Neurology India最新文献

Background: Posterior spinal artery infarctions are rarely described in the literature. Their clinical features and outcomes are poorly understood, and guidance on their treatment is lacking.

Objectives: To describe the features of posterior spinal artery infarctions and to identify factors associated with poorer ambulatory outcomes.

Methods: We conducted a literature review on the characteristics and outcomes of patients with posterior spinal artery infarctions reported over the past 30 years.

Results: We analyzed 40 cases from 33 studies published from January 1993 to June 2023. Their median age was 55 years (range 19-84), with 23 males and 17 females. Pain (18/39, 46%) was common, and hemiparesis and/or hemisensory deficits occurred in a significant number of cases (16/39, 41%). Infarcts preferentially affected the cervical cord (29/40, 73%). Most received treatment (28/40, 70%), which usually involved the use of antiplatelet agents (18/28, 64%), anticoagulants (8/28, 29%), (18/28, 64%), and/or corticosteroids (5/28, 18%). The prognosis appeared fair as most could ambulate (28/34, 82%), but nearly a third of them required assistance (8/28, 29%). Older patients, (median [range]: 67 years [52-84] vs 56 [28-79], P = 0.055), experienced trauma (50% vs 11%, P = 0.053), or with infarcts involving three or more cord segments (83 vs 33%, P = 0.062) may increase the risk of non-ambulant outcomes.

Conclusion: PSAIs are uncommon and may mimic cerebral strokes. Diagnostic clues include preceding trauma, endovascular treatment, and concomitant pain. Its prognosis appears favourable with most patients being able to ambulate. Advanced age, prior trauma, and longer infarcts may herald poorer ambulatory outcomes.

Background: Cerebral cavernous malformations are central nervous system vascular abnormalities, susceptible to intra-cerebral hemorrhages, with considerable clinical consequences.

Objective: This study aimed to predict the risk of hemorrhage in patients with cerebral cavernous malformations.

Methods: We conducted a retrospective analysis of 1,219 patients with cerebral cavernous malformations at a high-volume medical center between January 1, 2003, and December 31, 2018. We employed the Least Absolute Shrinkage and Selection Operation regression model to identify possibly relevant features while developing a novel model through multivariate Cox proportional hazards analysis.

Results: The model included surgical procedures, mean cerebral cavernous malformations volume, intracerebral hemorrhage occurrence, and brainstem localization. We achieved accurate calibration and discrimination in the training dataset using these factors. The training set produced areas under the curve values of 0.881, 0.867, and 0.820 for predicting the probability of hemorrhage at 1, 3, and 5 years, respectively. The model demonstrated strong calibration and discrimination in the validation set, with area under the curve values of 0.877, 0.881, and 0.859 for predicting the 1-, 3-, and 5-year hemorrhage risks, respectively. Decision curve analysis revealed that the model had significant clinical utility. In addition, we developed a web-based calculator (https://rehablitation.shinyapps.io/CCMs/) to display the prediction findings visually.

Conclusions: The nomogram integrating the four demographic and clinical parameters yielded an accurate hemorrhage prediction in individuals with cerebral cavernous malformations. This predictive model can guide physicians in clinical decision-making.

Abstract: Though insula is located close to several functional areas subserving higher mental function, only a few present with cognitive decline. A detailed neuropsychological assessment is needed to detect subtle impairments that may be missed on routine clinical examination. Detailed examination of cognition and language function in patients with insular glioma and their comparison with healthy controls. Forty-six cases of insular glioma and 30 healthy controls were evaluated with Montreal Cognitive Assessment (MOCA) score and Western Aphasia Battery of Tests (WAB). The results were then compared between these two groups. Three (6.5%) patients reported dysfunction in language and memory that affected their profession. The median score with interquartile range for MOCA was 27 (24-29) among controls and 20 (18-25) among cases. The values of individual domains of MOCA were significantly higher among controls than cases. The scores of WAB were higher in the control than patients and were statistically significant in aphasia quotient (P = 0.003), naming (P = 0.00), and comprehension (P = 0.015). Scores for recall memory, naming, and repetition were significantly lower for left-sided lesions. The use of a detailed neuropsychological assessment is essential to reveal subtle cognitive impairment in patients with insular glioma.

Background and objective: Glioblastoma (GBM) is a prevalent and aggressive intracranial malignant tumor characterized by high mortality and recurrence rates. Serine proteinase inhibitor A3 (SERPINA3) has been reported to be overexpressed in various cancers; however, its clinical significance and biological role in GBM remain unclear. This study aims to investigate the impact of SERPINA3 on gliomagenesis.

Methods and material: SERPINA3 expression in GBM was assessed. U87 cells were transfected, and the effects of SERPINA3 on GBM cells were investigated. The effect of SERPINA3 on GBM in vivo was investigated. The relationship between apolipoprotein E (APOE) and SERPINA3 was analyzed. The effect of APOE on ferroptosis-related markers glutathione, malondialdehyde, and Fe2 + was detected. U87 cells overexpressing SERPINA3 were treated, and the effect of SERPINA3 on the PI3K/AKT/FOXO1 pathway was investigated.

Results: SERPINA3 was highly expressed in GBM, and overexpressing SERPINA3 promoted the proliferation, migration, and invasion of GBM cells, enhanced the uptake of glucose and release of lactic acid from GBM cells, and inhibited apoptosis. Overexpressing SERPINA3 upregulated APOE. High expression of APOE inhibited ferroptosis in GBM cells, thereby promoting tumor progression. APOE was significantly upregulated in SERPINA3-overexpressing U87 cells and tumor tissues from xenografted mice. When overexpressing SERPINA3, PI3K/AKT/FOXO1 pathway-related proteins were increased in GBM cells. Inhibiting PI3K/AKT/FOXO1 expression reduced proliferation, migration, and invasion of GBM cells.

Conclusions: SERPINA3 promotes GBM progression by promoting APOE expression and modulating the PI3K/AKT/FOXO1 pathway.

Abstract: Ischemic stroke remains a predominant global cause of morbidity and mortality. Neurofilament light chain (NfL), a sensitive biomarker of axonal injury, aids in diagnosis and prognosis for ischemic stroke but requires further study due to variability and lack of standardization. This study systematically reviews the molecular characteristics of NfL, detection methodologies, and its clinical applications in ischemic stroke, with a particular focus on its role in diagnosis, severity assessment, prognosis prediction, and post-stroke cognitive impairment (PSCI). Additionally, the limitations of NfL and future research directions are discussed. A comprehensive literature review was conducted to analyze the molecular properties of NfL, its release pattern following ischemic stroke, and its correlation with neuronal injury. Furthermore, clinical studies evaluating its role in diagnosis, prognosis, and disease monitoring were systematically assessed. NfL demonstrates high specificity for neuronal injury, and its elevated levels are closely associated with stroke diagnosis, severity, infarct volume, early neurological deterioration, poor prognosis, and PSCI. Advances in detection technologies have improved the sensitivity of peripheral blood NfL measurement; however, factors such as age-related variability, blood-brain barrier integrity, and the influence of secondary inflammation pose challenges to its clinical application. NfL is a promising biomarker for stroke diagnosis and severity assessment. Future research should focus on the dynamic changes in NfL, optimization of detection technologies, and multi-omics integration to enhance diagnostic accuracy. Additionally, large-scale prospective studies are required to validate its clinical utility and establish standardized application guidelines.

Abstract: The intestinal microbiome represents the most extensive microbial community within the human body, significantly influencing neurodevelopment, aging, maintenance of normal physiological functions, and brain disorders, including ischemic stroke. Emerging research indicates that the gut microbiome might affect cerebrovascular health via multiple mechanisms. However, since many of these studies are observational, establishing a direct causal link remains challenging. Mendelian randomization, leveraging genetic variations, provides a novel approach to evaluate causality. We reviewed recent studies employing Mendelian randomization to investigate the potential causal associations between the gut microbiome and cerebrovascular diseases. Our analysis synthesizes findings from Mendelian randomization studies that connect specific gut microbial compositions with cerebrovascular conditions such as stroke and its subtypes, aneurysms, atherosclerosis, and cerebral small vessel disease. This aims to offer a more definitive framework for understanding the causal relationship between the gut microbiome and cerebrovascular health.

Background: Wake-up stroke (WS) poses a unique challenge to the emergency department (ED) physicians and neurologists in terms of planning optimal therapy, as the time of onset of the episode is unknown.

Objective: The aim of our study was to profile the WS presenting to the ED and compare the predictors of hemorrhagic versus ischemic types of stroke.

Materials and methods: This retrospective study was done in the ED of a large tertiary care hospital in South India from January 2017 to June 2017. The hospital electronic database was accessed for information on patients with WS.

Results and conclusions: During the study period, a total of 346 patients presented with a stroke, of which 88 (25.4%) patients had a WS. The mean (SD) age was 59 (13) years, three-fourths (73.9%) were males. Only 68% presented to the ED before noon (12 pm). A tenth (10.2%) had a previous stroke. Examination findings included motor deficit (79.5%), slurring of speech (46%). Magnetic resonance imaging (MRI) was done in 33 patients, and computed tomography (CT) was done in 52 patients. The majority (92%) were anterior circulation strokes, with ischemic strokes (82%) being the commonest. Patients with hemorrhagic strokes had a significantly lower mean age (54.31 vs 60.12 years), a higher mean systolic blood pressure (162.50 vs 143.66 mm Hg), and a higher incidence of hypoxia at ED arrival (18.8% versus 4.1%; P = 0.049).

Abstract: The diagnosis and treatment of sphenoparietal sinus thrombosis remain challenging. The cases of sphenoparietal sinus thrombosis were rarely reported in literature. We aimed to present the diagnosis and treatment of sphenoparietal sinus thrombosis through a case study. A 42-year-old male patient initially presented with an acute moderate headache. Cerebral edema and hemorrhage in the drainage area of the superficial cerebral veins were confirmed in a CT scan. The absence of veins around Sylvian fissure and sphenoparietal sinus was found by cerebral arteriography. Thrombosis in the right sphenoparietal sinus was diagnosed and anticoagulant therapy was administered. The CT features and clinical symptoms fairly improved afterward. The most powerful and necessary evidence for the diagnosis of sphenoparietal sinus should be cerebral edema in the drainage area of the lateral fissure vein associated with sphenoparietal sinus thrombosis.

Abstract: High cervical schwannomas are rare benign tumors that present significant surgical challenges due to their proximity to critical neural structures. To report a case of a C1-C2 schwannoma successfully treated with a minimally invasive tubular approach, emphasizing the benefits of the technique and the role of intraoperative neuromonitoring. A 47-year-old male underwent complete tumor resection using a minimally invasive tubular approach. The procedure was performed under intraoperative neurophysiological monitoring, allowing for safe and precise dissection. The technique minimized blood loss, muscle trauma, and neurological risks. The surgery was documented with a 2D operative video illustrating each step in detail. Postoperative follow-up showed complete resolution of symptoms with no complications. This case highlights the feasibility, safety, and effectiveness of minimally invasive spine surgery for lesions in the upper cervical spine, even in anatomically complex regions.