Neurologist最新文献

Objectives: This study aims to assess the effectiveness and safety of carotid artery stenting (CAS) as a method for reducing the risk of stroke in patients with carotid stenosis (CS).

Methods: This retrospective cohort study analyzed all patients with internal carotid artery (ICA) stenosis who underwent CAS at a single neurointerventional center from January 2016 to September 2022. Patients with concurrent intracranial stenosis, previous CEA, interfering neurological disorders, or incomplete data were excluded. Preoperative evaluations included comprehensive clinical assessments, and CAS procedures were conducted without embolic protection devices (EPDs). Postoperative monitoring involved intensive care unit (ICU) observation and MRI in selected cases.

Results: The study included 91 patients (mean age 69.2±10.2 y, 65.9% male). The right ICA was involved in 46 patients and the left in 45 patients. The degree of stenosis significantly decreased from 80.58±12.53% to 16.61±9.54% post-CAS. Early neurological complications were observed in 5.4% of patients. Transient bradycardia during the procedure was common but resolved with atropine. One patient experienced prolonged bradycardia, but it resolved without lasting effects. Two patients had transient contralateral paresis postprocedure; one showed diffusion restriction on MRI but both recovered fully. Severe complications included one death due to intracranial hemorrhage and one case of hemiplegia with partial recovery over 3 months. Follow-up ultrasound in 30 patients showed no instances of restenosis.

Conclusions: CAS significantly reduces CS and potentially aids in stroke prevention. The findings suggest that CAS without EPDs may achieve similar early outcomes, particularly in regions with limited EPD access.

Objectives: Hypertension (HBP) is a risk factor for the development of motor and cognitive functions in Parkinson disease (PD) patients, but the specific mechanism is unclear. This study investigated white matter structural network abnormalities and their mediation effect of cognitive decline in patients with PD and HBP.

Methods: PD patients with HBP and normal blood pressure (HBP and non-HBP) underwent conventional and multi-shell diffusion magnetic resonance imaging (MRI) at baseline. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at baseline and 12-month follow-up. Enlarged perivascular spaces (EPVS) in the basal ganglia and midbrain were assessed at baseline. White matter structural network based on the diffusion MRI was constructed. The mediation effect and correlations of EPVS and the network metrics with cognitive function were analyzed.

Results: At 12-month follow-up, the cognitive decline was found in the HBP group. Global connectivity was impaired in the HBP group. The number and maximum diameter of EPVS were higher in the HBP group. The nodal connectivity was impaired in the HBP group and associated with the cognitive function at baseline and follow-up. Both global and nodal network metrics, as well as the counts of EPVS mediated the effect of HBP on the cognitive decline.

Conclusions: The PD patients with HBP had worse cognitive function. Hypertensive impairment of white matter connectivity may be the underlying mechanism of cognitive decline in PD patients.

Objective: The aim of this study was to assess the effects of extracorporeal counterpulsation therapy (ECP) on the short-term outcomes of patients with acute ischemic stroke in the mid-stroke phase.

Methods: A total of 171 patients with acute ischemic stroke from the Department of Neurology at our hospital were selected and randomly assigned to 2 groups: 84 patients in the ECP group and 87 patients in the control group. Both groups received standard medication and rehabilitation. In addition, extracorporeal counterpulsation was incorporated into the treatment for the ECP group. At the conclusion of the treatment and after 90 days, both groups were evaluated based on the NIHSS and MRS scores.

Results: No statistically significant differences were detected between the NIHSS and MRS scores of the 2 groups before and following treatment ( P >0.05). However, on the 90th day, the NIHSS and MRS scores of the ECP group were significantly lower than those of the comparison group ( P <0.05). The difference in the proportion of patients with NIHSS scores ≤1 between the 2 groups was 20.8%, whereas the absolute difference in MRS scores was 14.1%.

Conclusion: Extracorporeal counter therapy effectively enhances neurological function in patients with ischemic stroke, thereby improving their ability to perform activities of daily living and overall prognosis.

Introduction: Spinal cord infarction has various clinical presentations, depending on the vascular territory involved at the spinal cord level. The most common symptom is bilateral weakness. However, unilateral hemiparesis can occur if the sulcal artery is involved. Stroke is the most common and serious cerebrovascular complication associated with kidney transplantation. Clinically asymptomatic renal transplant recipients may experience increased intima-media thickening, which is significantly associated with an increased prevalence of cerebrovascular diseases.

Case report: Herein, we report the case of a 64-year-old adult male with a history of kidney transplantation who presented with sudden-onset right-sided hemiparesis. The patient presented with right shoulder pain, right fingertip paresthesia, and recent dysuria, necessitating catheterization. T2-weighted magnetic resonance imaging at the C2-C3 level revealed hyperintensity corresponding to the right sulcal artery. Diffusion-weighted imaging revealed hyperintensities corresponding to T2 signal abnormalities, with a decreased apparent diffusion coefficient. The patient was diagnosed with cervical spinal cord infarction involving the right sulcal artery at the C2-C3 level. Subsequently, pulsed intravenous methylprednisolone and dual antiplatelet treatment (aspirin and clopidogrel) were administered. The patient showed a rapid and marked improvement in neurological function within 3 days.

Conclusion: The patient in this case report initially presented with unilateral hemiparesis. The symptoms mimicked those of stroke, making accurate diagnosis challenging. This case highlights the need to consider spinal cord infarction in the differential diagnosis of patients presenting with unilateral hemiparesis. In addition, our findings suggest that spinal cord infarction may be a long-term complication in kidney transplant recipients.

Objectives: We aimed to investigate the efficacy and safety of human urinary kallidinogenase (HUK) in real-world patients with acute ischemic stroke (AIS).

Methods: AIS patients with prospective follow-up between April 2019 and June 2022 were enrolled in this study. Based on their treatment, the eligible patients were separated into 2 groups: the HUK group and the non-HUK group. Propensity score matching (PSM) analysis was used to reduce the biases from the unequal distribution of initial characteristics. The validated clinical composite scoring system was used to evaluate the neurological recovery. The safety outcomes include stroke recurrence, all-cause mortality, and major complications.

Results: A total of 312 patients were enrolled in each of the 2 groups, and there were no significant differences in baseline characteristics between them. After treatment, both groups of AIS patients achieved favorable neurological outcomes. The National Institute of Health Stroke Scale (NIHSS) scores at discharge (3.47±3.41 vs. 4.37±2.85) demonstrated better neurological recovery in the HUK group. At the 90-day assessment, patients in the HUK group exhibited a higher incidence of favorable functional outcome (modified Rankin Scale score of 0 to 2, 74.68% vs. 60.58%), and lower risk of stroke recurrence (2.88% vs. 6.73%). The all-cause mortality (1.60% vs. 2.24%) was not significantly different between both groups.

Conclusions: HUK improved neurological and functional outcomes in patients with AIS in a large real-world population and had an acceptable safety profile.

Objectives: Stroke is a primary public health challenge worldwide, with its prognosis profoundly related to inflammation and nutritional status. Naples prognostic score (NPS) is an integrated indicator of combined inflammation and nutrition. The study aimed to elucidate the link between NPS and all-cause and cardiovascular (CVD) deaths in stroke patients.

Methods: NHANES (2001 to 2018) data set was used. Multivariate corrected Cox models, Kaplan-Meier, and restricted cubic spline analysis were adopted to explore the link between NPS, all-cause, and CVD mortality in stroke patients. Subgroup analyses based on age, sex, BMI, education, alcohol consumption, smoking, hypertension, and diabetes were performed to further explore associations.

Results: Totally, 1247 stroke patients were enrolled. High NPS levels were notably linked with a heightened risk of all-cause mortality (HR: 1.320, 95% CI: 1.180-1.470, P <0.001) and CVD death (HR: 1.390, 95% CI: 1.120-1.730, P =0.003) in stroke patients after adjusting for relevant factors. Compared with group 0 (NPS=0), group 2 (NPS=3-4) had a high hazard ratio for all-cause mortality (HR: 2.920, 95% CI: 1.820-4.670, P <0.001) and CVD mortality (HR: 2.610, 95% CI: 1.140-5.970, P =0.023). The RCS suggested a linear link between NPS and both all-cause ( P for nonlinear=0.2202) and CVD deaths ( P for nonlinear=0.9841) in stroke patients. These links were mostly consistent in subgroups. There was no pronounced interaction between status and NPS scores for each subgroup (all P <0.05).

Conclusions: High NPS scores are connected with an augmented risk of all-cause mortality and CVD death in stroke patients. NPS is possibly connected with prognosis in stroke patients.

Objective: This study aims to develop a machine learning-based risk prediction model for carotid restenosis in elderly ischemic stroke patients after interventional surgery.

Methods: We collected clinical data from 371 elderly ischemic stroke patients who underwent carotid interventional surgery between January 2020 and December 2023, as training dataset. Various machine learning methods were applied to analyze and compare the predictive performance of different models. In addition, data from 75 cases collected between January and June 2024 was as a validation set to assess model applicability.

Results: Six factors influencing carotid restenosis were identified: homocysteine (Hcy), platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), Interleukin-6 (IL-6), and C-reactive protein (CRP). Machine learning models were developed, with the Gradient Boosting Machine showing the best performance (AUROC=0.969). Other models included support vector machine (AUROC=0.962), logistic regression (AUROC=0.945), decision tree (AUROC=0.885), and extreme gradient boosting (AUROC=0.753). The GBM model's predictive variable ranking was Hcy, IL-6, CRP, PDW, PLT, and MPV. In the validation set, the GBM model demonstrated excellent performance, with an AUC 0.939, sensitivity 0.909, specificity 0.969, accuracy 0.960, negative predictive value 0.984, and positive predictive value 0.833.

Conclusion: Our research showed that compared with other machine learning algorithms, the GBM model demonstrates the best accuracy and stability in predicting the risk of carotid restenosis after interventional surgery in elderly ischemic stroke patients, and it has high clinical application value.

Objectives: Cerebral venous sinus thrombosis (CVST) often leads to seizures, potentially worsening prognosis. This study aimed to assess the relationship between specific occlusion sites and seizure occurrence.

Methods: We retrospectively analyzed 154 patients diagnosed with CVST in 3 major hospitals in Tehran. Medical records detailing sinus involvement, seizure occurrence, and baseline characteristics were reviewed. Statistical analyses included the χ 2 or the Fisher exact tests, followed by binomial logistic regression to identify independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) curves.

Results: The study included 102 women (66.2%) and 52 men (33.8%), with a mean age of 36.4±10.8 years. A total of 35 patients (22.7%) experienced seizures, predominantly generalized tonic-clonic (85.7%). Superior sagittal sinus (SSS) involvement was strongly associated with seizures (odds ratio=3.056, P =0.006), while left transverse sinus involvement showed a marginally significant inverse relationship in univariate analysis ( P =0.027), which became nonsignificant in the multivariate model ( P =0.056). Trolard vein thrombosis was rare but associated with a high seizure rate (3/4 cases). The ROC for the final model showed moderate predictive ability (AUC=0.676).

Conclusion: SSS thrombosis significantly predicted seizures in Iranian CVST patients. Although rare, trolard vein involvement may carry a substantial seizure risk. These findings underscore the importance of precise imaging and individualized treatment plans for high-risk CVST patients. By illuminating the role of SSS and trolard vein, this study highlights the need for prospective trials to refine clinical decision-making.

Background: There is a controversy in the literature regarding the role of pelvic venous abnormalities screening through Magnetic Resonance Venogram (MRV) in patients with Embolic Stroke of Undetermined Source (ESUS) and Patent Foramen Ovale (PFO). We aimed to describe diagnostic yield of pelvic MRV in ESUS patients.

Review summary: A systematic search was carried out using PubMed, ScienceDirect, and Google Scholar on the 5th of January of 2024, following PRISMA guidelines. We retrieved 6 cross-sectional and cohort studies, 2 case series, as well as 12 case reports with a total of 1321 patients and a mean age of 51 years. Only cross-sectional and cohort studies were included in the qualitative synthesis. The diagnostic yield of pelvic MRV in all included ESUS patients was 10% (95% CI: 8-12). In ESUS patients with a negative lower extremity DVT, the diagnostic yield was 9% (95% CI: 7-10). Patients with ESUS and PFO had significantly higher prevalence of abnormal pelvic MRV findings, OR=3.63 (95% CI: 1.53-8.61, P <0.01). All reviewed studies utilized pelvic MRV, except 4 reports, which used pelvic CTV and MRA.

Conclusion: Pelvic venous abnormalities are relatively common findings in ESUS patients with a PFO and negative lower extremity DVT. Pelvic MRV can be considered in these situations. Future research should strive to provide clear guidance on clinical decision-making and cost-effectiveness of utilizing this valuable tool using randomized, controlled, and comparative studies.

Objective: To evaluate the impact of early gastroscopy-assisted nasoenteric tube nutritional support on aspiration and prognosis in patients with hypertensive cerebral hemorrhage.

Methods: A total of 150 patients with hypertensive cerebral hemorrhage (December 2021-December 2023) were randomized into a control group (n=75) receiving nasogastric tube nutritional support and a study group (n=75) receiving gastroscopy-assisted nasoenteric tube nutritional support. Outcomes included the incidence of aspiration and aspiration pneumonia, aspiration risk (assessed by the ICU aspiration risk scale), nutritional indicators (hemoglobin, albumin, pre-albumin, and transferrin), and prognostic scores (GCS and APACHE II).

Results: The study group had significantly lower incidence rates of aspiration (8.00%) and aspiration pneumonia (6.67%) compared with the control group (33.33% and 20.00%, respectively, P <0.05). Preintervention measures showed no significant differences between groups ( P >0.05). Postintervention (weeks 1 and 2), the study group exhibited significantly improved aspiration risk scores, higher nutritional indicator levels, and better prognostic outcomes (higher GCS scores and lower APACHE II scores) compared with the control group ( P <0.05).

Conclusions: Gastroscopy-assisted nasoenteric tube nutritional support reduces aspiration risk and incidence in patients with hypertensive cerebral hemorrhage, enhancing nutritional status and improving prognosis.