Frontiers in Neurology最新文献

Background: The combined index (HALP) of hemoglobin, albumin, lymphocytes, and platelets is considered a novel scoring system that reflects systemic inflammation and nutritional status. This study aimed to investigate the relationship between HALP scores and poor outcomes in acute ischemic stroke (AIS) patients with type 2 diabetes mellitus (DM).

Methods: Patients with AIS and type 2 DM were screened from the Third China National Stroke Registry (CNSR-III) and divided into quartiles based on their HALP scores at admission. Clinical outcomes were adverse functional outcomes (modified Rankin scale [mRS] score of 3-6 or 2-6) and all-cause mortality at 3 months and 1 year. The association of HALP with the risk of poor functional outcome and all-cause mortality were analyzed by multivariable logistic regression and Cox proportional hazards regression.

Results: A total of 3,603 patients were included in this study. After adjusting for confounders, it was found that patients in the highest HALP score quartile had lower mRS scores of 2-6 (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.51-0.80) and 3-6 (OR, 0.53; 95% CI, 0.51-0.82) at the 3-month follow-up. At the 1-year follow-up, a significant correlation was observed between HALP scores and mRS scores of 2-6 (OR, 0.65; 95%CI, 0.57-0.81) and 3-6 (OR, 0.64; 95%CI, 0.47-0.86). Additionally, the highest HALP score quartile was associated with a reduced risk of all-cause mortality at the 3-month follow-up (hazard ratio [HR], 0.35; 95%CI, 0.13-0.93). Similar results were observed at the 1-year follow-up (HR, 0.34; 95%CI, 0.18-0.63).

Conclusion: At 3 months of AIS patients with type 2 diabetes and 1-year follow-up, lower HALP scores were associated with poorer functional outcomes and all-cause mortality.

Introduction: Conventional management approaches have been challenged in dealing with zoster-related trigeminal neuralgia. Percutaneous trigeminal ganglion stimulation (TGS) has been rarely reported as a potential treatment option for alleviating pain associated with this condition. The present study investigated the application of percutaneous TGS in a series of patients suffering from Zoster-related trigeminal neuralgia to evaluate its potential efficacy of pain relief.

Methods: We retrospectively reviewed the medical records of all patients who underwent TGS at the Department of Pain Management, Second Affiliated Hospital of Guangxi Medical University. All patients were followed for up to 6 months. Clinical data, including the Visual Analog Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and medication consumption were recorded before and after treatment. Adverse events related to the treatment were also documented.

Results: A total of nine patients underwent percutaneous TGS for Zoster-related trigeminal neuralgia. Among these patients, five (56%) experienced more than 50% pain relief at discharge. At the six-month follow-up, the mean VAS score decreased from preoperative 6.1 ± 1.5 to 2.5 ± 1.9, demonstrating a statistically significant reduction (t = 4.36, p < 0.05). The PSQI also showed a significant reduction from a baseline score of 14.1 to 6.5 at the six-month follow-up (Z = 4.2, p < 0.05). Seven patients reported satisfaction with the treatment and no serious adverse events occurred.

Discussion: The results of the present study suggest that this contributes growing evidence that percutaneous TGS may be an effective treatment for Zoster - related trigeminal neuralgia.

Body awareness (BA) is a complex multi-dimensional construct that refers to the subject's ability to consciously perceive and integrate sensory and proprioceptive information related to the position, movement, and balance of one's own body and body parts. Since it involves multiple brain regions and include different functional networks, it is very often affected by cerebrovascular damage such as stroke. Deficits in the ability to monitor our actions and predict their consequences or recognize our body parts and distinguish them from those of others may emerge after stroke. In this study, we decided to explore whether specific treatments targeting BA are discussed in current literature, and whether BA is considered as an outcome in neurorehabilitation processes for stroke patients. To achieve our goal, a scoping review on this often-underreported problem was performed. After analyzing the existing literature, emerged BA in stroke patients is rarely assessed or rehabilitated through specific stimulation or rehabilitation protocol. Additionally, treatment outcomes related to BA are often considered only from a "physical" perspective such as improvements in walking, balance, or the movement of specific body parts, rather than from a proprioceptive standpoint. Further research is needed to facilitate developing early and effective intervention strategies for the recovery of BA after stroke.

Background: Ancillary tests are often used in the determination of death by neurologic criteria (DNC), especially when the clinical examination is inconclusive. DNC is widely accepted, as defined by the comprehensive report of the World Brain Death Project. However, there are several medical, legal, religious, ethical, and social controversies. Accordingly, "premature" and "delayed" diagnoses of brain death attract these issues.

Methods: Depending upon the availability and experience of the managing medical teams, various ancillary tests are employed for an early and supplementary diagnosis of brain death.

Results: We describe the practicality, test performance, and utility of some of the commonly employed ancillary tests for the diagnosis of brain death in clinical practice, along with their case examples.

Conclusion: Brain death is a clinical diagnosis determined by history, physical examination, and adherence to recommended criteria. All ancillary investigations are used as supplementary tests with variable accuracy parameters. These ancillary tests often facilitate an early and "timely" diagnosis of brain death.

Objectives: Research on neurobehavioral abnormalities in neonates of mothers with subclinical hypothyroidism (SCH) is limited. The link between umbilical cord blood brain-derived neurotrophic factor (BDNF) levels and neurobehavioral outcomes in neonates has not been explored. This study investigates the correlation between alterations in umbilical cord blood BDNF levels and early neurobehavioral abnormalities in neonates born to pregnant women with SCH.

Methods: This study recruited 72 pregnant women with SCH and 76 healthy controls (HC). The study collected general information for all subjects, including body mass index, parity, thyroid function assessed during early to late pregnancy, and neonatal birth weight. Neonatal behavioral and neural abilities were evaluated using the Neonatal Behavioral Neurological Assessment (NBNA). BDNF levels in umbilical cord blood were measured using the Enzyme-Linked Immunosorbent Assay method.

Results: The results indicated that neonates with SCH during pregnancy had lower total NBNA scores, behavioral ability, passive muscle tone, active muscle tone, primitive reflexes, general assessment, and lower levels of cord blood BDNF compared to healthy controls. The cord blood BDNF of newborns with SCH during pregnancy was positively correlated with total NBNA score, behavioral ability, active muscle tone, and general assessment. Moreover, multiple linear regression analysis demonstrated an association between cord blood BDNF levels in pregnant patients with SCH and multiple measures of newborn health, including total NBNA score, behavioral ability, active muscle tone, and general assessment.

Conclusion: Infants born to pregnant women with SCH exhibit reduced behavioral and neural abilities linked to BDNF levels in umbilical cord blood.

Introduction: Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease (WED), is a sensorimotor disorder characterized by an uncontrollable urge to move the legs, typically accompanied by discomfort. Low iron levels, pregnancy, and age are some identified risk factors. RLS is treated using various pharmacological options, including dopamine agonists, benzodiazepines, anticonvulsants, opioids, and bupropion. Iron supplementation, particularly with intravenous Ferric carboxymaltose (FCM), has gained attention due to the role of iron deficiency in RLS pathophysiology. This meta-analysis evaluates the efficacy and safety of FCM in treating RLS symptoms.

Materials and methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines, using databases such as PubMed, Google Scholar, and Cochrane. Studies involving intravenous FCM in patients diagnosed with RLS were included. Statistical analysis was performed using Review Manager 5.4.

Results: Seven studies involving 539 participants were analyzed. FCM significantly reduced IRLS scores (WMD = -5.77; 95% CI = [-8.85, -2.70]; p = 0.0002) and improved VAS and SF-36 scores compared to placebo. However, FCM did not significantly improve RLS quality of life scores. Adverse events were more common in the FCM group, particularly nausea, but no significant differences were found for severe adverse events.

Conclusion: In conclusion, intravenous ferric carboxymaltose significantly reduces Restless Legs Syndrome symptoms, especially in patients with confirmed iron deficiency. The treatment appears generally well-tolerated, with adverse effects being manageable. However, further long-term studies are needed to fully assess the safety profile and confirm sustained symptom improvement in a broader population.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42024585233.

Introduction: Resting state-fMRI, provides a sensitive method for detecting changes in brain functional integrity, both with respect to regional oxygenated blood flow and whole network connectivity. The primary goal of this report was to examine alterations in functional connectivity in collegiate American football players after a season of repetitive head impact exposure.

Methods: Collegiate football players completed a rs-fMRI at pre-season and 1 week into post-season. A seed-based functional connectivity method, isolating the posterior cingulate cortex (PCC), was utilized to create individual functional connectivity maps. During group analysis, first, voxel-wise paired sample t-tests identified significant changes in connectivity from pre- to post-season, by player, and previous concussion history. Second, 10 DMN ROIs were constructed by overlaying an anatomical map over regions of positive correlation from one-sample t-tests of pre-season and post-season. These ROIs, plus the LpCun, were included in linear mix-effect modeling, with position or concussion history as covariates.

Results: 66 players were included (mean age 20.6 years; 100% male; 34 (51.5%) non-speed position players). The 10 DMN ROIs showed no alterations from pre-season to post-season. By concussion history, the right temporal ROI demonstrated a significant effect on baseline functional connectivity (p = 0.03). Speed players, but not non-speed players, demonstrated a significant decrease in functional connectivity in the precuneus from pre- to post-season (p < 0.001).

Discussion: There are region-specific differences functional connectivity related to both position and concussion history in American collegiate football players. Player position affected functional connectivity across a season of football. Position-specific differences in head impact exposure rate and magnitude plays a crucial role in functional connectivity alterations.

Introduction: Post-stroke depression (PSD) can lead to poorer functional outcomes and prognosis. Brain inflammation is a risk factor for PSD. Statins might be beneficial due to their anti-inflammatory properties. Different studies have yielded varying results regarding the effects of statins. Therefore, this meta-analysis aims to clarify the effect of statins on PSD.

Methods: Objectives: To evaluate the relationship between PSD and the use of statins. Data Sources: Databases including PubMed, Web of Science, Embase, and Cochrane Library. Eligibility Criteria: Original observational cohort studies. Participants: Patients with ischemic stroke. Interventions: Use of statins. Appraisal and Synthesis Methods: Forest plot to display pooled results; I ² test to evaluate heterogeneity.

Results: Of the 37 studies selected, four were eligible. The four studies included 93,893 patients (with statins: 45,598) and more than 17,470 PSD patients. The mean age ranged from 62.1 to 70.8 years. The percentage of female participants ranged from 42.1% to 57.9%. For PSD in different regions, the pooled OR for all regions using random-effects methods was 1.21 (95% CI: 0.44-3.33). The pooled OR for Asian populations was 1.42 (95% CI: 0.37-5.40), and for European populations, it was 0.76 (95% CI: 0.73-0.78). The pooled OR for all regions using fixed-effects methods was 0.84 (95% CI: 0.81-0.86). The pooled OR for Asian populations was 2.62 (95% CI: 2.34-2.93).

Conclusion: Depending on the pooling method used, statin use in Asia either increased or had no relationship with PSD. For European patients, statin use reduced the incidence of PSD.

Background: Amphetamines possess sympathomimetic properties that can affect cerebral vasculature though conflicting reports exist about their effect on vasospasm risk and clinical outcomes in aneurysmal subarachnoid hemorrhage. This study aimed to characterize the impact of recent amphetamine use on vasospasm development in aneurysmal subarachnoid hemorrhage as well as neurological outcomes.

Methods: We retrospectively screened 441 consecutive patients admitted with a diagnosis of subarachnoid hemorrhage who underwent at least one cerebral digital subtraction angiogram. Patients were excluded if no urinary toxicology screen was performed within 24 h of admission, if there was a diagnosis of non-aneurysmal subarachnoid hemorrhage, or if ictus was greater than 72 h from hospital admission. Vasospasm characteristics were collected from digital subtraction angiography and transcranial Doppler studies.

Results: 129 patients were included and 24 tested positive for amphetamines on urine drug screen. No significant differences were found in respect to patient age, sex, or admission clinical severity scales (Hunt-Hess and modified Fisher) based on amphetamine use. There was no difference in the severity of vasospasm or time to peak severity based on recent amphetamine use. A trend toward more isolated posterior circulation vasospasm was observed in the amphetamine present group (16.7% vs. 4.8%, p = 0.06), while there was higher incidence of anterior circulation vasospasm in the amphetamine absent group (79.2% vs. 94.3%, p = 0.03). There was no difference in delayed cerebral ischemia incidence, length of hospital stay, need for ventriculoperitoneal shunt placement, functional outcome at discharge or hospital mortality based on amphetamine use.

Interpretation: Recent amphetamine use was not associated with worse vasospasm severity or delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage patients. Further investigations about localized effects in the posterior circulation and impact on long-term functional outcomes are warranted.

Introduction: Severe or complicated atheromatosis of the aortic arch represents an important and often underdiagnosed embolic source in patients with ischemic stroke. The presence of a floating thrombus has significant clinical relevance, as it is associated with a high risk of early recurrence. The aim of this study was to analyze the potential of echocardiographic examination through the suprasternal window in both the detection of embolic sources and the monitoring of the response to anticoagulant treatment in patients with mobile thrombi.

Methods: This case series study included ten consecutive patients with a mobile floating aortic arch thrombus associated with an atheromatous plaque, detected by focused echocardiography and confirmed by Computed Tomography Angiography (CTA). Epidemiological, clinical, radiological, and ultrasound characteristics were analyzed. Clinical and ultrasound follow-up was performed after initiation of anticoagulation as secondary prevention to assess the efficacy and safety of this treatment.

Results: Ten patients (seven female) with a mean age of 76 years were identified. After anticoagulation, a complete resolution of the mobile thrombus was observed in eight of them during ultrasound follow-up. One patient suffered an ischemic recurrence. Two patients receiving associated antiplatelet therapy presented severe hemorrhagic complications, one of which was fatal. Once the disappearance of the mobile thrombus was detected, anticoagulation was discontinued, and no further ischemic recurrences were observed.

Discussion: Floating thrombus of the aortic arch is an underdiagnosed but clinically relevant condition. The study of the aortic arch with echocardiography through the suprasternal window is a highly available and harmless technique, that may be highly useful for the detection and monitoring of response to treatment of this pathology. Furthermore, early anticoagulation could be an effective and safe treatment in these patients.