Frontiers in Neurology最新文献

Objective: To identify independent risk factors for cardiac injury (CI) in patients with ischaemic stroke (IS) through a retrospective analysis, providing evidence for early screening and intervention strategies.

Methods: A single-center retrospective study was conducted among hospitalized patients with IS, who were classified into CI and non-CI groups. CI was defined as elevation of one or more cardiac biomarkers (cTnI/T, CK-MB, or BNP) above the upper reference limit, with concurrent ECG or echocardiographic abnormalities. Clinical characteristics, laboratory parameters, and prognostic variables were analyzed using univariate methods (chi-square test, t-test, or Mann-Whitney U test), followed by multivariate logistic regression to identify independent risk factors. Odds ratios (ORs) and 95% confidence intervals were then calculated.

Results: Across 393 patients with IS (100 with CI and 293 without CI), univariate analysis identified significant differences in multiple parameters, including age, vital signs, cardiac biomarkers (BNP, CK-MB, cardiac troponin I), inflammatory markers (hs-CRP, LDH), renal function (BUN, creatinine), coagulation markers (D-dimer), and comorbidities (atrial fibrillation, coronary heart disease, heart failure) between the groups (p < 0.05). However, after adjusting for these potential confounders in multivariate logistic regression analysis, neither Glasgow Coma Scale (GCS) scores nor blood urea nitrogen (BUN) levels remained statistically significant independent predictors of CI in patients with IS (p > 0.05).

Conclusion: Although GCS scores and BUN levels may be associated with CI in patients with IS, a clear operational definition of CI is essential for diagnostic consistency and early risk identification. Enhanced screening and monitoring of high-risk patients, combined with clinical and biomarker evaluation, are essential for optimizing early management strategies and improving outcomes.

Background: Continuous EEG (cEEG) is widely used in the inpatient setting to detect non convulsive seizures and status epilepticus. Prolonged EEG monitoring can increase healthcare cost burden and patient discomfort. Optimizing cEEG by safely reducing the duration of EEG monitoring can be done using a validated scoring system. 2HELPS2B score predicts seizure risk in the next 24 h based on first hour of EEG monitoring and provides recommendation on the total duration of EEG monitoring. We aimed to safely reduce the duration of cEEG monitoring in low-risk patients (2HELPS2B score

Methods: This study was performed as a quality improvement interventional study from January till April 2025 in the inpatient setting across three campuses of the University of Texas Medical Branch at Galveston, Texas. A 2-step smart phrase was created on the Epic electronic medical record (EMR) for 2HELPS2B score. This was made live on Epic on January 1, 2025. Epileptologists were educated through departmental grand rounds and timely reminders to incorporate the score by including the smart phrase in the first segment of the cEEG reports.

Results and conclusion: The mean monthly duration of cEEG in low-risk group patients reduced by 22.5% in post intervention group. None of the patients in the low-risk group had seizures. Effective implementation of 2HELPS2B scoring system in clinical practice can safely reduce the duration of EEG monitoring in the low-risk group. This will optimize EEG resource utilization and reduce healthcare costs.

Optic neuritis (ON) is an inflammatory, demyelinating optic neuropathy commonly associated with multiple sclerosis. It typically presents as monocular visual loss, with most visual functions recovering within several weeks. In addition to spontaneous remyelination, brain adaptation is thought to contribute to the recovery process. In this review, we discuss the role of functional MRI (fMRI) as a powerful tool for examining the cortical changes associated with ON. We explore studies that utilize a range of fMRI methodologies, highlighting their findings and implications for understanding cortical adaptation and recovery following peripheral visual loss. The review begins with traditional block-design fMRI protocols which assess activation strength in response to visual stimuli. It then shifts to analytical approaches that examine resting-state connectivity within the visual system. Advanced techniques, including population receptive field and connective field analyses, are also discussed, emphasizing their ability to probe neuronal spatial properties and detect changes following ON. Finally, we consider emerging fMRI methods that capture the temporal dynamics of cortical activity, underscoring their relevance for elucidating the time-dependent processes underlying cortical adaptation after ON.

Background: The development of Guillain-Barré syndrome (GBS) during bortezomib treatment for multiple myeloma (MM) is rare. Clinical vigilance regarding this serious adverse event is imperative for timely diagnosis and management.

Methods: We conducted a retrospective review of the hospital's health information system (HIS) and report three cases of GBS that occurred during bortezomib-based treatment in patients with MM. A retrospective analysis of the patients' clinical presentations, diagnostic processes, treatments, and prognoses was conducted. Additionally, a literature search was performed by using the keywords "multiple myeloma," "bortezomib," "GBS," and "polyneuropathy" in the PubMed and China National Knowledge Infrastructure (CNKI) databases, which yielded 30 relevant published cases for review.

Results: A total of 33 cases were included in the analysis. The VRD regimen (bortezomib, lenalidomide, and dexamethasone) appeared to be associated with the development of GBS in patients with IgA-type MM, whereas the VTD regimen (bortezomib, thalidomide, and dexamethasone) was more commonly associated with IgG-type MM. Intravenous immunoglobulin (IVIG) and plasma exchange represented the main first-line treatments, and most of the patients achieved varying degrees of neurological recovery within a median of 4.5 months (range: 3 weeks to 21 months).

Conclusion: Neurological examination, cerebrospinal fluid analysis revealing albuminocytologic dissociation, and nerve conduction studies were helpful for diagnosing GBS. Prompt treatment with IVIG and/or plasma exchange can significantly improve patient outcomes.

Background: Stroke is a major cause of death and disability in India. Many stroke patients seek care at government medical colleges but studies have not comprehensively assessed the quality of acute stroke care. This study aims to evaluate key indicators for optimal stroke care in the pre- implementation phase of implementation of an evaluation and treatment package for uniform stroke care (IMPETUS) study across 23 medical colleges in India.

Methods: IMPETUS stroke is a multicentric, prospective, multiphase, mixed-methods, quasi-experimental implementation study, comprising three phases. During its pre-implementation phase, baseline assessment of stroke care was performed using pre-structured case report form, among prospectively enrolled acute stroke patients.

Results: A total of 2,018 patients were enrolled during the pre-implementation phase. The mean (SD) age was 59.08 (14.4) years, with male preponderance (64.2%); 69.06% had an onset <24 h, majority had ischemic stroke (60.1%), followed by intracerebral hemorrhage (38.4%). Key risk factors were hypertension, diabetes, smoking, alcohol and previous stroke. Imaging performed included non-contrast computed tomography (NCCT) (69.6%), computed tomography angiography (CTA) (25.6%) and magnetic resonance angiography (MRA) (24.6%). Intravenous thrombolysis (IVT) was administered in 39.2% eligible patients, predominantly with tissue plasminogen activator (tPA) (72%). In-hospital delay was the most common reason for not receiving thrombolysis (44.8%). The median door-to-CT, CT-to-needle and door-to-needle time were 95, 36.5 and 67 min, respectively. Other important stroke care indices were also evaluated. In-hospital mortality was 19.4 and 33.1% patients achieved modified rankin scale (mRS) score 0-2 at 90-days.

Conclusion: This comprehensive data provides a representative baseline status of acute stroke care in select medical colleges across India, which will be useful in comparing advancements during the implementation phase and improve policy making.

Background: In patients with refractory delayed cerebral ischemia (DCI) after spontaneous subarachnoid hemorrhage (SAH), endovascular therapy of cerebral vasospasms is a treatment option. In our center, continuous intra-arterial vasospasmolysis with nimodipine (ciaN) has been introduced as the standard endovascular therapy for cerebral vasospasms since 2016. This study investigated the outcomes of SAH patients before and after introduction of ciaN.

Methods: Data pertaining to all patients treated for SAH in our center between 2011 and 2021 were retrospectively recorded.

Results: 145 patients before (pre-ciaN group) and 147 after (ciaN group) introduction of ciaN met the inclusion criteria. 36 patients in the pre-ciaN group and 51 in the ciaN group received endovascular vasospasm treatment. At discharge, outcomes tended to improve in the ciaN group. After 6 months, there was a significantly improved outcome in the ciaN group (mRS 0-2, Fisher's exact test). After propensity score matching, there were no significant differences between the pre-ciaN and ciaN groups in the subgroups of patients without endovascular vasospasm treatments. Conversely, in the subgroups of patients who had received endovascular vasospasm treatments, there was a significantly improved outcome at discharge and after 6 months, and a significant reduction of DCI-associated infarctions.

Conclusion: Outcome after spontaneous subarachnoid hemorrhage has improved since the introduction of ciaN in our center. Our data indicate a contribution of the changes in treatment standard for endovascular vasospasm therapies from angioplasties to ciaN. Prospective studies are needed to compare the effect of ciaN in DCI with standard medical therapy.

Objective: Vestibular migraine (VM) is a common neurological disorder characterized by recurrent vertigo and migraine symptoms. Due to its heterogeneous clinical presentation and lack of objective biomarkers, VM is often misdiagnosed. This study aimed to develop a diagnostic prediction model for VM based on multimodal data to improve diagnostic accuracy.

Methods: A total of 288 patients who visited the Vertigo Clinic of our Hospital between January 2023 and December 2024 were enrolled, including 141 VM patients and 147 non-VM controls. Multimodal data were collected, including clinical features, vestibular function tests, hematological indicators, contrast transthoracic echocardiography, and psychological assessments. Logistic regression was used to construct the prediction model, and its performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: VM patients were more likely to be female, younger, and had lower body mass index (BMI) compared to controls. They also exhibited higher rates of photophobia, phonophobia, tinnitus, emotional triggers, insomnia, and family history of migraine or vertigo. Vestibular function tests showed fewer peripheral abnormalities and more central pathway dysfunction in VM patients. Hematological analysis revealed lower levels of vitamin D and D-dimer, and higher platelet counts and calcium levels in VM patients. Right-to-left shunt (RLS) was more prevalent in VM patients. The final model included six variables: BMI, emotional triggers, insomnia triggers, history of motion sickness, and abnormal otoacoustic emissions at 8000 Hz (left ear) and 6,000 Hz (right ear). The model achieved an Area under the ROC curve of 0.8788 (95% CI: 0.8374-0.9202), indicating strong diagnostic performance.

Conclusion: The multimodal diagnostic prediction model developed in this study demonstrates high preliminary accuracy. It shows potential as a clinical tool for improving the diagnosis of VM, but its generalizability requires validation in larger, prospective cohorts.

Objective: This study explored latent profiles of Health Information-Seeking Behavior (HISB) among stroke patients and analyzed its influencing factors.

Methods: In this cross-sectional study, 311 stroke participants from two tertiary care hospitals in Gansu Province, China, were recruited between January and May 2025 using convenience sampling. Data were collected using a general information questionnaire, the Health Information-Seeking Behavior Scale, and the Health Behavior Decision-Making Assessment Scale for Stroke Patients. Latent profile analysis (LPA) was employed to identify distinct HISB profiles.

Results: Three latent profiles were identified: the high-demand low-barrier positive group, the moderate-balanced group, and the low-demand high-barrier negative group. Key predictors of profile membership included age, education level, monthly personal income, and the presence of comorbid chronic diseases.

Conclusion: The identification of three distinct HISB trait types provides an evidence-based foundation for developing personalized health education and tailored decision support interventions. Healthcare professionals can leverage this classification system to customize communication strategies for patients with different traits, deliver tiered information support, and ultimately empower patients to achieve better health behaviors and health outcomes.

Background: Motor neurone disease (MND) presentation is globally heterogenous and data on the clinical phenotype in Sub-Saharan Africa (SSA) is scarce. We sought to address this by describing the profile of MND patients in a Kenyan hospital-based population.

Methods: The medical charts of all adult MND patients assessed in the facility between January 2010 and December 2023 were retrospectively reviewed. The biographical data and clinical features of these patients were captured from their electronic and manual health records and statistical analysis performed.

Results: In total, 160 patients had their data analyzed. The male to female ratio was 1.76:1. The median age at presentation was 55.0 (IQR: 45.0-68.0) years with a median diagnosis delay of 4.0 (IQR: 2.0-8.5) months. The site of first symptom onset was the lower limbs in 34.4% and the bulbar region in 33.1% [95% CI (26.4-42.5%)]. Notably, 59% of the patients were not tested for HIV and amongst those tested, 13.9% were HIV positive on ART. Majority (56.2%) of the patients were on Riluzole.

Conclusion: This Kenyan case series of MND patients demonstrated a higher rate of bulbar onset disease [33.1, 95% CI (26.4-42.5%), p = 0.018] in comparison to what has been demonstrated in other African studies. A finding that supports geographic variation in MND presentation and that emphasizes the need for region specific genetic studies.

Introduction: The mechanisms underlying the clinical effect of Deep Brain Stimulation (DBS) for Parkinson's disease (PD) remain debated. Proton magnetic resonance spectroscopy (¹H-MRS) provides a biochemical non-invasive in vivo insight. This article aims to increase the understanding of advanced PD pathophysiology and DBS using MRS before and after surgery.

Methods: Eleven PD patients and seven healthy controls were included. Preoperatively and approximately 7 months postoperatively, single-voxel MRS using a PRESS sequence was performed on a 1.5 T (tesla) system. Voxels were placed bilaterally in the thalamus (14 × 13 × 13 mm³) and the lentiform nucleus (15 × 13 × 12 mm³). Metabolite concentrations of total N-acetylaspartate + N-acetyl-aspartyl-glutamate (tNA), total creatine + phosphocreatine (tCr), total choline + phosphocholine + glycerophosphocholine (tCho), and total glutamate and glutamine, which together constitute Glx were quantified. To assess treatment outcomes following surgery, medications were converted to levodopa equivalent doses (LED) using a standardized conversion formula, both pre- and post-DBS.

Results: A total of 11 patients, with a mean PD duration of 9.4 years, were implanted with bilateral implantation (22 leads). All patients self-reported relief of symptoms and significantly reduced their medication (p < 0.001), with a calculated preoperative LED of 925 ± 272 and a postoperative LED of 611 ± 210 (mean ± SD), representing a 32% reduction after surgery. The patients, prior to surgery, compared to a healthy control group, showed no differences in the resulting metabolite concentrations (tCr, tNA, tCho, Glx) in voxels placed in the thalamus and lentiform nucleus. However, thalamic tNA concentrations differed significantly following DBS targeting the subthalamic nucleus (STN), both in comparison to healthy controls (p = 0.02) and relative to preoperative concentrations within the patient group (p = 0.03). No furher resulting concentrations differed.

Conclusion: We present novel metabolite observations obtained through MRS in this exploratory study. Thalamic tNA concentrations in PD patients were comparable to those of healthy controls prior to surgery, but were significantly reduced following DBS implantation targeting the STN. These findings suggests the presence of a metabolite thalamic effect associated with DBS treatment.