Neurology India最新文献

Abstract: Posterior cervical surgery blindness (PCSB) is a rare but serious complication with significant implications for affected patients. Herein, we retrospectively analyzed two cases of postoperative blindness. Case 1: A 51-year-old with basilar invagination, atlantoaxial dislocation, and syringomyelia. Blindness, caused by central retinal artery occlusion, occurred after atlantoaxial decompression and fusion in the prone position. After the arterial thrombolytic therapy, the vision gradually improved. Case 2: A 58-year-old with radiculopathy-type cervical spondylosis. Blindness, caused by vitreous hemorrhage, occurred after dual-channel endoscopic cervical disc nucleotomy in the prone position. Vision did not recover after 1 year. PCSB is linked to the prone position and use of a horseshoe headrest. Early intra-arterial thrombolysis can significantly promote visual recovery. Preoperative counseling, careful intraoperative management, and active postoperative care are essential to reducing the risk.

Introduction: Carotid stenosis increases the risk of ischemic stroke in the ipsilateral carotid artery territory, contributing to 10-20% of all transient ischemic attacks and strokes. Carotid revascularization, including carotid endarterectomy and stenting, was performed to reduce this risk. This study aimed to evaluate the frequency of recurrent stroke in patients with symptomatic and asymptomatic carotid stenosis and to assess the risk factors for recurrent stroke after carotid stenting.

Objectives: This study included 330 patients aged >18 who underwent carotid stenting between January 2016 and April 2023. Patient data, including imaging and e-pulse records, were reviewed to identify whether recurrent strokes occurred after the procedure. This study aimed to determine the incidence of recurrent stroke and investigate its potential risk factors.

Results: Among the 330 patients who underwent carotid revascularization, 35 developed recurrent stroke during the follow-up period. No significant difference was found in hypertension between the two groups (P = 0.453). However, diabetes was significantly more prevalent in the stroke group (P = 0.023). Univariate logistic regression revealed that the risk of recurrent stroke in patients was 2.27 times higher (95% CI: 1.10-4.68) than in nondiabetic patients (P = 0.026). Additionally, patients with a history of stroke had a 2.25 times higher risk of recurrent stroke (95% CI: 1.02-4.96) than those without a history of stroke (P = 0.045).

Conclusions: Carotid stenting is an effective treatment for preventing recurrent strokes. The risk of recurrent stroke is higher in patients with diabetes and a history of stroke. Close monitoring, including regular assessment of antiplatelet therapy and lipid management, is essential for reducing the risk of recurrent stroke in high-risk patients.

Background: Mild ischemic stroke (MIS) patients with disabling symptoms often receive intravenous thrombolysis; however, the optimal post-thrombolysis antiplatelet regimen, especially for those at risk of early neurological deterioration (END), remains uncertain.

Objectives: To compare the clinical efficacy and safety of three post-thrombolysis antiplatelet strategies in MIS patients with disabling symptoms or END.

Methods: This retrospective cohort study included 243 MIS patients (NIHSS ≤ 3) who received intravenous thrombolysis. Patients were assigned to one of three groups based on antiplatelet regimens initiated 24 hours post-thrombolysis: aspirin monotherapy, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel, or tirofiban bridging followed by sequential DAPT. Clinical outcomes, including NIHSS improvement, modified Rankin Scale (mRS) scores, and adverse events, were evaluated on Day 7 and Day 90. Multivariate logistic regression was used to identify predictors of favorable functional outcomes (mRS ≤ 2 at 90 days).

Results: At Day 7, the tirofiban group exhibited significantly lower NIHSS scores (1.5 ± 1.1) compared to the aspirin group (2.1 ± 1.3; P = 0.04). At Day 90, the tirofiban group had the highest rate of functional independence (84.6% vs. 75.0% in the aspirin group). Multivariate analysis identified tirofiban bridging as an independent predictor of favorable outcomes (OR = 2.08, 95% CI: 1.01-4.30; P = 0.047). Safety outcomes, including symptomatic intracranial hemorrhage and systemic bleeding, were comparable across all groups.

Conclusion: Tirofiban bridging followed by dual antiplatelet therapy may enhance early neurological recovery and long-term functional outcomes without increasing bleeding risk in MIS patients with disabling symptoms or END.