Neurologia i neurochirurgia polska最新文献

Aim of the study: This study compared the clinical features of functional/dissociative seizures (FDS) and epileptic seizures using video-EEG.

Clinical rationale for the study: Early identification of functional/dissociative seizures based on clinical semiology.

Material and methods: Seizure semiology was retrospectively analyzed in 51 FDS and 51 age- and sex-matched epilepsy patients. All diagnoses were confirmed by video-EEG. Evaluated features included sustained eye closure, side-to-side head movements, pelvic thrusting, opisthotonus, side-to-side body movements, grimacing, fluctuating course, limb tremors, vocalization, awareness, and seizure duration.

Results: Functional/dissociative seizures patients more frequently exhibited sustained eye closure (90.2% vs. 31.4%), pelvic thrusting (43.1% vs. 5.9%), opisthotonus (27.5% vs. 0%), fluctuating course (66.7% vs. 21.6%), and limb tremors (76.5% vs. 39.2%) compared with epilepsy patients (all p < 0.001). FDS episodes were longer (median 180 s vs. 66 s, p < 0.001). Logistic regression identified sustained eye closure (OR: 56.9), pelvic thrusting (OR: 8.1), and seizure duration (OR: 1.011 per second) as independent predictors of FDS. Significant co-occurrences included opisthotonus with pelvic thrusting and grimacing, fluctuating course with tremor, and side-to-side body movement with head movement and pelvic thrusting.

Conclusions and clinical implications: Sustained eye closure, pelvic thrusting, and prolonged duration are key indicators of FDS. Recognizing these signs can improve diagnostic accuracy when video-EEG is unavailable, prevent unnecessary antiseizure treatment, and facilitate timely psychological care, enhancing overall patient management.

Introduction: Tandem lesions, where extracranial and intracranial vascular pathology coexists, have a poor prognosis and are a significant cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO); they present unique challenges in diagnosis and endovascular treatment.

Aim of the study: This retrospective study analyzed demographic parameters, risk factors, qualification procedures, fibrinolytic therapy, interventional management, complications, technical aspects, and clinical outcomes in tandem-occlusion anterior circulation stroke (TOS) patients treated at a Thrombectomy Capable Stroke Center (TCSC) in Wejherowo from 2020 to 2024. Acute stroke patients with TOS were compared to two groups: patients with isolated intracranial artery occlusion (iLVO) and patients with isolated extracranial internal carotid artery (iICA) lesion.

Material and methods: A total number of 193 patients who underwent endovascular therapy (EVT) were involved. The comparison between selected populations was performed to analyze frequency, risk factors, procedure complexity, complications, and clinical outcome.

Results: In the observed group the prevalence of tandem lesions was 17.1%, isolated extracranial internal carotid artery (ICA) occlusion was 11.4%, and isolated intracranial artery occlusion-71.5%. Tandem and ICA occlusion patients were younger (66.21 ± ± 9.8 vs. 70.34 ± 12.16; p < 0.01) and had a higher prevalence of smoking (45% vs. 26.1%; p < 0.05) compared to the intracranial LVO group. The latter had a higher rate of atrial fibrillation (21.2% vs. 60.9%; p < 0.001). Time intervals, including onset-to- -reperfusion (301.66 vs. 246.15 minutes; p < 0.01) and related to it: groin-to-first pass, groin-to-recanalization were significantly prolonged in the tandem group. Clinical outcomes, as measured by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), were worse in the tandem group compared to both the intracranial LVO (mRS 0-2: 24.2% vs. 44.9%; p < 0,01; NIHSS: 9.96 vs. 7.01; p < 0.01) and isolated extracranial ICA occlusion groups (mRS 0-2: 24.2% vs. 59.1%; p < 001; NIHSS: 9.96 vs. 4.53; p < 0.01). There were no significant differences in complication rates between the groups.

Conclusions and clinical implications: In the analyzed cohort of interventionally treated AIS patients, the presence of tandem lesions was correlated with poor clinical outcomes and associated with the presence of atherosclerosis risk factors. Endovascular procedures in these cases were more complex and involved extended time intervals. Conversely, patients with isolated intracranial lesions were generally older, with atrial fibrillation being the primary risk factor. In these patients, endovascular procedure times were shorter and resulted in more favorable clinical outcomes.

Aim of the study: Intracranial dural arteriovenous fistulas (DAVFs) are rare vascular malformations characterized by arteriovenous shunting within the dura mater. They are classified according to venous drainage patterns that correlate with clinical severity and hemorrhagic risk. Treatment options include surgery, radiosurgery and especially endovascular embolization. The aim of this article is to present our center's experience with endovascular treatment of DAVFs with a focus on the technical aspects and clinical results.

Material and methods: In this single-center study, we reviewed data from consecutive patients with DAVF who underwent embolization from 2015 to 2024. The efficacy of embolization, the method of embolization, as well as the rate of complication, were noted.

Results: A total of 48 patients with an average age of 53 years underwent selective embolization of DAVFs, the vast majority of them via the transarterial approach (46.96%). Prior to the procedure, the most common complaints included headache, intracranial hemorrhage and tinnitus. Satisfactory long-term embolization was achieved in 42 cases (88%). The most commonly used embolic agents included Onyx and nbutyl cyanoacrylate (n-BCA), and the most common culprit vessels were middle meningeal and occipital arteries. With the exception of minor intraprocedural difficulties, there were no serious complications associated with embolization. No neurological deficits occurred in relation to the endovascular procedure. Clinical improvement was reported by 35 patients (73%).

Conclusions: The results of our study indicate that endovascular treatment of DAVFs achieves a high rate of complete occlusion in the majority of cases. It is associated with a low complication rate and can be successfully performed across all DAVF types.

Introduction: Intracranial hemorrhage (ICH) after surgical evacuation of chronic subdural hematoma (cSDH) is a rare but serious complication associated with considerable morbidity and mortality. This review aims to provide an updated estimate, from existing literature, of the prevalence of ICH and to analyze the clinical features, potential risk factors, treatment approaches, and outcomes in a cohort of 76 patients.

Clinical rationale for the study: Because postoperative ICH can rapidly deteriorate neurological status and complicate recovery, understanding its prevalence and determinants is essential for improving safety in cSDH surgery.

Material and methods: Two systematic searches of the PubMed, Scopus, and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases were conducted in accordance with Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines on September 20th, 2025. The first search resulted in the inclusion of 18 articles, which were included in an analysis of the prevalence of ICH. The second search resulted in the inclusion of 56 articles, encompassing detailed clinical data on 76 patients who experienced postoperative ICH following surgical evacuation of cSDH.

Results: The prevalence of ICH after cSDH surgery was 2.3%. Patients' ages ranged from 22 to 93 years (mean: 66.5 years), with 79% being male. The most common type of postoperative ICH was intraparenchymal hemorrhage (IPH) (73.7%), followed by subdural hemorrhage (14.5%). ICH occurred on average 1.7 days after the procedure. Dominant symptoms of ICH post evacuation included the following: altered mental status (47.4%), motor weakness (30.3%), and headache (21.05%). Significant correlations between preoperative hypertension, antiplatelet therapy, IPH, and worse outcome (mRS > 3) have been established.

Conclusion and clinical implications: The data suggest that patients suffering from hypertension and using antiplatelet therapy may be predisposed to poorer outcomes. Stratification of patients based on comorbidities, scrupulous preparation of patients, and careful perioperative care may play a role in reducing ICH occurrence and improving patient prognosis.

Introduction: Central retinal artery occlusion (CRAO) is a relatively rare but underestimated medical emergency leading to severe vision loss. It is considered the ocular equivalent of ischemic stroke. There is still no definite recommendation for treatment. Currently considered and one of the increasingly preferred options is intravenous thrombolysis (IVT). Presented here are the results of a multicenter retrospective study to assess the safety and effectiveness of thrombolytic treatment in CRAO.

Material and methods: All patients with CRAO from eight centers who received IVT were included in the retrospective study. The effectiveness of the intervention was evaluated in two stages. The first stage was when the residual vision in the affected eye was achieved at least to the level of the ability to orientate in space (recognizing contours). The second stage was the improvement of vision to recognize objects and faces. The effectiveness was further evaluated depending on the duration of the difficulties before the intervention. Safety was assessed based on the symptomatic intracerebral hemorrhage (SICH).

Results: Sixty-four patients (age 67.9 ± 12.0 years, 51.6% men) were treated for CRAO with IVT. The median time from onset of symptoms to treatment was 4.5 hours. Improvement after treatment occurred in 60.9% (recognition of contours) and significant improvement in 39.1% (recognition of faces, ability to read). Intracerebral hemorrhage occurred in 6.3%. One fatal SICH was recorded. Two patients had vitreous hemorrhage. In both cases, vision improved to excellent condition.

Conclusions: Treatment of CRAO with IVT can be considered effective and safe. Secondary prevention should be in line with acute ischemic stroke (AIS) standards.

Introduction: To assess the potential benefit of artificial intelligence (AI) based imaging software in supporting mechanical thrombectomy (MT) transfer decisions in patients with acute ischemic stroke (AIS) referred from low-volume primary stroke centers (PSCs).

Clinical rationale for the study: Many MT-eligible patients are initially managed in PSCs, which often lack advanced imaging capabilities, stroke imaging expertise, and efficient interhospital image transfer systems. Artificial intelligence-based tools for automated large vessel occlusion (LVO) detection have shown promising results in improving stroke workflow metrics, yet data from low-volume PSCs remain limited.

Material and methods: This study presents a multicenter, retrospective analysis of 109 AIS patients transferred for anterior circulation LVO MT from five low-volume PSCs in Poland over a 53-month period (≤ 1 MT transfer/center/month). Standard imaging was retrospectively assessed using Brainomix 360 (Brainomix USA Inc., Chicago, USA) to assess early ischemic changes, collateral status, and LVO location. Two blinded vascular neurologists independently simulated transfer decisions based on post-processed imaging. Large vessel occlusion detection sensitivity and potential changes in transfer eligibility were analyzed. The workflow time parameters were compared to the comprehensive stroke center (CSC) cohort with a routine AI-assisted evaluation (n = 69). The maximal expected time benefit from AI implementation was also estimated.

Results: Artificial intelligence-based sensitivity for anterior circulation LVO detection was 83.5% [95% confidence interval (CI) 76.5-90.5], significantly higher for M1 than for internal carotid artery (ICA) occlusions (95.2% vs. 63.9%, p < 0.01). Among included patients, 78.9% (95% CI 70.3-85.5) were simulated as eligible and could potentially benefit from shorter workflow times. This is supported by the significantly shorter computed tomography angiography (CTA) to endovascular treatment (EVT) notification time in the CSC cohort with routine AI-assisted imaging compared with the low-volume PSC (11 vs. 48 min, p < 0.01). The median maximal potential reduction in door-in-door-out (DIDO) time was estimated at 30 min [interquartile range (IQR) 4-45). In contrast, 4.6% (95% CI 2.0-10.3) individuals were reclassified as ineligible due to extensive early ischemic changes and poor collaterals, potentially avoiding futile transfer.

Conclusions: Artificial intelligence-assisted imaging may significantly improve transfer decisions and workflow efficiency in low-volume PSCs, particularly in settings without real-time radiological interpretation. Its broader adoption may strengthen MT eligibility assessment within regional stroke networks.