Neurology India最新文献

Glioblastoma multiforme (GBM) is the most frequent primary brain malignancy in adults. Despite improvements in imaging and therapy, the prognosis remains poor. To evaluate and compare the impact of combining bevacizumab with temozolomide and radiotherapy on progression-free survival (PFS) and overall survival (OS) in patients diagnosed with GBM. A comprehensive search was conducted across multiple databases, including PubMed, Embase, Scopus, and The Cochrane Library, covering the period from their inception to December 2022. The collected data underwent analysis employing appropriate statistical methods. Six articles were included in this systematic review and meta-analysis. The addition of bevacizumab to the combination of temozolomide/radiotherapy did not increase the OS in GBM patients. The pooled odds ratio (OR) was 0.843 (95% CI: 0.615-1.156, P = 0.290). The addition of bevacizumab to radiotherapy/temozolomide did not increase the PFS in patients with GBM. The pooled OR was 0.829 (95% CI: 0.561-1.224, P = 0.346). The funnel plot demonstrated the absence of the alleged pleiotropic effects by showing no evidence of observable variability across the estimations. This study does not support the benefit of the addition of bevacizumab to temozolomide and radiotherapy in improving OS and PFS in GBM patients.

Background: N6-methyladenosine (m6A) is one of the most common forms of mRNA modification, which is dynamically regulated by the m6A-related genes; however, its effect in glioblastoma (GBM) is still unknown.

Objective: We sought to investigate the association between m6A-related genes (m6A-RGs) and GBM.

Methods: Transcriptome data and the relevant clinical data were downloaded from The Cancer Genome Atlas and Gene Expression Omnibus databases. The m6A-RGs were identified from differently expressed genes, and COX and lasso regression models were applied to locate the prognosis-related genes.

Results: We identified 15 out of 19 m6A-RGs differentially expressed between GBM and nontumor tissues. We identified two subgroups of GBM (clusters 1 and 2) by applying consensus clustering. Compared with the cluster 1 subgroup, the cluster 1 subgroup correlates with a poorer prognosis, and most of the 19 m6A-RGs are higher expressed in cluster 1. Through univariate Cox and lasso regression model, we identified three m6A-RGs, namely HNRNPC, ALKBH5, and FTO, which were used to construct a Cox regression risk model to predict the prognosis of GBM patients.

Conclusion: We identified a valuable m6A model for predicting the prognosis of GBM patients, which can provide useful epigenetic biomarkers.

Background: The intracranial fluid spaces (IFS), also known as "the extra-axial spaces," consist of the superficial cerebral sulci, the Sylvian fissures, the basal cisterns, the third ventricle, the fourth ventricle, and the two lateral ventricles. In diseases such as schizophrenia, Alzheimer's, Parkinson's, and especially hydrocephalus, IFS' enlargements are observed.

Objective: Our study aimed to determine the mean values of IFS measurements in patients with schizophrenia and compare them with healthy controls.

Material and methods: This work has been carried out on 188 cases, out of which 88 schizophrenia patients (56 men and 32 women) met the diagnostic criteria according to DSM-5 for schizophrenia and 100 healthy controls (50 men and 50 women). The 10 parameters have been used to evaluate IFS on magnetic resonance imaging (MRI) scans.

Results: The parameters showing statistically significant differences were higher in favor of the individual with schizophrenia. Except for the bifrontal index and Evan's index, most parameters (the bicaudate index, the fourth ventricle width, the fourth ventricle index, the maximum width of the anterior interhemispheric fissure, the maximum width of the right frontal subarachnoid space, the maximum width of the left frontal subarachnoid space, the maximum width of the right Sylvian fissure, and the maximum width of the left Sylvian fissure) were obtained statistically highly significant differences between the examined and control groups.

Conclusions: In schizophrenia, it is more practical to evaluate brain atrophy using some parameters, especially the width of the Sylvian fissure and the bicaudate index.

We report the case of a 63-year-old man with a midline posterior fossa tumor and peculiar imaging features where we were unsure of the nature of the lesion preoperatively. Histopathology revealed it to be a craniopharyngioma. It appeared to arise from the inferior medullary velum, a site not described before in the literature. The previous four cases mentioned in literature and speculations on the origins in this uncommon site are discussed.

Management of wide-necked aneurysms in cavernous ICA has significantly evolved in the endovascular era, with flow diverters and stent-assisted coiling being an effective modality. It is vital to select the type of stent according to the arterial anatomy, hemodynamics, and device characteristics. We report a catastrophic complication of laser-cut stent used for SAC of cavernous ICA aneurysm performed at another center 5 years back, presenting with regrowth and massive life-threatening epistaxis managed successfully. In tortuous angulated anatomy, laser-cut stents are difficult to place, poorly visible, and the device opening is uncertain. Unlike braided stents, laser-cut stents do not provide flow diversion effect, stent migration, and buckling phenomena are more likely to occur with laser-cut stents. We intend to discuss the technical fallacies behind using laser-cut stents in such case scenarios and the optimal treatment approach for such cases with an attitude to learn from such complications.

Purpose: Regaining gait is the primary goal in stroke rehabilitation. In this study, we aimed to investigate the effect of premorbid features of acute stroke patients on the ambulatory level.

Methods: The study included 174 patients who applied to our rehabilitation clinic within the first month after the onset of stroke. Demographic characteristics of patients, pre-stroke symptoms, and stroke characteristics were questioned from patient files and historical data. The ambulation levels of patients before and after rehabilitation were evaluated with the functional ambulation category. The relationship between demographic characteristics, pre-stroke symptoms, stroke characteristics, and ambulation levels of patients before and after rehabilitation was examined.

Results: The presence of coronary heart diseases, atrial fibrillation, and nausea/vomiting before stroke were independent negative risk factors on both pre- and post-rehabilitation ambulation levels (P < 0.05). Additionally, advanced age, oxygen, and mechanical ventilation requirement were other negative independent risk factors on post-rehabilitation ambulation levels (P < 0.05).

Conclusions: Knowing some of the pre-stroke characteristics of patients while applying rehabilitation programs may be useful in estimating the ambulatory levels on returning home.