Journal of Central Nervous System Disease最新文献

Background: Parkinson's disease (PD) is one of the most common neurodegenerative disorders. Previous research has confirmed that isofraxidin can reduce macrophage expression and inhibit peripheral inflammation. However, its effects on the central nervous system remain underexplored.

Objective: This study aims to determine whether isofraxidin offers protective effects against PD.

Methods: To assess the effects of isofraxidin, motor performance changes in LPS-induced PD mice were evaluated using rotarod, pole-climbing, and beam-walking tests. Striatal damage was examined through [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography (PET) imaging, and dopaminergic neurotoxicity was assessed using tyrosine hydroxylase (TH) staining. Microglial accumulation and activation were monitored with Iba-1 staining, while LPS-induced inflammation was examined via TNF-α and IL-1β staining.

Results: Isofraxidin pre-treatment significantly improved LPS-induced motor dysfunction, as evidenced by better performance in the rotarod, pole-climbing, and beam-walking tests. [¹⁸F]FDG PET imaging showed that isofraxidin restored glucose uptake in the striatum, countering LPS-induced damage. Furthermore, Iba-1 staining revealed that isofraxidin markedly inhibited LPS-induced microglial activation and accumulation. TNF-α and IL-1β staining indicated a reduction in inflammation with isofraxidin treatment. Additionally, TH staining supported the neuroprotective role of isofraxidin on dopaminergic neurons.

Conclusions: Isofraxidin exhibits notable neuroprotective properties by mitigating LPS-induced parkinsonian behaviors, microglial activation, inflammation, and dopaminergic neuron damage. These results highlight isofraxidin's potential as a therapeutic intervention for PD.

Background: Sneddon's syndrome is a rare thrombotic vasculopathy characterized by the coexistence of both cerebrovascular events and livedo reticularis.

Objective: This review aims to raise awareness among physicians by discussing the whole clinical spectrum of the disease. Typically, Sneddon syndrome presents in middle-aged women with a cerebrovascular accident and a preexisting skin rash, which is livedo reticularis. Diagnosis is primarily clinical, relying on a high index of suspicion. Management focuses mainly on reducing the risk of cerebral infarctions and alleviating symptoms.

Conclusion: Further research is necessary to better understand the disease's nature, which will contribute to improving early diagnosis and optimal management.

Stroke is a significant health concern impacting society and the health care system. Reperfusion therapy for acute ischemic stroke and standard rehabilitative therapies may not always be effective at improving post-stroke neurological function, and developing alternative strategies is particularly important. Vagus nerve stimulation (VNS) is a treatment option currently approved by the Food and Drug Administration (FDA) for intractable epilepsy, refractory depression, primary headache disorders, obesity, and moderate to severe upper-limb motor dysfunction in chronic ischemic stroke patients. Moreover, VNS has demonstrated potential efficacy in various conditions, including autoimmune diseases, disorders of consciousness, Alzheimer's disease, Parkinson's disease, traumatic brain injury, stroke, and other diseases. Although the popularity and application of VNS continue to increase rapidly, the field generally lacks a consensus on the optimal stimulation parameters. The stimulation parameters for VNS are directly related to the clinical outcome, and determining the optimal stimulation conditions for VNS has become an essential concern in its clinical application. This review summarizes the current evidence on VNS for stroke in preclinical models and clinical trials in humans, paying attention to the current types and stimulation parameters of VNS, highlighting the mechanistic pathways involved in the beneficial effects of VNS, critically evaluating clinical implementation challenges and proposing some suggestions for its future research directions. Achieving safe and effective clinical transformation of VNS requires further animal and clinical studies to determine the optimal stimulation parameters and therapeutic mechanisms.

Background: The paddle lead (PL) and cylindrical lead (CL) remain the main implant categories in spinal cord stimulation (SCS) for treating neuropathic pain. Surgeons often complain about the greater trauma associated with PL implantation, while percutaneous endoscopic technique offers a promising approach for minimizing the trauma associated to PL implantation. However, there remains a dearth of real-world case study on endoscopy-assisted CL implantation.

Purpose: This study aimed to demonstrate the endoscopic-assisted approach and outcomes of CL implantation in SCS for managing neuropathic pain.

Research design: A retrospective case series.

Study sample: Patients aged 18 years and above with chronic neuropathic pain persisting for at least three months, refractory to standardized conservative treatment, were enrolled between January 2021 and March 2023.

Data collection and analysis: The surgical key steps including puncture, working cannula placement, endoscopic laminotomy and endoscopic CL introduction were demonstrated. Characteristics as demographics, follow-up time, visual analog scale (VAS) score, pain disability index (PDI) score and patient-reported outcomes measurement information system (PROMIS) scale were assessed.

Results: Successful CL implantation under endoscopy was achieved in all patients, including 3 with failed back surgery syndrome, 2 with complex regional pain syndrome and 2 with chronic pelvic pain. No spinal cord injuries, dural tears, lead migration, lead fractures, or postoperative infections were observed. VAS score of regional pain, PDI score as well as PROMIS of patient's quality of life were all significantly improved after surgery.

Conclusion: Percutaneous endoscope-assisted CL implantation offered a new alternative technique for SCS in managing neuropathic pain.

Background: Cardiac high-sensitivity troponin T (hs-cTnT) is linked to the cardioembolic origin, severity, and outcome of acute ischemic stroke. Furthermore, larger brain infarctions are often accompanied by impaired dynamic cerebral autoregulation (dCA), which is also indicative of a poor prognosis.

Objectives: This study aimed to investigate whether hs-cTnT levels can serve as a predictor of dCA impairment.

Design: Retrospective cohort study.

Methods: In 330 consecutive patients with stroke (age 71 years [IQR 59-78]; 100 women; 229 territorial and 111 non-territorial brain infarcts) with successful dCA assessment, hs-cTnT levels were measured within 24 hours of stroke onset. These measurements were analyzed in relation to cerebrovascular risk factors, stroke origin, stroke severity (National Institute of Health Stroke Scale, NIHSS at entry), modified Rankin scale (mRs) at 3 months, and stroke volume determined by cranial computed tomography perfusion (CTP). dCA was assessed using transfer function analysis, which assessed the relationship between middle cerebral artery blood flow velocity and blood pressure. Coherence, gain, and phase were estimated across 3 frequency ranges: very low (0.02-0.07 Hz), low (0.07-0.15 Hz), and high (0.15-0.5 Hz).

Results: In univariate analysis, hs-cTnT was associated with cardioembolism and territorial infarction. In the multinomial logistic regression analysis, independent risk factors for the presence of a territorial infarction included atrial fibrillation, the NIHSS score, the infarct core on CTP, cardioembolism, and large vessel disease, but not hs-cTnT levels. Risk factors for a poor outcome (mRs >2) included age, hs-cTnT, and NIHSS score. Overall, the coherence, gain, and phase were not predicted by hs-cTnT levels.

Conclusions: Hs-cTnT levels are associated with poor stroke outcomes. However, they do not predict dCA impairment.

Registration: ClinicalTrials.gov NCT04611672, 11.10.2020.

Background: Traumatic brain injury (TBI) can cause damage to the blood-brain barrier, resulting in neuroinflammatory reactions and brain edema that seriously affect the recovery of neurological function. We hypothesize that an enriched environment (EE) regulates the TLR2/NF-κB signaling pathway and thereby modulates the integrity of the blood-brain barrier to achieve neuroprotective effects.

Objective: This study evaluated the expression of toll-like receptor (TLR)-2 after TBI in a rat model, with the aim of determining whether TLR2/NF-κB improves secondary brain injury by inhibiting the release of inflammatory factors and reducing brain edema.

Methods: We established a TBI model using Sprague-Dawley rats and implemented EE intervention or TLR2 siRNA to reduce TLR2. Western-blot analysis, real-time PCR, immunofluorescence staining, ELISA, TUNEL and FJC staining, wet-dry methods, rotarod testing, and neurological scoring were then applied for analysis.

Results: Our results revealed that TLR2 was activated after TBI in rats and that EE or silencing of TLR2 with TLR2 siRNA reduced the level of inflammation, significantly alleviating brain edema, neuronal apoptosis, and degeneration. TBI exacerbated brain edema and nerve damage caused by TLR2/NF-κB signaling, and EE appeared to regulate neuroinflammation and brain edema by reducing TLR2.

Conclusions: Inhibition of TLR2 with EE might constitute a successful approach in the management of TBI.

Introduction: Acute subdural hematomas are major causes of morbidity which warrant immediate treatment. If surgical intervention is warranted, craniotomy (CO) and decompressive craniectomy (DC) are employed, largely based on a loosely defined criteria and the neurosurgeon's best judgment. The primacy of one approach over another is a matter of dispute.

Objective: We attempt to further clarify any advantages in the two techniques, and include a propensity score matched (PSM) subgroup analysis to eliminate bias.

Design: This meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

Data sources and methods: A literature review was conducted on PubMed/Medline, Cochrane Central, and Google Scholar from inception to September 2023. 15 studies were extracted, and three outcomes were meta-analyzed: Mortality, Glasgow Outcome Scale (GOS) scores and patients undergoing re-operations/revisions. Odds Ratios (OR) and Mean Difference (MD) were used in dichotomous and continuous variables respectively. PSM data was used wherever possible. A subgroup analysis was conducted with 5 PSM studies and a trial. Heterogeneity was addressed if above 40% and the P-value is significant (≤ .05).

Results: A total of 15 studies were meta-analyzed with a total of 2327 and 2171 patients undergoing CO and DC respectively. Patients undergoing DC had a significantly worse GOS 5 outcome (OR: .63 [95% CI: .45-.87]; P = .005; I2 = 0%) and higher mortality (OR: 1.58 [95% CI: 1.20-2.08]; P = .001; I2 = 67%). In subgroup analysis of adjusted studies, DC still had significantly higher mortality. (OR: 1.50 [95% CI: 1.03-2.18]; P = .001; I2 = 83%).

Conclusions: This meta-analysis determines that CO is more viable than DC as a surgical option due to its less invasive nature. DC can be employed, albeit under strict preprocedural patient selection and for highly specific indications.

Hemorrhagic stroke (HS) in childhood accounts for almost 50% of childhood strokes, is among the top ten causes of deaths, or determines lifelong disability. These facts form significant socio-economic and demographic problems. The purpose of this review is to analyze current knowledge about HS in children. The data on HS terminology are presented, taking into account the International Classification of Diseases 11 edition. Attention is paid to the epidemiology of HS in children, including the results of individual local studies. The risk factors of HS in children were studied with an analysis of the causal, pathophysiological mechanisms of HS of various etiologies. The ideas about the clinical manifestations of HS in children are described. The analysis of HS treatment in children was carried out with an emphasis on achievements in neurointensive therapy of the acute period of HS. This review also includes information on the outcomes of HS in children.