Revista de neurologia最新文献

Objective: Existing research on the link between Life's Essential 8 (LE8) and the risk of Parkinson's disease (PD) remains limited. This study aimed to elucidate how LE8 relates to PD risk among USA adults aged 40 and above.

Methods: Data were derived from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Propensity score matching (PSM) was employed to control for selection bias. Multivariable logistic regression was applied to assess the association between LE8 and PD prevalence, while restricted cubic spline (RCS) modeling was adopted to explore potential relationships. Additionally, subgroup analyses were conducted to further examine the connection between LE8 and PD.

Results: A total of 18,270 participants were included, among whom 259 reported having PD. An inverse association was observed between LE8 and PD. Prior to matching, the odds ratio (OR) for per 1 point increase in LE8 was 0.98, and 0.97 after matching. Compared with individuals with low LE8 scores (<50), those with moderate scores (50-79) had a PD OR of 0.62 before matching and 0.52 after matching. Participants with high LE8 scores (≥80) observed a PD OR of 0.43 prior to matching and 0.32 post-matching. RCS curves suggested a non-linear inverse trend. Subgroup analyses revealed a consistent inverse association between LE8 scores and PD risk across the majority of strata.

Conclusion: Among adults aged 40 and older, LE8 was inversely correlated with PD prevalence. Given the cross-sectional design, causal relationships cannot be inferred; however, the findings suggest that lifestyle modifications may aid in PD prevention and warrant further investigation in prospective studies.

Objective: To evaluate the feasibility of plaque-based radiomics extracted from high-resolution magnetic resonance imaging (HR-MRI) data for assessing the short-term outcomes of endovascular treatment in patients with symptomatic intracranial artery stenosis.

Methods: HR-MRI was performed on patients with symptomatic intracranial artery stenosis. Plaque-based radiomics describing the morphological features and pixel value of the image were extracted from the HR-MRI data. Demographic features were also collected. The short-term favorable outcome was defined by a postoperative residual stenosis rate <35% with the absence of perioperative complications. Univariate analysis was conducted to identify features associated with favorable outcomes. Based on the results of this analysis, a prediction model was developed using logistic regression. The performance of both clinical and radiomic models was evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC).

Results: From January 2022 to December 2023, 42 consecutive patients with symptomatic intracranial artery stenosis were enrolled. Digital subtraction angiography (DSA) revealed a more than 70% stenosis rate in these patients. The stents were implemented in all 42 patients; 21 (50%) of these were male, and the mean age of all patients was 52.74 ± 13.02 years. Thirty-five patients (83.33%) had impaired sensory or motor function of the limbs. In the univariate analysis, 11 morphologic or first-order radiomics features and five clinical features were initially identified as potentially associated with short-term favorable outcomes. Logistic multivariate analysis further indicated that shape-flatness (p = 0.04, Odd ratio (OR) = 169.02, 95% CI: 1.30-22,026.5) and first-order-minimum (p = 0.02, OR = 94.63, 95% CI: 1.93-4592.5) might be independently related to post-stenting outcomes. A prediction model constructed based on the above morphologic and first-order features showed an AUC of 0.82 in this small cohort.

Conclusion: Plaque-based radiomic features, which describe the shape and voxel characteristics extracted from HR-MRI data, are associated with the short-term outcomes of patients treated with stent implementation.

Introduction: Migraine diagnosis relies on clinical criteria that encompass various pain features and associated symptoms, which can vary widely across patients. The aim of this study was to analyze the potential association between sociodemographic factors and the characteristics of migraine attacks.

Methods: We conducted an observational longitudinal study with prospective and real-time data collection using a custom-designed smartphone application. Clinical features and accompanying symptoms of each attack were recorded.

Results: A total of 377 migraine attacks from 51 patients were analyzed. Headache intensity was higher in women (p = 0.038), in those with lower cognitive reserve (p = 0.049), and in patients with higher Headache Impact Test-6 (HIT-6) scores (p = 0.020). Hemicranial pain was more common in patients with a longer disease duration (p = 0.028) and female sex was associated with a higher frequency of nausea (p = 0.034).

Conclusions: Prospective and real-time recording of migraine attacks provides added value by more accurately capturing their clinical variability. Our findings suggest that sociodemographic variables influence attack characteristics, supporting the need for more personalized therapeutic approaches.

Intracerebral hemorrhage (ICH) is a devastating stroke subtype with high morbidity and mortality. Beyond primary injury from blood extravasation, secondary injury driven by erythrocyte lysis and its toxic degradation products exacerbates inflammation, oxidative stress, and neuronal damage. Accelerating endogenous hematoma resolution, including the removal of erythrocytes and their byproducts, represents a promising therapeutic strategy. This review systematically delineates three key mechanisms of hematoma resolution post-ICH: (1) erythrophagocytosis by microglia/macrophages through Tyro3, Axl, and Mertk (TAM) receptors, the cluster of differentiation (CD) 36 receptor, the triggering receptor expressed on myeloid cells 2, and the signal regulatory protein α receptor; (2) clearance of hemolytic products through the hemoglobin-haptoglobin-CD163 and hemin-hemopexin-CD91 axes; and (3) glymphatic and meningeal lymphatic drainage. Pharmacological, genetic, and physical interventions targeting these pathways have demonstrated potential to enhance phagocytosis, promote glymphatic and meningeal lymphatic function, accelerate hematoma resolution, and improve neurological outcomes in ICH models. By leveraging the intrinsic clearance mechanisms of the intracerebral hematoma, this review highlights promising therapeutic targets and strategies to overcome current clinical limitations and demonstrates significant translational potential.

Background: Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease that mostly presents as sporadic cases. Currently, no mitochondrial-related gene mutations have been identified as the cause of ALS. Mitochondrial gene mutations cause rare hereditary diseases, and the symptoms of pure muscle weakness and muscle atrophy are rarely observed.

Case report: We report the case of a young patient clinically diagnosed with ALS concurrently associated with a pathogenic mutation in the mitochondrially encoded nicotinamide adenine dinucleotide: ubiquinone oxidoreductase core subunit 6 (MT-ND6) gene. However, the pathogenic relationship between the MT-ND6 gene and ALS has not been confirmed.

Conclusion: We provide a case report and a literature review aimed at increasing the understanding of the connection between the two. It is essential to consider the potential modifying role of mitochondrial pathogenic genes in ALS.

Objective: To evaluate the clinical utility of P300 event-related potentials combined with video electroencephalography (VEEG) in assessing post-stroke cognitive impairment (PSCI) in patients with strokes affecting different brain regions.

Methods: Stroke patients treated at our hospital were enrolled as the observation group. Based on lesion location, stroke patients were categorized into four subgroups: frontal lobe (n = 59), temporal lobe (n = 47), basal ganglia (n = 73), and brainstem (n = 35). An additional 60 age-matched healthy individuals were recruited as controls. All participants underwent cognitive assessment using the Mini-Mental State Examination (MMSE), and P300 and VEEG evaluations.

Results: At 7 days, 1 month, 3 months, and 6 months post-treatment, MMSE scores in the observation group were significantly lower than those in the control group. Correlation analysis showed that, in the frontal- and temporal-lobe groups, P300 amplitude and VEEG α and β power at day 7 were positively correlated with MMSE scores at 6 months. In contrast, P300 latency and VEEG delta and θ power, slow-wave index, and δ/α ratio (DAR) at day 7 were negatively correlated with 6-month MMSE scores. In the basal ganglia group, day 7 P300 amplitude and VEEG α power were positively correlated with 6-month MMSE scores, whereas P300 latency, δ and θ power, and DAR were negatively correlated. In the brainstem group, P300 latency, δ power, and slow-wave index at day 7 were negatively correlated with MMSE scores at 6 months. Receiver operating characteristic (ROC) analysis demonstrated that P300 combined with VEEG predicted PSCI in the frontal lobe group with a sensitivity of 94.32%, specificity of 92.58%, and area under the curve (AUC) of 0.932 (95% CI: 0.900-0.967). For the temporal lobe group, sensitivity was 82.74%, specificity 79.27%, and AUC 0.864 (95% CI: 0.812-0.915). In the basal ganglia group, sensitivity and specificity were 78.24% and 76.12%, respectively (AUC = 0.789, 95% CI: 0.727-0.851). For the brainstem group, sensitivity was 72.78%, specificity 69.56%, and AUC 0.727 (95% CI: 0.661-0.803).

Conclusions: The combination of P300 and VEEG is a valuable tool for the early screening of PSCI, particularly in patients with frontal- or temporal-lobe strokes, where it shows highly predictive sensitivity and specificity.

Objectives: There are inherent risks associated with intravenous thrombolysis (IVT) therapy in patients with acute ischemic stroke (AIS). The atherogenic index of plasma (AIP), defined as log (triglyceride [TG]/high-density lipoprotein cholesterol [HDL-C]), has recently been associated with the prognosis. We aimed to gauge AIP prognostic value in AIS patients receiving IVT.

Methods: We retrospectively collected data from 183 AIS patients who underwent IVT. We grouped modified Rankin Scale scores of 0-2 and 3-6 as good and poor outcomes at 1 year, respectively. Multivariate logistic regression, receiver operating characteristic (ROC) curve and restricted cubic spline (RCS) analyses were used to investigate the underlying link between the AIP and 1-year functional outcomes.

Results: In this study, 67 patients (36.6%) exhibited poor 1-year outcomes. An optimal AIP cut-off of 0.188 was used to divide the patients into low and high AIP levels. Our results showed that continuous AIP (odds ratio [OR] = 25.10, 95% confidence interval [CI]: 4.86-129.68, p < 0.001) was associated with poor 1-year outcome; when AIP was as a categorical variable, OR (95% CI) for the prognosis in the high AIP group was 27.86 (9.33-83.25) compared with the low AIP group. ROC analyses revealed that the area under the ROC curve for the AIP was 0.694 (0.603-0.785), with a sensitivity of 87.1% and a specificity of 61.2%. In the fully adjusted RCS, we found a positive but non-linear trend between the AIP and prognosis.

Conclusions: High AIP may offer potential value as a novel target for predicting 1-year outcomes in patients receiving IVT.

Background: Oculomotor nerve palsy (ONP) is a condition characterized by ptosis, restricted eye movement, and pupillary abnormalities, with causes ranging from congenital to acquired factors. Among these, posterior communicating artery aneurysm (PcomA) represents the most clinically urgent due to the risk of rupture. Despite its significance, no standardized treatment guidelines currently exist. This narrative review aims to summarize current treatment approaches and provide a decision-making framework for clinicians.

Methods: A literature review was conducted using Web of Science and PubMed from inception to December 30, 2024, with additional sources identified via manual reference searches.

Results: Both aneurysm clipping and endovascular therapy are effective for treating PcomA-induced ONP. Endovascular techniques include coil embolization, stent- or balloon-assisted coiling, flow diverter placement, and intrasaccular flow disruption device placement. Surgical clipping is preferred in younger patients (under 60 years old), those with ONP symptoms longer than 7 days, an aneurysm size ≥7 mm, or complete ONP. In contrast, endovascular therapy is recommended for older patients, those in poor health, or undergoing treatment with antithrombotic agents. Emerging evidence suggests flow diverter placement is a promising direction, though further research is warranted.

Conclusion: This review proposes a therapeutic algorithm to aid in clinical decision-making. The choice between aneurysm clipping and endovascular therapy should be individualized, taking into account patient-specific clinical factors.

Background: This study presents a systematic review on the use of functional near-infrared spectroscopy (fNIRS) in emotional tasks involving the prefrontal cortex (PFC), emphasizing the understanding of neurocognitive and emotional processes in various contexts through the measurement of oxygenation in the PFC as an indicator of brain activation.

Objective: To provide a detailed review of current research on the application of fNIRS to assess activity in the dorsolateral prefrontal cortex (DLPFC) during emotional processing tasks in adults.

Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases, following PRISMA guidelines, with specific inclusion criteria and bias analysis. Study selection was based on methodological quality and thematic relevance, followed by data extraction and analysis.

Results: The studied population includes healthy adults, and patients with mental disorders. The instruments and technical settings of fNIRS were diverse, and the emotional experiments involved various tasks, revealing patterns of brain activation in tasks that involve emotional processing; with altered left DLPFC activation can be observed in clinical populations, suggesting potential biomarkers of pathology. In contrast, right DLPFC activation in response to pleasant stimuli points to possible implications for future research and interventions related to cerebral laterality.

Conclusion: The review highlights the complexity of neurocognitive and emotional processes, underscoring the relevance of the DLPFC in psychology, neuroscience, and mental health. It also emphasizes the need to consider various contextual and methodological factors in future studies, such as adequate exposure time to tasks for optimal signal acquisition.