Neurologia i neurochirurgia polska最新文献

Aim of the study: To investigate subtle cognitive dysfunction in patients with cervical dystonia (CD) as a potential independent non-motor feature of the disease or as a consequence of interactions between motor and other non-motor symptoms (NMS).

Clinical rationale for the study: Cognitive impairment represents one of the most common non-motor symptoms in patients with cervical dystonia. However, the interrelations between cognitive dysfunction, motor symptoms, and other non-motor symptoms remain insufficiently explored.

Material and methods: Patients with CD (n = 34) underwent comprehensive assessment at baseline and 4-6 weeks after botulinum toxin (BoNT) treatment. Clinical and sociodemographic variables, as well as motor and non-motor symptoms of dystonia were assessed. Matched controls (n = 33) underwent a single assessment. Cognitive function, depressive and anxiety symptoms, and sleep disturbances were assessed by a neuropsychologist in both groups.

Results: At baseline, 52.9% of patients with CD scored below the Montreal Cognitive Assessment (MoCA) cut-off for cognitive impairment, compared with 3.0% of healthy controls. Patients also showed higher rates of depressive symptoms, anxiety, and sleep disturbances. Cognitive performance was significantly lower in the CD group across multiple domains [executive functions, visuospatial abilities, language, memory, and attention (p < 0.05)]. Following botulinum toxin treatment, significant improvements were observed in overall MoCA scores and in specific domains of executive function, visuospatial abilities, language, and memory (p < 0.05). No correlation was found between overall dystonia severity and cognitive performance, although executive function correlated with motor symptom severity at baseline (R = -0.41, p = 0.017). In the multivariate model, sleep disturbances were identified as the strongest negative predictor of cognitive function (β = -0.40, p = 0.006), while higher education showed a protective effect. Other variables, including depression, anxiety, age, disease duration, and dystonia severity, were not significant predictors.

Conclusions and clinical implications: The study explores cognitive impairment in cervical dystonia in relation to motor severity and non-motor domains, with the multivariable model suggesting a potential role of sleep disturbances. The findings do not allow a definitive distinction between cognitive impairment as a core feature of dystonia or a secondary effect related to non-motor symptoms, but they indicate complex and interdependent mechanisms.

Introduction: We examined whether cellular fibronectin (cFn) is associated with thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF).

Clinical rationale for the study: Up to 5% of anticoagulated AF patients experience major bleeding, and identifying those at elevated risk remains challenging. Cellular fibronectin, a marker of endothelial dysfunction and vascular injury, has been linked to altered prothrombotic fibrin clot features in atherosclerosis, stroke, and venous thromboembolism, but its levels and role in AF are unknown.

Material and methods: In this cohort study, we enrolled 185 consecutive AF patients on rivaroxaban aged 70.0 [interquartile range (IQR) 62.0-76.0] years with a median CHA₂DS₂-VASc of 3.0 (IQR 1.0-4.0). We determined plasma cFn along with clinical and laboratory parameters, including fibrin clot permeability. During a median follow-up of 49.0 (IQR 46.0-51.0) months, we recorded both clinically relevant major and nonmajor bleeding according to the International Society on Thrombosis and Haemostasis (ISTH) and a composite ischemic endpoint involving ischemic cerebrovascular events or cardiovascular (CV) death.

Results: Plasma cFn (median 3.5, IQR 2.7-4.5 μg/mL) correlated positively with fibrinogen and C-reactive protein (CRP), and inversely with clot permeability. During follow-up, bleeding occurred in 25 patients (13.5%, 3.55/100 patient-years), including major bleeding in 13 (7.0%, 1.78/100 patient-years). Patients with cFn in the lowest quartile ( < 2.7 μg/mL) had an almost 4-fold higher risk of bleeding compared to those in the highest quartile ( > 4.5 μg/mL) [hazard ratio (HR) 3.85, 95% confidence interval (CI): 1.06-14.00]. On multivariate analysis adjusted for age and sex, low cFn was an independent predictor of bleeding and major bleeding, but not of the ischemic endpoint.

Conclusions and clinical implications: Our results suggest that low cFn levels might help identify patients with AF at increased bleeding risk during long-term anticoagulation, and this association could partly be related to the formation of looser fibrin networks.

Parkinson's disease (PD) is identified clinically by the presence of prominent motor signs; however, in recent years there has been growing recognition of non-motor symptoms (NMS) causing a similar or even greater impact on patients' quality of life. Wide spectrum of non-motor problems includes cognitive, neuropsychiatric, sensory, gastrointestinal, urinary, and cardiovascular issues, among others. Some of them are integral parts of the disease, while others may be side effects of applied therapies. Non-motor symptoms like hyposmia, cognitive decline, autonomic symptoms, and sleep disorders may indicate specific PD subtypes or signal prodromal disease before the appearance of motor parkinsonian signs. The burden of NMS increases with disease progression, but early presence of autonomic failure, hallucinations, or cognitive impairment points toward atypical parkinsonian syndromes. Non-motor symptoms significantly limit the possibility of applying certain pharmacological, surgical, and infusion therapies. Orthostatic hypotension (OH), impulse control disorder, or increased sleepiness are contraindications for use of dopamine agonists (DAs) and apomorphine infusion. Medications with anticholinergic properties may exacerbate existing cognitive and gastrointestinal problems. Moreover, neuropsychiatric problems with dementia, depression, and hallucinations may exclude patients from receiving deep brain stimulation (DBS), apomorphine, and levodopa/carbidopa or foslevodopa/ /foscarbidopa (LDp/CDp) infusions. While NMS are not routinely assessed by diagnostic criteria and standard tools during PD therapy, they should be carefully evaluated at every step of PD management. In this review, we summarize the underrated role of NMS in PD diagnosis and therapy planning and discuss potential measures to better address them.

Introduction: The modified Rankin Scale (mRS) score at discharge from the stroke unit (SU) is often used as a surrogate for the 3-month outcome, but the reliability of such an approach remains uncertain. Our aim was to investigate how mRS assessment at SU discharge compares with early post-discharge and 3-month post-discharge evaluation, considering discharge destination.

Material and methods: We prospectively enrolled adult acute stroke patients discharged from a single tertiary SU with residual neurological deficit and mRS 1-4. Functional assessment was made by a single mRS-certified neurologist using the Rankin Focused Assessment (RFA) at SU discharge, and at 7-21 and 83-97 days post-discharge.

Results: Of 116 enrolled patients, 109 completed the early post-discharge assessment and 104 the 3-month follow-up. The agreement between mRS at SU discharge and in the early follow-up was moderate overall (Krippendorff's alpha 0.71) and in patients discharged from the hospital (alpha 0.68) but poor in those transferred to the rehabilitation ward (RW) (alpha 0.41). Somewhat worse reliability was observed for the 3-month mRS (alpha 0.63, 0.53, and 0.26, respectively). Discharge assessments tended to overestimate dependency, particularly in RW-transferred patients (28.3% vs. 8.6% in discharges from the hospital).

Conclusions: The modified Rankin Scale assessment reliability performed by an experienced neurologist at SU discharge is moderate and significantly poorer in RW-transferred patients. However, on the population level, it seems satisfactory for patients discharged from the hospital, even as a surrogate for the 3-month post-discharge mRS.

The pathogenesis of restless legs syndrome (RLS) is still poorly understood. Nevertheless, several medications are in clinical use, namely dopamine agonists (DA), gabapentinoids, opioids, and ferrum preparations, and their effectiveness has been confirmed in numerous clinical trials. In 2025 the American Academy of Sleep Medicine published new practice guidelines and changed the positioning of previously highly rated medications. The first-line treatment options with a "strong recommendation" are now gabapentinoids (gabapentin, gabapentin enacarbil, pregabalin) along with intravenous ferric carboxymaltose. Dopamine agonists previously classified at the same level have been moved to the category of "conditional against". This was based on the clinical data on the effectiveness of gabapentinoids but was not based on new clinical trials proving lower efficacy of DAs. In our opinion, this change is related to the potential side effects of DAs as augmentation and for impulse control disorder. Nevertheless, gabapentinoids are recommended in high doses vs. DAs, which are recommended in low doses. In older patients with co-morbidities in whom gabapentinoids are not well tolerated it results in relatively high rates of withdrawal. In this point of view paper, we present our personal views (supported by clinical data) on the need for both groups of medications in clinical practice because none of them is free of potential side effects and may still be useful.

Aim of the study: Despite advancements in mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS) due to large vessel occlusion, nearly half of patients with successful recanalization do not achieve good functional outcome (GFO). We aimed to analyze the association between novel perfusion-based biomarkers and prognosis after AIS.

Clinical rationale for the study: The role of perfusion imaging biomarkers, particularly relative cerebral blood volume (rCBV), as an indicator of tissue-level collateral circulation and a predictor of post-MT clinical trajectory remains insufficiently explored.

Material and methods: This single-center retrospective study included patients with anterior circulation AIS who achieved successful recanalization following MT at the Comprehensive Stroke Center, University Hospital, Krakow, between January 2019 and July 2023. We evaluated the predictive value of rCBV for early neurological improvement (ENI) and long-term GFO and compared its prognostic utility with other perfusion-based parameters. Furthermore, we assessed the extent to which the effect of rCBV on GFO was mediated by its influence on ENI. Early neurological improvement was defined as a ≥ 4-point reduction in the National Institutes of Health Stroke Scale score or complete symptom resolution within 24 hours post-admission. GFO was defined as a modified Rankin Scale score of < 3 at 90 days.

Results: Relative cerebral blood volume was an independent predictor of 90-day GFO after multivariable adjustment (adjusted odds ratio [aOR] = 1.38; 95% confidence interval [CI]: 1.19-1.6; p < 0.001). Additionally, total hypoperfusion volume (T6max) independently contributed to GFO prediction when included alongside rCBV (aOR = 0.96 per 10 mL increase; 95% CI: 0.94-0.99; p = 0.019), enhancing prognostic accuracy. Relative cerebral blood volume was also a strong predictor of ENI (aOR = 1.35; 95% CI: 1.19-1.54; p < 0.001), with 35% (4-67%; p = 0.029) of its effect on GFO mediated through its impact on ENI.

Conclusion and clinical implications: Relative cerebral blood volume is a robust predictor of both early neurological recovery and long-term functional outcome following MT. Moreover, T6max provides independent prognostic value when assessed in conjunction with rCBV, suggesting that these parameters complement each other. Their combined assessment provides a more comprehensive understanding of ischemic tissue fate, aiding clinical decision-making in patients selected for MT.

Introduction: Several methods of clot extraction during mechanical thrombectomy (MT) have been developed, among which the SOFIA 6F aspiration catheter (SAC) solo navigation (SNAKE) and aspiration technique has become the preferred approach at our institution. We present a single-center, retrospective, large-cohort, real-world study focusing on the SAC's ability to navigate vascular anatomy without additional devices and its efficacy in clot removal.

Material and methods: The cohort consisted of 109 consecutive patients who underwent MT with an intention to be treated with SNAKE and aspiration. We analyzed the efficacy of SAC navigation, clot extraction, costs, procedural safety and duration, as well as potential factors reducing SNAKE efficacy.

Results: Overall, 76.1% of SNAKE procedures were successful. In the subgroup of 83 successful SNAKE procedures, subsequent SAC aspiration achieved a first-pass effect (FPE) Thrombolysis In Cerebral Infarction (TICI) 2c-3 in 57.8% of cases and final TICI 2b-3 in 83.1% of cases. Overall, regardless of SNAKE success or MT technique used, final TICI 2b-3 was achieved in 97.2% of cases, and the FPE rate was 57.7%. Successful SNAKE resulted in a significantly shorter groin puncture-to-recanalization time (mean 18.66 min vs. 29.46 min, p = 0.0004) and significant cost reduction in subsequent MTs (mean €2,824.02 vs. €3,948.34, p = 0.0017).

Conclusions: SAC SNAKE navigation with aspiration is a safe, cost-effective, relatively simple, and fast MT method, achieving high first-pass rates and good final angiographic re sults. Se vere intracranial carotid artery at herosclerosis can significantly hinder SNAKE navigation. In cases of failed SNAKE or an insufficient aspiration effect, this method can be easily combined with a stent-retriever (SR) to ensure optimal navigation and high final angiographic success.

Introduction: Alzheimer's disease (AD) is the leading cause of dementia, characterized by progressive cognitive and functional decline. As the population ages, the prevalence of AD is expected to increase significantly, imposing a growing burden on patients, caregivers, and healthcare systems. Advances in our understanding of AD pathophysiology and biomarker-based diagnosis have redefined clinical practice, introducing challenges in early detection, accurate diagnosis, and effective treatment.

State of the art: Current AD diagnostic frameworks incorporate clinical assessment alongside biomarkers of amyloid and tau pathology, cerebrovascular contributions, and neurodegeneration. Imaging modalities and fluid biomarker analyses enable more precise diagnosis, although accessibility remains limited in many settings. Recent therapeutic advancements in the form of anti-amyloid monoclonal antibodies offer disease-modifying potential but are accompanied by implementation challenges, such as patient selection, monitoring for adverse events, and cost considerations.

Clinical implications: Integrating biomarker testing into routine clinical practice requires a careful review of individual risks and benefits for each patient, balancing diagnostic accuracy with practical considerations like testing consequences, test availability, pretest probability, and patient preferences. Shared decision-making is pivotal when discussing treatment options, weighing potential clinical benefits against risks and the overall burden of care.

Future directions: Enhancing the delivery of anti-amyloid antibodies and advancing research into tau-targeted therapies represent promising therapeutic avenues. Incorporating scalable, non-invasive biomarkers, e.g., plasma-based biomarkers, into clinical practice has the potential to transform diagnostic workflows, provided they are applied in appropriate clinical contexts. Bridging the gap between research innovations and real-world implementation will require coordinated, multidisciplinary collaboration across healthcare systems.

Primary central nervous system lymphoma (PCNSL) is an aggressive malignancy, which is challenging to diagnose, often leading to delays in treatment initiation. The gold standard for diagnosis is brain biopsy, an invasive technique with a risk of neurologic compromise, and in some cases, biopsy may not be feasible or safe. Thus, there have been significant efforts to develop less invasive methods of diagnosis, particularly utilizing cerebrospinal fluid (CSF). Liquid diagnostics is an emerging area of research in many types of cancer, particularly central nervous system (CNS) tumors. Standard CSF cytology and flow cytometry lack sufficient sensitivity; however, the identification of specific biomarkers, particularly genomic variants such as the MYD88 L265P mutation, which can be detected in circulating tumor DNA (ctDNA), has demonstrated increasing promise as a diagnostic tool for PCNSL. Here, we review key advancements in the field of liquid diagnostics for PCNSL, and their potential to reform the approach to diagnosis.