European Neurology最新文献

Background: Circadian rhythms - endogenous 24-h oscillations - shape the risk, pathophysiology, and recovery of ischemic stroke. Diurnal variation in stroke onset, severity, and treatment responsiveness reflects clock control over cardiovascular tone, hemostasis, immune activity, neurovascular integrity, and metabolic homeostasis. After a stroke, circadian misalignment can blunt repair programs, amplify neuroinflammation, and accelerate cognitive decline.

Summary: We synthesize how circadian mechanisms act across the neurovascular unit to modulate neuronal excitability, receptor and transport cycles, glial reactivity, endothelial barrier function, hemostasis/fibrinolysis, and glymphatic clearance. Particular emphasis is placed on the ischemic penumbra, where intrinsic (BAX/BCL-2-regulated) and extrinsic death-receptor pathways show time-of-day sensitivity that influences salvageability. We link post-stroke circadian disruption to proteostasis and amyloid-β handling, providing a mechanistic bridge to long-term cognitive impairment. We also reconcile treatment-timing data, including biological phase (e.g., PAI-1/tPA rhythms, blood-brain barrier permeability), and operational factors jointly shape outcomes for thrombolysis and endovascular therapy. Finally, we outline chronotherapeutic avenues - light, melatonin, time-targeted pharmacology, personalized rehabilitation - and candidate biomarkers to guide timing.

Key messages: The circadian phase is a key determinant of stroke susceptibility, tissue vulnerability, and recovery potential. Integrating chronobiology into prevention, reperfusion, and rehabilitation enables time-tailored strategies that align interventions with intrinsic rhythms, thereby improving outcomes and reducing disability.

Introduction: The aim of this study was to investigate the diagnostic utility of brain Magnetic resonance imaging (MRI) in anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDAR encephalitis) and analyze the relationship between clinical and brain MRI characteristics and disease prognosis.

Methods: A retrospective analysis was conducted on forty-six (59% female, median age: 24.5 years) clinically identified anti-NMDAR encephalitis patients from December 2012 to April 2022. All the patients underwent multiparametric MRI, with thirteen returning for follow-up. All the relevant clinical information was collected. The initial and follow-up brain MRI was sequentially analyzed for signal abnormalities, involvement of anatomy and structure, and brain/structure atrophy by two experienced neuroradiologists. Additionally, the relationship between clinical and brain MRI features and prognosis was examined.

Results: The most common symptom (33/46, 72%) in anti-NMDAR encephalitis was aberrant psychiatric behavior. Five (10%) cases combined with other positive antibodies. Although 91% of patients with mRS >2 before treatment, a statistically significant decrease mRS were observed after treatment (mRS: 3.50 ± 0.94 vs. mRS: 1.91 ± 1.53, p < 0.001). More than half of the patients had abnormal MRI findings. T2-weighted fluid-attenuated inversion recovery (FLAIR) hyperintense lesions that involve the frontal lobe and the limbic system are the characteristic imaging predilection of anti-NMDAR encephalitis. On follow-up MRI, we noticed 5 patients with significant hippocampal atrophy. Further analysis showed that the hippocampal involvement was a significant factor in predicting worse mRS scores both before and after treatment (p < 0.05).

Conclusion: T2-FLAIR hyperintense lesions in the frontal lobe and the limbic system are indicative of anti-NMDAR encephalitis. The involvement of the hippocampus is a risk factor for a poor prognosis.

Introduction: Tuberous sclerosis (TSC) is an autosomal dominant genetic disorder with a wide range of clinical manifestations. This study aimed to retrospectively analyze the clinical records of TSC patients, focusing on the first onset times and age ranges for various symptoms.

Methods: The clinical data of TSC patients were analyzed retrospectively, including general information, clinical manifestations, and treatment plans, with particular attention to the first onset times and age ranges for different symptoms.

Results: The study found that 15 patients presented with different types of skin lesions, 13 patients, including 6 with intellectual disabilities, experienced epileptic seizures. Additionally, 14 patients had kidney damage, 6 showed varying degrees of cardiac involvement, and 8 exhibited lung lesions.

Conclusion: By integrating the clinical features and imaging characteristics of TSC, multiple manifestations of the disease were identified, providing further clinical evidence for its recognition. This is beneficial for early monitoring and effective disease prevention and improvement.

Introduction: Hypertension is a significant risk factor for the development of cerebral small vessel disease (SVD). This study was performed to evaluate the impact of intensive antihypertensive treatment on the progression of imaging markers and cognitive function of SVD.

Methods: Two independent reviewers searched for randomised controlled trials (RCTs) that investigated the associations between intensive antihypertensive treatment and the progression of imaging markers of SVD, including white matter hyperintensities (WMHs), brain atrophy, lacunes, or microbleeds and cognitive function scores. Fixed-effects models were used to pool the data for WMHs, brain atrophy, and severe adverse events, whereas cognitive function scores were synthesised with a random-effects model and were measured as standardised mean differences (SMDs) and odds ratios (ORs).

Results: A total of 8 RCTs were included in this meta-analysis, involving 2,891 participants with a follow-up period of 24 to 49 months. Compared with standard blood pressure treatment, intensive antihypertensive treatment was observed to be more effective at delaying WMH progression (SMD = -0.33, 95% CI: -0.44, -0.21) but was associated with greater brain volume loss (SMD = 4.06, 95% CI: 1.97, 6.15). No increased risk of incident lacunes (OR = 1.11, 95% CI: 0.57, 2.19) or significant association with cognitive function changes (SMD = -0.08, 95% CI: -0.23, 0.06) was observed. However, the pooled analysis of cerebral microbleeds was limited by the small number of eligible studies included in this meta-analysis.

Conclusion: Antihypertensive treatment (particularly intensive therapy) is associated with reductions in the progression of WMH volume and total brain volume. However, no significant association was observed between antihypertensive therapy and either the incidence of new lacunes or changes in cognitive function.

Introduction: Strokes rank among the most common acute conditions in neurology, leading to substantial increases in morbidity and mortality rates. It is essential to preserve patients' autonomy in decision-making regarding resuscitation measures to prevent unnecessary interventions and safeguard their right to self-determination. This study aimed to identify the factors associated with an active decision against post-stroke patient resuscitation.

Methods: We conducted a retrospective analysis of 139 patients from 2014 to 2021 at the University Hospital Zurich, Switzerland. All patients died within 3 months after stroke, with a documented active decision against resuscitation within this timespan. We examined sociodemographic and clinical factors, including outcome scores associated with the decision to change of code status.

Results: Our cohort had a median age of 76.8 years, with 58% men. The median duration from stroke until do-not-resuscitate (DNR) decision was 4 days (range = 0-69), and 3 days (range = 0-59) from DNR decision until death. In total, 5 (range = 0-23) documented discussions were held with each patient's family during the disease trajectory. Existing pre-stroke illnesses did not significantly influence these decisions. A total of 22.3% (n = 31) of patients received a consultation from palliative care specialists and/or palliative treatment, and 9.4% (n = 13) were referred to the PC ward.

Conclusions: Our findings suggest that decisions against resuscitation primarily result from collaboration between healthcare professionals and families, respecting patients' wishes, and were neither associated with comorbidities nor the severity of stroke. Every fifth patient was seen by a palliative care specialist, supporting the complex decision-making in this non-cancer population.

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: 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 (SSEP) 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 (adjusted odds ratio (aOR) 2.4 [CI: 1.40-4.17]; p = 0.002) and (aOR 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 postoperatively (aOR 2.76, 1.72-4.42; p < 0.001) and (aOR 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 postoperative 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.