Frontiers in Neurology最新文献

Post-traumatic benign paroxysmal positional vertigo (BPPV) is a common but frequently underrecognized cause of dizziness following trauma. Unlike idiopathic BPPV, trauma-related BPPV arises from diverse injury mechanisms and is often characterized by heterogeneous canal involvement, greater need for repeated treatment, and frequent coexistence with broader vestibular dysfunction. These features contribute to diagnostic delays and variable clinical outcomes, particularly in the trauma and emergency care settings. We conducted a structured literature search and synthesized clinical, epidemiological, mechanistic, and implementation-focused evidence across diverse trauma contexts. This review aimed to synthesize current evidence on the mechanisms, epidemiology, and clinical characteristics of post-traumatic BPPV, contrast it with idiopathic BPPV, and propose a pragmatic clinical pathway to improve early recognition and management. We reviewed the clinical, epidemiological, mechanistic, and implementation-focused literature on post-traumatic BPPV across trauma contexts, including head injury, concussion, whiplash, sports-related injury, and traumatic brain injury. Evidence from cohort studies, comparative analyses, meta-analyses, and qualitative and feasibility studies was integrated to inform a clinically oriented framework. Accumulating evidence suggests that post-traumatic BPPV should not be regarded solely as a mechanical disorder of displaced otoconia. Trauma may disrupt the otolithic membrane, promote otoconial detachment, and induce utricular dysfunction, leading to canalithiasis or cupulolithiasis and potential interaction with central vestibular injury. Compared with idiopathic BPPV, post-traumatic cases more frequently involve horizontal or multiple canals, often require repeated canalith repositioning maneuvers, and demonstrate variable recurrence patterns. System-level barriers, including limited screening, insufficient training, and fragmented care pathways, further contribute to underdiagnosis and suboptimal management. Post-traumatic BPPV represents a distinct clinical phenotype within the spectrum of trauma-related vestibular disorders. Early identification through systematic screening, comprehensive positional testing, and timely canal-specific interventions provides practical opportunities to improve outcomes. We propose a structured clinical pathway emphasizing early recognition, planned reassessment, and escalation to integrated vestibular care when symptoms persist. Future research should clarify the relationships between trauma biomechanics and BPPV phenotypes, identify predictors of recurrence, and evaluate the real-world effectiveness of pathway-based care models across diverse trauma populations.

Background: Insomnia is a common sleep disorder that substantially impairs quality of life. Drug-induced insomnia (DII), an important cause of secondary insomnia, is often underrecognized, and many potential signals are not yet documented in drug labels. Evidence regarding sex-specific differences in DII remains limited, hindering the development of tailored safety strategies.

Objective: To identify drug-insomnia associations, assess sex-specific differences, validate signals in an independent database, and characterize the time-to-onset (TTO) of high-risk drugs using large-scale real-world pharmacovigilance data.

Methods: We conducted a retrospective observational pharmacovigilance study using insomnia-related reports from FAERS (2004Q1-2025Q2). Disproportionality analyses (ROR, PRR, BCPNN, MGPS) were performed, and sex-stratified associations were compared using Wald chi-square tests. Signals were externally validated in the Canadian Vigilance Adverse Reaction Database (CVARDD). Weibull models were applied to evaluate TTO for the drugs with the highest insomnia report counts.

Results: A total of 266,429 insomnia-related reports were identified, with more reports from females (60.1%) than males (32.0%). A total of 237 drugs demonstrated significant disproportionality signals, including several without labeled insomnia risk. Among the 20 most frequently implicated drugs, 15 showed significant sex-drug interactions. Duloxetine exhibited a stronger association in males, whereas niraparib and levothyroxine showed higher risks in females. External validation confirmed 124 overlapping drugs with consistent signals. TTO analyses revealed an early-failure pattern (Weibull β < 1) for all five high-reporting drugs, with median onset ranging from 3 to 211.5 days.

Conclusion: This study identified multiple drug-insomnia signals, quantified sex-specific differences, and validated findings in an independent database. These results underscore the importance of recognizing DII and monitoring sex-related variability in clinical practice.

Objective: To investigate the effect of pre-ICU aspirin use on neuroinflammation and prognosis in sepsis-associated encephalopathy (SAE) patients.

Methods: Clinical data of SAE patients admitted to our ICU (Mar 2022-Feb 2025) were retrospectively analyzed. Patients were grouped based on pre-admission aspirin use: exposed (n = 45) and non-exposed (n = 68). After 1:1 propensity score matching (age, infection source; caliper = 0.2), 42 matched pairs were compared. Cerebral hemodynamics (Vm, Vd, and Vs), coagulation function (PLT, TT, PT, and APTT), neuroinflammation markers (IL-6, TNF-α, and S100β), Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores (admission, days 1, 3, and 5), ICU length of stay, adverse events, 28- and 60-day mortality were analyzed using appropriate statistical tests (t-test, χ² test; P < 0.05 significant).

Results: The exposed group had higher Vm, Vd, and Vs at all time points (P < 0.05). IL-6, TNF-α, and S100β levels were lower in the exposed group (P < 0.05). GCS scores were higher in the exposed group on days 3 and 5 (P < 0.05). Adverse event incidence, ICU stay, and 28-day mortality did not differ significantly (P < 0.05). The 60-day mortality was lower in the exposed group (P < 0.05).

Conclusions: Pre-ICU aspirin use can improve cerebral hemodynamics, reduce neuroinflammation, and improve 60-day survival in SAE patients without increasing adverse reactions.

Background: Art therapy is emerging as a promising adjunct to neurorehabilitation, giving creative engagement to improve motor, cognitive, and emotional outcomes. Digital technologies such as virtual reality (VR), augmented reality (AR), exergames, and sensor-based systems enable immersive and interactive therapeutic experiences, potentially enhancing rehabilitation effectiveness. This scoping review systematically evaluates the impact of technology-assisted art therapy on neurological rehabilitation and to identify effective intervention types.

Methods: A systematic search was conducted in PubMed, Cochrane, Web of Science, and Embase following PRISMA-ScR and JBI guidelines. Studies were included if they involved adults with neurological conditions receiving technology-supported art therapy and reported motor, cognitive, or emotional outcomes.

Results: Of 584 records screened, 19 studies were included. Interventions comprised dance therapy, music therapy, and visual art therapy supported by VR platforms, tablet-based applications, serious games, and motion-tracking systems. Reported benefits included improvements in motor function, attention and executive function, emotional well-being, and therapy engagement. However, most studies were small-scale, with heterogeneous methodologies and limited follow-up periods.

Conclusion: Technology-enhanced art therapy appears to be a promising approach in neurorehabilitation, offering personalized, engaging, and potentially effective interventions. Further high-quality randomized controlled trials with standardized outcome measures are needed to confirm these findings and guide clinical application.

Background: Executive function deficits are common among patients with Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Executive function refers to higher-order cognitive processes thought to involve fronto-striatal circuits. Some patients with executive deficits may be unable to recognize or report them, a condition we refer to as executive anosognosia.

Objective: To conduct a comparative analysis of executive anosognosia in patients diagnosed with PSP and PD.

Methods: We compared an objective neuropsychological assessment (ONA) of composite executive function (ONA-CEF), which includes semantic and phonemic verbal fluency, as well as two sub-scores from the Wisconsin Card Sorting Test, with patient- and informant-reported rating scales. We used the Dysexecutive Questionnaire Revised (DEX-R) to evaluate near-transfer executive complaints and the Aachen Activity and Participation Index: Cognition and Participation (AAPI-CP) composite to evaluate far-transfer cognitive and social difficulties. Discrepancy indices were calculated for patients and informants (ONA-CEF minus DEX-R and ONA-CEF minus AAPI-CP).

Results: PSP patients had significantly larger negative discrepancies than PD patients, indicating stronger executive anosognosia. Although informant reports reduced these discrepancies, significant underreporting persisted in PSP informants. Correlational analyses revealed that patient-reported DEX-R difficulties were strongly correlated with depressive symptoms (r ≈ 0.65) but not with objective executive performance (r ≈ 0.00).

Conclusion: Executive anosognosia is a marker of PSP, highlighting the need for objective neuropsychological assessments in clinical trials. PSP patients' reports of executive dysfunction are more associated with mood than actual impairment, which challenges the validity of patient-reported outcomes in PSP and related neurological diseases.

Background: Total deafness-type sudden sensorineural hearing loss (SSNHL) represents one of the most challenging subtypes of SSNHL due to its poor response to initial therapy and uncertain prognosis. Secondary inpatient treatment has been proposed as a potential salvage strategy; however, its efficacy and predictors of favorable outcomes remain poorly defined.

Methods: This study included 120 patients with unilateral total deafness-type SSNHL, divided into secondary treatment and control groups. Hearing thresholds at low, middle, high, and full frequencies, pure-tone average (PTA) at speech frequencies, and speech recognition rate were evaluated across six time points (T1-T6). Tinnitus Handicap Inventory (THI) scores and improvement rates were also analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of marked hearing recovery. A nomogram was constructed to predict the hearing prognosis of patients with SSNHL.

Results: Compared with the control group, the secondary treatment group exhibited significantly earlier onset and greater magnitude of improvements in hearing thresholds and speech recognition rate (all p < 0.05), with distinct frequency-specific patterns. Recovery initiated at 4-8 weeks and stabilized after 12 weeks, while the control group showed delayed improvement. Tinnitus relief occurred earlier in the secondary treatment group. Multivariate analysis identified age ≤50 years, disease duration ≤3 days, absence of vertigo, and normal vestibular function (vHIT and caloric test) as independent predictors of marked recovery (all p < 0.05). The area under the receiver operating characteristic (ROC) curve was 0.876 (95% confidence interval [CI]: 0.762-0.989). The calibration curve showed good agreement with the standard curve. The decision curve analysis demonstrated that the prediction model yielded positive net benefits across nearly all threshold probability ranges.

Conclusion: Secondary inpatient treatment offers a significant auditory benefit for patients with total deafness-type SSNHL by accelerating and amplifying recovery. Young age, early intervention, and well-preserved vestibular function are key determinants of a favorable prognosis. The predictive model constructed hereby can effectively predict the prognosis of patients.

Subarachnoid hemorrhage (SAH) is increasingly being recognized as a potential complication of cerebral venous sinus thrombosis (CVST), posing challenges in diagnosis and prognosis. We conducted a systematic search of case reports published from 1996 to 2023 in PubMed and Web of Science using the terms "sinus thrombosis, intracranial" and "subarachnoid hemorrhage" and identified 94 cases from 58 articles. Analysis of these cases suggests potential predictors of CVST complicated by SAH, including epilepsy, pregnancy history, abortion history, migraine history, thrombosis in the superior sagittal sinus, and thrombosis involving both the superior sagittal and transverse sinuses. These findings could stimulate further research on the diagnosis and treatment of CVST complicated by SAH.

Objective: This study aimed to systematically evaluate and compare the efficacy and safety of different repositioning maneuvers for posterior canal benign paroxysmal positional vertigo (BPPV).

Methods: PubMed, Embase, Web of Science and the Cochrane Library were searched from inception to August 2025. Randomized controlled trials (RCTs) comparing the Epley, Semont, Brandt-Daroff, and other repositioning maneuvers for posterior canal BPPV were included. Two reviewers independently performed literature screening, data extraction and risk-of-bias assessment. Network meta-analysis and league tables were generated using StataSE 15 and R 4.4.3, respectively.

Results: Twenty RCTs involving 2,089 patients were included. The Epley maneuver ranked highest in overall effectiveness, with a surface under the cumulative ranking curve (SUCRA) of 97.84%, and was significantly superior to the Semont maneuver (RR = 1.04), the Brandt-Daroff maneuver (RR = 1.35) and control (RR = 1.30). For cure rate, the Epley and Semont maneuvers performed best and were significantly more effective than other interventions. For recurrence rate, the quality of evidence was generally low, and no optimal strategy could be identified. For safety, the incidence of nausea, vomiting and dizziness showed no statistically significant differences among the Epley, Semont and Brandt-Daroff maneuvers, although SUCRA rankings indicated a more favorable safety profile for the Epley maneuver.

Conclusion: The Epley and Semont maneuvers demonstrated optimal short-term efficacy (effectiveness and cure rate) with favorable safety profiles for posterior canal BPPV and should be recommended as first-line repositioning strategies. Future high-quality studies are needed to clarify the long-term effects on recurrence and applicability in specific populations.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420250653366.

Background: The optimal surgical strategy for petroclival meningiomas (PCMs) remains debated, balancing the extent of resection against the risk of neurological morbidity. While the goal of gross total resection is widely acknowledged, its functional benefit is not uniform and may be significantly influenced by specific anatomical and pathological factors, such as cavernous sinus (CS) invasion patterns and World Health Organization (WHO) grade. This study aimed to develop and validate a quantitative, individualized surgical decision-making framework incorporating these understudied parameters.

Methods: We conducted a retrospective cohort analysis of 100 consecutive patients who underwent microsurgical resection for PCMs between 2013 and 2023. High-resolution MRI was used to preoperatively grade CS invasion (0-3 scale) and neurovascular encirclement (≥270° contact). Functional outcomes were assessed serially using the Karnofsky Performance Scale (KPS) preoperatively and up to 24 months postoperatively. Multivariable logistic regression and propensity score matching were employed to identify independent predictors of functional outcome (KPS improvement). Subgroup analyses informed the development of a novel Resection Utility Score (RUS).

Results: Complete resection predicted KPS improvement (OR = 2.34, p = 0.001), while CS invasion (OR = 0.52, p = 0.013), WHO Grade 2 (OR = 0.61, p = 0.022), and neurovascular encirclement (OR = 0.45, p = 0.002) reduced functional gains. The derived RUS guided a decision algorithm. For subgroups with RUS > 1 (CS 0-1, WHO Grade 1), complete resection was recommended. For RUS < 1 (CS 2-3, WHO Grade 2), subtotal resection was advised.

Conclusion: The functional benefit of resection in PCMs is modulated by CS invasion and WHO grade. The proposed RUS and decision algorithm provide a quantitative, evidence-based framework for individualized surgical planning, shifting the paradigm from a universal goal of maximal resection toward a risk-adapted strategy aimed at optimizing functional preservation without compromising oncologic control. Prospective multicenter validation is warranted.