European Neurology最新文献

Introduction: Dilated perivascular spaces (PVS) are associated with small vessel disease in the aging population. We sought to investigate the incidence and dynamic evolution of MRI-detectable PVS progression in patients with cerebral amyloid angiopathy (CAA).

Methods: Patients with symptomatic CAA who underwent baseline and follow-up MRI scans >2 years apart were included. The severity of both basal ganglia (BG) and centrum semiovale (CSO) PVS were rated. Multivariable logistic regression was used to determine the risk factors for PVS progression.

Results: We included 90 patients with CAA (mean age 72.6 years, SD 8.0 years), of which 53 (58.9%) had intracerebral hemorrhage (ICH) at baseline. During a median follow-up of 4.8 years (IQR 3.6 - 6.6 years), PVS progression was observed in 24 patients (26.7%) at follow-up MRI. After adjusting for age, hypertension and time between baseline and follow-up MRI, cerebral microbleed (CMB) progression (OR 4.12, 95% CI 1.31 - 12.95; p=0.015) and presence of ICH at baseline (OR 8.61, 95% CI: 2.09 - 35.52; p=0.003) were independent predictors of PVS progression. In multivariable regression analysis, presence of ICH (OR 8.78, 95% CI 1.74 - 44.35; p=0.009) and hypertension (OR 5.73, 95% CI 1.25 - 26.29; p=0.025) were associated with BG-PVS progression. However, only CMB progression (OR 10.17, 95% CI 1.84 - 56.35; p=0.008) was associated with CSO-PVS progression.

Conclusion: PVS progression occurs in a subset of CAA patients reimaged after a median of 4.8 years and is associated with CMB progression. PVS progression might be a useful neuroimaging marker for visualizing CAA-related vascular changes.

Introduction: Brain-derived neurotrophic factor (BDNF) plays an important role in the survival of dopaminergic neurons. Clinical studies have suggested that serum BDNF levels are reduced in patients with Parkinson's disease (PD). However, no study has investigated peripheral BDNF levels and BDNF Val66Met polymorphism in the prodromal stage of PD and their relationship with disease conversion.

Methods: 120 patients with video-polysomnographically (v-PSG) confirmed iRBD and 120 healthy controls (HCs) were enrolled. Genetic analyses were performed, and plasma levels of BDNF were measured. All patients with iRBD underwent comprehensive clinical testings, and 107 iRBD patients were prospectively followed-up.

Results: Plasma BDNF levels were significantly lower in the iRBD group than in HCs (18878.85 pg/ml vs. 24649.85 pg/ml, p = 0.002), but no differences were observed in BDNF Val66Met carrier rates between the two groups. Plasma BDNF levels did not differ significantly between BDNF Val66Met carriers and non-carriers. Notably, higher plasma BDNF levels were associated with an increased risk of short-term disease con-version (Hazard Ratio = 3.418, 95% CI 1.520-7.684, p = 0.003), whereas BDNF Val66Met carrier rates showed no such association.

Conclusion: Our findings suggest that plasma BDNF is significantly associated with iRBD and may likely serve as a prognostic biomarker for the development of neurodegenerative dis-ease. However, the BDNF Val66Met polymorphism may not be involved in the path-ogenesis of iRBD as well as phenoconversion in the studied population.

Introduction: Recently, a nationwide stroke care consisting of stroke care units (SCUs) and stroke centers (SCs) was established in the Republic of Georgia.

Patients and methods: A hospital-based prospective registry to evaluate the quality of stroke care and an additional nationwide survey on factors leading to prehospital delay and subsequent low rate of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT).

Results: A total of 5,385 consecutive patients with acute stroke (3,636 ischemic, 1,302 TIA, and 447 hemorrhagic) were included in the stroke registry, of whom 2,459 (46%) were female, with a mean age of 70.3±11.3 years. A total of 1,538 (28.6%) patients presented <6 h (1,160 [21.5%] <4.5 h). Of 3,636 patients with ischemic stroke, 121 (3.3%) patients received IVT, 72 (2.0%) received EVT, and 17 (0.5%) received both. An additional 1,067 patients with acute ischemic stroke (898) and TIA (169) were interviewed to understand the factors of prehospital delay. Of these, 472 (44.2%) were female, with a mean age of 70.5 ± 11.4 years, and 339 (31.8%) patients arrived <6 h (219 [20.5%] <4.5 h). Forty-two patients (4.7%) received IVT, 37 (4.1%) received EVT, and 6 (0.7%) received both. Pre-ictal education level, high socio-economic status, stroke awareness, calling the ambulance, and a knowledgeable ambulance team transferring patients to the stroke-ready hospital predicted timely arrival at the SC.

Conclusions: The study reveals major problems in the prehospital management of acute stroke.

Discussion: There is a great need for a nationwide geographic transfer plan for acute stroke service, connecting ambulances, SCUs, and SCs and for the educational campaigns to increase stroke awareness among the population.

Introduction: Identification of acute ischemic stroke (AIS) patients within the 4.5-h therapeutic window is critical for therapy. Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences are an approach to determine whether the time since stroke (TSS) is within 4.5 h. However, interobserver variability and limited accuracy are observed in visual assessments. We aimed to develop a transfer learning model for predicting AIS onset within 4.5 h.

Materials and methods: A total of 266 AIS patients with known TSS who underwent imaging scans before treatment were retrospectively analyzed, divided into a training set (n = 211) and a validation set (n = 55). The model was built using DWI and FLAIR sequences. After image preprocessing and data augmentation, a 3D ResNet-18 pretrained on the Kinetics dataset was selected and adapted via transfer learning with DWI-FLAIR input. The model performance was compared with human visual assessment, which was based on the DWI-FLAIR mismatch principle. Partial mismatch was defined as hyperintense infarct on DWI with a smaller corresponding hyperintense area on FLAIR.

Results: Baseline characteristics did not differ between the training and validation sets. On the validation set, the model achieved sensitivity of 0.833 (0.703-0.941), specificity of 0.880 (0.737-1.000), and AUC of 0.929 (0.758-0.935), outperforming human visual assessment (sensitivity 0.767 [0.613-0.903]; specificity 0.360 [0.185-0.560]; AUC 0.563 [0.451-0.693]). For partial DWI-FLAIR mismatch cases, the model correctly classified all 15 cases, whereas humans classified 4.

Conclusion: The 3D ResNet-18 model shows promise in identifying AIS within 4.5 h, including partial DWI-FLAIR mismatch, but requires multicenter validation before use.

Introduction: Hemorrhagic transformation is one of the most common complications of acute ischemic stroke. However, the association between hemorrhagic transformation and internal carotid artery (ICA) tortuosity has rarely been investigated. This study investigated the effect of ICA tortuosity on hemorrhagic transformation after acute ischemic stroke.

Methods: We conducted a retrospective analysis on stroke patients' data collected from prospective hospital-based stroke registry. The baseline demographics, clinical and radiological variables, including the Fazekas scale, advanced Fazekas scale (grade 0-9), white matter hyperintensity volume, presence of cerebral microbleeds, and hemorrhagic transformation, were compared based on the severity of ICA tortuosity and divided into quartiles (Q1: <25%, Q2+Q3: 25%-75%, and Q4: >75%). ICA tortuosity was examined using in-house vessel analysis software. The primary outcome was hemorrhagic transformation.

Results: A total of 146 patients were analyzed, including 167 ICAs, which were vascular territories with acute cerebral infarction. Among the various risk factors considered, intravenous thrombolysis, endovascular thrombectomy, stroke severity, and ICA tortuosity index were associated with the occurrence of hemorrhagic transformation. In multivariate analysis, ICA tortuosity was also significantly associated with the occurrence of hemorrhagic transformation, while the severity of ICA tortuosity was negatively correlated (Q1: reference, Q2+Q3: 0.27 [0.09-0.84], Q4: 0.14 [0.03-0.70]; p = 0.023 for Q2+Q3, p = 0.016 for Q4).

Conclusions: We identified a paradoxical relationship between ICA tortuosity and hemorrhagic transformation after acute ischemic stroke. Patients with more severe tortuosity experienced fewer hemorrhagic transformations, and vice versa. These findings highlight the potential of ICA tortuosity as a marker for identifying high-risk patients.

Introduction: We aimed to investigate the prevalence and pattern of color vision deficiency (CVD) in relapsing-remitting multiple sclerosis (RRMS) patients, with or without a history of optic neuritis (ON), and to assess its potential as a marker of subclinical optic pathway dysfunction.

Methods: Color vision was assessed in a large cohort of 345 RRMS patients using the Waggoner Computerized Color Vision Test, screening for protan, deutan, tritan, and composite color deficiencies, with severity grading based on score thresholds. Statistical differences between eyes with a history of ON, fellow eyes without ON, and eyes from MS patients with no history of ON were analyzed using multivariable logistic regression, controlled for age, gender, disease duration, Expanded Disability Status Scale, and treatment status.

Results: Out of the 676 eyes analyzed, CVD was observed in 76.0% of ON-affected eyes, 65.1% of fellow eyes without ON, and 62.3% of eyes from patients without ON. Multivariable logistic regression showed ON-affected eyes had significantly higher odds of severe CVD compared to fellow eyes (OR = 2.48, p = 0.020), which in turn had higher odds of moderate CVD compared to the no-ON group (OR = 2.27, p = 0.010). Conversely, the no-ON group had higher odds of mild CVD compared to fellow eyes without ON (OR = 2.01, p = 0.003). Composite CVD was the most frequent type (57.7%), with tritan deficiencies being the most common pure type (39.9%). Fellow eyes demonstrated higher odds of composite CVD compared to the no-ON group (OR = 1.97, p = 0.016).

Conclusions: CVD is highly prevalent in MS even without clinical ON, indicating diffuse, subclinical optic pathway damage.

Introduction: Neuroplasticity is the ability of the central nervous system (CNS) to adapt structurally and functionally in response to motor and sensory dysfunction caused by injury and disease. Spinal interneurons are key components of neuroplastic changes that ameliorate impaired motor function after CNS injury. A lateral spinal cord hemisection model exhibited spontaneous motor recovery of the hind limb on the affected side. Hence, neuroplastic changes within the spinal cord on the affected and/or unaffected side may occur during motor recovery following unilateral spinal cord injury (SCI). However, it remains unclear how the spinal neurons on the affected and unaffected side contribute to motor recovery in the ipsilesional hind limb following unilateral SCI. Thus, we aimed to explore whether the thoracic spinal neurons above the lesion were involved in the motor recovery of the ipsilesional hind limb.

Methods: In our SCl model, unilateral lesions were made at the tenth thoracic vertebral level.

Results: Following unilateral SCI, hind limb motor function on the ipsilateral side was initially impaired but showed spontaneous recovery in the behavioral tests, which was subsequently lost after ablation of thoracic spinal neurons in the ipsilesional spinal cord above the lesion. In contrast, changes in the ipsilesional hind limb motor function were not observed after ablation of the contralesional thoracic spinal neurons.

Conclusion: These results suggest that thoracic spinal neurons on the ipsilesional side above the lesion are key components for hind limb motor recovery in a model of unilateral SCI.

Introduction: Approximately 50-70% of people with multiple sclerosis (MS) experience at least one fall event during their lifetime. These events can have debilitating consequences in the quality of life of the individuals' experiencing them, as they can often result in injury, extending beyond physical harm, which may negatively impact the rehabilitation process as well as their psychological well-being.

Methods: This systematic review and meta-analysis aimed to determine the proportion of one-time and repeated falls among patients with MS within a year and investigate any potential associations with demographic and disease-specific characteristics. Adhering to PRISMA guidelines, a systematic search of the MEDLINE, PubMed, Scopus, and Google Scholar databases was conducted.

Results: Results from 4,342 patients were included. The pooled proportion of one fall within a year was estimated at 28.03% (95% CI [20.21, 36.57]), and for repeated falls, 31.74% (95% CI [23.73, 40.31]). Subgroup analyses revealed significant heterogeneity, while meta-regression showed no significant associations between fall prevalence and age, EDSS, or disease duration.

Conclusion: 42.5% of patients experienced a one-time fall, while 44.7% reported repeated falls. These findings, demonstrate the significant prevalence of falls among individuals with MS, underlying the need for targeted interventions to mitigate fall risk.

We revisit a landmark clinical case recorded by Jean-Martin Charcot in 1877-78, describing a patient with bulbar-onset amyotrophic lateral sclerosis (ALS). This case offers a rich window into Charcot's observational method, clinical reasoning, and early neuropathological insights. We discuss the methodological rigor of Charcot's case analysis and place it in dialogue with modern understandings of ALS pathophysiology, diagnosis, and care. This historical reflection highlights how 19th-century neurology laid the foundation for current multidisciplinary approaches to managing neurodegenerative diseases.