Journal of Clinical Neurology最新文献

Hypertension is a major risk factor for stroke, and appropriate management of blood pressure (BP) is crucial for both prevention and treatment. Since the 2009 publication of the Clinical Practice Guideline (CPG) by the Korean Stroke Society (KSS), significant advances have been made in BP management for stroke patients, particularly in cases involving intracerebral hemorrhage and in the context of endovascular reperfusion therapy for ischemic stroke. In light of recent evidence, the CPG Committee of the KSS initiated an update of the guidelines for BP management in acute stroke. The updated guidelines outline comprehensive strategies for BP management for both primary and secondary stroke prevention, which includes a total of 19 recommendations. These guidelines aim to provide healthcare professionals with up-to-date, evidence-based recommendations to support the improvement of quality of care for stroke patients.

Background and purpose: This study aimed to evaluate the predictive value of serum substance P (SP) levels at hospital admission for the development of pulmonary infection during hospitalization in patients with acute cerebral infarction. Additionally, the study explored the association between SP levels and the severity of inflammation following pulmonary infection.

Methods: A total of 340 patients with acute cerebral infarction were retrospectively analyzed. Serum SP concentrations were measured upon hospital admission. During hospitalization, 96 patients developed pulmonary infections of varying severity, while 244 patients remained free of pulmonary infection. In patients who developed infection, serum levels of high-sensitivity C-reactive protein, procalcitonin, and interleukin-6 were also measured.

Results: Invasive procedures, dysphagia, admission National Institutes of Health Stroke Scale (NIHSS) score, age, and serum SP concentration at admission were identified as significant risk factors for pulmonary infection in patients with acute cerebral infarction. Receiver operating characteristic curve analysis showed that serum SP concentration at admission had a sensitivity of 65.63% and specificity of 85.66% for predicting pulmonary infection (area under the curve=0.81, p<0.001). Moreover, SP levels at admission were positively correlated with NIHSS scores and the levels of inflammatory markers.

Conclusions: Serum SP concentration at the time of admission has predictive value for the development of pulmonary infection during hospitalization in patients with acute cerebral infarction and may serve as an early indicator of infection risk.

Background and purpose: Migraine is a common neurological disorder associated with structural and functional brain changes, while small vessel disease (SVD) is the leading cause of white matter damage in older adults. Diffusion tensor imaging (DTI) is effective for assessing white matter, and the peak width of skeletonized mean diffusivity (PSMD) is a novel marker for such damage. No study has used PSMD to assess SVD in migraine patients. This study aimed to investigate the relationship between migraine and SVD using PSMD.

Methods: Seventy-three migraine patients and 73 healthy controls underwent brain DTI to calculate PSMD. Clinical data on migraine characteristics were collected. We compared PSMD values between groups and analyzed correlations with clinical factors in patients with migraine.

Results: Patients with migraine had a significantly higher PSMD than healthy controls (2.08×10⁻⁴ mm²/s vs. 2.04×10⁻⁴ mm²/s, p=0.027), indicating increased white matter damage due to SVD. However, there was no difference in the PSMD between men and women with migraine. No significant differences in the PSMD were found between patients with migraine with and without aura (2.14×10⁻⁴ mm²/s vs. 2.07×10⁻⁴ mm²/s, p=0.074). A positive correlation existed between the PSMD and disease duration in men with migraine (r=0.601, p=0.006). Sex differences were evident, with men having a higher prevalence of aura and with women having a greater headache intensity (47.3% vs. 12.9%, p=0.002; 6.0 vs. 8.0, p=0.025).

Conclusions: Our findings indicate a potential association between migraine and SVD, with PSMD serving as a useful MRI marker for assessing white matter damage in headache disorders.

Background and purpose: Epilepsy is associated with increased risk of sudden death (SD). The risk factors of developing SD in patients with epilepsy are not fully addressed. This study aimed to develop and validate a short-term prediction model for SD in patients with epilepsy using nationwide data from Taiwan.

Methods: A retrospective cohort study used data from the National Health Insurance Research Database from 2011 to 2020. It focused on epilepsy patients over 18 years old who were prescribed anti-seizure medication (ASM). The study evaluated patient comorbidities, medication adherence, and recent hospital admissions. It aimed to assess the association between these factors and the occurrence of SD within 30 days. The analysis used a multiple logistic regression model and decision-tree classifier and assessed predictive accuracy using the area under the receiver operating characteristic curve.

Results: Out of 161,773 treatment events, 3,454 SD events were identified (2.1%). Factors associated with increased risk of SD included older age, intensive care unit admission, chronic kidney disease, psychotic disorder, poor ASM adherence (medication possession rate <0.5), and recent intravenous ASM use. The logistic model's area under curve was 0.752 in the 2020 testing dataset, and the testing dataset's sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.569, 0.832, 3.391, 0.518, and 6.543, respectively. A calibration curve showed reasonable alignment between predicted and observed probabilities of SD.

Conclusions: Patients with epilepsy recently admitted to the hospital, showing poor ASM compliance and using intravenous ASMs, face an increased risk of SD within 30 days. Improving ASM adherence and treatment optimization may reduce this risk.

Background and purpose: Cerebral small vessel disease (cSVD) is associated with the vascular geometry of the intracranial arteries. This study aimed to determine the associations of the burden of pre-existing cSVD with the geometry and hemodynamic parameters of the middle cerebral artery (MCA) in patients with acute ischemic stroke.

Methods: This study enrolled consecutive patients with acute ischemic stroke in the MCA territory who underwent high-resolution vessel wall magnetic resonance imaging and four-dimensional flow magnetic resonance imaging in accordance with the protocol of Kyung Hee University Hospital. Patients were categorized into two groups based on the burden of pre-existing cSVD in the hemisphere contralateral to the stroke lesion: those with a modified burden score of 0-4 (low cSVD burden) and those with a modified burden score of 5-7 (high cSVD burden). The vascular geometry (straight, U-shaped, or inverted-U- and S-shaped) and wall shear stress (WSS) measured at five different points in the contralesional MCA were compared between the two burden groups.

Results: This study included 145 patients with cSVD: 109 with a low burden and 36 with a high burden. A low cSVD burden was correlated with a U- or inverted-U-shaped MCA (p< 0.001). A high cSVD burden was associated with an S-shaped MCA (reference U- or inverted U-shaped MCA: odds ratio [OR]=8.653, 95% confidence interval [CI]=2.789-26.843, p<0.001), and with an increased maximum WSS at the second quintile point (OR=1.109, 95% CI=1.005-1.225, p=0.040) and elevated variability (standard deviation: OR=1.759, 95% CI=1.277-2.423, p=0.001).

Conclusions: A tortuous MCA along with an increased WSS magnitude and variability were independently associated with a high cSVD burden.