Journal of Clinical Neuroscience最新文献

{"title":"Rescue strategy for management of an undeflating dual lumen balloon micro-catheter","authors":"Sunil V. Furtado,&nbsp;Parichay J. Perikal,&nbsp;Potineni Suresh,&nbsp;Vedanth Manjunath","doi":"10.1016/j.jocn.2025.111836","DOIUrl":"10.1016/j.jocn.2025.111836","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial balloon microcatheters are vital in neurointerventions, yet balloon non-deflation has not been previously reported in the cerebral vasculature.</div></div><div><h3>Method</h3><div>We describe a 32-year-old woman undergoing embolization for a parieto-occipital arteriovenous malformation who developed failure of deflation of a dual-lumen balloon microcatheter placed in the posterior cerebral artery, despite standard manoeuvres.</div></div><div><h3>Result</h3><div>Controlled catheter transection distal to the hub, followed by gradual capillary action assisted drainage of diluted contrast, enabled safe balloon collapse and retrieval.</div></div><div><h3>Conclusion</h3><div>This case highlights a rare but critical complication and presents a practical bailout technique when conventional deflation methods fail, ensuring atraumatic intracranial balloon retrieval.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111836"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882452","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}

{"title":"Post-stroke seizures in malignant middle cerebral artery infarction treated with decompressive hemicraniectomy: A meta-analysis of predictive factors and clinical outcomes","authors":"Kaike Lobo ,&nbsp;Felipe Moraes Costa ,&nbsp;Rafael Reis de Oliveira ,&nbsp;Ruan Pablo da Silva Gomes ,&nbsp;Giovana Pereira Lobato Brito ,&nbsp;Enzo Gabriel Lacerda Rodrigues ,&nbsp;Janilzo de Jesus Mendes Costa Júnior ,&nbsp;Ana Luíza Mendonça de Almeida ,&nbsp;Yurie Lima Yamada ,&nbsp;Yasmin Lamas Medeiros ,&nbsp;M Ali Aziz-Sultan","doi":"10.1016/j.jocn.2025.111835","DOIUrl":"10.1016/j.jocn.2025.111835","url":null,"abstract":"<div><h3>Background</h3><div>Decompressive hemicraniectomy (DHC) is a life-saving intervention for malignant middle cerebral artery (MCA) infarction. However, the additional factors which further increase seizure risk within this high-risk population remain unclear. This <em>meta</em>-analysis aimed to evaluate incremental risk factors for seizure development after DHC in malignant MCA infarction and to assess the association between seizures and clinical outcomes.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, and Cochrane Library for studies evaluating risk factors for seizure development after DHC for malignant MCA infarction. Odds ratios (ORs) and mean differences were computed for dichotomous and continuous outcomes, respectively, using 95% confidence intervals (CIs) under a random-effects model. Heterogeneity was assessed with I² statistics.</div></div><div><h3>Results</h3><div>Five retrospective cohort studies were included, comprising a total of 456 patients, of whom 195 (42.76 %) developed seizures, and 261 (57.24 %) did not. No significant differences between groups were observed for age, female gender, hypertension, diabetes, dyslipidemia, alcohol consumption, history of previous ischemic event, stroke etiology, hemispheric laterality, presence of reperfusion therapy, stroke limited to MCA territory, hemorrhagic transformation, NIH Stroke Scale scores on admission, and time to craniectomy. However, there was a significantly higher proportion of modified Rankin Scale scores ≤ 3 and a lower mortality rate in patients with seizures when compared with those without.</div></div><div><h3>Conclusion</h3><div>In conclusion, none of the variables analyzed were identified as independent risk factors for seizure development, although there was an increased rate of good functional outcome and lower mortality in patients with seizures, possibly reflecting a time-dependent factor of seizure detection.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111835"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882397","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}

{"title":"Clinical outcomes of microvascular clipping compared to endovascular coiling for ruptured anterior communicating artery aneurysms","authors":"Jake Nowicki ,&nbsp;Edoardo Aromataris","doi":"10.1016/j.jocn.2025.111821","DOIUrl":"10.1016/j.jocn.2025.111821","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;A ruptured intracranial aneurysm is a devastating pathology that is associated with significant morbidity and mortality. The anterior communicating artery (ACOM) is the most common location to have an intracranial aneurysm form and rupture. The two management options for ruptured intracranial aneurysms include microsurgical clipping and endovascular coiling. The clinical outcomes of microsurgical clipping and endovascular coiling for ruptured ACOM aneurysms remains unclear. The aim of this review was to investigate the clinical outcomes, including functional outcomes, treatment efficacy and safety of microsurgical clipping and endovascular coiling for the management of ruptured ACOM aneurysms.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A search for published and unpublished literature included PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, International Clinical Trial Registry, Australia and New Zealand Clinical Trial Registry Search Strategy and &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;. Studies were included if they explored the functional outcomes and/or safety of microsurgical clipping and endovascular coiling for ruptured ACOM aneurysms. Eligible studies were critically appraised by two reviewers to assess methodological qualitied. Where possible, data from included studies was &lt;em&gt;meta&lt;/em&gt;-analysed using a random effects Mantel-Haenszel model. Effect measures included odds ratio and risk difference where no events were recorded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The search yielded 818 records. Following screening of titles and abstracts against the review inclusion criteria, 25 articles were retrieved for full-text screening. Of these, 11 studies, all of which were non-randomised studies (2 quasi-experimental and 9 retrospective cohort studies), were included.&lt;/div&gt;&lt;div&gt;For the primary outcome (favourable functional outcomes), analysis revealed overall no statistically significant difference between microsurgical clipping and endovascular coiling (79.4 % versus 73.6 %, OR 1.11, 95 % CI 0.78 – 1.57, p = 0.56). Results from the quasi-experimental studies demonstrated favourable outcomes in the clipping group were non-significantly higher than the coiling group (86.2 % versus 80.4 %, OR 2.26, 95 % CI 0.6–8.52, p = 0.23). In cohort studies, favourable outcomes in the clipping group were non-significantly higher than the coiling group (78.9 % versus 72.3 %, OR 1.05, 95 % CI 0.71–1.53, p = 0.23). For the secondary outcomes of recurrence and complications, overall no statistically significant difference was found between clipping versus coiling (recurrence − 4.6 % versus 5.7 %, RD 0.00, 95 % CI −0.06 – 0.06, p = 0.47; complications- 21.6 % versus 14.2 %, OR 1.00 95 % CI 0.49 – 2.05, p = 1.00). Occlusion was found to be significantly higher in the clipping group compared to coiling (95 % versus 75 %, OR 7.01, 95 % CI 2.82 – 17.45, p=&lt;0.0001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Concl","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111821"},"PeriodicalIF":1.8,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882456","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}

{"title":"Clinical outcomes and cost-utility analysis of programmable versus non-programmable ventriculoperitoneal shunts in communicating hydrocephalus: A population-based study","authors":"Yu-Lun Wu ,&nbsp;I-Chen Lee ,&nbsp;Chun-Hao Yin ,&nbsp;Jin-Shuen Chen ,&nbsp;Yao-Shen Chen ,&nbsp;Shih-Feng Weng ,&nbsp;Shu-Chuan Jennifer Yeh ,&nbsp;Hong-Yi Hsu ,&nbsp;Hon-Yi Shi","doi":"10.1016/j.jocn.2025.111838","DOIUrl":"10.1016/j.jocn.2025.111838","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluated the clinical outcomes and cost-utility of programmable versus non-programmable ventriculo-peritoneal (VP) shunts in patients with communicating hydrocephalus.</div></div><div><h3>Methods</h3><div>Patients who underwent VP shunt surgery at three major medical centers in Taiwan were included. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between 1,161 patients receiving programmable shunts and 1,061 receiving non-programmable shunts. Cox regression analyses were conducted to compare shunt revision, complication, and mortality rates. Cost-utility was assessed using a Markov decision-analytic model constructed from a healthcare provider perspective, incorporating a 1-year cycle length, a 10-year time horizon, and a 2% annual discount rate for both costs and effectiveness.</div></div><div><h3>Results</h3><div>No significant differences were observed in shunt revision, complication, or mortality rates between the two groups. The cost-utility analysis demonstrated that programmable shunts yielded lower total costs (US$55,482.03 vs. US$63,176.72) and higher quality-adjusted life years (QALYs) (6.03 vs. 5.48). The incremental cost-utility ratio (ICUR) was −US$13,889.09/QALYs, indicating dominance of the programmable shunt strategy. At a willingness-to-pay threshold equivalent to one gross domestic product (GDP) per capita, programmable shunts could generate potential savings of US$69.4 million over 10 years, with an estimated net saving of approximately US$57 million after accounting for additional device costs.</div></div><div><h3>Conclusions</h3><div>Programmable VP shunts demonstrated superior cost-effectiveness and comparable clinical outcomes relative to non-programmable devices. These findings support the clinical and economic value of programmable shunts and provide evidence to inform policy decisions and shared decision-making in hydrocephalus management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111838"},"PeriodicalIF":1.8,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882454","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}

{"title":"ICH-FOS for evaluating surgical outcomes in supratentorial spontaneous ICH: Toward precision neurosurgical care","authors":"Wenyu Dong ,&nbsp;Feifei Ma ,&nbsp;Yanfang Li ,&nbsp;Qixuan Guan ,&nbsp;Wenrui Xing ,&nbsp;Huining Chen ,&nbsp;Runhua Zhang ,&nbsp;Xingquan Zhao ,&nbsp;Ruijun Ji","doi":"10.1016/j.jocn.2025.111831","DOIUrl":"10.1016/j.jocn.2025.111831","url":null,"abstract":"<div><h3>Objective</h3><div>Identifying patients with supratentorial spontaneous intracerebral hemorrhage (sICH) who are most likely to benefit from neurosurgical intervention remains challenging. We aimed to assess the value of the Intracerebral Hemorrhage Functional Outcome Score (ICH-FOS) for stratifying baseline risk and evaluating outcomes across risk strata following neurosurgical intervention.</div></div><div><h3>Methods</h3><div>We analyzed two observational ICH cohorts from China: a prospective, multicenter cohort (cohort 1) enrolled from January 2014 to September 2016 and a retrospective, single-center cohort (cohort 2) enrolled from November 2023 to December 2024. Patients were stratified into low (0–4), moderate (5–8), and high (9–16) risk groups based on ICH-FOS. The primary outcome was 1-year favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–3. Outcomes were assessed with logistic regression models, adjusting for covariates selected based on clinical relevance and baseline imbalances between groups.</div></div><div><h3>Results</h3><div>Cohort 1 included 1057 patients with 203 (19.2 %) receiving neurosurgical intervention. Cohort 2 included 636 patients with 107 (16.8 %) undergoing surgery. In cohort 1, neurosurgical intervention was associated with better 1-year functional outcomes in high-risk patients (odds ratio [OR], 2.99; 95 % CI, 1.12–7.98), but worse outcomes in low- (OR, 0.24; 95 % CI, 0.09–0.62) and moderate-risk groups (OR, 0.39; 95 % CI, 0.18–0.87). Consistent patterns were observed at 3 months, with surgery associated with worse outcomes in low- (OR, 0.33; 95 % CI, 0.14–0.77) and moderate-risk groups (OR, 0.20; 95 % CI, 0.09–0.44), and no significant functional benefit in high-risk patients (OR, 1.02; 95 % CI, 0.30–3.49), but improved survival in this group. The results of cohort 2 were consistent with those of cohort 1.</div></div><div><h3>Conclusions</h3><div>Among patients with supratentorial sICH, those classified as low- to moderate-risk by the ICH-FOS derived greater benefit from conservative management, whereas high-risk patients experienced improved survival and potential long-term functional benefit with neurosurgical intervention. These findings highlight the value of ICH-FOS in stratifying baseline risk and evaluating potential outcomes across patient subgroups, supporting a precision-medicine perspective in sICH.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111831"},"PeriodicalIF":1.8,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882455","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}

{"title":"Association between health literacy and quality of life in patients with multiple sclerosis","authors":"Walid Al-Qerem ,&nbsp;Sawsan Khdair ,&nbsp;Dunia Basem ,&nbsp;Anan Jarab ,&nbsp;Judith Eberhardt ,&nbsp;Lubna Al-Khareisha ,&nbsp;Alaa Khudair","doi":"10.1016/j.jocn.2025.111820","DOIUrl":"10.1016/j.jocn.2025.111820","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) is a chronic autoimmune disease that significantly affects the quality of life (QOL) of patients. Health literacy, employment, and medication adherence are key factors influencing disease management and overall well-being. However, limited research has explored these relationships in Jordanian MS patients.</div></div><div><h3>Objective</h3><div>This study aimed to examine the association between health literacy, employment status, medication adherence, and QOL among MS patients in Jordan.</div></div><div><h3>Method</h3><div>A cross-sectional study was conducted with 307 MS patients (median age 35 years (IQR: 28–44), 68.4 % females) from Al-Bashir Hospital in Amman. Participants completed validated questionnaires, including the Health Literacy Survey-12 (HLS-Q12), the Multiple Sclerosis Impact Scale (MSIS-29), and the Medication Adherence Rating Scale (MARS-5). Disease severity was assessed using the Expanded Disability Status Scale (EDSS) and Language function was evaluated using the Communication and Language Assessment in Multiple Sclerosis (CALMS). Associations between predictor variables and QOL outcomes were assessed using quantile regression analysis.</div></div><div><h3>Results</h3><div>Higher health literacy (HL) was linked to better QOL (per-point HLS-Q12: physical β =  −0.27, 95 % CI − 0.50–−0.05, p = 0.019; psychological β =  −0.31, 95 % CI −0.46–−0.16, p &lt; 0.001). After adding CALMS (Model B), the HL–psychological QOL association remained but weakened (β =  −0.20, 95 % CI − 0.37–−0.02, p = 0.034), while the physical effect lost significance. The influence of non-injectable regimens and age on psychological QOL also diminished. Disability remained the strongest and most consistent predictor (per-point EDSS: physical Model A β = 5.19, 95 % CI [4.57, 5.80], Model B β = 4.29, 95 % CI [2.937, 5.65]; both &lt; 0.001; psychological Model A β = 1.61, 95 % CI [1.24, 1.98], Model B β = 1.17, 95 % CI [0.672, 1.664]; both p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Key drivers of QOL were health literacy, treatment route, and disability. Interventions that raise HL and enable shared selection of non-injectable options, when clinically appropriate, are likely to yield the largest QOL gains.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111820"},"PeriodicalIF":1.8,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882453","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}

{"title":"The utility of high-resolution magnetic resonance imaging in the detection of fibrotic plaques associated with chronic internal carotid artery occlusion","authors":"Zixuan Wei ,&nbsp;Hengping Wu ,&nbsp;Yu Feng,&nbsp;Yihui Ma,&nbsp;Weiyu Sun,&nbsp;Tingbao Zhang,&nbsp;Jincao Chen,&nbsp;Wenyuan Zhao","doi":"10.1016/j.jocn.2025.111829","DOIUrl":"10.1016/j.jocn.2025.111829","url":null,"abstract":"<div><h3>Objective</h3><div>High-resolution VWI is a non-invasive technique for evaluating atherosclerotic plaque composition. This study aims to delineate the characteristics of VWI and DSA in CICAO patients with highly fibrotic plaques, enhancing preoperative identification.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with CICAO who underwent VWI and DSA before surgical intervention at our hospital from 2017 to 2024. Patients were categorized based on histopathological findings into two groups: those with highly fibrotic plaques and those with significant necrotic cores. A comparative analysis assessed differences in VWI and DSA characteristics between the groups. Imaging features were also summarized for five patients who underwent bypass surgery after unsuccessful interventional recanalization attempts.</div></div><div><h3>Results</h3><div>Five cases of CICAO were included, confirmed to have highly fibrotic plaques, while 22 cases had plaques with significant necrotic cores. The fibrotic plaques showed greater T1 isointensity on VWI (p=0.0005), while the necrotic cores exhibited higher signals on VWI T2 sequences and a trend toward conical residuals on DSA. In cases of failed interventional recanalization requiring bypass surgery, VWI showed T1 isointensity (40%) and T2 high signals (80%), while DSA indicated blunt or absent residuals (80%).</div></div><div><h3>Conclusion</h3><div>Clinical physicians can identify CICAO with fibrotic plaques using preoperative VWI and DSA, enabling them to select hybrid surgical techniques that enhance intervention success.</div><div>Abbreviations: CICAO, chronic internal carotid artery occlusion; DSA, digital subtraction angiography; VWI, vessel wall imaging; MRA, magnetic resonance angiography; CTA, computed tomography angiography; CEA, carotid endarterectomy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111829"},"PeriodicalIF":1.8,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878450","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}

{"title":"Association of plasma homocysteine levels with the presence of intracranial aneurysms and the risk of rupture: A systematic review and meta-analysis","authors":"Amirhossein Akhavan-Sigari ,&nbsp;Vita Olson ,&nbsp;Maria José Pachón-Londoño ,&nbsp;Charbel K. Moussalem ,&nbsp;Zhen Wang ,&nbsp;David J. Park ,&nbsp;Chandan Krishna ,&nbsp;Steven D. Chang ,&nbsp;Fredric B. Meyer ,&nbsp;Bernard R. Bendok","doi":"10.1016/j.jocn.2025.111830","DOIUrl":"10.1016/j.jocn.2025.111830","url":null,"abstract":"<div><h3>Background</h3><div>The majority of intracranial aneurysms (IAs) remain asymptomatic and undiagnosed throughout a patient’s life. However, IA rupture poses a significant risk of mortality. Elevated homocysteine (Hcy) levels are associated with increased vascular inflammation, leading to endothelial dysfunction and degradation of the extracellular matrix. The objective of this study is to synthesize existing evidence on the association between plasma Hcy levels and IA presence and their rupture risk.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and <em>meta</em>-analysis to assess plasma Hcy levels in relation to IA presence and rupture risk. Case-control and cohort studies comparing Hcy levels between patients with and without IAs or ruptured and unruptured IAs were included.</div></div><div><h3>Results</h3><div>A total of seven studies comprising 11,911 participants were included in the review. The studies were divided into two subgroups, four comparing hyperhomocysteinemia (HHcy) status in patients with and without IAs, and three comparing Hcy levels in patients with ruptured and unruptured IAs. Pooled odds ratios (ORs) indicated that HHcy was significantly associated with higher odds of IA presence (OR = 1.87, 95% CI = [1.78–1.97]). Among studies comparing Hcy levels in ruptured and unruptured IAs, there was no significant association between increasing Hcy levels and rupture risk (OR = 1.14, 95 % CI = [0.69–1.88]).</div></div><div><h3>Conclusion</h3><div>Individuals with HHcy have significantly higher odds of developing IAs, suggesting a potential association between HHcy and IA presence. Increasing Hcy levels were not associated with increased risk of IA rupture. Additional studies evaluating the effect of elevated Hcy levels on IA rupture risk and longitudinal studies evaluating the causal effect of HHcy on IA development are needed.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111830"},"PeriodicalIF":1.8,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145863112","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}

{"title":"Neoadjuvant PD1 blockade with laser interstitial thermal therapy for recurrent high-grade glioma","authors":"Carter M. Suryadevara ,&nbsp;Hayley Donaldson ,&nbsp;Hammad A. Khan ,&nbsp;Karenna J. Groff ,&nbsp;Claire D. Kim ,&nbsp;Siddhant Dogra ,&nbsp;Jose Gautreaux ,&nbsp;Leah Geiser Roberts ,&nbsp;Matthew G. Young ,&nbsp;Matija Snuderl ,&nbsp;David Zagzag ,&nbsp;Christopher M. William ,&nbsp;J. Ricardo McFaline-Figueroa ,&nbsp;Maria del Pilar Guillermo Prieto Eibl ,&nbsp;Christine A. Cordova ,&nbsp;Sylvia Kurz ,&nbsp;Marissa Barbaro ,&nbsp;Dimitris G. Placantonakis","doi":"10.1016/j.jocn.2025.111823","DOIUrl":"10.1016/j.jocn.2025.111823","url":null,"abstract":"<div><h3>Background</h3><div>While immune checkpoint inhibitors (ICI) induce potent responses against several systemic malignancies, clinical efficacy against high-grade glioma has been limited by immunosuppression, low mutational burden and limited lymphocyte infiltration into tumors. Laser interstitial thermal therapy (LITT) induces coagulative necrosis and disrupts the peritumoral blood–brain barrier (BBB), creating a potentially antigenic milieu. We hypothesized that neoadjuvant and adjuvant ICI would synergize with LITT to potentiate antitumor immune responses and enhance survival.</div></div><div><h3>Methods</h3><div>This retrospective study is an exploratory case series that includes 9 adult patients with recurrent IDH wild-type glioblastoma (GBM, n = 6), IDH mutant high-grade astrocytoma (n = 2) and H3K27M mutant diffuse midline glioma (n = 1). All patients received neoadjuvant anti-PD1 ICI prior to LITT and most received adjuvant ICI (8/9). Disease burden was followed through radiographic volume segmentation of gadolinium-enhancing disease. Patients were followed for progression-free (PFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Patients (age 29–64 years; 7 male, 2 female) had pre-operative mean tumor volumes of 11.15 cm³ (range 2.93–26.09 cm³). Mean ablation volume was 12.08 cm³ (range 5.14–18.60 cm³). There were no perioperative complications. All patients showed an initial increase in gadolinium-enhancing volume after LITT. Seven of 9 (78 %) patients demonstrated subsequent regression in total gadolinium-enhancing volume. Three non-contiguous satellite lesions naïve to laser ablation exhibited complete or near-complete regression in 2 patients. Median PFS was 5.90 months (range 1.00–41.23), and median OS was 9.97 months (range 1.20–41.23).</div></div><div><h3>Conclusions</h3><div>Combination therapy with neoadjuvant and adjuvant pembrolizumab and LITT is feasible and safe in recurrent high-grade glioma. Responses may be more robust in certain molecular subtypes of glioma. Further studies are needed to investigate this potential synergy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111823"},"PeriodicalIF":1.8,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839243","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}

{"title":"Impact of dehydration on functional outcomes in large vessel occlusion stroke","authors":"April Pivonka ,&nbsp;Manisha Koneru ,&nbsp;Abigail Baldwin-LeClair ,&nbsp;Jamir Pitton Rissardo ,&nbsp;Karan Patel ,&nbsp;Avish Patel ,&nbsp;Scott Kamen ,&nbsp;Lauren Thau ,&nbsp;Jared Wolfe ,&nbsp;Linda Zhang ,&nbsp;Nicholas Vigilante ,&nbsp;Mary Penckofer ,&nbsp;Michael J. Dubinski ,&nbsp;Olga R. Thon ,&nbsp;Tudor G. Jovin ,&nbsp;Jane Khalife ,&nbsp;Hermann Christian Schumacher ,&nbsp;Khalid A. Hanafy ,&nbsp;James E. Siegler ,&nbsp;Jesse M. Thon","doi":"10.1016/j.jocn.2025.111832","DOIUrl":"10.1016/j.jocn.2025.111832","url":null,"abstract":"<div><h3>Background</h3><div>Dehydration at stroke onset has been linked to worse outcomes, but its impact in large vessel occlusion (LVO) stroke treated with endovascular thrombectomy (EVT) remains unclear. We evaluated whether dehydration at presentation influences functional recovery in this population.</div></div><div><h3>Methods</h3><div>A prospectively maintained registry of adults with anterior circulation LVO (ICA, M1, M2) who achieved successful EVT (mTICI ≥ 2B) between 10/2019 and 12/2021 was analyzed. Dehydration was defined as serum osmolality ≥ 295 mOsm/kg and BUN/Cr ≥ 20. Primary outcomes were NIHSS at 24 h and good functional recovery at 90 days (mRS 0–2 or return to baseline). Multivariable logistic regression adjusted for age, sex, baseline NIHSS, ASPECTS, occlusion site, diuretic use, and pre-stroke mRS.</div></div><div><h3>Results</h3><div>Of 206 patients, 31 were dehydrated at presentation. They were older (median 77 vs. 69 years), more often female, and more likely to use diuretics (p ≤ 0.03). Dehydrated patients had higher NIHSS at 24 h (median 14 vs. 10, p = 0.02) and worse 90-day mRS (p = 0.003). Good functional recovery occurred in 30 % of dehydrated vs. 50 % of non-dehydrated patients (p = 0.04). Dehydration independently predicted lower odds of NIHSS improvement at 24 h (aOR 0.37, 95 % CI 0.14–0.98, p = 0.04), but not worse recovery at 90 days.</div></div><div><h3>Conclusion</h3><div>Dehydration at presentation is associated with worse early neurological improvement and potentially poorer functional outcomes after EVT for LVO stroke. These findings highlight the importance of recognizing hydration status in this patient population and the need for future studies to confirm these findings and assess potential interventions.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111832"},"PeriodicalIF":1.8,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839244","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}