European Neurology最新文献

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 aimed to assess whether the extent of pineal gland calcifications (PGCs) and choroid plexus calcifications (CPCs) is independent or correlated 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% CI: 0.009-0.027), after adjusting for demographics. The Pearson's correlation coefficient for this association was 0.1636 (p < 0.001), while the Spearman's 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: The aim of the study was to observe the brain network characteristics of delayed encephalopathy after carbon monoxide poisoning (DEACMP) using functional near-infrared spectroscopy (fNIRS) technology.

Methods: Fifteen patients with carbon monoxide poisoning (DEACMP group) hospitalized in the Department of Neurology, Affiliated Hospital of North Sichuan Medical College, from November 2023 to March 2024 were selected. Fifteen healthy volunteers (the control group) were also recruited. Six-minute resting-state fNIRS data were collected from all subjects. Five cognitive-related key brain regions were selected as regions of interest (ROI): parietal cortex (PC), premotor cortex (PMC), frontopolar cortex (FPC), orbitofrontal cortex (OFC), and dorsolateral prefrontal cortex (DLPFC). NirSpark software was used to analyze the differences in whole-brain functional connectivity strength and functional connectivity strength within and between ROIs between the two groups.

Results: The functional connectivity strength of the left PMC, right PMC, and left FPC, etc. In the DEACMP group, it was significantly lower than that in the control group (p < 0.05, FDR corrected). Compared with the control group, the brain network of DEACMP patients showed heterogeneity from left PC to right PC; left PC∼left PMC; left PC∼right PMC; left PC∼left DLPFC, etc. The functional connectivity strength between the left PC and the right DLPFC area has significantly decreased. All these differences were statistically significant (p < 0.05, FDR adjusted).

Conclusion: DEACMP exhibits abnormal functional connectivity in both whole-brain and cognitive-related key brain regions. This aberrant connectivity may represent the underlying neural network mechanisms responsible for the cognitive dysfunction observed in DEACMP.

Introduction: In patients enrolled in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial levels of osteopontin, neopterin, N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase, monocyte chemoattractant protein-1 (MCP-1), resistin, matrix metalloproteinase-9 (MMP-9), adiponectin, high-sensitive C-reactive protein (hsCRP), lipoprotein-associated phospholipase-A2 (Lp-PLA2), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble CD40-ligand (sCD40L), and HDL cholesterol (HDL-c) were measured 1-6 months after the qualifying stroke or TIA. We determined whether any of these biomarkers were associated with disability in case of recurrence.

Methods: Among 463 recurrent strokes, the associations of these biomarkers with the National Institutes of Health-Stroke Scale (NIHSS), Barthel Index, and modified Rankin Score (mRS) measured after 90 days were assessed. Using adjusted logistic regression analysis, biomarker levels were compared between unfavorable versus favorable outcome (NIHSS ≥2 versus 0-1; Barthel Index <95 versus 95-100; and mRS 2-6 versus 0-1).

Results: Higher baseline levels of osteopontin (OR: 1.166; 95% CI: 1.01-1.347, p = 0.0367) and neopterin (OR: 1.531; 95% CI: 1.07-2.188, p = 0.0195) predicted poorer outcomes after recurrent stroke. For participants with ischemic stroke, higher levels of neopterin (OR: 1.488; 95% CI: 1.022-2.167, p = 0.0384) and NT-proBNP, (OR: 1.399; 95% CI: 1.035-1.891, p = 0.0289) were predictor of unfavorable mRS. Analyses including stroke and TIA showed that lower HDL-c levels were associated with an unfavorable mRS (OR: 0.564; 95% CI: 0.328-0.971, p = 0.0387).

Conclusions: Higher levels of osteopontin, neopterin and NT-ProBNP and lower levels of HDL-c after stroke were independently associated with greater disability in case of recurrent stroke.

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.

Background: Mechanical thrombectomy represents a mainstay of management for acute ischemic stroke in the setting of large vessel occlusion. However, there are no clinical practice guidelines defining the role of thrombectomy at the extremes of age. In this scoping review, we aimed to summarize the existing medical and neurosurgical literature pertaining to mechanical thrombectomy in nonagenarians. The PubMed database was queried using the following terms and relevant citations assessed: "thrombectomy nonagenarian," "thrombectomy age 90," "stroke nonagenarian," and "ischemic stroke thrombectomy." Common measurable outcomes, including mortality, modified Rankin scale (mRS) score, and thrombolysis in cerebral infarction (TICI) scale score, were utilized to compare results.

Summary: Thrombectomy was shown to improve functional outcomes in all eight of the studies included in the analysis. Mortality was assessed in only two reported studies, and thrombectomy was shown to provide a mortality benefit in 1 study among patients for whom first-pass reperfusion was achieved. Other outcomes of reported interest included greater early neurologic recovery at discharge and improved functional outcomes at 90 days among nonagenarians who underwent thrombectomy as compared to those who received thrombolytic therapy alone. Nonagenarians with good functional status at baseline were the most likely to have favorable outcomes.

Key messages: Mechanical thrombectomy improves outcomes among nonagenarians presenting with acute ischemic stroke due to large vessel occlusion. Further large-scale prospective studies are warranted to optimize patient selection and develop clinical practice guidelines specific to this important patient demographic.