Pub Date : 2026-02-10Epub Date: 2026-01-07DOI: 10.1212/WNL.0000000000214584
Samuel W Terman
{"title":"Heart of the Matter: Calcitonin Gene-Related Peptide Antagonists and Cardiovascular Risk.","authors":"Samuel W Terman","doi":"10.1212/WNL.0000000000214584","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214584","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e214584"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2026-01-08DOI: 10.1212/WNL.0000000000210311
Lina Palaiodimou, Georgios Tsivgoulis
{"title":"Author Response: Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours: A Systematic Review and Meta-Analysis of Randomized Trials.","authors":"Lina Palaiodimou, Georgios Tsivgoulis","doi":"10.1212/WNL.0000000000210311","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210311","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e210311"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2026-01-08DOI: 10.1212/WNL.0000000000214608
Sevinj Isazade, Onder Ertem, Deniz Kılıc, Emre Unal, Mustafa Kemal Demir
{"title":"Lumbar Epidural Varix Mimicking Metastasis: A Rare Cause of Radiculopathy.","authors":"Sevinj Isazade, Onder Ertem, Deniz Kılıc, Emre Unal, Mustafa Kemal Demir","doi":"10.1212/WNL.0000000000214608","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214608","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e214608"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2026-01-08DOI: 10.1212/WNL.0000000000210285
Pablo Ioli
{"title":"Reader Response: Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours: A Systematic Review and Meta-Analysis of Randomized Trials.","authors":"Pablo Ioli","doi":"10.1212/WNL.0000000000210285","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210285","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e210285"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2026-01-07DOI: 10.1212/WNL.0000000000214479
Jay B Lusk, Lauren E Wilson, Carlene Moore, Stephanie Yarnell, Cheryl Kalapura, Aparna Choudhury, Matthew Schrag, Sven Poli, Fan Li, Brian Mac Grory
Background and objectives: Calcitonin gene-related peptide (CGRP) inhibitors have entered widespread use in the United States for treatment of migraine, but data on their cardiovascular risk profile are lacking. The objective of this study was to determine whether exposure to a CGRP inhibitor is associated with cardiovascular events in patients with migraine.
Methods: A retrospective, observational, cohort study was conducted using computerized claims data from a proprietary, insurance-based registry, MarketScan (by Merative). Beneficiaries with at least one claim related to a migraine diagnosis and continuous coverage for at least 12 months before migraine diagnosis were included. Using a sequential trial framework, the rate of cardiovascular events was computed in those who did and did not initiate a CGRP inhibitor, using both crude estimates and those derived in propensity score overlap-weighted cohorts. Adjusted hazard ratios (HR) and corresponding 95% CI were computed. The principal exposure was initiation of any CGRP inhibitor. The primary end point was a composite of myocardial infarction (MI), cerebral ischemic stroke, revascularization, peripheral arterial disease, or central retinal artery occlusion (CRAO). Secondary end points included each component individually. A falsification end point (humeral fracture) was included.
Results: In total, 900,370 beneficiaries (median age 41 [Q1, Q3: 31, 51] years; 77.8% female) were included, of whom 58,679 initiated a CGRP inhibitor and 841,691 did not initiate a CGRP inhibitor during the study period. Beneficiaries initiating a CGRP inhibitor exhibited a greater degree of cardiovascular morbidity at baseline than noninitiators. In the overlap-weighted analysis, there was a higher rate of the primary end point among beneficiaries who initiated a CGRP inhibitor (8.77 events/1,000 person-years vs 6.76 events/1,000 person-years; aHR 1.26 [95% CI 1.10-1.45]). Initiation of a CGRP inhibitor was associated with a significantly higher rate of one secondary end point (ischemic stroke [aHR 1.26 (95% CI 1.07-1.49)]) but not 4 other secondary end points: MI, revascularization, CRAO, and intracranial hemorrhage.
Discussion: In a nationwide cohort study, initiation of a CGRP inhibitor was associated with an increased risk of a composite of cardiovascular events; however, the magnitude of the increased risk was low.
Classification of evidence: This study provides Class II evidence that in patients with migraine, initiation of a CGRP inhibitor was associated with a modestly increased risk of a composite of cardiovascular events.
背景和目的：降钙素基因相关肽（CGRP）抑制剂在美国已广泛用于治疗偏头痛，但缺乏其心血管风险的数据。本研究的目的是确定暴露于CGRP抑制剂是否与偏头痛患者的心血管事件相关。方法：回顾性、观察性、队列研究使用来自专有的、基于保险的登记处MarketScan （Merative）的计算机索赔数据进行。受益人至少有一项索赔与偏头痛诊断有关，并且在偏头痛诊断前至少连续覆盖12个月。使用顺序试验框架，使用粗略估计和倾向评分重叠加权队列得出的结果，计算了使用和未使用CGRP抑制剂的患者的心血管事件发生率。计算校正风险比（HR）和相应的95% CI。主要暴露是任何CGRP抑制剂的起始。主要终点是心肌梗死（MI）、缺血性脑卒中、血运重建术、外周动脉疾病或视网膜中央动脉闭塞（CRAO）的组合。次要终点分别包括每个成分。伪造终点（肱骨骨折）包括在内。结果：共纳入900,370名受益人（中位年龄41岁[Q1， Q3: 31, 51]岁；77.8%为女性），其中58,679人在研究期间开始使用CGRP抑制剂，841,691人未使用CGRP抑制剂。启动CGRP抑制剂的受益人在基线时比未启动者表现出更大程度的心血管发病率。在重叠加权分析中，开始使用CGRP抑制剂的受益人的主要终点发生率更高（8.77事件/ 1000人年vs 6.76事件/ 1000人年；aHR 1.26 [95% CI 1.10-1.45]）。开始使用CGRP抑制剂与一个次要终点（缺血性卒中[aHR 1.26 (95% CI 1.07-1.49)]）的发生率显著升高相关，但与其他4个次要终点（心肌梗死、血运重建、CRAO和颅内出血）的发生率无关。讨论：在一项全国性队列研究中，开始使用CGRP抑制剂与心血管事件复合风险增加相关；然而，风险增加的幅度很低。证据分类：该研究提供了II级证据，表明偏头痛患者开始使用CGRP抑制剂与心血管事件复合风险适度增加相关。
{"title":"Calcitonin Gene-Related Peptide Inhibitors and Cardiovascular Events in Patients With Migraine: A Retrospective, Observational Cohort Study.","authors":"Jay B Lusk, Lauren E Wilson, Carlene Moore, Stephanie Yarnell, Cheryl Kalapura, Aparna Choudhury, Matthew Schrag, Sven Poli, Fan Li, Brian Mac Grory","doi":"10.1212/WNL.0000000000214479","DOIUrl":"10.1212/WNL.0000000000214479","url":null,"abstract":"<p><strong>Background and objectives: </strong>Calcitonin gene-related peptide (CGRP) inhibitors have entered widespread use in the United States for treatment of migraine, but data on their cardiovascular risk profile are lacking. The objective of this study was to determine whether exposure to a CGRP inhibitor is associated with cardiovascular events in patients with migraine.</p><p><strong>Methods: </strong>A retrospective, observational, cohort study was conducted using computerized claims data from a proprietary, insurance-based registry, MarketScan (by Merative). Beneficiaries with at least one claim related to a migraine diagnosis and continuous coverage for at least 12 months before migraine diagnosis were included. Using a sequential trial framework, the rate of cardiovascular events was computed in those who did and did not initiate a CGRP inhibitor, using both crude estimates and those derived in propensity score overlap-weighted cohorts. Adjusted hazard ratios (HR) and corresponding 95% CI were computed. The principal exposure was initiation of any CGRP inhibitor. The primary end point was a composite of myocardial infarction (MI), cerebral ischemic stroke, revascularization, peripheral arterial disease, or central retinal artery occlusion (CRAO). Secondary end points included each component individually. A falsification end point (humeral fracture) was included.</p><p><strong>Results: </strong>In total, 900,370 beneficiaries (median age 41 [Q1, Q3: 31, 51] years; 77.8% female) were included, of whom 58,679 initiated a CGRP inhibitor and 841,691 did not initiate a CGRP inhibitor during the study period. Beneficiaries initiating a CGRP inhibitor exhibited a greater degree of cardiovascular morbidity at baseline than noninitiators. In the overlap-weighted analysis, there was a higher rate of the primary end point among beneficiaries who initiated a CGRP inhibitor (8.77 events/1,000 person-years vs 6.76 events/1,000 person-years; aHR 1.26 [95% CI 1.10-1.45]). Initiation of a CGRP inhibitor was associated with a significantly higher rate of one secondary end point (ischemic stroke [aHR 1.26 (95% CI 1.07-1.49)]) but not 4 other secondary end points: MI, revascularization, CRAO, and intracranial hemorrhage.</p><p><strong>Discussion: </strong>In a nationwide cohort study, initiation of a CGRP inhibitor was associated with an increased risk of a composite of cardiovascular events; however, the magnitude of the increased risk was low.</p><p><strong>Classification of evidence: </strong>This study provides Class II evidence that in patients with migraine, initiation of a CGRP inhibitor was associated with a modestly increased risk of a composite of cardiovascular events.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e214479"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12782279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2026-01-09DOI: 10.1212/WNL.0000000000214149
Craig Anderson
{"title":"Medical Big Data for Studying Cerebral Amyloid Angiopathy: New Opportunities, Familiar Challenges.","authors":"Craig Anderson","doi":"10.1212/WNL.0000000000214149","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214149","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e214149"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145945266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2025-12-31DOI: 10.1212/WNL.0000000000214564
Antonio Cabrera Muras, Juan José Gómez Muga, Lander Antón Méndez, Juan Carlos Garcia-Monco
{"title":"Teaching NeuroImage: Acquired Midbrain Cleft in a Professional Boxer.","authors":"Antonio Cabrera Muras, Juan José Gómez Muga, Lander Antón Méndez, Juan Carlos Garcia-Monco","doi":"10.1212/WNL.0000000000214564","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214564","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e214564"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2026-01-08DOI: 10.1212/WNL.0000000000210312
Jian Huang
{"title":"Reader Response: Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours: A Systematic Review and Meta-Analysis of Randomized Trials.","authors":"Jian Huang","doi":"10.1212/WNL.0000000000210312","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210312","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e210312"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-10Epub Date: 2026-01-08DOI: 10.1212/WNL.0000000000214622
Alexander German, Alexander Grotemeyer, Veit Rothhammer, Arnd Doerfler, Juergen Winkler, Martin Regensburger
We present a case of reversible leukoencephalopathy and parkinsonism associated with type III mixed cryoglobulinemic vasculitis in a patient who initially presented with systemic vasculitic symptoms such as rash and arthralgias. Neither hepatitis C nor monoclonal gammopathy-typical triggers of cryoglobulinemia-was identified. The neurologic syndrome evolved with tremor, rigidity, significant cognitive decline, and extensive white matter abnormalities on MRI, mimicking primary neurodegenerative conditions such as multiple system atrophy. Diagnostic workup ruled out infectious, metabolic, autoimmune, and drug-related etiologies. After immunosuppressive therapy with methotrexate and steroids, the patient experienced marked clinical and radiologic improvement, paralleled by a decline in serum neurofilament levels. This case highlights the importance of recognizing inflammatory CNS involvement as a potentially reversible cause of rapidly progressive parkinsonism and cognitive impairment. Prompt identification and timely immunosuppressive treatment may reverse symptoms and prevent permanent neurologic damage.
{"title":"Pearls & Oy-sters: Reversible Leukoencephalopathy and Parkinsonism Due to CNS Involvement in Cryoglobulinemia.","authors":"Alexander German, Alexander Grotemeyer, Veit Rothhammer, Arnd Doerfler, Juergen Winkler, Martin Regensburger","doi":"10.1212/WNL.0000000000214622","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214622","url":null,"abstract":"<p><p>We present a case of reversible leukoencephalopathy and parkinsonism associated with type III mixed cryoglobulinemic vasculitis in a patient who initially presented with systemic vasculitic symptoms such as rash and arthralgias. Neither hepatitis C nor monoclonal gammopathy-typical triggers of cryoglobulinemia-was identified. The neurologic syndrome evolved with tremor, rigidity, significant cognitive decline, and extensive white matter abnormalities on MRI, mimicking primary neurodegenerative conditions such as multiple system atrophy. Diagnostic workup ruled out infectious, metabolic, autoimmune, and drug-related etiologies. After immunosuppressive therapy with methotrexate and steroids, the patient experienced marked clinical and radiologic improvement, paralleled by a decline in serum neurofilament levels. This case highlights the importance of recognizing inflammatory CNS involvement as a potentially reversible cause of rapidly progressive parkinsonism and cognitive impairment. Prompt identification and timely immunosuppressive treatment may reverse symptoms and prevent permanent neurologic damage.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 3","pages":"e214622"},"PeriodicalIF":8.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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