Globally, acute ischemic stroke (AIS) remains a leading cause of mortality, and recurrence further worsens long-term outcomes. Oxidative–inflammatory imbalance plays a crucial role in stroke recurrence. Myeloperoxidase (MPO) is a key pro-oxidant enzyme, while albumin (Alb) is the predominant antioxidant protein. Integrating both parameters, the MPO-to-albumin ratio (MPO/Alb) may better capture this imbalance. This study examined the relationship between MPO/Alb and 90-day stroke recurrence.
Methods
In this retrospective cohort, 422 AIS patients admitted to Shanxi Bethune Hospital (October 2022–September 2023) were enrolled. Baseline clinical and laboratory data were collected, and MPO/Alb ratio was calculated. The primary outcome was 90-day recurrence, assessed via telephone follow-up. Multivariable logistic regression, quartile trend tests, restricted cubic spline (RCS) modeling and subgroup analyses were conducted.
Results
Of 422 patients, 23 experienced recurrence within 90 days. Compared with the non-recurrence group, recurrent cases had significantly higher MPO and MPO/Alb levels (p < 0.05). Fully adjusted regression indicated that every unit increase in MPO/Alb predicted a 21 % greater recurrence risk (OR = 1.21). Quartile analysis indicated a dose–response relationship, with the highest quartile exhibiting a nearly 10-fold elevated risk (OR = 9.93). RCS analysis confirmed a linear association. No significant interactions were detected across the predefined subgroups.
Conclusion
Elevated MPO/Alb ratio at admission independently predicts 90-day recurrence in AIS. As a simple and inexpensive biomarker, it may aid early risk stratification and secondary prevention, pending validation in multicenter prospective studies.
{"title":"MPO-to-albumin ratio at admission predicts 90-day stroke recurrence","authors":"Xiangqi Kong, Haobo Wang, Penghong Li, Xinyue Yuan, Wei Jing","doi":"10.1016/j.jocn.2025.111794","DOIUrl":"10.1016/j.jocn.2025.111794","url":null,"abstract":"<div><h3>Background</h3><div>Globally, acute ischemic stroke (AIS) remains a leading cause of mortality, and recurrence further worsens long-term outcomes. Oxidative–inflammatory imbalance plays a crucial role in stroke recurrence. Myeloperoxidase (MPO) is a key pro-oxidant enzyme, while albumin (Alb) is the predominant antioxidant protein. Integrating both parameters, the MPO-to-albumin ratio (MPO/Alb) may better capture this imbalance. This study examined the relationship between MPO/Alb and 90-day stroke recurrence.</div></div><div><h3>Methods</h3><div>In this retrospective cohort, 422 AIS patients admitted to Shanxi Bethune Hospital (October 2022–September 2023) were enrolled. Baseline clinical and laboratory data were collected, and MPO/Alb ratio was calculated. The primary outcome was 90-day recurrence, assessed via telephone follow-up. Multivariable logistic regression, quartile trend tests, restricted cubic spline (RCS) modeling and subgroup analyses were conducted.</div></div><div><h3>Results</h3><div>Of 422 patients, 23 experienced recurrence within 90 days. Compared with the non-recurrence group, recurrent cases had significantly higher MPO and MPO/Alb levels (p < 0.05). Fully adjusted regression indicated that every unit increase in MPO/Alb predicted a 21 % greater recurrence risk (OR = 1.21). Quartile analysis indicated a dose–response relationship, with the highest quartile exhibiting a nearly 10-fold elevated risk (OR = 9.93). RCS analysis confirmed a linear association. No significant interactions were detected across the predefined subgroups.</div></div><div><h3>Conclusion</h3><div>Elevated MPO/Alb ratio at admission independently predicts 90-day recurrence in AIS. As a simple and inexpensive biomarker, it may aid early risk stratification and secondary prevention, pending validation in multicenter prospective studies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111794"},"PeriodicalIF":1.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-06DOI: 10.1016/j.jocn.2025.111790
Aaron Phung , Justin Hyde , Justin Azmoodeh , Theodore Quan , Lancelot Benn , Christopher P. Bellaire , Oliver Tannous , Joseph Ferguson , Seyed B Kalantar , David Weiner , Andrew Mo , Fred Mo , Sean Bae , Ala Alshomali , Crisanto L. Macaraeg , Kevin Yoon , Jonathan P. Japa , Mark Ehioghae , Addisu Mesfin
Introduction
Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic spinal condition resulting from progressive endochondral ossification of the posterior longitudinal ligament, leading to spinal canal narrowing and spinal cord compression. Primarily seen in East Asian countries, OPLL has been increasingly recognized in North American cohorts. This study aims to evaluate the demographic characteristics and outcomes of patients undergoing surgery for OPLL in a North American cohort.
Methods
This was a single-center retrospective cohort study of patients with OPLL undergoing surgery between July 2011 and November 2024. Data collected included demographic information, body mass index (BMI), comorbidities, surgical approach, OPLL classification, and K-line measurement. Estimated blood loss (EBL), intra/post-operative complications, length of stay, and disposition status were also recorded. Descriptive statistics and multivariable analyses were conducted with a p value < 0.05 considered to be statistically significant.
Results
In total, 81 patients underwent surgery for OPLL (mean age of 60 years; 50.6 % male). Most of the patients were Black (43 patients, 53.1 %).The mean BMI was 33.1 kg/m2. Forty-four patients (54.3 %) had diabetes. Most of the surgeries were elective (88.9 %). The classification of OPLL for the patients were: 31.7 % segmental, 20 % continuous, and 40 % mixed. 73.3 % of the patients had a positive K-line. Surgically, the posterior approach (41 patients, 50.6 %) was more common. A posterior approach was more likely to be utilized for patients with a positive K-line measurement (p = 0.029). Obesity was associated with increased EBL (p = 0.032). Five patients experienced intraoperative complications. The mean length of stay was 6.5 days, and average follow-up was 20.4 months. Three patients (3.7 %) passed post-operatively, and none underwent reoperation.
Conclusion
This study highlights the demographic and clinical characteristics of OPLL in a diverse North American cohort. Surgical management, predominantly via anterior or posterior approaches, was associated with low complication rates and no reoperations during follow-up.
{"title":"Evaluating the demographics and complications of North American surgical patients with ossification of the posterior longitudinal ligament","authors":"Aaron Phung , Justin Hyde , Justin Azmoodeh , Theodore Quan , Lancelot Benn , Christopher P. Bellaire , Oliver Tannous , Joseph Ferguson , Seyed B Kalantar , David Weiner , Andrew Mo , Fred Mo , Sean Bae , Ala Alshomali , Crisanto L. Macaraeg , Kevin Yoon , Jonathan P. Japa , Mark Ehioghae , Addisu Mesfin","doi":"10.1016/j.jocn.2025.111790","DOIUrl":"10.1016/j.jocn.2025.111790","url":null,"abstract":"<div><h3>Introduction</h3><div>Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic spinal condition resulting from progressive endochondral ossification of the posterior longitudinal ligament, leading to spinal canal narrowing and spinal cord compression. Primarily seen in East Asian countries, OPLL has been increasingly recognized in North American cohorts. This study aims to evaluate the demographic characteristics and outcomes of patients undergoing surgery for OPLL in a North American cohort.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective cohort study of patients with OPLL undergoing surgery between July 2011 and November 2024. Data collected included demographic information, body mass index (BMI), comorbidities, surgical approach, OPLL classification, and K-line measurement. Estimated blood loss (EBL), intra/post-operative complications, length of stay, and disposition status were also recorded. Descriptive statistics and multivariable analyses were conducted with a p value < 0.05 considered to be statistically significant.</div></div><div><h3>Results</h3><div>In total, 81 patients underwent surgery for OPLL (mean age of 60 years; 50.6 % male). Most of the patients were Black (43 patients, 53.1 %).The mean BMI was 33.1 kg/m<sup>2</sup>. Forty-four patients (54.3 %) had diabetes. Most of the surgeries were elective (88.9 %). The classification of OPLL for the patients were: 31.7 % segmental, 20 % continuous, and 40 % mixed. 73.3 % of the patients had a positive K-line. Surgically, the posterior approach (41 patients, 50.6 %) was more common. A posterior approach was more likely to be utilized for patients with a positive K-line measurement (p = 0.029). Obesity was associated with increased EBL (p = 0.032). Five patients experienced intraoperative complications. The mean length of stay was 6.5 days, and average follow-up was 20.4 months. Three patients (3.7 %) passed post-operatively, and none underwent reoperation.</div></div><div><h3>Conclusion</h3><div>This study highlights the demographic and clinical characteristics of OPLL in a diverse North American cohort. Surgical management, predominantly via anterior or posterior approaches, was associated with low complication rates and no reoperations during follow-up.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111790"},"PeriodicalIF":1.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-06DOI: 10.1016/j.jocn.2025.111789
Na Zhang , Bei Dou , Chao Sun , Jing Wang , Liping Tan , Qingchun Mu
Background
To investigate the changes and predictive factors of gastrointestinal (GI) motility in patients with severe traumatic brain injury (TBI).
Methods
A total of 118 patients with severe TBI were enrolled, and their GI motility index was monitored daily using ultrasound starting from the initiation of enteral nutrition. Monitoring was performed every 6 h for 5 consecutive days. A latent class growth model was applied to analyze and fit the trajectory of GI motility changes, and multiple logistic regression was used to identify predictive factors associated with different trajectories.
Results
Two distinct trajectories of GI motility changes were identified, with 84 cases (71.1 %) in the low motility group and 34 cases (28.9 %) in the high motility group. Multivariate logistic regression analysis revealed that the use of potassium and proton pump inhibitors were predictive factors distinguishing the two trajectories (both P < 0.05).
Conclusions
Patients with severe TBI demonstrate high and low levels of GI motility. Brain edema following TBI may be associated with reduced GI motility, and the use of potassium supplements and proton pump inhibitors was also associated with lower motility. These findings suggest that attention to factors potentially influencing GI motility, along with early enteral nutrition strategies, may be important in the clinical management of patients with severe TBI.
{"title":"Analysis of gastrointestinal motility trajectory in patients with severe traumatic brain injury","authors":"Na Zhang , Bei Dou , Chao Sun , Jing Wang , Liping Tan , Qingchun Mu","doi":"10.1016/j.jocn.2025.111789","DOIUrl":"10.1016/j.jocn.2025.111789","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the changes and predictive factors of gastrointestinal (GI) motility in patients with severe traumatic brain injury (TBI).</div></div><div><h3>Methods</h3><div>A total of 118 patients with severe TBI were enrolled, and their GI motility index was monitored daily using ultrasound starting from the initiation of enteral nutrition. Monitoring was performed every 6 h for 5 consecutive days. A latent class growth model was applied to analyze and fit the trajectory of GI motility changes, and multiple logistic regression was used to identify predictive factors associated with different trajectories.</div></div><div><h3>Results</h3><div>Two distinct trajectories of GI motility changes were identified, with 84 cases (71.1 %) in the low motility group and 34 cases (28.9 %) in the high motility group. Multivariate logistic regression analysis revealed that the use of potassium and proton pump inhibitors were predictive factors distinguishing the two trajectories (both P < 0.05).</div></div><div><h3>Conclusions</h3><div>Patients with severe TBI demonstrate high and low levels of GI motility. Brain edema following TBI may be associated with reduced GI motility, and the use of potassium supplements and proton pump inhibitors was also associated with lower motility. These findings suggest that attention to factors potentially influencing GI motility, along with early enteral nutrition strategies, may be important in the clinical management of patients with severe TBI.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111789"},"PeriodicalIF":1.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.jocn.2025.111785
Daniel Winecoff , Elizabeth O. Moreton , Anne Bryden , Mia Kang , Robb Wasserman , James Williams , Abhijit V. Lele , Samuel N. Blacker
This systematic review elucidates the level of detail of anesthesia care in randomized clinical trials (RCTs) of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). RCTs between January 1, 2004, and December 31, 2024, were searched and reviewed. A scoring system for individual trial elements was developed and reported, categorized as demographic (n = 9), essential monitoring (n = 13), anesthetic care (n = 13), and MT outcomes (n = 5). The elements were reported as median [Q1; Q3] and compared before and after the 2014 Society for Neuroscience in Anesthesiology and Critical Care (SNACC) guidelines for endovascular thrombectomy were published. This study was registered on the International Prospective Register of Systematic Reviews on January 19, 2025. A total of 77 studies (25 enrolling patients before the SNACC guidelines and 52 enrolling afterwards) were included. The reporting of trial elements were: demographics (7 of 9 elements, 77.8 % [Q1:Q3: 77.8 %;88.9 %], essential monitoring (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%], anesthesia (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%]), and outcomes (3 of 5 elements, 60 % [Q1:Q3: 60 %;80 %]). When an anesthesiologist was included as an author, there was a significant improvement for the essential monitoring score (42 % vs. 0 %, p = 0.03) and the anesthesia score (42 % vs. 0 %, p = 0.0096), and in the anesthesia score in single-center studies (15 % vs. 0 %, p = 0.0024). Anesthesia and physiologic details are rarely included in the MT-related RCTs for AIS; therefore, future RCTs should include anesthesia-related details.
{"title":"Anesthetic reporting in stroke thrombectomy randomized clinical trials: a systematic review","authors":"Daniel Winecoff , Elizabeth O. Moreton , Anne Bryden , Mia Kang , Robb Wasserman , James Williams , Abhijit V. Lele , Samuel N. Blacker","doi":"10.1016/j.jocn.2025.111785","DOIUrl":"10.1016/j.jocn.2025.111785","url":null,"abstract":"<div><div>This systematic review elucidates the level of detail of anesthesia care in randomized clinical trials (RCTs) of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). RCTs between January 1, 2004, and December 31, 2024, were searched and reviewed. A scoring system for individual trial elements was developed and reported, categorized as demographic (n = 9), essential monitoring (n = 13), anesthetic care (n = 13), and MT outcomes (n = 5). The elements were reported as median [Q1; Q3] and compared before and after the 2014 Society for Neuroscience in Anesthesiology and Critical Care (SNACC) guidelines for endovascular thrombectomy were published. This study was registered on the International Prospective Register of Systematic Reviews on January 19, 2025. A total of 77 studies (25 enrolling patients before the SNACC guidelines and 52 enrolling afterwards) were included. The reporting of trial elements were: demographics (7 of 9 elements, 77.8 % [Q1:Q3: 77.8 %;88.9 %], essential monitoring (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%], anesthesia (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%]), and outcomes (3 of 5 elements, 60 % [Q1:Q3: 60 %;80 %]). When an anesthesiologist was included as an author, there was a significant improvement for the essential monitoring score (42 % vs. 0 %, p = 0.03) and the anesthesia score (42 % vs. 0 %, p = 0.0096), and in the anesthesia score in single-center studies (15 % vs. 0 %, p = 0.0024). Anesthesia and physiologic details are rarely included in the MT-related RCTs for AIS; therefore, future RCTs should include anesthesia-related details.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111785"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145692892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.jocn.2025.111781
James Kelbert , Tara Ghalambor , Kennedy Sparling , Kristin Nosova , Joseph Georges , Robert W Bina
Introduction
Melanoma has the greatest incidence of brain metastases among all cancers and once patients develop melanoma brain metastases (MBM) it is the primary contributor to patient mortality. Following the FDA approval of immune checkpoint inhibitors in 2011, there has been a significant reduction in melanoma patient mortality. Therefore, we investigated the impact of immunotherapy on overall survival (OS) pre and post implementation of immunotherapy in the management of MBM.
Methods
Data from patients with MBM upon diagnosis and seen between 2010–2012 and 2018–2020 were collected from Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival curves, cox regression models, and log rank tests were conducted using case-listing survival data from Seer*Stat 4.8.2.
Results
There were a total of 1426 patients with MBM at diagnosis: 403 patients (304 men and 99 women) from 2010 to 2012 and 1023 patients (715 men and 308 women) from 2018 to 2020. Median OS for patients from the 2010–2012 and 2018–2020 group was 4 months (95 % CIs: 4–5 month) and 14 months (95 % CIs: 12–19 months), respectively. Patients from 2010 to 2012 had a significantly worse (p = 1e−06) 5-year OS of 9.7 % (95 % CIs: 7.2–13.0 %) compared with 33.4 % (95 % CIs: 29.9–37.3 %) in 2018–2020. When stratified by sex, median OS in men was statistically worse compared to women in the 2010–2012 time period, (HR 2.11, p < 2.2e−16), but demonstrated virtually no difference in 2018 to 2020 (HR 1.02, p = 0.63).
Conclusion
The introduction of immunotherapy with checkpoint inhibitors significantly improved OS among patients with MBM and may have helped mitigate historical disparities in survival between men and women.
{"title":"Impact of immunotherapy on outcomes of cutaneous melanoma and concurrent brain metastasis: a surveillance, epidemiology, and end results analysis of 2010–2020","authors":"James Kelbert , Tara Ghalambor , Kennedy Sparling , Kristin Nosova , Joseph Georges , Robert W Bina","doi":"10.1016/j.jocn.2025.111781","DOIUrl":"10.1016/j.jocn.2025.111781","url":null,"abstract":"<div><h3>Introduction</h3><div>Melanoma has the greatest incidence of brain metastases among all cancers and once patients develop melanoma brain metastases (MBM) it is the primary contributor to patient mortality. Following the FDA approval of immune checkpoint inhibitors in 2011, there has been a significant reduction in melanoma patient mortality. Therefore, we investigated the impact of immunotherapy on overall survival (OS) pre and post implementation of immunotherapy in the management of MBM.</div></div><div><h3>Methods</h3><div>Data from patients with MBM upon diagnosis and seen between 2010–2012 and 2018–2020 were collected from Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival curves, cox regression models, and log rank tests were conducted using case-listing survival data from Seer*Stat 4.8.2.</div></div><div><h3>Results</h3><div>There were a total of 1426 patients with MBM at diagnosis: 403 patients (304 men and 99 women) from 2010 to 2012 and 1023 patients (715 men and 308 women) from 2018 to 2020. Median OS for patients from the 2010–2012 and 2018–2020 group was 4 months (95 % CIs: 4–5 month) and 14 months (95 % CIs: 12–19 months), respectively. Patients from 2010 to 2012 had a significantly worse (p = 1e−06) 5-year OS of 9.7 % (95 % CIs: 7.2–13.0 %) compared with 33.4 % (95 % CIs: 29.9–37.3 %) in 2018–2020. When stratified by sex, median OS in men was statistically worse compared to women in the 2010–2012 time period, (HR 2.11, p < 2.2e−16), but demonstrated virtually no difference in 2018 to 2020 (HR 1.02, p = 0.63).</div></div><div><h3>Conclusion</h3><div>The introduction of immunotherapy with checkpoint inhibitors significantly improved OS among patients with MBM and may have helped mitigate historical disparities in survival between men and women.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111781"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145692941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early brain injury (EBI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH) that occurs within the first 72 h after the event. Burden of cerebral edema during EBI (early cerebral edema [ECE]) and its impact on patient outcomes remains to be completely explored. The primary objective of our study was to determine the incidence and identify the predictors of ECE after aSAH using the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES).
Methods
This retrospective study included adult patients with aSAH of any severity grade presenting within 72 h of ictus and undergoing definitive treatment in our hospital over a three-year period. Our primary outcome of ECE was evaluated on non-contrast brain computed tomography. Our secondary outcomes were burden of systemic inflammatory markers in patients with and without ECE. Our tertiary outcomes were the incidence of intracranial pressure (ICP)-targeted interventions.
Results
ECE was noted in 57.75 % (287/497) of aSAH patients and was predicted by younger age, higher total leucocyte count (TLC), and higher Modified Fischer grade (MFG). Though there was no difference in the inflammatory markers, external ventricular drain (EVD) placements were more frequently required among patients with ECE when compared to those without (67 % versus 33 %, p < 0.05).
Conclusions
The burden of ECE is high after aSAH especially among the younger patients with higher MFG, and TLC, which may adversely affect outcomes. Our study demonstrates the crucial role of edema in strongly predicting the need for additional maneuvers to restore the ICP.
{"title":"Incidence, predictors, and impact of cerebral edema during the early brain injury phase of aneurysmal subarachnoid hemorrhage: A retrospective cohort study","authors":"Janani Raja , Rajeeb Mishra , Sriganesh Kamath , Shubha Shree , Hima S Pendharkar , Nishanth Sadashiva , R.P. Sangeetha","doi":"10.1016/j.jocn.2025.111792","DOIUrl":"10.1016/j.jocn.2025.111792","url":null,"abstract":"<div><h3>Background</h3><div>Early brain injury (EBI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH) that occurs within the first 72 h after the event. Burden of cerebral edema during EBI (early cerebral edema [ECE]) and its impact on patient outcomes remains to be completely explored. The primary objective of our study was to determine the incidence and identify the predictors of ECE after aSAH using the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES).</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients with aSAH of any severity grade presenting within 72 h of ictus and undergoing definitive treatment in our hospital over a three-year period. Our primary outcome of ECE was evaluated on non-contrast brain computed tomography. Our secondary outcomes were burden of systemic inflammatory markers in patients with and without ECE. Our tertiary outcomes were the incidence of intracranial pressure (ICP)-targeted interventions.</div></div><div><h3>Results</h3><div>ECE was noted in 57.75 % (287/497) of aSAH patients and was predicted by younger age, higher total leucocyte count (TLC), and higher Modified Fischer grade (MFG). Though there was no difference in the inflammatory markers, external ventricular drain (EVD) placements were more frequently required among patients with ECE when compared to those without (67 % versus 33 %, p < 0.05).</div></div><div><h3>Conclusions</h3><div>The burden of ECE is high after aSAH especially among the younger patients with higher MFG, and TLC, which may adversely affect outcomes. Our study demonstrates the crucial role of edema in strongly predicting the need for additional maneuvers to restore the ICP.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111792"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145692895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.jocn.2025.111778
Ameerah Gardee , Eranga Goonewardena , Sytske Lub , Hassan Ismahel , Attika Chaudhary , Laulwa Nasser Al-Salloum , Devansh Mitesh Shah , Sanskar Ranglani , Samih Hassan , Mohammad Ashraf , Scott Border
Background
Neuroanatomy is a cornerstone of medical education, yet is perceived by many as daunting. Student-led events, such as the National Undergraduate Neuroanatomy Competition (NUNC), newly re-established in Scotland, provides a platform to address this challenge by fostering academic interest and enhancing learning through extracurricular achievement and specialty talks.
Methods
This mixed-methods study analysed data from the 11th NUNC, involving 93 registered medical students. Post-event surveys collated participants’ experiences with institutional neuroanatomy education, preferred learning resources, and self-assessment of their performance in NUNC’s written and practical exams. Quantitative responses were analysed using descriptive and inferential statistics, while qualitative data provided insights into learning preferences and challenges.
Results
Of 58 survey respondents, most reported dissatisfaction with the depth and accessibility of institutional neuroanatomy teaching. Online resources (74.1 %) and textbooks (53.4 %) were most frequently used for self-directed learning, in addition to resources provided by students’ institutions. Participants rated both the single-best-answer and spotter exams as difficult, and demonstrated accurate self-assessment of their performance, with modest but significant correlations between perceived and actual scores in both assessments (p = 0.0002).
These findings highlight a potential dichotomy between reliance on institutional teaching and students’ preferred resources, emphasising the value of supplementary, accessible, and clinically contextualised materials in the learning of future clinicians. Accuracy in self-assessment suggests that NUNC encourages reflective learning and confidence in neuroanatomy knowledge. This has positive implications for the future clinical practice of these participants as it is increasingly common for non-specialist clinicians to be first point-of-contact for neurological presentations.
Conclusion
NUNC provides an impactful platform for addressing gaps in neuroanatomy/clinical neuroscience education, promoting self-directed learning, and inspiring confidence among students interested in careers in neuroanatomy-related fields such as neurosurgery, neurology and other neuroanatomy related fields. Future efforts should focus on integrating a broader range of learning modalities into medical curricula to improve the learning experience and establish reliable foundations for future clinical practice.
{"title":"Effective self-directed learning and performance perception: Insights from the United Kingdom National Undergraduate neuroanatomy competition","authors":"Ameerah Gardee , Eranga Goonewardena , Sytske Lub , Hassan Ismahel , Attika Chaudhary , Laulwa Nasser Al-Salloum , Devansh Mitesh Shah , Sanskar Ranglani , Samih Hassan , Mohammad Ashraf , Scott Border","doi":"10.1016/j.jocn.2025.111778","DOIUrl":"10.1016/j.jocn.2025.111778","url":null,"abstract":"<div><h3>Background</h3><div>Neuroanatomy is a cornerstone of medical education, yet is perceived by many as daunting. Student-led events, such as the National Undergraduate Neuroanatomy Competition (NUNC), newly re-established in Scotland, provides a platform to address this challenge by fostering academic interest and enhancing learning through extracurricular achievement and specialty talks.</div></div><div><h3>Methods</h3><div>This mixed-methods study analysed data from the 11th NUNC, involving 93 registered medical students. Post-event surveys collated participants’ experiences with institutional neuroanatomy education, preferred learning resources, and self-assessment of their performance in NUNC’s written and practical exams. Quantitative responses were analysed using descriptive and inferential statistics, while qualitative data provided insights into learning preferences and challenges.</div></div><div><h3>Results</h3><div>Of 58 survey respondents, most reported dissatisfaction with the depth and accessibility of institutional neuroanatomy teaching. Online resources (74.1 %) and textbooks (53.4 %) were most frequently used for self-directed learning, in addition to resources provided by students’ institutions. Participants rated both the single-best-answer and spotter exams as difficult, and demonstrated accurate self-assessment of their performance, with modest but significant correlations between perceived and actual scores in both assessments (p = 0.0002).</div><div>These findings highlight a potential dichotomy between reliance on institutional teaching and students’ preferred resources, emphasising the value of supplementary, accessible, and clinically contextualised materials in the learning of future clinicians. Accuracy in self-assessment suggests that NUNC encourages reflective learning and confidence in neuroanatomy knowledge. This has positive implications for the future clinical practice of these participants as it is increasingly common for non-specialist clinicians to be first point-of-contact for neurological presentations.</div></div><div><h3>Conclusion</h3><div>NUNC provides an impactful platform for addressing gaps in neuroanatomy/clinical neuroscience education, promoting self-directed learning, and inspiring confidence among students interested in careers in neuroanatomy-related fields such as neurosurgery, neurology and other neuroanatomy related fields. Future efforts should focus on integrating a broader range of learning modalities into medical curricula to improve the learning experience and establish reliable foundations for future clinical practice.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111778"},"PeriodicalIF":1.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1016/j.jocn.2025.111777
Puru Sadh , Alejandro Perez-Albela , Ishan Shah , Samuel Bara-Garcia , Timothy Jeng , Bryce A. Basques
Objective
Depression is highly prevalent among patients with degenerative cervical spine disease and has been linked to worse postoperative outcomes across various surgical procedures. Prior studies in anterior cervical discectomy and fusion (ACDF) have primarily focused on limited endpoints such as pain or discharge disposition and were conducted before the COVID-19 pandemic. Given the rise in depression prevalence and its multidimensional impact on functional recovery, resilience, and quality of life in the post-pandemic population, a more comprehensive evaluation of its influence on ACDF outcomes is warranted.
Methods
A retrospective review of a prospectively maintained database was performed for patients undergoing ACDF between 2020 and 2022 at a single academic institution. Patients were grouped by presence or absence of a pre-existing complete depression diagnosis that were actively being treated. Demographic, perioperative, radiographic, and multiple PROs, were collected preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Multivariate logistic and linear regression controlled for age, sex, BMI, Charlson Comorbidity Index, smoking status, surgical levels, and relevant preoperative symptoms.
Results
Of 302 patients, 134 (44.4 %) had depression. Compared with non-depressed patients, the depression cohort had higher reoperation rates (18.7 % vs. 4.8 %, p = 0.007) Depression was associated with greater persistent arm pain at 2 years (VAS 5.92 vs. 2.67, p < 0.001) and lower PROMIS Physical (38.26 vs. 44.37, p = 0.008) and Mental (41.15 vs. 50.14, p < 0.001) scores at 1 year. No significant differences were found in cervical sagittal alignment or rates of structural complications.
Conclusions
Unlike prior ACDF studies, which largely evaluated limited endpoints or smaller cohorts, this study employed multiple PROs alongside clinical and radiographic measures to comprehensively characterize depression’s postoperative impact, in the context of rising depression rates following the COVID-19 pandemic. Preoperative depression independently predicted an approximately fourfold increased risk of reoperation and consistently worse PROs through 2 years after ACDF, despite similar radiographic correction. Routine preoperative mental-health screening and targeted perioperative interventions, such as expectation setting, adherence support, and activity counseling, may improve outcomes for this high-risk population.
目的：抑郁症在退行性颈椎疾病患者中非常普遍，并且与各种外科手术后较差的预后有关。之前关于颈椎前路椎间盘切除术和融合（ACDF）的研究主要集中在有限的终点，如疼痛或出院处置，并且是在COVID-19大流行之前进行的。鉴于抑郁症患病率的上升及其对大流行后人群功能恢复、复原力和生活质量的多方面影响，有必要对其对ACDF结果的影响进行更全面的评估。方法对2020年至2022年在单一学术机构接受ACDF的患者进行前瞻性维护的数据库进行回顾性审查。患者根据是否存在预先存在的完全抑郁症诊断进行分组，并积极接受治疗。术前、术后3个月、6个月、1年和2年收集人口统计学、围手术期、影像学和多重PROs数据。多变量logistic和线性回归控制了年龄、性别、BMI、Charlson合并症指数、吸烟状况、手术水平和相关术前症状。结果302例患者中有134例（44.4%）存在抑郁症。与非抑郁症患者相比，抑郁症患者的再手术率更高（18.7% vs. 4.8%, p = 0.007）。抑郁症患者在2年时持续性手臂疼痛更大（VAS 5.92 vs. 2.67, p < 0.001）， 1年时PROMIS物理评分（38.26 vs. 44.37, p = 0.008）和精神评分（41.15 vs. 50.14, p < 0.001）更低。在颈椎矢状位对齐或结构并发症发生率方面没有发现显著差异。与之前的ACDF研究不同，该研究主要评估有限的终点或较小的队列，在COVID-19大流行后抑郁症发病率上升的背景下，该研究采用多种PROs以及临床和放射学测量来全面表征抑郁症的术后影响。术前抑郁独立预测ACDF后2年内再手术风险增加约4倍，且PROs持续恶化，尽管有类似的影像学校正。常规术前心理健康筛查和有针对性的围手术期干预，如期望设定、依从性支持和活动咨询，可能改善这一高危人群的预后。
{"title":"Preoperative depression is associated with higher reoperation rates following anterior cervical discectomy and fusion: a multidimensional evaluation in the post–COVID-19 era","authors":"Puru Sadh , Alejandro Perez-Albela , Ishan Shah , Samuel Bara-Garcia , Timothy Jeng , Bryce A. Basques","doi":"10.1016/j.jocn.2025.111777","DOIUrl":"10.1016/j.jocn.2025.111777","url":null,"abstract":"<div><h3>Objective</h3><div>Depression is highly prevalent among patients with degenerative cervical spine disease and has been linked to worse postoperative outcomes across various surgical procedures. Prior studies in anterior cervical discectomy and fusion (ACDF) have primarily focused on limited endpoints such as pain or discharge disposition and were conducted before the COVID-19 pandemic. Given the rise in depression prevalence and its multidimensional impact on functional recovery, resilience, and quality of life in the post-pandemic population, a more comprehensive evaluation of its influence on ACDF outcomes is warranted.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively maintained database was performed for patients undergoing ACDF between 2020 and 2022 at a single academic institution. Patients were grouped by presence or absence of a pre-existing complete depression diagnosis that were actively being treated. Demographic, perioperative, radiographic, and multiple PROs, were collected preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Multivariate logistic and linear regression controlled for age, sex, BMI, Charlson Comorbidity Index, smoking status, surgical levels, and relevant preoperative symptoms.</div></div><div><h3>Results</h3><div>Of 302 patients, 134 (44.4 %) had depression. Compared with non-depressed patients, the depression cohort had higher reoperation rates (18.7 % vs. 4.8 %, p = 0.007) Depression was associated with greater persistent arm pain at 2 years (VAS 5.92 vs. 2.67, p < 0.001) and lower PROMIS Physical (38.26 vs. 44.37, p = 0.008) and Mental (41.15 vs. 50.14, p < 0.001) scores at 1 year. No significant differences were found in cervical sagittal alignment or rates of structural complications.</div></div><div><h3>Conclusions</h3><div>Unlike prior ACDF studies, which largely evaluated limited endpoints or smaller cohorts, this study employed multiple PROs alongside clinical and radiographic measures to comprehensively characterize depression’s postoperative impact, in the context of rising depression rates following the COVID-19 pandemic. Preoperative depression independently predicted an approximately fourfold increased risk of reoperation and consistently worse PROs through 2 years after ACDF, despite similar radiographic correction. Routine preoperative mental-health screening and targeted perioperative interventions, such as expectation setting, adherence support, and activity counseling, may improve outcomes for this high-risk population.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111777"},"PeriodicalIF":1.8,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.jocn.2025.111779
Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Aryan Aarabi , Sara Moslehi , Sama Jabbaripour , Samin Sadraei , Arman Hasanzade , Dorsa Najari , Azin Ebrahimi , Mohammad Amin Habibi
Background
The management of trigeminal neuralgia secondary to multiple sclerosis (MS-TN) remains clinically challenging due to its refractory course and aggressive symptom pattern. Among available interventions, stereotactic radiosurgery (SRS) has emerged as a minimally invasive and effective option. This systematic review and meta-analysis aims to assess the efficacy and safety of SRS in patients with MS-related trigeminal neuralgia.
Methods
A comprehensive literature search was conducted on March 26, 2025, to identify studies that reported pain-related outcomes and adverse radiation effects (AREs) in patients with MS-TN treated with SRS.
Results
A total of 23 studies comprising 837 patients with MS-TN were analyzed. The mean follow-up period across studies ranged from 6.1 to 88.3 months. Pooled results demonstrated an initial pain-free rate of 32 % (95 % CI: 13–55 %) and an initial adequate pain-relief rate of 74 % (95 % CI: 50–92 %). At the final follow-up, the pain-free rate was 17 % (95 % CI: 5–32 %), while adequate pain relief was maintained in 65 % (95 % CI: 50–78 %) of patients. The pooled incidence of AREs following SRS was 9 % (95 % CI: 2–18 %).
Conclusions
SRS shows promising pain outcomes and a low rate of AREs in patients with MS-TN. Nonetheless, larger comparative investigations are required to evaluate different SRS approaches and to determine how MS subtypes may influence treatment response.
{"title":"Stereotactic radiosurgery for trigeminal neuralgia secondary to Multiple Sclerosis: A systematic review and Meta-Analysis","authors":"Bardia Hajikarimloo , Salem M. Tos , Ibrahim Mohammadzadeh , Aryan Aarabi , Sara Moslehi , Sama Jabbaripour , Samin Sadraei , Arman Hasanzade , Dorsa Najari , Azin Ebrahimi , Mohammad Amin Habibi","doi":"10.1016/j.jocn.2025.111779","DOIUrl":"10.1016/j.jocn.2025.111779","url":null,"abstract":"<div><h3>Background</h3><div>The management of trigeminal neuralgia secondary to multiple sclerosis (MS-TN) remains clinically challenging due to its refractory course and aggressive symptom pattern. Among available interventions, stereotactic radiosurgery (SRS) has emerged as a minimally invasive and effective option. This systematic review and <em>meta</em>-analysis aims to assess the efficacy and safety of SRS in patients with MS-related trigeminal neuralgia.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted on March 26, 2025, to identify studies that reported pain-related outcomes and adverse radiation effects (AREs) in patients with MS-TN treated with SRS.</div></div><div><h3>Results</h3><div>A total of 23 studies comprising 837 patients with MS-TN were analyzed. The mean follow-up period across studies ranged from 6.1 to 88.3 months. Pooled results demonstrated an initial pain-free rate of 32 % (95 % CI: 13–55 %) and an initial adequate pain-relief rate of 74 % (95 % CI: 50–92 %). At the final follow-up, the pain-free rate was 17 % (95 % CI: 5–32 %), while adequate pain relief was maintained in 65 % (95 % CI: 50–78 %) of patients. The pooled incidence of AREs following SRS was 9 % (95 % CI: 2–18 %).</div></div><div><h3>Conclusions</h3><div>SRS shows promising pain outcomes and a low rate of AREs in patients with MS-TN. Nonetheless, larger comparative investigations are required to evaluate different SRS approaches and to determine how MS subtypes may influence treatment response.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"143 ","pages":"Article 111779"},"PeriodicalIF":1.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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