Neurological Sciences最新文献

A 53-year-old female presented with vertigo and vomiting, which worsened 12 hours later with right facial numbness and ataxia. CT scans were normal, but CTA revealed occlusion of the right vertebral artery and a filling defect in the basilar artery, indicative of a free-floating thrombus, with the characteristic "donut sign." Thrombectomy was performed to remove the thrombus; however, the patient deteriorated rapidly with severe vomiting and loss of consciousness. Repeat angiography revealed complete basilar artery occlusion, leading to a second thrombectomy. Post-procedure imaging showed recanalization of the vertebral and basilar arteries, with reperfusion of the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery. MRI revealed a high DWI signal in the right medulla and cerebellum. Ten days later, the patient was discharged with persistent dysphagia, dysarthria, and right-sided sensory deficits. This case highlights the rare occurrence of a free-floating thrombus in the basilar artery, which may mimic Wallenberg syndrome. It underscores the importance of considering thrombus migration and suggests that early removal of residual thrombus may prevent recurrent embolism. Further research is needed to refine treatment strategies.

Objective: Pediatric intramedullary spinal cord tumors (PIMSCTs) seriously threaten children's growth and development. This study aims to evaluate the pathological features of PIMSCTs and analyze related factors influencing clinical outcomes.

Methods: A retrospective analysis was conducted on 96 children with PIMSCT who underwent surgical treatment at our hospital from January 2015 to June 2024. Relevant clinical data were collated to comprehensively analyze clinical and pathological characteristics, and to explore factors potentially affecting prognosis and neurological function.

Results: Among the 96 included patients, the thoracic spine was the most common tumor location (n = 43, 44.8%). Most patients presented with mild neurological deficits (MMS Ⅱ) at admission. Overall survival was unrelated to tumor length but correlated with the WHO grade of the tumor. No significant difference in survival was observed between H3K27M mutant and wild-type tumors (p = 0.087), while both Ki-67 and p53 expression were significantly associated with postoperative survival. Short-term postoperative neurological function correlated with tumor length, initial symptoms, and preoperative neurological status. For long-term neurological function, influencing factors included age, WHO grade, syringomyelia, postoperative MMS, and changes in the platelet-to-lymphocyte ratio (PLR).

Conclusion: Astrocytoma was the most prevalent pathology in this study. H3K27M mutation did not significantly affect survival in high-grade spinal astrocytoma, while high Ki-67 and p53 expression correlated with poorer prognosis. Tumor length was associated with short-term but not long-term neurological function. Long-term neurological outcomes were mainly linked to inherent tumor properties and postoperative neurological status; postoperative PLR changes may partly indicate long-term neurological function.

Introduction: Neurological disorders are a significant contributor to the global health burden. This study aims to provide a comprehensive assessment of the national and subnational burden of neurological disorders in Iran from 1990 to 2021 using the latest Global Burden of Disease (GBD) Study data.

Methods: We extracted data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for major neurological disorders in Iran from the GBD 2021 study. The disorders were Alzheimer's disease (AD) and other dementias, headache disorders, idiopathic epilepsy, multiple sclerosis (MS), Parkinson's disease, motor neuron disease, and other neurological disorders.

Results: Neurological disorders affected 35.2 million individuals (95% uncertainty interval [UI]: 32.6-37.9 million) in 2021 in Iran. From 1990 to 2021, the age-standardized DALY and death rates neurological disorders in Iran decreased (-5.5% and - 8.9%, respectively). However, all-ages numbers increased substantially for all metrics. The five conditions with the highest age-standardized DALY rates per 100,000 in 2021 were headache disorders (716.3), AD and other dementias (473.6), idiopathic epilepsy (121.5), Parkinson's disease (73.8), and MS (28.0). Significant geographic variations were observed, with East Azarbayejan and Tehran consistently showing higher burdens.

Conclusions: Despite improvements in age-standardized DALY rates, the absolute burden of neurological disorders in Iran has increased significantly from 1990 to 2021. Targeted interventions and resource allocation to address the growing challenge of neurological disorders in Iran are warranted.

Clinical trial number: Not applicable.

Background: Epilepsy is a neurological condition characterized by recurrent, spontaneous seizures stemming from sudden, abnormal synchronization of neuronal activity in specific brain regions, driven by structural or functional alterations. This disorder is preceded by epileptogenesis, a dynamic process marked by cellular and molecular changes that heighten brain excitability. Although anti-seizure medications (ASMs) remain the cornerstone of treatment, roughly 30% of patients develop refractory epilepsy, which resists ASMs therapy. Critically, ASMs do not prevent epileptogenesis, implying divergent mechanisms govern disease progression.

Methods: This review evaluates the pathway's contributions to neuroinflammation, epileptogenesis, and epilepsy, and explores the promise of COX-2 inhibitors in managing refractory epilepsy.

Results: Epileptogenesis continues even after seizures manifest and is strongly associated with drug-resistant forms such as temporal lobe epilepsy (TLE). Neuroinflammation, which develops subsequent to the epileptic seizure, aggravates refractory epilepsy by enhancing the extrusion of ASMs across the blood-brain barrier (BBB), reducing their therapeutic efficacy. Following epileptic seizures, cyclooxygenase-2 (COX-2), a key enzyme in prostaglandin (PG) synthesis, is upregulated and activates the COX-2/PG pathway, leading to exacerbation of neuroinflammation and acceleration of epilepsy progression. Furthermore, by inducing neuronal hyperexcitability and epileptogenesis, elevated COX-2 and PG levels correlate with increased seizure severity and frequency.

Conclusion: Consequently, targeting of the COX-2/PG axis has emerged as a potential therapeutic strategy.

Background: Manganese (Mn) is an essential but neurotoxic trace element implicated in neurodegenerative disorders. Its association with amyotrophic lateral sclerosis (ALS) remains uncertain. We conducted a systematic review and meta-analysis to evaluate whether Mn concentrations differ between ALS patients and healthy controls.

Methods: We systematically searched PubMed, EMBASE, Web of Science, and Scopus for observational studies comparing Mn concentrations between ALS patients and healthy controls. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with the I² statistic, and publication bias was evaluated by Egger's test.

Results: Twelve studies (446 ALS cases, 652 controls) measuring Mn in blood, serum, cerebrospinal fluid (CSF), hair, urine, toenail, plasma, or tissue were included. The pooled SMD was 0.05 (95% CI: - 0.20 to 0.30; p = 0.68; I² = 71.7%), indicating no significant difference in Mn concentrations. Subgroup analyses by biological matrix and analytical method showed no consistent pattern; meta-regression identified analytical method as a significant source of heterogeneity.

Conclusion: No publication bias was detected (Egger's p = 0.53). Peripheral Mn concentrations do not differ significantly between ALS patients and controls. Future research should employ longitudinal and CNS-targeted approaches, incorporating occupational exposure assessment and standardized analytical protocols.