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Medical Big Data for Studying Cerebral Amyloid Angiopathy: New Opportunities, Familiar Challenges. 脑淀粉样血管病研究的医学大数据:新机遇,老挑战。
IF 8.5 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-10 Epub Date: 2026-01-09 DOI: 10.1212/WNL.0000000000214149
Craig Anderson
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引用次数: 0
Tiger Man Sign in Sarcoid Myopathy. 结节性肌病的虎人征。
IF 8.5 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-10 Epub Date: 2025-12-31 DOI: 10.1212/WNL.0000000000214604
Qing Sun, Xin Lu, Xinyue Xiao, Xia Liu, Yunchao Su, Renbin Wang, Wei Wang
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引用次数: 0
Teaching NeuroImage: Acquired Midbrain Cleft in a Professional Boxer. 教学神经影像:职业拳击手后天性中脑裂。
IF 8.5 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-10 Epub Date: 2025-12-31 DOI: 10.1212/WNL.0000000000214564
Antonio Cabrera Muras, Juan José Gómez Muga, Lander Antón Méndez, Juan Carlos Garcia-Monco
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引用次数: 0
Reader Response: Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours: A Systematic Review and Meta-Analysis of Randomized Trials. 读者反应:替奈普酶与阿替普酶在4.5小时内治疗急性缺血性卒中:随机试验的系统评价和荟萃分析。
IF 8.5 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-10 Epub Date: 2026-01-08 DOI: 10.1212/WNL.0000000000210312
Jian Huang
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引用次数: 0
Pearls & Oy-sters: Reversible Leukoencephalopathy and Parkinsonism Due to CNS Involvement in Cryoglobulinemia. 珍珠和卵:可逆性脑白质病和帕金森病由于中枢神经系统参与冷球蛋白血症。
IF 8.5 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-10 Epub Date: 2026-01-08 DOI: 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.

我们报告一例可逆性脑白质病和帕金森病合并III型混合性冷球蛋白性血管炎,患者最初表现为全身血管症状,如皮疹和关节痛。丙型肝炎和单克隆伽玛病(低温球蛋白血症的典型诱因)均未被发现。神经系统综合征演变为震颤、僵硬、显著的认知能力下降和MRI上广泛的白质异常,类似于原发性神经退行性疾病,如多系统萎缩。诊断排除了感染性、代谢性、自身免疫性和药物相关的病因。在用甲氨蝶呤和类固醇进行免疫抑制治疗后,患者的临床和放射学表现明显改善,同时血清神经丝水平下降。本病例强调了认识到炎症性中枢神经系统受累作为快速进行性帕金森病和认知障碍的潜在可逆原因的重要性。及时识别和及时的免疫抑制治疗可以逆转症状,防止永久性的神经损伤。
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引用次数: 0
Pearls & Oy-sters: Hereditary Spastic Paraplegia Type 15 Presenting as Juvenile Onset Levodopa-Responsive Parkinsonism. 珍珠和男孩:遗传性痉挛性截瘫15型表现为青少年发作的左旋多巴反应性帕金森病。
IF 8.5 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-02-10 Epub Date: 2026-01-08 DOI: 10.1212/WNL.0000000000214514
Abhilash Thatikala, Aditya Vikram Boddu, Divya Nayar, Tuhin Virmani

We report the case of a 27-year-old man with a history of speech delay and chronic, progressive movement disorder. He first developed gait difficulty at the age of 12. Given clinical signs of bradykinesia and resting tremor, he received a clinical diagnosis of childhood-onset parkinsonism. Treatment with oral levodopa initially improved symptoms, but after 2 years, he developed motor fluctuations and dyskinesias. Additional signs of spasticity and brain MRI showing a thin corpus callosum prompted genetic testing that identified a heterozygous pathogenic variant in the PRKN gene. However, he exhibited a progressive loss of response to chronic dopaminergic therapy, first with oral and later with continuous levodopa-carbidopa intestinal gel infusion, with disease progression over 7 years. This progression led to further genetic testing and the diagnosis of hereditary spastic paraplegia type 15 (SPG 15). Advancing motor symptoms prompted deep brain stimulation and botulinum toxin injections, although these had limited benefit. This case highlights the challenges of diagnosing and managing juvenile-onset parkinsonism and the value of comprehensive genetic analysis in evaluating genotypic-phenotypic correlations. Hereditary spastic paraplegias (HSPs) are a rare group of neurodegenerative disorders with diverse clinical and genetic features. They can be inherited in autosomal dominant, recessive, X-linked, or mitochondrial patterns. The SPG15 subtype (or HSP-ZFYVE26), caused by pathogenic variants in the ZFYVE26 gene, is a common form of autosomal recessive HSP. Presenting symptoms vary but commonly include cognitive impairment with a history of speech delay or learning disability and balance impairment or clumsiness from spasticity of the lower limbs.

我们报告的情况下,一个27岁的男子语言延迟和慢性进行性运动障碍的历史。他12岁时开始出现步态困难。鉴于运动迟缓和静息性震颤的临床症状,他接受了儿童期帕金森病的临床诊断。口服左旋多巴最初改善了症状,但2年后,他出现了运动波动和运动障碍。痉挛的其他迹象和脑MRI显示胼胝体薄,促使基因检测确定了PRKN基因的杂合致病变异。然而,他对慢性多巴胺能治疗的反应逐渐丧失,先是口服,后来持续左旋多巴-卡比多巴肠凝胶输注,病情进展超过7年。这一进展导致进一步的基因检测和遗传性痉挛性截瘫15型(spg15)的诊断。运动症状的恶化促使深部脑刺激和肉毒杆菌毒素注射,尽管这些方法的效果有限。本病例强调了诊断和管理青少年发病帕金森病的挑战,以及综合遗传分析在评估基因型-表型相关性方面的价值。遗传性痉挛性截瘫(HSPs)是一种罕见的神经退行性疾病,具有多种临床和遗传特征。它们可以常染色体显性、隐性、x连锁或线粒体模式遗传。SPG15亚型(或HSP-ZFYVE26)由ZFYVE26基因的致病变异引起,是常染色体隐性遗传病的一种常见形式。其症状各不相同,但通常包括有语言迟缓或学习障碍史的认知障碍、下肢痉挛引起的平衡障碍或笨拙。
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引用次数: 0
SUDEP Awareness: A Gulf Neurologists Must Cross. 突然意识:神经科医生必须跨越的鸿沟。
IF 9.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-01-30 DOI: 10.1212/wnl.0000000000214720
Anup D Patel,Neil Kulkarni
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引用次数: 0
Author Response: The Time Has Come. The Time Is Now. IV Alteplase, Will You Please Go Now? 作者回应:时机已到。时间就是现在。请你现在就走好吗?
IF 9.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-01-30 DOI: 10.1212/wnl.0000000000213380
Anna Ranta
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引用次数: 0
Reader Response: The Time Has Come. The Time Is Now. IV Alteplase, Will You Please Go Now? 读者回应:时机已到。时间就是现在。请你现在就走好吗?
IF 9.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-01-30 DOI: 10.1212/wnl.0000000000213342
Steven H Horowitz
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引用次数: 0
SUDEP Awareness and Effect on Parental Trauma, Grief, and Coping After the Death of a Child: A Qualitative Investigation. 猝死意识及其对父母创伤、悲伤和儿童死亡后应对的影响:一项定性调查。
IF 9.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2026-01-30 DOI: 10.1212/wnl.0000000000214623
Itay Tokatly Latzer,Daniel Friedman,David N Williams,Gardiner Lapham,Alison Kukla,Orit Karnieli-Miller,Phillip L Pearl
BACKGROUND AND OBJECTIVESSudden unexpected death in epilepsy (SUDEP) is the leading cause of seizure-related deaths in people with epilepsy. Despite evidence that SUDEP counseling does not cause stress, improves treatment adherence, and empowers people with epilepsy and their caregivers, it remains underdiscussed. This study aimed to explore the in-depth perspectives of parents who have lost a child to SUDEP, focusing on their experiences, grief, and coping strategies, while factoring in their demographics, the clinical features of their deceased children, and their previous awareness of SUDEP, all aspects that have not been systematically investigated before.METHODSThis qualitative phenomenological study involved in-depth semistructured interviews with 51 parents of 43 children who died of SUDEP. Transcripts were analyzed using immersion/crystallization qualitative methodology with Dedoose software, using an iterative consensus-building process. Thematic analysis revealed common perspectives, grief narratives, coping strategies, and perceived needs among parents after their child's SUDEP.RESULTSOf the 51 participating parents (mean age 54.1 ± 9.4 years, 71% female), 27 reported being unaware of SUDEP before it occurred, whereas 24 reported previous awareness of it. These groups shared similar demographics and clinical characteristics. However, "unaware" parents expressed more intense trauma and prolonged maladaptive grief, characterized by guilt, extreme anger, and medical distrust. By contrast, "aware" parents described mitigated trauma, with less guilt- and anger-ridden grief, and reduced reliance on specialized support groups. Previous SUDEP awareness provided emotional preparation, buffering the devastating reality and fostering agency and acceptance. Another theme highlighted the struggles parents faced immediately after SUDEP, particularly with law enforcement and treating physicians. Unanimously, parents emphasized the paramount importance of counseling about the known relationship between epilepsy and SUDEP.DISCUSSIONPrevious awareness of SUDEP (or lack thereof) has complex and far-reaching effects on the subsequent parental perceived trauma, grief, and coping processes. Furthermore, emergency responders, official personnel, and treating physicians may mishandle the aftermath of SUDEP. This study's findings strongly advocate for a paradigm shift in SUDEP-related practices across multiple disciplines, including legislation. Emphasis should be placed on increasing proactive SUDEP counseling to mitigate the traumatic effect and subsequent grieving process when SUDEP occurs.
背景与目的癫痫猝死(SUDEP)是癫痫患者癫痫相关死亡的主要原因。尽管有证据表明,癫痫猝死症咨询不会造成压力,提高治疗依从性,并赋予癫痫患者及其护理人员权力,但它仍未得到充分讨论。本研究旨在深入探讨因猝死而失去孩子的父母的观点,重点关注他们的经历、悲伤和应对策略,同时考虑他们的人口统计学特征、他们已故孩子的临床特征以及他们之前对猝死的认识,这些都是以前没有系统调查过的方面。方法采用半结构化访谈法对43例猝死患儿的51名家长进行定性现象学研究。使用浸泡/结晶定性方法和Dedoose软件分析转录本,使用迭代共识构建过程。主题分析揭示了父母在孩子猝死后的共同视角、悲伤叙事、应对策略和感知需求。结果51名家长(平均年龄54.1±9.4岁,71%为女性)中,27名家长在发病前未意识到SUDEP, 24名家长在发病前意识到SUDEP。这些组具有相似的人口统计学和临床特征。然而,“不知情”的父母表现出更强烈的创伤和长期的不适应悲伤,其特征是内疚、极度愤怒和对医生的不信任。相比之下,“有意识”的父母描述的创伤减轻了,内疚和愤怒的悲伤减少了,对专门支持团体的依赖也减少了。先前对猝死症的认识提供了情感准备,缓冲了毁灭性的现实,培养了能动性和接受性。另一个主题强调了父母在猝死后立即面临的斗争,特别是与执法部门和治疗医生的斗争。家长们一致强调,就癫痫和猝死之间的已知关系进行咨询至关重要。先前对猝死的意识(或缺乏意识)对随后父母感知到的创伤、悲伤和应对过程有着复杂而深远的影响。此外,紧急救援人员、官方人员和治疗医生可能对SUDEP的后果处理不当。这项研究的结果强烈主张在包括立法在内的多个学科中进行与sudap相关的实践范式转变。重点应放在增加主动的猝死咨询,以减轻发生猝死时的创伤效应和随后的悲伤过程。
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