Neurology最新文献

{"title":"Prenatal and Early Postnatal Lead Exposure and Later Adulthood Cognitive Function in the St. Louis Baby Tooth-Later Life Health Study.","authors":"Ruby C Hickman, Joyce J Y Lin, Kaleigh A McAlaine, Tracy Punshon, Brian P Jackson, Felicitas B Bidlack, Laura T Germine, Scott M Bartell, Joseph J Mangano, Justin Farmer, Joel Schwartz, Rajarshi Mukherjee, Susan A Korrick, Marc G Weisskopf","doi":"10.1212/WNL.0000000000214616","DOIUrl":"10.1212/WNL.0000000000214616","url":null,"abstract":"<p><strong>Background and objectives: </strong>Early exposure to lead has known neurocognitive impacts in childhood, but few studies have examined the long-term impacts extending into later adulthood. We estimated associations between prenatal and early postnatal lead exposure and later adulthood cognitive function and examined specific periods of exposure and effect modification by sex.</p><p><strong>Methods: </strong>The St. Louis Baby Tooth-Later Life Health study (SLBT) is a prospective cohort study that re-enrolled participants of the Baby Tooth Survey, originally centered in St. Louis, MO, who had donated their deciduous teeth between 1958 and 1972. SLBT participants completed surveys and a battery of cognitive tests in later adulthood. Tooth dentin lead concentrations were assessed using laser ablation inductively coupled plasma mass spectrometry across prenatal (second and third trimesters) and early postnatal periods. Cognitive function was assessed using a computerized cognitive battery taken at home using computers or personal digital devices. We used weighted generalized estimating equations to estimate associations between lead exposure and a composite outcome of later adulthood cognitive function.</p><p><strong>Results: </strong>A total of 715 participants (52% female, mean age at cognitive testing: 62 years) had completed tooth metals analysis. The association between lead and performance on the vocabulary test was positive and statistically significantly different from the other tests. For each part per million (ppm) higher second trimester tooth dentin lead concentration, performance on a composite of tests excluding vocabulary was 0.07 SDs lower (95% CI -0.15 to 0.02). This effect was similar when coadjusting for third trimester and postnatal lead. These findings were driven by females, among whom each 1 ppm higher second trimester lead concentration was statistically significantly associated with 0.16 SD worse cognitive function (95% CI -0.29 to -0.03), equivalent to a 3-year difference in age in the same model. The results were robust to adjustment for additional potential sources of confounding and alternate methods of averaging tooth lead concentrations.</p><p><strong>Discussion: </strong>We found suggestive evidence for associations between early lead exposures and later adulthood cognitive function, although these only reached statistical significance for second trimester lead exposure among females. A coadjusted analysis suggested the second trimester may be most relevant for later cognitive function.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 6","pages":"e214616"},"PeriodicalIF":8.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220489","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}

{"title":"Previous Antiplatelet Therapy and Outcomes of Acute Ischemic Stroke With Large Vessel Occlusion Treated With Direct Endovascular Therapy.","authors":"Zeno Benci, Giovanni Bianco, Giulio Disanto, Susanne Wegener, David Julian Seiffge, Jan Gralla, Mira Katan, Marios Psychogios, Marco Pileggi, Gian Marco De Marchis, Patrik Michel, Tamer Jubeh, Sami Curtze, João Pedro Marto, Andrea Zini, Alessandro Pezzini, Nabila Wali, Paul J Nederkoorn, Visnja Padjen, Stefan T Engelter, Henrik Gensicke, Roberta Noseda, Carlo W Cereda","doi":"10.1212/WNL.0000000000214672","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214672","url":null,"abstract":"<p><strong>Background and objectives: </strong>Previous antiplatelet therapy (APT) may influence outcomes in patients undergoing direct endovascular therapy (EVT) for anterior circulation large vessel occlusion (LVO) stroke, but evidence on clinical benefits and safety is limited and inconsistent. We aimed to evaluate the effects of previous APT on the outcomes of direct EVT.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of consecutive patients treated at 20 high-volume stroke centers across 9 European countries and Israel (EVA-TRISP registry, 2015-2023). We included adults with anterior circulation LVO strokes, without previous use of IV thrombolysis (IVT) or anticoagulants. We compared outcomes of direct EVT patients stratified by previous APT regimen, using propensity score matching based on medical history and multilevel models to address confounders. The primary outcome was the 90-day modified Rankin Scale (mRS) score. The secondary efficacy outcomes were 90-day independence and the rate of successful reperfusion. The secondary safety outcomes were the rate of symptomatic intracranial hemorrhage (sICH) and mortality.</p><p><strong>Results: </strong>Among 12,950 patients, 2,611 met the criteria and 1,308 were matched: 480 without previous APT and 828 with any previous APT, among whom 764 were on single APT and 64 on dual APT. The overall mean age was 75.8 ± 11.4 years, and 49.4% were female; the mean NIH Stroke Scale score was 13.1 ± 7.2 points, the successful reperfusion rate was 74.7%, and the median mRS score was 3 (interquartile range 2-4), with 38.8% of patients independent at 90 days. When compared with no previous APT, any previous APT was associated with a shift toward lower mRS scores at 90 days (odds ratio [OR] 1.30, CI 1.04-1.61, <i>p</i> = 0.018). Independence at 90 days was associated with any previous APT (OR 1.62, CI 1.22-2.16, <i>p</i> = 0.001). Any previous APT was not associated with successful reperfusion (OR 0.96, CI 0.69-1.35, <i>p</i> = 0.821), sICH (OR 1.06, CI 0.47-2.39, <i>p</i> = 0.880), or mortality (OR 0.89, CI 0.66-1.21, <i>p</i> = 0.821). There was no significant interaction between any previous APT and proximal/distal occlusion location (<i>p</i> = 0.213) or time-to-groin earlier/later than 6 hours (<i>p</i> = 0.743).</p><p><strong>Discussion: </strong>In patients with anterior circulation LVO stroke treated with direct EVT and no previous anticoagulation, pretreatment with any APT was independently linked to better 90-day functional outcomes and higher independence, without increasing sICH risk.</p><p><strong>Classification of evidence: </strong>This study provides Class III evidence that, in patients with anterior circulation LVO stroke treated with direct EVT, previous APT is associated with better 90-day functional outcomes compared with no previous APT.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 6","pages":"e214672"},"PeriodicalIF":8.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165722","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}

{"title":"Test-Retest Reliability of Remote Assessments in Patients With Myotonic Dystrophy Type 1.","authors":"Laura Tufano, Erin Richardson, Jeanne M Dekdebrun, Eleanor Stanton, Chandani Warnasooriya, Mikaella Docteur, Katy Eichinger, Johanna I Hamel","doi":"10.1212/WNL.0000000000214615","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214615","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;We previously demonstrated the feasibility of remote assessments in individuals with myotonic dystrophy type 1 (DM1). This study aimed to evaluate test-retest reliability and agreement of remote assessments and the interrater reliability of video-recorded functional assessments in DM1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants were remotely recruited from the National Registry and provided with a toolkit containing a tablet equipped with videoconferencing software and devices for strength and functional assessments. Two remote study visits (RSV1, RSV2) were conducted within 3 months. During each visit, participants completed video-supervised assessments: handgrip, pinch grip (PG), 9-hole peg test (9HPT), video hand opening time (vHOT), timed up and go (TUG), 10-meter walk/run test (10MWRT), sitting and supine forced vital capacity (FVC), sniff nasal inspiratory pressure (SNIP), and tongue and buccal strength tests. Timed tests were video-recorded and scored using standardized protocols. Intraclass correlation coefficients (ICCs) were calculated using 2-way mixed-effects model for test-retest reliability and 2-way random-effects model for interrater reliability. Agreement was evaluated using Bland-Altman plots and measurement sensitivity with minimal detectable differences at 95% confidence (MDD95%). Patient-reported outcomes (PROs) assessing dysphagia (Eating Assessment Tool-10 [EAT-10]) and upper and lower extremity function (Upper Extremity Function Index [UEFI], Lower Extremity Functional Scale [LEFS]) were collected at RSV1 and correlated with quantitative assessments (Spearman coefficient, ρ).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty individuals with DM1 (average age 47, 55% female) completed both RSVs. Test-retest reliability (ICC, 95% CI) was excellent for handgrip (0.99, 0.98-0.99), sitting and supine FVC (0.98, 0.96-0.99), 10MWRT (0.96, 0.91-0.98), TUG (0.94, 0.89-0.97), and 9HPT (0.93, 0.86-0.97) with adequate measurement sensitivity (MDD95% &lt;30% for all). ICCs were acceptable for PG (0.96, 0.92-0.98), tongue strength (0.93, 0.86-0.96), right (0.93, 0.85-0.97) and left buccal strength (0.88, 0.75-0.94), and SNIP (0.88, 0.77-0.94) and moderate for vHOT (thumb 0.67, 0.42-0.83; middle finger 0.66, 0.40-0.83), but with inadequate measurement sensitivity (MDD95% &gt;30% for all). Interrater reliability (ICC, 95% CI) was excellent for 9HPT (1), vHOT (thumb 0.99, 0.98-0.99; middle finger 0.98, 0.97-0.99), 10MWRT, and TUG (both 0.99, 0.98-0.99). Bland-Altman plots showed no systematic bias. Correlation (ρ, |95% CI|) was strong between handgrip and UEFI (+0.70, 0.49-0.84), 10MWRT and LEFS (-0.72, 0.86-0.49), and moderate between PG and UEFI (+0.60, 0.30-0.82), TUG and LEFS (-0.53, 0.73-0.23), and tongue strength and EAT-10 (-0.49, 0.71-0.20).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Remote assessments are feasible and safe. Many measurements demonstrate high reliability, show adequate measurement sensitivity","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 6","pages":"e214615"},"PeriodicalIF":8.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290637","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}

{"title":"Inflammation, Limbic White Matter Microstructure, and Clinical Symptoms After Repetitive Head Impacts.","authors":"Melissa Shuman Paretsky","doi":"10.1212/WNL.0000000000214721","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214721","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 6","pages":"e214721"},"PeriodicalIF":8.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290556","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}

{"title":"Contrast-Associated Acute Kidney Injury After Thrombectomy for Ischemic Stroke: Prognostic Impact and CAN-REST Predictive Score.","authors":"Ghil Schwarz, Angelo Cascio Rizzo, Gareth Ambler, Pawel Wrona, Agnieszka Slowik, Szymonn Kotas, Mohamed F Doheim, Alhamza R Al-Bayati, Raul G Nogueira, Ana Paiva Nunes, Patricia Ferreira, Matteo Paolucci, Andrea Zini, Luigi Simonetti, Norbert Leško, Jakub Fedorko, Zuzana Gdovinova, Luca Scarcia, Erwah Kalsoum, Firas Farhat, Morin Beyeler, Adnan Mujanovic, Marcel Arnold, Torcato Meira, Marta Morais, Leonor Francisco, Marcin Wiacek, Paulina Pudło, Halina Bartosik-Psujek, Patricia Calleja, Fernando Ostos, David Seoane, Anca Negrila, Razvan Alexandru Radu, Cristina Tiu, Sami Al Kasab, Ahmad Abu Qdais, Imad Samman Tahhan, Oscar Ayo-Martin, Maria Paya, Juan David Molina-Nuevo, Beata Labuz-Roszak, Danilo Toni, Karolina Moszko, Mateusz Łukasz Roszak, Manuela De Michele, Elena Barrile, Prasanna Eswaradass, Margaret Houghton, Tiffany Barkley, Amir Ali, Jelle Demeestere, Wayne Martin Bauknight, Sunil Sheth, Louise Maes, Anke Wouters, João Pedro Marto, Josè Blazer Costa, Nicola D Loizzo, Andrea Romi, Carmelo Tiberio Currò, Piotr Luchowski, Maksymilian Seweryn, Konrad Rejdak, Piers Klein, Mohamad Abdalkader, Valentina Saia, Antioco Sanna, Tiziana Tassinari, Maurizio Acampa, Francesca Rosini, Rossana Tassi, Marta Bilik, Anna Maria Bandzarewicz-Samcik, Jiangyong Min, Naser HajAissa, Marilena Mangiardi, Sabrina Anticoli, Enrico Pampana, Carlos Hervás-Testal, Ricardo Rigual, Blanca Fuentes, Davide Strambo, Carl Manuata Tetaria, Guillaume Saliou, Andrea Salvatore Caramma, Davide Maimone, Pier Andrea Rizzo, Marco Moci, Irene Scala, Antonio Cruz-Culebras, Rocío Vera Lechuga, Sebastián García-Madrona, Giovanni Merlino, Mariarosaria Valente, Arianna Cella, Manuel Bolognese, Lehel-Barna Lakatos, Grzegorz M Karwacki, Paolo Candelaresi, Vincenzo Andreone, Carlo Maurea, Roberto Tarletti, Angelica Mele, Antonio Ciacciarelli, Michele Alessiani, Gabriella Monteforte, David Pakizer, Martin Roubec, David Školoudík, Fenne Vandervorst, Sylvie De Raedt, Martijn Verdam, Josef Bartoš, Martin Sramek, Valentina Mazzoleni, Luca Quilici, Dario Alimonti, Jessica Moller, Ilaria Maestrini, Marina Diomedi, Giordano Lacidogna, Osama O Zaidat, Eugene Lin, Mohammad Almajali, Claudio Baracchini, Matteo Zaccagnino, Federica Viaro, Alessandro Pezzini, Giulia Avola, Chiara Ferraro, Milena Świtońska, Paulina Sobieszak-Skura, Grzegorz Meder, Lukas Mayer-Suess, Michael Knoflach, Elke R Gizewski, Matthew R Common, Patrick Nicholson, Sarah Power, Marta Nowakowska-Kotas, Michal Puła, Maciej Guzinski, Soledad Pérez-Sánchez, Joan Montaner, Alexandra Sevilla Bravo, Simona Marcheselli, Francesca Vodret, Costanza Maria Rapillo, Liliana Pereira, Miguel Rodrigues, Adam Jaros, Martin Kovar, Jan Vojik, Gloria Valcamonica, Serena Gallo Cassarino, Alessandra Cardillo, Marco Petruzzellis, Silvia Grimaldi, Nicola Marrone, Ameer E Hassan, Samantha Miller, Mohammad W Khasawneh, Valentina Poretto, Simone Tonello, Saverio Tollot, Aleksander DęBiec, Jacek Staszewski, Adam Stepien, Francisco Bernardo, Jorge Ferrao, Marialuisa Zedde, Rosario Pascarella, Alessandra Sanna, Rossella Meloni, Sennur Delibas, Simona Sacco, Maria Grazia Vittorini, Raffaele Ornello, Marina Mannino, Valeria Terruso, Marco Filizzolo, Emily Hall, Christine Roffe, Malgorzata Dorobek, Justyna Zielińska-Turek, Giuseppe Scopelliti, Leonardo Pantoni, Guglielmo C Pero, Antonio Macera, Amedeo Cervo, Simone Bellavia, Mine Sezgin, Yavuz Dilmen, Esme Ekizoglu, Georgios Tsivgoulis, Aikaterini Theodorou, Vlad Tiu, Cristina Aura Panea, Simona Petrescu, Mariangela Piano, Thanh N Nguyen, Maria Sessa","doi":"10.1212/WNL.0000000000214655","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214655","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication after exposure to iodinated contrast media. In patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the incidence and clinical impact are poorly characterized, and no validated prediction tool is currently available. The aim of this study was to assess the incidence and prognostic significance of CA-AKI in EVT-treated patients with AIS and to develop and validate a predictive score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January-December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score &gt;3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (&lt;i&gt;p&lt;/i&gt; &lt; 0.20), backward elimination (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615-3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110-2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057-2.216). A preprocedural risk model including 12 routine clinical variables-sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis-demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682-0.738]; precision-recall area under the curve 0.13 [95% CI 0.10-0.16]), good calibration (slope 0.870 [95% CI 0.759-0.928]), good overall performance (Brier score 0.045 [95% CI 0.042-0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedu","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"106 6","pages":"e214655"},"PeriodicalIF":8.5,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227145","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}

{"title":"Impact of Basal Ganglia Perivascular Spaces on Ischemic and Hemorrhagic Risks in Patients Taking Antithrombotic Therapies.","authors":"Soya Iwamoto,Kaori Miwa,Masatoshi Koga,Sohei Yoshimura,Kanta Tanaka,Yusuke Yakushiji,Makoto Sasaki,Haruhiko Hoshino,Masayuki Shiozawa,Yoshiki Yagita,Kohsuke Kudo,Yoshinari Nagakane,Masafumi Ihara,Kazutoshi Nishiyama,Jin Nakahara,Teruyuki Hirano,Kazunori Toyoda, ","doi":"10.1212/wnl.0000000000214745","DOIUrl":"https://doi.org/10.1212/wnl.0000000000214745","url":null,"abstract":"BACKGROUND AND OBJECTIVESEnlarged perivascular spaces (ePVSs) are considered to increase the risk of stroke. However, data regarding the benefits and risks of antithrombotic therapy in patients with ePVSs are currently limited. This study assessed the association between ePVSs and the risks of hemorrhagic or ischemic events in patients taking antithrombotic agents.METHODSThis prospective, multicenter observational study enrolled patients with cerebrovascular or cardiovascular diseases who had newly started or were continuing to take oral antithrombotic agents at 52 hospitals across Japan between 2016 and 2019. Baseline multimodal MRI was performed for all of the study participants. The images were then centrally evaluated for cerebral small vessel disease (SVD), including white matter hyperintensities, cerebral microbleeds, lacunes, and basal ganglia-enlarged perivascular spaces (BGPVSs). BGPVSs were categorized as 0, 1-10, 11-20, or ≥21. Outcomes included major bleeding, intracranial hemorrhage, ischemic events, ischemic stroke, and mortality. Multivariable Cox proportional hazards models were used for the BGPVSs (in categorical and ordinal forms), adjusted for patient demographics, vascular risk factors, and other SVD markers.RESULTSOf the total 5,065 patients (1,663 women; median age 74 [interquartile range 67-81] years), antiplatelets and anticoagulants were administered at the baseline to 3,820 (75.4%) and 1,502 (29.7%) patients, respectively. Their BGPVS distributions were as follows: 0, 475 (9.4%); 1-10, 2,615 (51.6%); 11-20, 1,267 (25.0%); and 21+, 708 patients (14.0%). Over a median follow-up period of 2.0 (interquartile range 1.8-2.0) years, we noted 266 ischemic events, 188 ischemic strokes, 92 major bleeding events, 54 intracranial hemorrhages, and 198 deaths. Higher BGPVS was associated with an increased risk of major bleeding (BGPVS ≥21: adjusted hazard ratio [aHR] 4.04, 95% CI 1.17-13.92; per-unit increase: aHR 1.38, 95% CI 1.07-1.77) and ischemic stroke (BGPVS ≥21: aHR 2.58, 95% CI 1.21-5.50; per-unit increase: aHR 1.28, 95% CI 1.07-1.53) but was not significantly associated with higher risks of ischemic events, intracranial hemorrhage, or mortality.DISCUSSIONHigher BGPVS burdens are associated with higher risks of ischemic stroke and major bleeding in patients receiving antithrombotic therapy. BGPVSs may serve as useful imaging biomarkers for vascular risk assessment and personalized therapy.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"1 1","pages":"e214745"},"PeriodicalIF":9.9,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490034","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}

{"title":"Teaching NeuroImages: Generalized Onset With Focal Evolution (GOFE) Seizures: A Rare and Newly Recognized Seizure Pattern in Generalized Epilepsy.","authors":"Hanife Saglam,Sarah Tolaymat,Amr Ewida","doi":"10.1212/wnl.0000000000214826","DOIUrl":"https://doi.org/10.1212/wnl.0000000000214826","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"13 1","pages":"e214826"},"PeriodicalIF":9.9,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490003","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}

{"title":"Striatal Dopamine Transporter and Rest Tremor in Parkinson Disease: A Clinical Validation.","authors":"Kalle J Niemi,Elina Jaakkola,Elina Maaria Myller,Mikael R E Eklund,Simo Nuuttila,Tuomas Mertsalmi,Kirsi-Marja Murtomäki,Reeta Levo,Tomm Noponen,Toni Ihalainen,Filip Scheperjans,Juho Joutsa,Valtteri Kaasinen","doi":"10.1212/wnl.0000000000214811","DOIUrl":"https://doi.org/10.1212/wnl.0000000000214811","url":null,"abstract":"BACKGROUND AND OBJECTIVESThe mechanisms underlying tremor generation in Parkinson disease (PD) remain unclear. Previously, we demonstrated a connection between rest tremor amplitude and higher dopamine transporter (DAT) binding in the ipsilateral striatum among the Parkinson Progression Markers Initiative cohort. Here, we investigated the association of parkinsonian motor symptoms with striatal DAT binding in a sizable and clinically representative sample of patients with parkinsonian signs to validate the previously observed ipsilateral relationship in PD.METHODSThis observational cross-sectional study included right-handed patients referred for [123I]FP-CIT SPECT because of clinically uncertain parkinsonism or tremor at Turku University Hospital and the Helsinki and Uusimaa Hospital District, Finland. Each patient underwent a comprehensive clinical evaluation and follow-up (median 3.0 years [interquartile range (IQR) 2.5]). Associations between striatal tracer binding and symptoms were investigated using voxel-wise linear models, adjusting for age, sex, motor symptom severity, and medication. The primary outcome measure was the association between rest tremor amplitude and striatal DAT binding.RESULTSAt the end of the follow-up period, of the 414 patients included (median age 68 years [IQR 14], 49.4% female), 148 were evaluated to have PD and 79 other forms of parkinsonism with striatal DAT deficit. In total, 187 patients had normal binding. Among the patients with PD, left and right rest tremor amplitudes were positively associated with ipsilateral striatal DAT binding (β = +0.12 [95% CI +0.05, +0.19] and +0.10 [+0.05, +0.15] specific binding ratio [SBR] per point; pFWE + Bonf. < 0.05, respectively). Left and right bradykinesia (β = -0.16 [-0.22, -0.09] and -0.18 [-0.25, -0.10] SBR per 5 points, pFWE + Bonf. < 0.05, respectively) and rigidity (β = -0.07 [-0.08, -0.04] and -0.08 [-0.11, -0.05] SBR per point, pFWE + Bonf. < 0.05, respectively) mainly showed a negative association with contralateral striatal DAT binding. No consistent associations were observed in non-PD groups.DISCUSSIONThese findings confirm the positive association between rest tremor amplitude and ipsilateral striatal DAT binding in a clinical sample of PD patients. However, the non-PD groups were diagnostically heterogeneous, limiting conclusions about disease specificity.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"11 1","pages":"e214811"},"PeriodicalIF":9.9,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483690","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}

{"title":"Resting-State EEG Microstates as Dynamic Biomarkers of Network Dysfunction and Cognitive Impairment in Patients With Multiple Sclerosis.","authors":"Giorgio Leodori,Davide Maccarrone,Marco Mancuso,Maria Ilenia De Bartolo,Angelo Collura,Stefano Pellegrini,Leonardo Malimpensa,Federica Satriano,Mariangela Fratino,Daniele Belvisi,Gina Ferrazzano,Diego Centonze,Antonella Conte","doi":"10.1212/wnl.0000000000214778","DOIUrl":"https://doi.org/10.1212/wnl.0000000000214778","url":null,"abstract":"BACKGROUND AND OBJECTIVESMultiple sclerosis (MS) is characterized by large-scale brain network dysfunctions. EEG microstate analysis may track these dynamics. We investigated whether microstates could distinguish patients with MS from healthy volunteers, and cognitively impaired from cognitively preserved (CP) patients.METHODSFor this cross-sectional observational study, we recruited participants from the Policlinico Umberto I Multiple Sclerosis Center (Rome). We compared microstates of patients with relapsing-remitting MS (Expanded Disability Status Scale [EDSS] score <3, no relapses within 30 days) with those of age-matched and sex-matched healthy volunteers. We also compared cognitively impaired and preserved patients. Group comparisons were performed on microstate temporal parameters and topographies (topographic analysis of variance). Classification used stepwise linear discriminant analysis (LDA).RESULTSWe enrolled 88 patients with MS (60 women, mean age 42.75 years) and 46 healthy volunteers (23 women, mean age 33.7 years). Compared with healthy volunteers (n = 45, 23 women, mean age 33.7 years), patients with MS (n = 46, 25 women, mean age 34.6 years) showed greater explained variance (p < 0.001), occurrence (p < 0.001), and coverage (p < 0.001) of class B (visual network) and reduced mean duration (MD) of classes F (salience network, p = 0.014) and G (sensorimotor network, p = 0.009). Topographic differences were found between cognitively impaired (n = 57, 20 women, mean age 35.5 years) and preserved (n = 31, 40 women, mean age 46.7 years) patients for classes C, F, and G (p < 0.05). Patients with cognitive impairment exhibited significantly reduced explained variance of class F (p = 0.003). Class A was associated with longer disease duration (explained variance, p = 0.006; MD, p = 0.042; coverage, p = 0.007), higher EDSS scores (MD, p = 0.013), and poorer ambulation (explained variance, p = 0.049). Class D inversely correlated with EDSS scores (occurrence, p = 0.011; coverage, p = 0.036), whereas class B inversely correlated with information processing speed (explained variance, p = 0.025; occurrence, p = 0.018; coverage, p = 0.028). Stepwise LDA identified classes B and D as discriminators between patients with MS and healthy volunteers (77% accuracy, p < 0.001), and class F as a discriminator between CP and impaired participants (64.8% accuracy, p = 0.007).DISCUSSIONEEG microstates reveal behaviorally relevant alterations in patients with MS, supporting their utility as sensitive markers of large-scale functional network reorganization associated with clinical disability.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"189 1","pages":"e214778"},"PeriodicalIF":9.9,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483689","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}

{"title":"Systolic Blood Pressure Trajectory and Outcomes in Acute Intracerebral Hemorrhage: Pooled Analysis of the 4 INTERACT and ATACH-II Clinical Trials.","authors":"Xia Wang,Thanh G Phan,Xinwen Ren,Henry H Ma,Qiang Li,Menglu Ouyang,Candice Delcourt,Xiaoying Chen,Jiguang Wang,Thompson G Robinson,Hisatomi Arima,Lu Ma,Xin Hu,Chao You,Leibo Liu,Paula Munoz Venturelli,Sheila Co Martins,Octavio M Pontes-Neto,John Philip Chalmers,Lili Song,Adnan I Qureshi,Craig Anderson","doi":"10.1212/wnl.0000000000214671","DOIUrl":"https://doi.org/10.1212/wnl.0000000000214671","url":null,"abstract":"BACKGROUND AND OBJECTIVESWhile moderate and rapid systolic blood pressure (SBP) lowering was associated with better functional outcomes after intracerebral hemorrhage (ICH), large reductions in SBP within 1 hour, for example, reductions from >200 to <140 mm Hg, diminished or even reversed these beneficial effects. We aimed to define the optimal trajectory of SBP control in relation to favorable functional outcomes after acute ICH.METHODSWe conducted a pooled analysis of individual patient-level data from all 4 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) and second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trials, which were international, randomized, open-label, blinded, end point-assessed, controlled trials that determined the effectiveness of early intensive SBP control in acute ICH. Latent class analysis grouped SBP trajectories over the first 24 hours (9 measurements) into defined clusters. The primary outcome was functional recovery at 90 days after randomization, defined as modified Rankin Scale (mRS) scores of 3-6. Logistic regression models with adjustment for baseline covariates and trial were used to determine associations between SBP cluster trajectories and outcomes in INTERACT, with validation in ATACH-II.RESULTSA total of 11,269 patients (INTERACT n = 10,269; ATACH-II n = 1,000; mean age 62.4 years; female 36.4%) with at least 1 postrandomization SBP reading were included. Six SBP trajectories were identified: low, moderate-to-low, moderate, high, high-to-moderate, and high-to-low. Compared with the low SBP group, associations with poor functional outcome (mRS scores 3-6) increased progressively across other groups in INTERACT (p = 0.04 for trend). Adjusted odds ratios (95% CI) for groups 2 to 6 were 1.16 (0.98-1.37), 1.44 (1.18-1.75), 1.46 (1.15-1.87), 1.90 (1.32-2.73), and 1.28 (1.02-1.60), respectively. A similar albeit nonsignificant trend was observed in ATACH-II due to limited power.DISCUSSIONDistinct SBP trajectories over 24 hours defined prognosis after ICH, with a severe hypertensive group having the highest odds of death or disability, regardless of the BP-lowering strategy used. These findings highlight the importance of well-controlled but tailored SBP management strategies after ICH.CLASSIFICATION OF EVIDENCEThis study provides Class III evidence that distinct SBP trajectories over 24 hours are associated with prognosis after acute ICH, with a severe hypertensive group having the highest odds of poor functional outcome, regardless of the BP-lowering strategy used.TRIAL REGISTRATION INFORMATION(INTERACT1 NCT00226096; INTERACT2 NCT00716079; INTERACT3 NCT03209258; INTERACT4 NCT03790800; ATACH-2 NCT01176565).","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"89 1","pages":"e214671"},"PeriodicalIF":9.9,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483687","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}