Neurologist最新文献

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.

Introduction: Pulmonary arteriovenous malformations (PAVMs) are infrequently associated with ischemic stroke. PAVMs rarely cause large vessel occlusions (LVO), whereas medium (MeVOs) and distal vessel occlusions (DVOs) are more common. Isolated PAVMs are uncommon but may cause paradoxical embolisms.

Case reports: We describe 2 clinical cases of patients with ischemic stroke associated with PAVMs. One patient suffered a stroke caused by a MeVO and was successfully treated with intravenous thrombolysis (IVT). Transcranial Doppler ultrasound (TCD) with bubble test revealed a right-to-left shunt, but transesophageal echocardiography (TEE) ruled out a patent foramen ovale (PFO) in both patients. The presence of PAVMs was confirmed by pulmonary computed tomography angiography (CTPA), and they were successfully treated with embolization. The patients received antiplatelet therapy for secondary prevention, and no recurrence of ischemic events occurred during the follow-up period (12 mo for case 1 and 24 mo for case 2).

Conclusions: Pulmonary arteriovenous malformations are rarely associated with ischemic stroke. Embolization is considered the treatment of choice for these patients. After the procedure, antiplatelet therapy is generally recommended, although anticoagulation may be indicated in selected patients.

Introduction: Despite the involvement of the thalamus in the auditory pathway, hearing loss is not commonly recognized as a sequela of thalamic hemorrhage. Interestingly, only a few case reports in the literature describe thalamic hemorrhage as a cause of sudden sensorineural hearing loss (SSHL). The use of brainstem evoked potentials (BAEPs) to evaluate hearing loss in these patients has not been reported in the literature.

Case report: A 56-year-old man presented to the emergency room for an acute onset of hearing loss and left perioral and foot numbness. On neurological examination, he was found to have mild left hemiparesis, sensory deficit, ataxia, and complete hearing loss. His National Institutes of Health Stroke Scale was 6. Initial noncontrast head computed tomography (CT) showed a focal acute parenchymal hemorrhage in the right thalamus and posterior limb of the internal capsule. Magnetic resonance imaging (MRI) of the brain confirmed the presence of the right thalamocapsular hematoma, and the gradient echo sequence demonstrated remote hematoma in the left lentiform nucleus. Otolaryngology was consulted and diagnosed the patient with idiopathic sudden sensorineural hearing loss. Given the unclear etiology, BAEPs were pursued and revealed an intact brainstem auditory pathway and suggested reduced activity in thalamic auditory regions. He was discharged on prednisone taper and referred for formal outpatient audiometry testing.

Conclusions: This case highlights sensorineural hearing loss as a potential thalamic syndrome and the utilization of BAEPs as diagnostic tools in suspected central origin of hearing impairment.

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: Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has shown potential in enhancing motor recovery and cognitive function in chronic stroke patients. However, the application of tDCS in the acute setting of ischemic stroke remains largely unexplored.

Methods: This randomized, double-blind, sham-controlled study enrolled 60 acute ischemic stroke patients within 2 days of onset. Participants were randomly assigned to receive either real tDCS or sham stimulation for 5 sessions over 7 days. The primary outcomes were changes in the Fugl-Meyer (FM) motor scale, National Institutes of Health Stroke Scale (NIHSS) scores, incidence of early neurological deterioration, and favorable functional outcome (modified Rankin Scale ≤2) at 3 months poststroke.

Results: Early neurological deterioration occurred in 6.7% of the tDCS group and 26.7% of the sham group, but this difference did not reach statistical significance ( P =0.065). No significant differences were observed between the tDCS and sham groups in terms of FM scores, NIHSS scores, or favorable functional outcomes at 3 months. No significant group-by-time interactions were found for FM scores ( P =0.481) or NIHSS scores ( P =0.157).

Conclusions: This study demonstrates that tDCS can be safely administered in the acute phase of ischemic stroke. While no significant effects on motor function or neurological outcomes were observed compared with sham stimulation, the trend toward reduced early neurological deterioration warrants further investigation.

Objectives: A cluster analysis was conducted to classify the 7 different cognitive domains affected by PSCI patients, to explore the correlation and similarity between cognitive domains and provide a basis for targeted intervention.

Methods: We collected demographic and disease-related data from 724 PSCI patients. We used Python 3.8 software to perform K-means clustering and hierarchical clustering on the 7 cognitive domains assessed by the MoCA scale, and used the silhouette coefficient to determine the optimal number of clusters k.

Results: The results of K-means clustering and hierarchical clustering show that the 7 dimensions of MoCA can be grouped into 2 categories. Cluster 1 scored lower in the cognitive areas of visual space and executive function, attention, language, abstraction, and delayed recall, whereas cluster 2 had higher scores in the naming and orientation domains. The scores in all cognitive domains of cluster 1 are lower than those of cluster 2, indicating severe cognitive impairment. Compared with cluster 2, the subjects in cluster 1 have poor physical health, living conditions, economic status, and social support ability.

Conclusions: The 7 dimensions of MoCA can be divided into 2 categories. In clinical practice, health care professionals should pay special attention to the severity of the patient's condition, the affected area, and individual differences, and develop precise and personalized treatment plans to improve the patient's cognitive function and quality of life.

Introduction: Foster Kennedy syndrome classically occurs in frontal space-occupying lesions (SOL). It describes the appearance of optic atrophy in one eye and optic nerve swelling in the other. Optic atrophy occurs due to direct compression from lesion (on the ipsilateral side) and optic nerve head swelling occurs due to increased intracranial tension due to mass effect (on the contralateral side).

Case report: We report a case of a 37-year-old female presenting with a right SOL, yet left optic nerve atrophy and right optic nerve head swelling; inverse Foster Kennedy syndrome.

Conclusion: Inverse Foster Kennedy syndrome is a rare entity that should be taken into consideration when reviewing a patient with optic atrophy in one eye and swelling in the other.

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.