European Neurology最新文献

The two components of today's electroneuromyography (i.e. neurography and myography) gradually emerged from the harmful practice of electrotherapy during the crucial period of 1800-1950. At the beginning of the 19th century, galvanism was supplemented by the fashionable induction coils created by Heinrich Daniel Ruhmkorff (1803-1877). In the same decades, major physiological research was performed by the Italian Carlo Matteuci (1811-1868), the Germans Emil Heinrich du Bois Reymond (1818-1896) and Eduard Pflüger (1829-1910) and the French Claude Bernard (1813-1878). This led to the description of the nerve action potential and to the measurement of the speed of nerve impulses in frogs by Hermann von Helmholtz (1821-1894). In the mid-19th century, Guillaume Duchenne de Boulogne (1806-1875) designed his own electrical equipment to perform faradisation, a focal electrification using induction current. Duchenne's methodology and conclusions led to a heated debate with Robert Remak (1815-1865) about the use of galvanic current, and with Hugo von Ziemssen (1829-1902) about the points which were to become the motor point. In the following years, the galvanic polar method was developed. Rudolf Brenner (1821-1884) formalised a literal notation of this method, expressing the muscle contraction formula by a system of letters. From the 1880s, a standardisation of electrodiagnostic exploration began. The German neurologist Wilhelm Erb (1840-1921) formalised a more complex situation called Entartungsreaktion (degenerative reaction). During WW1, a bipolar method was used and André Strohl (1887-1977) performed the electrical recording of tendon reflexes. Myography emerged in the first years of the 20th century thanks to the physiological work of Keith Lucas (1879-1916) and Charles Sherrington (1857-1952). The concentric needle, designed by Edgar Adrian (1889-1977) and Detlev Bronk (1807-1975), and the development of the cathode-ray oscilloscope were of great interest for electromyography. Such oscilloscopes also allowed Joseph Erlanger (1874-1965) and Herbert Gasser (1888-1963) to graph the action potential of a frog's sciatic nerve. During WW2, the American James G. Golseth (1912-2003) and James A. Fizzell (1912-1995) worked with the Canadian Herbert H. Jasper (1906-1999). They demonstrated the importance of interpreting myography and neurography together. In England, Herbert Seddon (1903-1977) and Graham Weddell (1908-1990) described the evolution of nerve injuries and muscle denervation on wounded soldiers. In the 1950s, the first widespread marketing of electromyographic devices allowed a new generation of neurologists to be invested in this novel topic.

Introduction: Little is known about the association between the most common brain structures presenting with calcium deposits, the pineal gland and the choroid plexus. This study aims to assess whether the extent of pineal gland calcifications (PGC) and choroid plexus calcifications (PGC) are independent or correlate to each other.

Methods: The study included 1,009 individuals aged ≥40 years enrolled in a population-based cohort who received a head CT. Images were converted to the Neuroimaging Informatics Technology Initiative format, and whole brain segmentation was performed using SynthSeg. Voxels within the pineal gland region and the ventricular cavities with attenuation >50 HU were considered to contain a calcified component. Total voxel volumes within both regions were calculated for each participant. Linear regression models were fitted to assess the association between PGC and CPC volumes. Non-parametric locally weighted scatterplot smoothing regression was used to evaluate the relationship between these variables.

Results: PGC were associated with CPC (β: 0.018; 95% C.I.: 0.009 - 0.027), after adjusting for demographics. The Pearson correlation coefficient for this association was 0.1636 (p<0.001) while the Spearman pairwise rank correlation coefficient was 0.1647 (p<0.001).

Conclusions: PGC and CPC are significantly correlated, suggesting the existence of an intrinsic predisposition to facilitate calcium deposits in brain tissues.

Introduction: Postoperative delirium (POD) that is associated with intracranial surgeries can have several adverse outcomes, including a high rate of morbidity and mortality. The use of intraoperative neurophysiological monitoring (IONM) via somatosensory evoked potentials (SSEPs) and electroencephalography (EEG) provides continuous information regarding cerebral blood flow (CBF) during aneurysm clipping. In this study, we hypothesize that CBF changes during aneurysm clipping increase the risk of POD. We aimed to demonstrate that significant changes in IONM data during surgery increase the risk of POD after adjusting for clinical and intraoperative factors.

Methods: 470 patients undergoing craniotomy for aneurysm clipping surgery with IONM were retrospectively reviewed for the development of POD. Significant IONM changes were evaluated based on a visual review of EEG and SSEP data and documentation of significant changes during surgery. Data changes during IONM were classified as SSEP changes, EEG changes, or IONM changes (SSEP and/or EEG changes).

Results: Of the 470 patients who underwent aneurysm clipping, 115 (24.5%) had POD and 35 (30.4%) had IONM changes. IONM and SSEP changes were significantly associated with POD (P< 0.001). After adjusting for confounding variables, IONM and SSEP changes were significantly associated with POD (OR 2.4 (CI 1.40-4.17); P=0.002, OR 2.49 (CI 1.39-4.45); P = 0.002, respectively). We also found that the odds of POD were higher in patients with ruptured aneurysms, and in patients who developed focal neurological deficits post-operatively (OR 2.76,1.72-4.42; P< 0.001, OR 2.11,1.02-4.36, P=0.04, respectively).

Conclusion: Patients who develop POD after craniotomy for aneurysm clipping surgery are twice as likely to have experienced significant IONM or SSEP changes during the surgery. Patients with ruptured aneurysms and who develop post-operative focal neurological deficits are also more than twice as likely to develop POD. These findings provide a strong platform for future research in testing therapeutic interventions based on IONM changes, which aim to decrease the risk of POD after aneurysm clipping surgeries.

Introduction: Cerebral small vessel disease (CSVD) is a major cause of primary lobar intracerebral hemorrhage (ICH) due to cerebral amyloid angiopathy (CAA) or hypertensive arteriopathy (HA). Sex differences in CSVD imaging markers and prevalence of CAA vs HA in lobar ICH remain unexplored.

Methods: We performed a retrospective analysis of patients with primary lobar ICH who underwent MRI during hospitalization. We collected demographic, clinical, and outcome data. We reviewed MRIs for CSVD markers and calculated composite CSVD burden score (cCSVDbs). We assigned possible/probable CAA using Boston criteria 2.0. We grouped patients based on their sex and examined associations between sex and CSVD markers, cCSVDbs, or CAA. Kaplan Meier survival analysis was used to determine ICH-onset age among patients with first-ever symptomatic lobar ICH.

Results: 214 patients were included (102 [47.66%] women). Men were more likely to be current alcohol abusers (25.69% vs. 9.09%, p = 0.002), current smokers (24.30% vs. 12.12%, p = 0.024) and have coronary artery disease (26.79% vs. 15.69%, p = 0.048), and hyperglycemia on admission (142.79 ± 59.59 vs. 126.58 ± 37.29, p = 0.019). Women were older (74.91 ± 11.69 vs. 69.28 ± 14.53 years, p = 0.002), and more likely to have possible/probable CAA in univariate (97.06% vs. 88.39%; OR: 4.33, 95% CI: 1.19-15.67; p = 0.025) but not multivariate analysis. We found no significant differences in MRI markers of CSVD, cCSVDbs, or CAA. Among patients who presented with their first-ever primary symptomatic lobar ICH (n = 187), men were younger than women (73 vs 77 years, p = 0.001).

Conclusions: In our cohort of patients with primary lobar ICH, we found no significant difference in clinical and imaging characteristics between sexes. However, men were more likely to have a younger lobar ICH-onset age compared to women.

Introduction: Epilepsy is a prevalent neurological disorder globally, with about 30% of patients developing resistance despite optimal antiseizure drug therapies. Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique and offers a potential therapeutic alternative for drug-resistant focal epilepsy, aiming to reduce seizure frequency and improve patient quality of life.

Methods: Following PRISMA guidelines, a search was performed on MEDLINE, Web of Science, and Cochrane Library from inception to June 2024. Included articles were randomized controlled trials reporting seizure frequency, IEDs, and adverse events in patients with focal epilepsy treated with tDCS. Quality assessment was conducted using RoB2, and data were analyzed using a random-effects model.

Results: Nine studies involving 253 patients met the inclusion criteria. tDCS significantly reduced seizure frequency at 1- and 2-month follow-up compared to placebo, with a mean difference (MD) of -2.62, 95% CI (-5.20, -0.04), p = 0.05 at 1 month and MD of -2.80, 95% CI (-5.08, -0.53), p = 0.02 at 2 months. No significant changes in IEDs were observed. Adverse events were generally mild and consisted of itching, skin rash, and headache being the most common.

Conclusion: tDCS reduces seizure frequency in patients with drug-resistant focal epilepsy and is associated with minimal adverse effects. However, there was no significant impact on IEDs, and the studies included exhibited considerable heterogeneity. More standardized research is required to validate these findings and optimize treatment protocols.

Introduction: Current guidelines recommend transthoracic echocardiography (TTE) for routine screening of cardiac emboli; however, the visualization of the left atrial appendage (LAA) where the thrombi are commonly found is poor. Transesophageal echocardiography (TEE) would provide better detectability of LAA thrombus, but it is a time-consuming and semi-invasive method. Extending non-gated carotid computed tomography angiography (CTA) examination to the LAA could reliably detect thrombi and could also aid treatment and secondary prevention of stroke.

Methods: We extended the CTA scan range of acute stroke patients 4 cm below the carina to include the left atrium and appendage. During the review, we evaluated LAA thrombi based on contrast relations. We then used gradient boosting to identify the most important predictors of LAA thrombi from a variety of different clinical parameters.

Results: We examined 240 acute stroke patients' extended CTA scans. We detected LAA thrombi in eleven cases (4.58%), eight of them had atrial fibrillation. 23.75% of all patients (57 cases) had recently discovered or previously known atrial fibrillation. Windsack morphology was the most commonly associated morphology with filling defects on CTA. According to the gradient-boosting analysis, LAA morphology showed the most predictive value for thrombi.

Conclusion: Our extended CTA scans reliably detected LAA thrombi even in cases where TTE did not and showed that 2 patients' LAA thrombus would have been untreated based on electrocardiogram monitoring and TTE. We also showed that the benefits of CTA outweigh the disadvantages arising from the slight amount of excess radiation.

Introduction: Endovascular thrombectomy (EVT) is the standard of care for patients with large-vessel occlusion acute ischemic stroke (AIS). There may be differing recanalization effectiveness based on patients' sex, and understanding such variations can improve patient outcomes by adjusting for differences. We aimed to assess the sex differences in outcome after EVT for patients with AIS.

Methods: We retrospectively analyzed 250 consecutive AIS patients who underwent EVT from July 2019 to February 2022 across two large comprehensive tertiary care stroke centers in China. Outcomes of male patients were compared to females, where poor outcome was defined as a modified Rankin score (mRS) of 3-6 at 90 days.

Results: Male patients had higher rates of symptomatic intracranial hemorrhage (sICH) (12.50% vs. 4.05%, p = 0.042) and higher hospitalization costs (114,541.08 vs. 105,790.27 RMB, p = 0.024). Male patients also had a longer median onset-to-needle time (ONT) (146.00 [104.00, 202.00] versus 120.00 [99.25, 144.75], p = 0.026). However, there were no differences in hospitalization length (p = 0.251), 90-day favorable outcome (p = 0.952), and 90-day mortality (p = 0.931) between the sexes.

Conclusion: Female patients had lower hospitalization costs and sICH rates than males after EVT for AIS. Identifying such differences and implementing measures, including adaptations to workflow optimization, would help to reduce the ONT and last known normal-to-puncture time seen in males to improve patient outcomes. Despite such variations, favorable outcomes and mortality are similar in female and male AIS patients.