Frontiers in Neurology最新文献

Objectives: The use of anticoagulants in patients increases the risk of intracranial hemorrhage (ICH). Our aim was to identify factors associated with cerebral hemorrhage in patients using anticoagulants and to develop a predictive model that would provide an effective tool for the clinical assessment of cerebral hemorrhage.

Methods: In our study, indications for patients receiving anticoagulation included AF, VTE, stroke/TIA, arteriosclerosis, peripheral vascular diseases (PVD), prosthetic mechanical valve replacement, etc. Data were obtained from the patient record hospitalization system. Logistic regression, area under the curve (AUC), and bar graphs were used to build predictive models in the development cohort. The models were internally validated, analytically characterized, and calibrated using AUC, calibration curves, and the Hosmer-Lemeshow test.

Results: This single-center retrospective study included 617 patients treated with anticoagulants. Multifactorial analysis showed that male, leukoaraiosis, high risk of falls, APTT ≥ 45.4 s, and FIB ≥ 4.2 g/L were independent risk factors for cerebral hemorrhage, and β-blockers were protective factors. The model was constructed using these six factors with an AUC value of 0.883. In the validation cohort, the model had good discriminatory power (AUC = 0.801) and calibration power. Five-fold cross-validation showed Kappa of 0.483.

Conclusion: Predictive models based on a patient's medical record hospitalization system can be used to identify patients at risk for cerebral hemorrhage. Identifying people at risk can provide proactive interventions for patients.

Thus far, clinical data relating to the treatment of cerebral cavernous malformation (CCM) patients with acute stroke (AIS) are incredibly scare due to the low incidence of CCM. Furthermore, the safety profile of using tissue plasminogen activator, the only drug approved for AIS treatment within 4.5 h, remains controversial in patients with CCM. Recently, balloon angioplasty has been reported as a successful treatment for intracranial large atherosclerotic AIS patients. In our department, we treated a patient with intracranial large atherosclerotic AIS and CCM using balloon angioplasty, resulting in a positive outcome. Here, we discuss the safety and efficiency of balloon angioplasty for the treatment of intracranial large atherosclerotic AIS in patients with CCM. In conclusion, we suggest that balloon angioplasty may be a potentially safe and effective treatment for intracranial large atherosclerotic AIS patients with CCM. However, further research is needed to explore the use of mechanical revascularization in AIS patients with CCM.

Background: Recent years, the use of optical molecular imaging (OMI) techniques guided nerve imaging has made significant progress. However, a comprehensive bibliometric analysis in this field is currently lacking. In this study, we aim to shed light on the current status, identify the emerging hot topics, and provide valuable insights for researchers within this field.

Methods: In this study, we collected 414 research via the Web of Science Core Collection (WoSCC) from 2009 to 2023. CiteSpace, VOSviewer and R package "bibliometrix" were used for analysis of countries, institutions, journals, etc., to evaluate the trends.

Results: The amounts of publications in relation to OMI guided nerve imaging has been increasing. United States and China contributed to over 60% of the publications. The Shanghai Jiao Tong University contributed the highest number of publications. Investigative Ophthalmology and Visual Science is considered the most prestigious and prolific journal in the field. It is also widely regarded as the most cited journal. Among the top 10 authors in terms of output, Hehir CAT has the highest number of citations. The "neurosciences neurology," "science technology other topics," and "ophthalmology" are representative research areas. The main cluster of keywords in this field includes "axonal regeneration," "mouse," and "optical coherence tomography."

Conclusion: This bibliometric investigation offers a comprehensive portrayal of the structure of knowledge and the progression patterns, presents an all-encompassing synthesis of findings, discerns and illustrates the forefront within OMI guided nerve imaging for the first time. It will provide a valuable reference for relevant scholars.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused millions of infections and deaths globally. Post-COVID-19 syndrome, or long COVID is characterized by lingering symptoms such as chronic fatigue, headaches, and sleep disturbances. This study aimed to investigate the correlation between these symptoms and T2-hyperintense white matter lesions detected on magnetic resonance imaging (MRI) of the brain and spine in patients with post-COVID-19 syndrome.

Methods: This retrospective, single-center study analyzed a sample of 96 patients from Bern University Hospital in Switzerland who presented with suspected post-COVID-19 syndrome between 2020 and 2022. Patients completed self-report questionnaires evaluating fatigue, emotional wellbeing, and daytime sleepiness. Brain and spine MRIs were independently rated by 2 neuroradiologists for T2-hyperintense lesions. The correlation between these lesions and symptoms of fatigue and headache was assessed.

Results: The cohort consisted predominantly of women (73%) with an average age of 46 years. Chronic fatigue (90%), sleep disorders (51%), and headache (57%) were the most prevalent symptoms. The fatigue questionnaires indicated high levels of fatigue. Brain MRI revealed T2-hyperintense lesions in 72% of patients, whereas spine MRI showed these lesions in only 16%. There was no statistically significant correlation between the presence of cerebral T2-hyperintense lesions and symptoms of fatigue (p = 0.815) or headaches (p = 0.178). Similarly, no significant correlation was found when considering numbers of pathological brain lesions (fatigue: p = 0.557; headaches: p = 0.820).

Conclusion: While T2-hyperintense lesions are common in patients with post-COVID-19 syndrome, their presence does not correlate significantly with symptoms of fatigue or headaches. These findings suggest that T2-hyperintense brain lesions may not be directly related to the subjective experience of these symptoms. Further research with larger sample sizes and adjustment for potential confounding factors is necessary to better understand the relationship between MRI findings and post-COVID-19 syndrome symptoms.

Background: Epilepsy, a common neurological disorder, is characterized by susceptibility to recurrent seizures. Increasing evidence suggests that autophagy plays a crucial role in the initiation and progression of epilepsy. However, the precise mechanisms by which autophagy deficiencies involved in epileptogenesis are still not fully understood.

Methods: Two datasets of epilepsy (GSE143272 and GSE256068) were downloaded from the Gene Expression Omnibus (GEO) database. Differential expression genes (DEGs) analysis and weighted gene co-expression network analysis (WGCNA) were employed to screen for autophagy related differential expression genes (ARDEGs) in GSE143272 database. Subsequently, protein-protein interaction, transcription factors and miRNAs networks were constructed. Additionally, the functional enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were applied. The hub ARDEGs were identified through CytoHubba, followed by the LASSO analysis. The Immune Cell Abundance Identifier (ImmuCellAI) was used to estimate peripheral immune cells abundance of epilepsy. Furthermore, the expression level of hub ARDEGs were detected in patients treated with different epilepsy monotherapies to explore the role of autophagy in the responsiveness of antiepileptic drug therapy. Finally, the expression level of hub ARDEGs were further validated in hippocampus of GSE256068 to enhance the reliability of the results.

Results: Twenty ARDEGs in epilepsy were screened out by integrating DEGs and WGCNA analysis. KEGG enrichment analysis showed that the ARDEGs in epilepsy were not only involved in the autophagy, but also apoptosis, the NOD-like receptor signaling pathway, the neurotrophin signaling pathway, etc. Four hub ARDEGs (PIK3R1, TRIM21, TRIM22, and ITPR3) were screened through integrating CytoHubba plug and LASSO analysis. The immune infiltration analysis showed that there was a significantly increased abundance of macrophages and a decreased abundance of CD4 and CD8 T cells, including Tr1, nTreg, Tfh, CD8 naïve, cytotoxic T cells and effector memory T cells in the epilepsy group. Furthermore, the hub ARDEGs were significantly correlated with the abundance of differential immune cells. In expression level validation and anti-epileptic drug responsiveness analysis, PIK3R1 and ITPR3 had significant differences in the hippocampus of patients with epilepsy. PIK3R1 expression level was found to be related with carbamazepine resistance.

Conclusion: This study elucidated the autophagy-related gene signatures in epilepsy and clarified their association with immune infiltration and anti-epileptic drug responsiveness, providing a novel target for future therapeutic interventions and disease markers in epilepsy.

Introduction: Large vessel occlusions (LVO) account for over 60% of stroke-related mortality and disability. Lean body mass (LBM) represents metabolically active body tissue and has been associated with reduced mortality. This study aimed to investigate whether body composition influences LVO stroke perfusion volumes and whether this effect is sex-specific.

Methods: Data were retrospectively collected from all patients admitted between January 2017 and January 2022 with LVO ischemic stroke at the Erasmus Hospital (Brussels), for whom anthropometric and perfusion data were available. Body mass index (BMI) and LBM were calculated using, respectively, the Quetelet's and the James' formula. Correlations between body composition and stroke volumes were investigated using Spearman correlations.

Results: A total of 152 patients were included in this study. Mean age 72 ± 14y, female ratio 62.5%, core volume 26 ± 38 mL, penumbra volume 104 ± 61 mL. LBM correlated significantly with stroke volumes (penumbra and core) in the entire group (core: p = 0.001; penumbra: p = 0.001). There was a significant sex-effect, with a significant correlation observed only in women (core: p = 0.008; penumbra: p = 0.007). BMI did not correlate with perfusion volumes at the group level nor at the sex-level.

Conclusion: LBM significantly impacts LVO stroke volumes, but this effect is observed only in women. LBM may serve as a superior indicator of body composition compared to BMI.

Background: Connective tissue disorders (CTDs) are a heterogeneous group of disorders often presenting with a variety of comorbidities including musculoskeletal, autonomic, and immune dysfunction. Some CTDs such as hypermobile Ehlers-Danlos syndrome (hEDS), which is one of the most common, have been associated with neurological disorders requiring surgical intervention. The frequency of these comorbidities in these populations and their subsequent requirement for neurosurgical intervention remains unclear.

Methods: Based on our initial experience with this population, we investigated the presentation rates of specific comorbidities and neurosurgical interventions in a cohort of individuals referred to our institution for evaluation and neurosurgical management of issues secondary to diagnosed or suspected CTDs from 2014 to 2023. Primary diagnoses were made by referring physicians or institutions based on clinical presentation and standard-of-care criteria. We evaluated relationships between diagnoses and surgical interventions by multivariate correlation and intersection plots using the UpSetR package.

Results: Of 759 individuals, we excluded 42 based on incomplete data. From the remaining (total cohort, N = 717), 460 (64%) individuals were diagnosed with hEDS, 7 were diagnosed with a CTD other than hEDS, and 250 lacked a formal CTD diagnosis. We found that individuals with hEDS had a higher frequency of certain comorbidities, such as Mast Cell Activation Disorder and Postural Orthostatic Tachycardia Syndrome, and neurosurgical intervention compared to individuals without a CTD diagnosis (unaffected). Of the total cohort, 426 (59%) were diagnosed with Chiari I Malformation, which shared a significant overlap with hEDS. Of those who elected to undergo surgery (n = 612), 61% required craniocervical fusion (CCF). Notably, of the 460 individuals diagnosed with hEDS, 404 chose surgical intervention, of which, 73% required CCF for craniocervical instability.

Conclusion: In this retrospective study of individuals referred to our institution for evaluation of CTDs potentially requiring neurosurgical intervention, we defined the frequency of presentation of specific comorbidities that we commonly encountered and revealed the rate at which they required neurosurgical intervention.

Introduction: The vast majority of cellular studies on mammalian vestibular hair cells have been carried out in rodent models due in part to the inaccessibility of human inner ear organs and reports describing electrophysiological recordings from human inner ear sensory hair cells are scarce. Here, we obtained freshly harvested vestibular neuroepithelia from adult translabyrinthine surgical patients to obtain electrophysiological recordings from human hair cells.

Methods: Whole cell patch clamp recordings were performed on hair cells mechanically isolated from human cristae to characterize voltage-dependent and pharmacological properties of membrane currents. Hair cells were classified as type I or type II according to morphological characteristics and/or their electrophysiological properties.

Results: Type I hair cells exhibited low voltage-activated K⁺ currents (IKLV) at membrane potentials around the mean resting membrane potential (-63 mV) and large slowly activating outward K⁺ currents in response to depolarizing voltage steps. Recordings from type II hair cells revealed delayed rectifier type outward K⁺ currents that activated above the average resting potential of -55 mV and often showed some inactivation at more depolarized potentials. Perfusion with the K⁺ channel blocker 4-aminopyridine (1 mM) substantially reduced outward current in both hair cell types. Additionally, extracellular application of 8-bromo-cGMP inhibited IKLV in human crista type I hair cells suggesting modulation via a nitric oxide/cGMP mechanism. A slow hyperpolarization-activated current (Ih) was observed in some hair cells in response to membrane hyperpolarization below -100 mV.

Discussion: In summary, whole cell recordings from isolated human hair cells revealed ionic currents that strongly resemble mature current phenotypes previously described in hair cells from rodent vestibular epithelia. Rapid access to surgically obtained adult human vestibular neuroepithelia allows translational studies crucial for improved understanding of human peripheral vestibular function.

Objectives: Neurological deterioration (ND) is common after acute isolated pontine infarction, and no evidence-based treatment is available to prevent this. We determined whether intravenous thrombolysis (IVT) with tissue plasminogen activator soon after pontine infarction prevents ND.

Methods: We retrospectively enrolled consecutive patients admitted to our hospital within 4.5 h after the onset of isolated pontine infarction identified using diffusion-weighted imaging. Patients were divided into the IVT and non-IVT groups. ND was defined as any ≥2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score between the maximal and initial neurological deficits during hospitalization. Patients' clinical characteristics, laboratory findings, and outcomes were analyzed to determine the efficacy and safety of IVT.

Results: Of 211 study patients (median age, 67 years [interquartile range, 57-75 years]; 132 [62.6%] men), 74 received IVT; 137 patients did not receive IVT, but accepted other antithrombotic therapies, including antiplatelet or anticoagulant drugs. The NIHSS score on admission was higher in the IVT group than in the non-IVT group (7 vs. 4, P = 0.000), but that at discharge was similar in both groups (4 vs. 5, P = 0.975). ND occurred in 17 (23.0%) and 51 (37.2%) patients in the IVT and non-IVT groups, respectively (P = 0.044). Multiple logistic regression analysis identified IVT (odds ratio, 1.509; 95% confidence interval, 1.250-3.034) as an independent factor for preventing ND. The incidence of intracranial hemorrhagic transformation (P = 0.351) and major visceral organ hemorrhage (P = 0.122) was similar in both groups.

Conclusions: IVT may prevent early ND after acute pontine infarction without increasing intracranial hemorrhagic transformation, possibly by decreasing the total thrombotic burden.

Objective: This study aims to explore the correlation between brain natriuretic peptide (BNP) levels and prognosis in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH).

Methods: This retrospective study included patients diagnosed with aneurysmal subarachnoid hemorrhage (aSAH) at Beijing Tiantan Hospital between January 2015 and September 2021. Plasma BNP levels were measured upon admission and log-transformed to reduce skewness. Elevated BNP was defined as lgBNP ≥1.79 (equivalent to BNP ≥62 pg./mL). The primary outcome was poor prognosis, defined as a modified Rankin Scale (mRS) score ≥ 3 at 90 days. Univariable and multivariable logistic regression analyses were conducted to examine the association between BNP levels and prognosis. Additionally, we assessed the potential impact of incorporating BNP into a predictive model for poor prognosis.

Results: The statistical analysis encompassed a total of 932 patients. Among them, 171 individuals experienced unfavorable prognosis (mRS ≥3) during follow-up, and 444 patients had elevated BNP levels, defined as lgBNP ≥1.79. After accounting for confounding factors, elevated BNP levels remained a significant independent risk factor of a poor prognosis (p = 0.047, OR = 1.49, 95%CI = 1.01-2.20). Nevertheless, BNP's predictive value alone might not warrant its inclusion in a prognostic model.

Conclusion: Elevated BNP levels independently forecast unfavorable prognosis in patients with aSAH, even though the cutoff value is lower than the cardiology standards. Continuous monitoring and personalized hospitalization plans can be vital for these patients.