy and safety of a direct switch from FIN to SIP in nine MS patients who had switched directly from FIN to SIP due to SPMS diagnosis at the Multiple Sclerosis Center of the University Hospital Policlinico of Bari.</p></div><div><h3>Results and Conclusion</h3><p>Real-world results from our cohort demonstrated that the direct switch from FIN to SIP in patients transitioning in SP course is associated with clinical and disability progression stability, with a favorable safety profile.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142002405","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}
Pub Date : 2024-08-06DOI: 10.1016/j.clineuro.2024.108502
Objective
Primary intracerebral hemorrhage (ICH) accounts for 85 % of ICH and is associated with high morbidity and mortality. Identification of prognostic factors is critical to its management. However, previous studies showed conflicting results in whether diabetes mellitus (DM) is associated with outcomes among ICH patients. The present study examined the association between DM and long-term functional outcomes prospectively after ICH.
Design
This prospective study examined the functional outcomes in primary ICH patients. This study excluded patients who died before discharge and those with ICH related to aneurysm, arteriovenous malformation, or trauma. Patients were followed up for 1 year after ICH. Functional outcome was based on the Barthel Index (BI). Severe dependency in ADL was defined by a BI of ≤60, and functional independence was defined by a BI of >90.
Results
A total of 100 patients completed the 1-year follow-up, and 24 patients had DM. DM was significantly associated with worse functional outcomes 1 year post-ICH. The association remained significant after adjusting for baseline characteristics, comorbidities, and ICH score.
Conclusion
DM was an independent predictor of worse functional outcomes 1 year post-ICH. This study is the first to examine the effect of DM on long-term functional outcomes after ICH.
目的原发性脑内出血（ICH）占 ICH 的 85%，发病率和死亡率都很高。确定预后因素对治疗至关重要。然而，以往的研究显示，糖尿病（DM）是否与 ICH 患者的预后相关，结果却相互矛盾。本研究对糖尿病与 ICH 患者长期功能预后之间的关系进行了前瞻性研究。本研究排除了出院前死亡的患者以及与动脉瘤、动静脉畸形或外伤相关的 ICH 患者。患者在 ICH 后接受了 1 年的随访。功能结果基于巴特尔指数（Barthel Index，BI）。BI≤60为ADL严重依赖，BI≥90为功能独立。结果共有100名患者完成了为期1年的随访，其中24名患者患有DM。慢性阻塞性肺病与慢性阻塞性肺病术后1年的功能预后较差有明显相关性。在对基线特征、并发症和 ICH 评分进行调整后，这种关联仍然显著。本研究首次探讨了 DM 对 ICH 后长期功能预后的影响。
{"title":"Diabetes mellitus is associated with worse long-term functional outcomes in primary intracerebral hemorrhage survivors – A prospective study","authors":"","doi":"10.1016/j.clineuro.2024.108502","DOIUrl":"10.1016/j.clineuro.2024.108502","url":null,"abstract":"<div><h3>Objective</h3><p>Primary intracerebral hemorrhage (ICH) accounts for 85 % of ICH and is associated with high morbidity and mortality. Identification of prognostic factors is critical to its management. However, previous studies showed conflicting results in whether diabetes mellitus (DM) is associated with outcomes among ICH patients. The present study examined the association between DM and long-term functional outcomes prospectively after ICH.</p></div><div><h3>Design</h3><p>This prospective study examined the functional outcomes in primary ICH patients. This study excluded patients who died before discharge and those with ICH related to aneurysm, arteriovenous malformation, or trauma. Patients were followed up for 1 year after ICH. Functional outcome was based on the Barthel Index (BI). Severe dependency in ADL was defined by a BI of ≤60, and functional independence was defined by a BI of >90.</p></div><div><h3>Results</h3><p>A total of 100 patients completed the 1-year follow-up, and 24 patients had DM. DM was significantly associated with worse functional outcomes 1 year post-ICH. The association remained significant after adjusting for baseline characteristics, comorbidities, and ICH score.</p></div><div><h3>Conclusion</h3><p>DM was an independent predictor of worse functional outcomes 1 year post-ICH. This study is the first to examine the effect of DM on long-term functional outcomes after ICH.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142044818","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}
Pub Date : 2024-08-06DOI: 10.1016/j.clineuro.2024.108495
Background
Perihematomal edema (PHE) is regarded as a potential intervention indicator of secondary injury following intracerebral hemorrhage (ICH). But it still lacks a comprehensive prediction model for early PHE formation.
Methods
The included ICH patients have received an initial Computed Tomography scan within 6 hours of symptom onset. Hematoma volume and PHE volume were computed using semiautomated computer-assisted software. The volume of the hematoma, edema around the hematoma, and surface area of the hematoma were calculated. The platelet-to-lymphocyte ratio (PLR) was calculated by dividing the platelet count by the lymphocyte cell count. All analyses were 2-tailed, and the significance level was determined by P <0.05.
Results
A total of 226 patients were included in the final analysis. The optimal cut-off values for PHE volume increase to predict poor outcomes were determined as 5.5 mL. For clinical applicability, we identified a value of 5.5 mL as the optimal threshold for early PHE growth. In the multivariate logistic regression analyses, we finally found that baseline hematoma surface area (p < 0.001), expansion-prone hematoma (p < 0.001), and PLR (p = 0.033) could independently predict PHE growth. The comprehensive prediction model demonstrated good performance in predicting PHE growth, with an area under the curve of 0.841, sensitivity of 0.807, and specificity of 0.732.
Conclusion
In this study, we found that baseline hematoma surface area, expansion-prone hematoma, and PLR were independently associated with PHE growth. Additionally, a risk nomogram model was established to predict the PHE growth in patients with ICH.
{"title":"A comprehensive prediction model predicts perihematomal edema growth in the acute stage after intracerebral hemorrhage","authors":"","doi":"10.1016/j.clineuro.2024.108495","DOIUrl":"10.1016/j.clineuro.2024.108495","url":null,"abstract":"<div><h3>Background</h3><p>Perihematomal edema (PHE) is regarded as a potential intervention indicator of secondary injury following intracerebral hemorrhage (ICH). But it still lacks a comprehensive prediction model for early PHE formation.</p></div><div><h3>Methods</h3><p>The included ICH patients have received an initial Computed Tomography scan within 6 hours of symptom onset. Hematoma volume and PHE volume were computed using semiautomated computer-assisted software. The volume of the hematoma, edema around the hematoma, and surface area of the hematoma were calculated. The platelet-to-lymphocyte ratio (PLR) was calculated by dividing the platelet count by the lymphocyte cell count. All analyses were 2-tailed, and the significance level was determined by P <0.05.</p></div><div><h3>Results</h3><p>A total of 226 patients were included in the final analysis. The optimal cut-off values for PHE volume increase to predict poor outcomes were determined as 5.5 mL. For clinical applicability, we identified a value of 5.5 mL as the optimal threshold for early PHE growth. In the multivariate logistic regression analyses, we finally found that baseline hematoma surface area (p < 0.001), expansion-prone hematoma (p < 0.001), and PLR (p = 0.033) could independently predict PHE growth. The comprehensive prediction model demonstrated good performance in predicting PHE growth, with an area under the curve of 0.841, sensitivity of 0.807, and specificity of 0.732.</p></div><div><h3>Conclusion</h3><p>In this study, we found that baseline hematoma surface area, expansion-prone hematoma, and PLR were independently associated with PHE growth. Additionally, a risk nomogram model was established to predict the PHE growth in patients with ICH.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912057","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}
Pub Date : 2024-08-06DOI: 10.1016/j.clineuro.2024.108499
Background
Edinburgh Cognitive and Behavioral ALS Screen (ECAS) is a validated assessment designed to screen cognitive functions and behavioral disorders in amyotrophic lateral sclerosis (ALS). Objective of this study is to determine the factors associated with ECAS impairment in a cohort of ALS patients without a co-morbid diagnosis of dementia, at the time of diagnosis.
Methods
We enrolled 71 non-demented ALS patient. We collected clinical and demographic data, ALS familiarity, analysis of the most commonly mutated genes in ALS, ALS Milano Torino Staging System and ALS Functional Rate Scale revised scores, progression rate; finally, we recorded whether symptoms onset involved spinal or bulbar area. The alteration of the ECAS was estimated based on age and education-adjusted-validated cut off for each of the items included in ECAS. A multivariable regression analysis was done.
Results
The significant determinants of ECAS alterations were: bulbar onset in both ALS-specific test and total ECAS score; bulbar onset and familiarity in ALS-non-specific test; finally, familiarity and diagnosis delay in ALS-behavioral test. All the subjects carrying C9orf72 mutations had alteration of both total ECAS score and ALS-specific tests.
Discussion
At diagnosis, bulbar-onset ALS, family history, diagnosis delay and C9orf72 hexanucleotide repeat expansion may contribute to impairment of ECAS.
背景爱丁堡认知和行为ALS筛查（ECAS）是一项经过验证的评估，旨在筛查肌萎缩侧索硬化症（ALS）患者的认知功能和行为障碍。本研究的目的是确定一组未合并痴呆诊断的 ALS 患者在确诊时与 ECAS 损伤相关的因素。我们收集了临床和人口统计学数据、ALS 熟悉程度、ALS 最常见突变基因分析、ALS 米兰都灵分期系统和 ALS 功能率量表修订版评分、病情进展率；最后，我们记录了发病症状涉及脊柱还是球部。根据年龄和受教育程度调整的 ECAS 各项目的验证截止值，估算了 ECAS 的变化情况。结果ECAS变化的重要决定因素是：在ALS特异性测试和ECAS总分中，球部发病；在ALS非特异性测试中，球部发病和熟悉程度；最后，在ALS行为测试中，熟悉程度和诊断延迟。所有携带C9orf72突变的受试者在ECAS总分和ALS特异性测试中均有改变。
{"title":"Factors associated with Edinburgh Cognitive and Behavioural ALS Screen (ECAS) alteration at time of diagnosis, in amyotrophic lateral sclerosis","authors":"","doi":"10.1016/j.clineuro.2024.108499","DOIUrl":"10.1016/j.clineuro.2024.108499","url":null,"abstract":"<div><h3>Background</h3><p>Edinburgh Cognitive and Behavioral ALS Screen (ECAS) is a validated assessment designed to screen cognitive functions and behavioral disorders in amyotrophic lateral sclerosis (ALS). Objective of this study is to determine the factors associated with ECAS impairment in a cohort of ALS patients without a co-morbid diagnosis of dementia, at the time of diagnosis.</p></div><div><h3>Methods</h3><p>We enrolled 71 non-demented ALS patient. We collected clinical and demographic data, ALS familiarity, analysis of the most commonly mutated genes in ALS, ALS Milano Torino Staging System and ALS Functional Rate Scale revised scores, progression rate; finally, we recorded whether symptoms onset involved spinal or bulbar area. The alteration of the ECAS was estimated based on age and education-adjusted-validated cut off for each of the items included in ECAS. A multivariable regression analysis was done.</p></div><div><h3>Results</h3><p>The significant determinants of ECAS alterations were: bulbar onset in both ALS-specific test and total ECAS score; bulbar onset and familiarity in ALS-non-specific test; finally, familiarity and diagnosis delay in ALS-behavioral test. All the subjects carrying <em>C9orf72</em> mutations had alteration of both total ECAS score and ALS-specific tests.</p></div><div><h3>Discussion</h3><p>At diagnosis, bulbar-onset ALS, family history, diagnosis delay and <em>C9orf72</em> hexanucleotide repeat expansion may contribute to impairment of ECAS.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141985239","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}
Pub Date : 2024-08-06DOI: 10.1016/j.clineuro.2024.108500
Objective
This study aimed to externally validate different predictive scores for symptomatic intracranial hemorrhage (SICH) after intravenous thrombolysis (IVT), with a particular focus on their predictive abilities in Asian stroke patients.
Methods
We retrospectively enrolled stroke patients who received a standard dose of alteplase within 4.5 hours from symptom onset at the First Affiliated Hospital of Dalian Medical University from July 2010 to August 2023. SICH was defined as the hemorrhagic transformation detected on the head CT scan completed within 48 h post-IVT, accompanied by a clinical deterioration of at least a 4-point increase in NIHSS score. Predictive abilities of the HAT, MSS, SEDAN, SPAN-100, and GRASPS scores were tested. Discrimination and calibration were performed using the area under the receiver operating characteristic curve (ROC-AUC), DeLong test, and Hosmer-Lemeshow (H-L) goodness-of-fit test.
Results
The study included 1007 stroke patients, of whom 31 (3.08 %) developed SICH. ROC-AUCs for predicting SICH were: 0.796 (95 %CI: 0.726–0.866) for the GRASPS score, 0.724 (95 %CI: 0.644–0.804) for the MSS score, 0.715 (95 %CI: 0.619–0.811) for the SEDAN score, 0.714 (95 %CI: 0.611–0.817) for the HAT score, and 0.605 (95 %CI: 0.491–0.720) for the SPAN-100 score (all P < 0.05). DeLong tests showed that the GRASPS score demonstrated significantly better discrimination than the MSS score (P = 0.010), the SEDAN score (P = 0.009), the HAT score (P = 0.049), and the SPAN-100 score (P = 0.000). H-L tests indicated good calibrations which were ranked HAT > SEDAN > MSS > SPAN-100 > GRASPS scores.
Conclusion
The GRASPS score showed reasonable predictive ability for SICH, indicating its potential utility for Asian stroke patients receiving IVT.
{"title":"External validation of different predictive scores for symptomatic intracranial hemorrhage after intravenous thrombolysis in Asian stroke patients","authors":"","doi":"10.1016/j.clineuro.2024.108500","DOIUrl":"10.1016/j.clineuro.2024.108500","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to externally validate different predictive scores for symptomatic intracranial hemorrhage (SICH) after intravenous thrombolysis (IVT), with a particular focus on their predictive abilities in Asian stroke patients.</p></div><div><h3>Methods</h3><p>We retrospectively enrolled stroke patients who received a standard dose of alteplase within 4.5 hours from symptom onset at the First Affiliated Hospital of Dalian Medical University from July 2010 to August 2023. SICH was defined as the hemorrhagic transformation detected on the head CT scan completed within 48 h post-IVT, accompanied by a clinical deterioration of at least a 4-point increase in NIHSS score. Predictive abilities of the HAT, MSS, SEDAN, SPAN-100, and GRASPS scores were tested. Discrimination and calibration were performed using the area under the receiver operating characteristic curve (ROC-AUC), DeLong test, and Hosmer-Lemeshow (H-L) goodness-of-fit test.</p></div><div><h3>Results</h3><p>The study included 1007 stroke patients, of whom 31 (3.08 %) developed SICH. ROC-AUCs for predicting SICH were: 0.796 (<em>95 %CI</em>: 0.726–0.866) for the GRASPS score, 0.724 (<em>95 %CI</em>: 0.644–0.804) for the MSS score, 0.715 (<em>95 %CI</em>: 0.619–0.811) for the SEDAN score, 0.714 (<em>95 %CI</em>: 0.611–0.817) for the HAT score, and 0.605 (<em>95 %CI</em>: 0.491–0.720) for the SPAN-100 score (all <em>P</em> < 0.05). DeLong tests showed that the GRASPS score demonstrated significantly better discrimination than the MSS score (<em>P</em> = 0.010), the SEDAN score (<em>P</em> = 0.009), the HAT score (<em>P</em> = 0.049), and the SPAN-100 score (<em>P</em> = 0.000). H-L tests indicated good calibrations which were ranked HAT > SEDAN > MSS > SPAN-100 > GRASPS scores.</p></div><div><h3>Conclusion</h3><p>The GRASPS score showed reasonable predictive ability for SICH, indicating its potential utility for Asian stroke patients receiving IVT.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906093","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}
Pub Date : 2024-08-05DOI: 10.1016/j.clineuro.2024.108472
Objective
Limitations to medical student clinical rotation opportunities brought on by the pandemic has the potential to exacerbate differences in access to clinical experience between medical schools, and thus impact the distribution of graduates matching into neurosurgical programs nationwide. The utilization of virtual interviews that started after the pandemic are likely here to stay. In this study we seek to evaluate match rates for American (AMGs) and international medical graduates (IMGs) across the 6 most recent academic years, examining specifically the rate of home-institution matching before, during, and after the COVID-19 pandemic.
Methods
All neurological surgery residents for the years 2018–2024 were included in this analysis, with basic information about each resident being collected using publicly available online resources. For any remaining programs where information was not publicly available, program directors were contacted. Statistical analysis was performed using SPSS version 26.0 with a level of significance p<0.05.
Results
Of the total of 1271 AMGs, 1005 (79.1 %) matched away from their home institution. When dividing the 6 academic years into 3 subgroups (pre, intra, and post COVID-19), there was no significant variation between the rates of home institution matching (pre=21.0 %, during=20.4 %, post=21.3 %, p=0.740). Similar results were found while assessing IMGs (pre=28.6 %, during=30.8 %, post=32.3 %, p=0.777). Our analysis found no variation in match rates when isolating for gender across the 6 years studied either for AMGs or IMGs. However, overall institute-specific variations were found where some programs showed increased likelihood of home program match (p<0.001).
Conclusion
Preliminary data analysis suggests that contrary to the broader trends seen in other specialties, neurosurgery applicants do not exhibit a significant shift towards matching in closer proximity to their home institutions post COVID-19 pandemic and during the virtual interviews era.
{"title":"Match rate of neurosurgery residents in the United States at their home institution: A comparative analysis of Pre COVID-19, During COVID-19 and Post COVID-19 pandemic","authors":"","doi":"10.1016/j.clineuro.2024.108472","DOIUrl":"10.1016/j.clineuro.2024.108472","url":null,"abstract":"<div><h3>Objective</h3><p>Limitations to medical student clinical rotation opportunities brought on by the pandemic has the potential to exacerbate differences in access to clinical experience between medical schools, and thus impact the distribution of graduates matching into neurosurgical programs nationwide. The utilization of virtual interviews that started after the pandemic are likely here to stay. In this study we seek to evaluate match rates for American (AMGs) and international medical graduates (IMGs) across the 6 most recent academic years, examining specifically the rate of home-institution matching before, during, and after the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p>All neurological surgery residents for the years 2018–2024 were included in this analysis, with basic information about each resident being collected using publicly available online resources. For any remaining programs where information was not publicly available, program directors were contacted. Statistical analysis was performed using SPSS version 26.0 with a level of significance p<0.05.</p></div><div><h3>Results</h3><p>Of the total of 1271 AMGs, 1005 (79.1 %) matched away from their home institution. When dividing the 6 academic years into 3 subgroups (pre, intra, and post COVID-19), there was no significant variation between the rates of home institution matching (pre=21.0 %, during=20.4 %, post=21.3 %, p=0.740). Similar results were found while assessing IMGs (pre=28.6 %, during=30.8 %, post=32.3 %, p=0.777). Our analysis found no variation in match rates when isolating for gender across the 6 years studied either for AMGs or IMGs. However, overall institute-specific variations were found where some programs showed increased likelihood of home program match (p<0.001).</p></div><div><h3>Conclusion</h3><p>Preliminary data analysis suggests that contrary to the broader trends seen in other specialties, neurosurgery applicants do not exhibit a significant shift towards matching in closer proximity to their home institutions post COVID-19 pandemic and during the virtual interviews era.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896951","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}
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