Journal of Central Nervous System Disease最新文献

Retroclival epidural hematoma (EDH) is a rare form of intracranial hemorrhage located between the clivus and the dura mater, predominantly affecting pediatric patients due to the anatomical vulnerability of the craniocervical junction. This case report describes a 4-year-old boy involved in a motorcycle accident who presented with facial trauma and was found to have a retroclival EDH and multiple mandibular fractures. Despite the hematoma measuring 8.7 mm in thickness and 3 cc in volume, the patient remained neurologically intact with a Glasgow Coma Scale of 15. He underwent surgical repair for the mandibular fractures while the retroclival EDH was managed conservatively. The patient recovered fully without neurological deficits at follow-ups extending to 6 months. A comprehensive literature review reveals that retroclival EDH in children is commonly associated with high-energy trauma such as motor vehicle accidents and often results from tectorial membrane stripping injury. While clinical presentations vary, many cases, like the one described, show minimal neurological signs despite the presence of significant hematomas, emphasizing the importance of high clinical suspicion and appropriate neuroimaging. Computed tomography is the initial diagnostic tool, but magnetic resonance imaging is superior for identifying associated ligamentous injuries and differentiating from subdural hematomas. Most pediatric retroclival EDH cases are managed conservatively with excellent outcomes, reserving surgical intervention for cases involving brainstem compression or craniocervical instability. This report reinforces the favorable prognosis of isolated retroclival EDH in neurologically stable pediatric patients and underscores the critical role of imaging and clinical vigilance in trauma assessment.

Background: Emerging evidence has indicated gut dysbiosis as a potential modifiable contributor to the pathogenesis of Parkinson's disease (PD). Fecal microbiota transplantation (FMT), a microbiome-centric model aimed at modulating the intestinal microbial taxa, represents a novel therapeutic approach. However, its safety and efficacy profile in improving PD symptoms remains inadequately researched.

Methods: PubMed, ScienceDirect, and the Cochrane Central Registry were searched to retrieve relevant articles from inception till February 2025. Risk ratios (RR) and Mean differences (MD), along with 95% confidence intervals (CI), were pooled under the random-effect model for dichotomous and continuous outcomes, respectively. The primary outcomes of interest were change in Movement Disorder Society Unified Parkinson's Disease Rating Scale part 1 (MDS-UPDRS 1), change in MDS-UPDRS 2. Secondary endpoints of interest were change in MDS-UPDRS 3 (on medication), change in MDS-UPDRS 3 (off medication), change in MDS-UPDRS 4, change in Irritable Bowel Severity Scoring System (IBS-SSS), change in Montreal Cognitive Assessment (MoCA), change in Parkinson Disease Questionnaire Summary Index (PDQ-39 SI), and GI adverse events. The Cochrane Risk of Bias 2.0 (RoB 2.0) tool was used for the quality assessment of the included randomized controlled trials (RCTs). A Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment was done for the certainty of evidence.

Results: This systematic review and meta-analysis included 145 patients across 3 RCTs. FMT and placebo were comparable regarding the primary outcomes that include MDS-UPDRS Part I (MD = -0.36; 95% CI:[-2.18,1.45]; P = .70; I² = 33%), Part II (MD = -0.46; 95% CI:[-1.91,0.99]; P = .53; I² = 0%). The secondary outcomes, involving MDS-UPDRS Part III on-medication (MD = 1.41; 95% CI:[-2.14,4.42]; P = .50; I² = 17%), Part III off-medication (MD = 1.26; 95% CI:[-2.27,4.79]; P = .48; I² = 0%), and Part IV (MD = -0.39; 95% CI:[-1.63,0.85]; P = .54; I² = 24%) were also comparable between the two groups. No significant changes were observed in IBS-SSS (MD = -15.91; 95% CI:[-63.17,31.89]; P = .51; I² = 76%), PDQ-39 SI (MD = -2.13, 95% CI:[-5.62,1.36]; P = .23; I² = 0%), and MOCA scores (MD = 0.11; 95% CI:[-1.34,1.57]; P = .88; I² = 68%). However, the FMT group had more frequent adverse gastrointestinal events (RR = 3.32; 95% CI: [1.01,10.87]; P = .05; I² = 39%).

Conclusion: FMT shows no evidence of superiority compared to placebo. Variations in the findings of existing studies suggest that donor fecal composition, host-microbiota interactions, and methodological heterogeneity may determine outcomes. Further RCTs employing tailored microbiota and s

Background: Stroke is one of the leading causes of disability and mortality worldwide, and the 30-day readmission rate is a crucial indicator for assessing the quality of healthcare and patient outcomes. Previous studies have reported a readmission rate of approximately 10%-20%.

Objectives: This study investigated the impact of the COVID-19 pandemic on the readmission rate at 30 days among hospitalized stroke patients.

Methods: This retrospective cohort study was conducted in a 1500-bed medical center in central Taiwan between January 1, 2020, and December 31, 2023. Data, including 5095 hospitalized stroke patients, 505 readmissions within 30 days, and multiple variables that influence hospital readmission at 30 days, including demographics, clinical characteristics, physiological data, and medication use before discharge, were obtained from hospital electronic health records (EHR).

Results: The results revealed a significant decline in 30-day readmission rates between the early (2020∼2021) and latter (2022∼2023) phases of the pandemic, decreasing from 10.71% to 8.97% (P = .039). This reduction may be attributed to improvements in medical strategies, increased adoption of telemedicine, and improved post-discharge care. Generalized linear regression analysis indicated that male patients were at higher risk of readmission than female patients (OR = 1.28, P = .01), while other variables, such as age, BMI, and blood pressure, did not reach statistical significance. Furthermore, common cardiovascular and metabolic medications (antithrombotic agents, lipid-lowering drugs, antihypertensive drugs, and antidiabetic medications) did not significantly affect the risk of readmission (P > .05).

Conclusions: This finding suggests that improvements in medical management during the early pandemic phase may have contributed to a reduced risk of readmission. Furthermore, male patients had a higher risk of readmission, highlighting the need for improved care strategies for this group.

Purpose: This study aimed to evaluate the influence of the triglyceride-glucose index (TyG index) on clinical outcomes and to develop nomogram models for predicting early neurological deterioration (END) and long-term prognosis in acute ischemic stroke (AIS) patients following intravenous thrombolytic (IVT) therapy.

Methods: We conducted a multi-center retrospective cohort study involving 333 AIS patients treated with IVT. The short-term and long-term outcomes were defined as the occurrence of END and 90-day prognosis. Multivariate logistic regression was used to develop nomogram models for forecasting these clinical outcomes.

Results: Patients in the high-TyG group exhibited significantly higher risks of END (P = 0.0010) and poor 90-day outcomes (P = 0.0012). Independent risk factors for END included a lower baseline NIHSS score, delayed door-to-needle time (DNT), reduced ASPECTS score, elevated TyG index, higher potassium (K+) levels, and incomplete Willis artery. Additionally, a higher initial NIHSS, increased TyG levels, presence of END, and a history of hypertension were predictors of poor prognosis. Based on the identified risk factors, two nomogram models yielded AUC values of 0.746 and 0.849 for predicting END and poor prognosis, respectively. NIHSS scores, TyG index, and admission glucose levels (Glu) emerged as prognostic indicators across all patients, while higher mean platelet volume (MPV) and history of stroke were identified as novel risk factors for poor prognosis in NO-END group.

Conclusion: A higher TyG index correlates with poor clinical outcomes in AIS patients post-IVT. The nomograms combining the TyG index with various factors enhanced risk prediction for END and poor prognosis.

Background: Epidural spinal cord stimulation (EES) is a promising intervention for motor rehabilitation after spinal cord injury (SCI), but the extent and trajectory of motor recovery remain unclear.

Objective: This phase II trial evaluates the acquisition of voluntary movements in paraplegic patients (ASIA A or B) following SCI, assessed by the Fugl-Meyer Lower Extremity (FMA-LE) score and electromyography (EMG).

Methods: This interim analysis includes five patients implanted with EES and followed for 12 months. The primary outcome was motor recovery, measured by FMA-LE and EMG. Secondary outcomes included balance (Berg Balance Scale), spasticity (Modified Ashworth Scale), pain, autonomic functions, mood, quality of life (WHO-QOL), and safety. Adverse events were monitored.

Results: The FMA-LE score improved from 36 ± 9 (SD) to 55 ± 2 at 3 months (P < 0.05), 59 ± 2 at 6 months (P < 0.05), and 64 ± 4 at 12 months (P < 0.05). EMG confirmed increased voluntary activation. Balance and spasticity improved, while pain and autonomic functions remained unchanged. Motor gains plateaued after 5 months, reaching 68% above baseline. No serious adverse events occurred, though minor complications included transient nociceptive pain and a self-resolving pressure ulcer.

Conclusions: These findings support the role of EES in facilitating early motor recovery in SCI patients, consistent with prior studies. However, the plateau effect suggests a limit to long-term gains. Future research should explore strategies to sustain improvements, including regenerative therapies or optimized neuromodulation protocols.Trial registration number: NCT06847295.

Background and purpose: Nationwide data on childhood stroke prevalence and incidence in Mainland China are unavailable now. We aim to investigate the prevalence and incidence of childhood arterial ischaemic stroke and haemorrhagic stroke in China nationwide.

Methods: In 2013, we implemented a nationally representative, door-to-door epidemiological survey on stroke in China through a complex, multistage, probability sampling design. A post-hoc subgroup analysis was conducted to examine both the crude point prevalence and annual incidence of childhood stroke. Due to the small case number, the Poisson distribution was used to estimate the 95% confidence intervals (CIs) for the crude rates.

Results: In this survey, only 4 strokes were identified. The crude point prevalence of childhood stroke was 4.82 (95% CI: 1.31-12.34) per 100 000 children in China; 4.51 (95% CI: 0.55-16.29) per 100 000 boys, and 5.17 (95% CI: 0.63-18.69) per 100 000 girls. Haemorrhagic stroke prevalence was 3.61 (95% CI: 0.75-10.56) vs 1.20 (95% CI: 0.03-6.71) per 100 000 children for arterial ischaemic stroke. The crude annual incidence of childhood stroke was 2.34 (95% CI: 0.28-8.45) per 100 000 children in China; 5.01 (95% CI: 0.60-18.10) per 100 000 girls. The crude annual incidences of both arterial ischaemic stroke and intracerebral haemorrhage were the same at 1.17 (95% CI: 0.03-6.52) per 100 000 children.

Conclusions: The point prevalence and annual incidence estimates of childhood stroke were 4.82 and 2.34 per 100 000 children in China, respectively. Chinese children may have more prevalent cases of haemorrhagic than arterial ischaemic strokes.

Gastrointestinal (GI) dysfunction is a common and often underappreciated aspect of Parkinson's disease (PD), with symptoms manifesting at multiple levels of the digestive tract, from swallowing difficulties to challenges with defecation. These non-motor symptoms can be more debilitating than the hallmark motor impairments of PD, profoundly affecting patients' quality of life. The burden of GI issues in PD extends beyond discomfort, contributing to malnutrition, weight loss, and impaired medication absorption, which can exacerbate both motor and non-motor symptoms. Despite their clinical significance, GI symptoms are frequently overlooked or mismanaged in routine practice. Inappropriate treatments, including certain medications and dietary recommendations, may inadvertently worsen the disease course. Therefore, a comprehensive understanding of GI dysfunction in PD is critical for clinicians, especially neurologists, to optimize patient care. This review provides an updated overview of the common GI manifestations in PD, including drooling, dyspepsia and dysphagia, gastroparesis, constipation, H. pylori infection, and small intestinal bacterial overgrowth. We discuss current diagnostic approaches, non-pharmacological and pharmacological treatment strategies. Recognizing and appropriately managing GI dysfunction in PD is essential for optimizing symptom control and improving patients' overall well-being.

Background: Blebs are small bulges on the surface of intracranial aneurysms (IAs) that increase rupture risk. Among Chinese individuals, the prevalence, distribution, and clinical, geometric, and local hemodynamic characteristics of small- and medium-sized (<15 mm) blebbed IAs remain unclear.

Objectives: To investigate the prevalence, distribution, and associated clinical, geometric, and hemodynamic features of blebs in small- and medium-sized IAs among Chinese patients, and to identify predictors of aneurysm rupture and bleb formation.

Design: A retrospective observational study.

Methods: CTA or DSA data from 214 patients with ruptured (RIAs) and unruptured IAs (UIAs) (<15 mm), with or without blebs, were analyzed. Three-dimensional reconstruction, geometric measurement, and computational fluid dynamics (CFD) analysis were conducted using Mimics and ANSYS Fluent. Hemodynamic parameters were assessed across the neck, body, and dome, and logistic regression was used to identify predictors of rupture and bleb formation.

Results: Aneurysms from 214 patients (93 men, 121 women; mean age 59.90 ± 11.76 years) were analyzed. Blebs were found in 107 aneurysms (56.7% of RIAs, 39.1% of UIAs). They were more frequent in ACoA, PCoA, and bifurcation aneurysms (all P < 0.05) and were associated with rupture. RIAs had larger blebs than UIAs (2.73 ± 1.28 mm vs 2.06 ± 1.07 mm, P = 0.009). Blebbed IAs exhibited larger size, more irregular shape, higher AR, SR, BN, HWR, and lower NWSS, TAWSS, OSI (all P < 0.05). SR was the strongest rupture predictor (AUC = 0.718, SR > 1.3144). Aneurysms at ACoA (OR = 8.812,CI:2.455-31.634), PCoA (OR = 6.376,CI:2.094-19.414), and high SR (OR = 2.738,CI:0.98-7.651) were significant rupture risk factors. PCoA (OR = 2.261,CI:0.759-6.739) and SR (OR = 4.683,CI:1.937-11.324) independently predicted bleb formation.

Conclusion: Blebs are common in small- and medium-sized IAs, especially at the ACoA, PCoA, and bifurcations, and are associated with an increased risk of rupture. Larger blebs are more often seen in ruptured IAs. A high SR is a key predictor of both rupture and bleb formation. Further studies on bleb-related hemodynamics in the neck, body, and dome are warranted.

Background: Cognitive impairment is common in patients with multiple sclerosis (MS). Physical activity is clearly linked to cognitive performance, and several studies have shown the importance of regular cognition testing, but such testing is still not routinely performed in clinical practice.

Objective: This study aimed to investigate the association between cognition, disability, and physical performance in relapsing-remitting MS (RRMS) patients.

Methods: A total of 41 patients with RRMS with an Expanded Disability Status Scale (EDSS) level of 0-5.5 and 20 healthy controls completed the MS Functional Composite (MSFC) test and the Symbol Digit Modality Test (SDMT). Six-Minute Walk (6MW) was evaluated for all participants, and they used an accelerometer for seven days.

Results: A significant correlation was found between cognition and disability level measured by the MSFC (MSFC/SDMT, r = 0.668, P = .001) and between disability and 6MW (EDSS/6MW, r = -0.516, P = .001; MSFC/6MW, r = 0.348, P = .028) in the patients' group. Cognition results (SDMT) were statistically significantly weaker in patients with EDSS >2.5 vs EDSS ≤2.5 or control group. Total daily activity (MVPS) correlated with cognition as measured by the SDMT in the control group but not in the patients' group. In the EDSShigh group, better results on the 6MW test were associated with better cognition results as measured by the SDMT (r = 0.505, P = .039).

Conclusion: There was a clear association between disability, 6MW and cognition. Better results on the 6MW predicted better cognition and disability.Clinical trial registration number: NCT04115930.

Introduction: Calcium pyrophosphate deposition (CPPD) disease is characterized by calcium pyrophosphate crystals in hyaline and fibrocartilage. Chondrocalcinosis, a radiographic hallmark for CPPD, becomes more prevalent with age. Although CPPD mainly targets peripheral joints, spinal involvement, affecting intervertebral discs and spinal ligaments, is less common but significant, seen in 24.3% of hospitalized patients with CPPD disease. This report describes a rare case of spinal CPPD causing spinal canal stenosis in the lumbar region.

Case description: A 79-year-old woman with a 3-year history of low back pain presented with severe left-sided pain and mobility impairment. Initial examination showed lumbar tenderness and normal muscle strength. Computed tomography (CT) and magnetic resonance imaging scans revealed a calcified extradural mass occupying the anterior portion of the lumbar spinal canal, most likely associated with the posterior longitudinal ligament. The patient underwent L3-L5 hemilaminectomies and dorsal spondylodesis, removing a whitish intraspinal mass. Histopathology confirmed CPPD. Post-surgery, the patient experienced initial pain relief but required emergency surgery due to complications. Over the next year, her mobility and pain improved significantly.

Discussion: Spinal CPPD manifests with varied clinical presentations, complicating diagnosis. Imaging reveals calcifications ranging from deposits to mass-like lesions causing compression. CT provides detailed visualization of characteristic calcifications, aiding in diagnosis, while histopathology remains the gold standard. Multidisciplinary collaboration is vital for accurate diagnosis and optimal management.