Neurology India最新文献

Introduction: The objectives of the present research were to examine the associations of gaseous air pollutants and climate change (humidity and temperature) with occurrence of stroke (incidence), whether the associations differ in season, sex, and age (elderly vs young) in order to capture subpopulations and association with stroke subtypes (ischemic and hemorrhagic and ischemic subtypes).

Method: This is a case-crossover design. All strokes within 2 weeks from onset and within 1 year of event were screened and recruited. After a general neurological examination, the following gaseous pollutants were measured: NO2, SO2, and CO along with PM 2.5 and respirable suspended particulate matter PM10 diameter in areas of Delhi in using the help of New Delhi's Central Pollution Control Board at onset of stroke (24 h interval), 15 days of enrolment and 3 months. The other covariates measured were physical activity, cooking fuel, domestic ventilation, location of house, and socioeconomic status. A smile drive air quality meter was used to measure the indoor pollution.

Results: A total of 280 patients were screened, and 110 stroke patients were recruited in the study. The mean age for all patients was 52.3 ± 11.2 years with a mean NIHSS of 5.86 ± 1.3 and mean mRS of 1.04 ± 0.07. N =77 were ischemic, and n = 32 were hemorrhagic; 44.5% were stroke in young, and 70% of the total sample were hypertensive with 63.3% having positive smoking history (n = 70). One-way ANOVA between PM2.5 and PM10 levels at different time points was different (F = 2.9, P = 0.16; F = 1.9, P = 0.43, respectively). The cold season observed the highest number of patients (n = 54); mild cold observed a total of n = 29 patients. Multivariate regression analysis keeping age and type of stroke as constants showed that covariables like type of fuel used and in-house CO followed by PM2.5 showed strong association toward occurrence of stroke (R2 = 0.119, F = 3.92, P = 0.057).

Conclusion: The present study indicates that there is some association of occurrence of stroke with air pollution and climatic changes affect the incidence of stroke. PM 2.5 and PM 10 levels through Delhi were different at all time points (F = 1.9, P = 0.043). A quantifiable database will be generated, which can be used to control pollution and consequently in stroke guidelines.

Background and objective: Length of stay is an important factor for managing the limited resources of a hospital. The early, accurate prediction of hospital length of stay leads to optimized disposition of resources, particularly in complex stroke treatment. In the present study, we evaluated different machine learning techniques in their ability to predict the length of stay of patients with stroke of the anterior circulation who were treated with thrombectomy.

Materials and methods: This retrospective study evaluated four algorithms (support vector machine, generalized linear model, K-nearest neighbor, and random forest) to predict the length of hospitalization of 113 patients with acute stroke who were treated with thrombectomy. Input variables encompassed baseline data at admission, as well as peri-procedural and imaging data. Tenfold cross-validation was used to estimate accuracy. The accuracy of the algorithms was checked with a validation dataset. In addition to a regression analysis, we performed a binary classification analysis to identify patients who stayed longer than the mean length of stay.

Results: The median length of stay was 10.6 days (interquartile range 6-15). The sensitivity of the best performing random forest model was 0.8, the specificity was 0.68, and the area under the curve was 0.73 in the classification analysis. The mean absolute error of the best performing random forest model was 4.6 days in the validation dataset in the regression analysis.

Conclusion: The length of stay of patients with acute ischemic stroke of the anterior circulation can be predicted with machine learning. Machine learning could aid in optimal resource allocation in clinical routine.

Abstract: Spontaneous intracranial hypotension (SIH) is characterized by an orthostatic variation in headache precipitation.The typical history connotes headaches that are triggered by an upright posture and partially or completely relieved in the supine decubitus. In most patients, the site of cerebrospinal fluid (CSF) leak is at the cervical or thoracic spinal level. The imaging modalities needed to establish the diagnosis of SIH include computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, CT, and MRI myelography, and radionuclide cisternography. Treatment usually consists of conservative measures of prolonged bedrest in the supine decubitus over a few weeks. However, patients unresponsive to such measures are treated by an autologous epidural blood patch (EBP) administration at the site of CSF leak. We describe an unusual patient who developed SIH due to vigorous bearing down efforts during childbirth resulting in dural tear at cervical spine level and who was treated with a minimally invasive percutaneous image guided epidural blood patch using freshly drawn autologous blood with a very rewarding outcome.

Background: The population of very old persons (aged > 85 years) is at significantly increased risk of stroke, with incidence rising due to increased life expectancy. However, clinical data on stroke characteristics and outcomes in this age group remain limited.

Objective: To characterize the risk factors, stroke etiology, and clinical outcomes among patients aged over 85 years who experienced a stroke.

Methods: We conducted a retrospective review of patients aged >85 years who presented with stroke between January 2009 and December 2019. Clinical risk factors and comorbidities were documented. Neuroimaging, cardiac, and vascular investigations were assessed, and stroke etiology was classified using the TOAST criteria. A modified Rankin Scale (mRS) score of <2 at discharge was considered a favorable outcome.

Results and conclusions: Among 11,896 patients screened, 72 were aged >85 years, of whom 62 had ischemic strokes. The most common etiology was cardioembolic stroke. One patient received intravenous thrombolysis. In-hospital mortality occurred in seven patients. A favorable outcome (mRS <2) at discharge was observed in 59.7% of cases. These findings emphasize the importance of including very old persons in stroke research, as this group is frequently underrepresented in clinical trials. This study provides preliminary data on stroke characteristics and outcomes in this growing demographic.

Abstract: Marchiafava-Bignami disease (MBD) is a rare demyelinating disease, which mostly diagnosed among alcoholics. Previous studies on cerebral perfusion of patients with MBD mostly found hypoperfusion of corpus callosum and extra-callosal lesions. Nevertheless, hyperperfusion of corpus callosum in MBD has rarely been described.The aim of this study was to report a case of MBD with hyperperfusion on arterial spin labeling and completely recovered. We described a case of MBD with hyperperfusion in the corpus callosum on arterial spin labeling perfusion magnetic resonance imaging, presented with altered mental state. This MBD patient eventually achieved a complete recovery. We suppose that the hyperperfusion of corpus callosum in this patient may be associated with the vasodilation caused by the inflammatory response in the lesions. Future researches are needed to confirm our finding.

Background: Infection with rhino-orbito-cerebral mucormycosis (ROCM) has increased in the coronavirus disease (COVID) era, especially in diabetic patients. Rapid extension from the nose and paranasal sinuses to the orbit and brain is noted by osseous erosion, vascular invasion, and infrequently documented perineural spread.

Objective: To determine the incidence of perineural spread in ROCM cases and evaluate the common neural pathways involved, which help in prognosticating and triaging patients.

Methods and materials: We evaluated demographic, clinical, and radiological findings of 270 patients of histopathologically diagnosed ROCM. Imaging signs were used along cranial nerves for diagnosing perineural spread on magnetic resonance imaging (MRI).

Results: The perineural spread was observed in 30.4% patients. The most common nerves involved are the infra-orbital (20%), optic (19.2%), and maxillary (16.2%) nerves. Ischemic neuropathy was noted in 13.3% patients, predominantly along the optic nerve.

Conclusion: We documented a substantial incidence of perineural spread and common nerves involved in ROCM cases, which has not been previously described in the literature. Perineural spread determines the true extent of disease spread which can bring about better management in this rapidly fatal infection.

Abstract: Treatment options for dementia mainly comprise of symptomatic treatment, as no disease-modifying therapy currently exists that directly reduces the pathology. This systematic review assessed the effectiveness of neflamapimod (VX-745), a p38α kinase inhibitor, as a therapeutic agent for treating dementia, including Alzheimer's disease (AD) and Lewy Body Dementia (LBD). The systematic review evaluated the therapeutic effect of neflamapimod on dementia. Five electronic databases were included in the systematic review: PubMed, Embase, ProQuest, Cochrane Library, and Web of Science, which were searched until May 5, 2024. Two independent reviewers conducted title and abstract screening, followed by full-text review and data extraction, with disagreements resolved by a third reviewer. The risk of bias in the included studies was assessed using the ROB 2.0 tool. PROSPERO Registration ID: CRD42024542377. The review identified clinical results, biomarker effects, and mechanistic insights from two key trials. Due to the inclusion of only two eligible studies with varying methodologies and outcome measures, a meta-analysis could not be performed. While the primary cognitive outcomes, such as "neuropsychological test battery (NTB)" and "Hopkins Verbal Learning Test-Revised (HVLT-R)" were not statistically different, episodic memory, executive function, attention, gait dysfunction, and motor issues showed improvements, especially in patients with elevated plasma tau181, a marker for AD pathology. Biomarker analysis also indicated a statistically significant reduction in cerebrospinal fluid (CSF) tau and phosphorylated tau biomarkers, which are closely related to neuroinflammation and synaptic impairment in dementia. The findings of the current review suggested that while the cognitive effects of neflamapimod remain uncertain, its ability to influence disease-specific biomarkers makes it a potential drug to be used in dementia. This review connects biological and clinical outcomes, paving the way for future advancements in dementia treatment strategies.

Background: Over 2/3rd of strokes are caused by carotid artery disease (CAD). Be it symptomatic or asymptomatic patients, the role of carotid artery stenting (CAS) in carotid artery disease is well established. Data on the effect of morphology on the CAS outcomes are limited. In addition, there are limited Indian data on the long-term outcomes of this procedure. This study attempted to address this data deficiency.

Objective: To determine the effect of the morphological types of carotid artery lesions like soft stenosis, soft plaque, and ulcerative and total obstruction on the long-term follow-up of patients who underwent CAS.

Materials and methods: This was a single-center retrospective study conducted at a tertiary care facility. In total, 116 patients underwent CAS between 2000 and 2017. The mean follow-up period was 4.5 years. Stenosis was quantified using the North American Symptomatic Carotid Endarterectomy Trial. Long-term outcomes such as all-cause mortality and stroke (Major and Minor) were recorded.

Results: Among the 116 patients with CAS, 31.03% (36) were asymptomatic and 68.97% (80) were symptomatic. The various symptoms included motor weakness in 50 (43.1%) patients, loss of consciousness in 8 (6.9%), amaurosis in 9 (7.7%), giddiness in 6 (5.2%), dysarthria in 5 (4.3%), and headache in 2 (1.7%). Post CAS, the first 30 days mortality was 0.86% (one death), and stroke was 1.72% (two major strokes). A total of 53 (45.7%) patients had soft stenosis, 57 (49.13%) had ulcerated plaques, 5 (4.31%) had soft plaques, and 1 (0.86%) had total occlusion. Long-term follow-up (69% follow-up) showed a mortality rate of 17.5% (14 deaths) and stroke of 5% (4 major strokes).

Conclusions: CAS is an effective treatment modality for symptomatic and asymptomatic CAD. Almost all the stroke patients had ulcerated plaque and soft stenosis with worst outcomes compared to soft plaque/total occlusion. The long-term all-cause mortality and incidence of major stroke were comparable to those of carotid endarterectomy.