Revista de neurologia最新文献

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.

Objective: To investigate the optimal timing of stereotactic minimally invasive surgery (SMIS) in individuals with supratentorial intracerebral hemorrhage (sICH) and brain herniation.

Method: A retrospective analysis was conducted on patients with sICH and brain herniation who underwent SMIS in the emergency department of the Affiliated Hospital of Guizhou Medical University between January 2019 and October 2024. The patients were categorized into three groups based on the time from the onset of brain herniation to receiving SMIS: ≤6-h group (112 cases), 6-12-h group (57 cases), and >12-h group (32 cases). All enrolled patients were monitored over a 6-month period, and their prognoses were assessed using the Glasgow Outcome Scale Extended (GOSE), which was used for grouping. Clinical data, imaging findings, complications, comorbidities, infection markers, and outcome data were collected and analyzed comprehensively. Detailed analyses and comparisons were performed based on GOSE scores, Modified Rankin Scale (mRS) scores, and survival rates at 1, 3, and 6 months after sICH. Patients with mRS scores of 1-3 and GOSE scores of 4-8 had favorable outcomes. A detailed analysis of the six-month survival rate and post-treatment functional outcomes was conducted to draw research conclusions.

Result: This study included 201 patients. At 6 months sICH, the mRS scores were 3.71 ± 1.30 for the ≤6-h group, 4.61 ± 1.25 for the 6-12-h group, and 4.18 ± 1.35 for the >12-h group, with the ≤6-h group showing markedly higher scores (p < 0.001). The GOSE scores at 6 months postoperatively were 4.05 ± 1.73 for the ≤6-h group, 3.05 ± 1.76 for the 6-12-h group, and 3.19 ± 1.73 for the >12-h group, with the ≤6-h group showed markedly higher scores (p = 0.001). The proportion of favorable outcomes at 6 months postoperatively was 47.3% for the ≤6-h group, 24.6% for the 6-12-h group, and 18.8% for the >12-h group, with the proportion of favorable outcomes highest in the ≤6-h group (p = 0.001). The Kaplan-Meier survival curve showed that the survival rate of the ≤6-h group was 80.4%, which was significantly higher than the 57.9% of the 6-12-h group and the 65.6% of the >12-h group (F = 10.060, p = 0.007).

Conclusion: Undergoing SMIS intracranial hematoma evacuation within 6 h of brain herniation onset can effectively reduce neurological damage, significantly improve survival rates, and provide favorable prognosis.

Although prospective studies directly estimate the influence of a factor on the onset of a disease, case-control sampling is often cheaper, faster, and sometimes the only feasible option. In these studies, a random sample of individuals with the disease (cases) is taken, and the proportion of them, P₁, who were exposed to the factor is evaluated. A random sample of individuals without the disease (controls) is also taken, and the proportion of them, P₀, who were exposed is evaluated. From these two proportions, the respective odds and their ratio, the odds ratio (OR), are calculated. When the incidence of the disease is small, say less than 10%, this OR value closely approximates the relative risk (RR), and therefore tells us, with good approximation, how much greater the risk of having the disease is if one is exposed to the factor. In all cases, case-control studies tend to have more confounding factors, which are not easily controllable, than prospective studies. However, under certain circumstances, they have a much higher statistical power than the prospective design.

Introduction: Given the important role of motor imagery (MI) in rehabilitation, this study aimed to compare MI abilities in individuals with spastic diplegic cerebral palsy (SDCP) and typically-developing (TD), and to determine the factors associated with MI ability in SDCP.

Patients and methods: This study was planned as a cross-sectional, case-control study. SDCP (n = 26) and TD (n = 26) individuals participated in the study. SDCP individuals were selected from Special Education and Rehabilitation Centers, while TD participants were recruited from relatives of patients receiving therapy at these centers and from volunteers responding to bulletin board announcements. All assessments were performed before or after the weekly physiotherapy sessions, to avoid interfering with routine physiotherapy and rehabilitation sessions. Visual and kinesthetic imagery abilities were assessed using the Movement imagery questionnaire for children (MIQ-C), Implicit MI capacity laterality task, and Explicit MI capacity mental chronometry.

Results: The SDCP group had a mean age of 11.69 (3.78) years, consisting of 12 females and 14 males; 10 participants were classified as Gross Motor Function Classification System (GMFCS) Level I and 16 as Level II. The TD group had a mean age of 11.50 (2.30) years, including 16 females and 10 males. A significant difference was found between the groups in MIQ-C and mental chronometry performance (p < 0.05). While there was a significant difference in reaction time according to dominance in SDCP (p = 0.038), there was no difference in accuracy rate (p = 0.699). Reaction time and accuracy rate were significantly different between groups according to dominance (p < 0.05). There was no correlation between MIQ-C total score, dominant reaction time and accuracy rate and age, Body Mass Index (BMI), and GMFCS (p > 0.05). While age and BMI were not related to mental chronometry; GMFCS was found to have a significant positive effect on mental chronometry (p = 0.000).

Conclusions: In children with SDCP MI ability differs from that of typically developing peers, being weaker across all assessed subparameters. Moreover, MI ability showed a moderate association with the GMFCS level.

Introduction: Moyamoya angiopathy is a cerebrovascular disease characterized by progressive stenosis of the intracranial internal carotid arteries. There is limited literature addressing epilepsy in this condition, especially in Western countries.

Methodology: This was a retrospective study conducted in the public hospitals of Aragón, analyzing data from all patients diagnosed with moyamoya angiopathy between 1981 and 2024. Epidemiological aspects of the disease were studied, as well as the presence of epilepsy and its management in this group of patients.

Results: A total of 26 patients were included, with an estimated prevalence in Aragón of 1.71 cases per 100,000 inhabitants. The mean age at diagnosis was 36.64 years, with an equal sex distribution. Half of the patients presented with moyamoya syndrome. Fifty percent of the patients experienced a seizure and 42.31% of the total met diagnostic criteria for epilepsy. Most seizures were focal (81.8%), with a predominance of frontal lobe semiology. Levetiracetam was the most commonly used treatment. Up to four of the twelve patients with epilepsy met diagnostic criteria for drug-resistant epilepsy.

Conclusions: Although the prevalence of moyamoya in our series was lower than in Asian populations, the prevalence of epilepsy was significantly higher (50% of patients with seizures vs 0.9-18.9% in Asian series). In our cohort, epilepsy in moyamoya angiopathy was associated with the occurrence of syncope, cognitive impairment, affective disorders, and an earlier age at diagnosis. There are no other studies available addressing the percentage of drug-resistant epilepsy in these patients.

Introduction: Lyme disease is a zoonosis caused by spirochetes of the genus Borrelia, presenting with a broad spectrum of clinical manifestations. This heterogeneity may hinder diagnosis, particularly in regions with low prevalence.

Case report: We present the case of a 65-year-old woman who attended the emergency department with a 24-hour history of diplopia upon awakening, without other neurological focal signs. Neuroborreliosis was diagnosed after identifying a history of travel to an endemic area and compatible cutaneous manifestations. Clinical progression, together with serological confirmation, enabled early diagnosis and initiation of appropriate antibiotic therapy, resulting in complete resolution of symptoms.

Conclusions: This case highlights the importance of including Lyme disease in the differential diagnosis of patients with any neurological focal signs and a history of travel to endemic regions, even in the absence of recalled tick bites or classical manifestations. Early detection and timely treatment are crucial to prevent chronic and disabling complications.