Neurologist最新文献

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: The perioperative period refers to the 3 phases of the surgical procedure: preoperative, intraoperative, and postoperative. Proper management of chronic diseases in the perioperative period plays a critical role in improving patient outcomes and requires a multidisciplinary approach. Perioperative management of neurological diseases can be challenging due to their chronic nature and the necessity for multiple drug use in neurological disorders, which may potentially interact with anesthetics.

Review summary: This review summarizes the perioperative management of various neurological disorders, including epilepsy, dementia, acute confusional state, movement disorders, stroke, demyelinating diseases, neuromuscular disorders, sleep disorders, and headache.

Conclusion: Perioperative management of patients with neurological diseases requires a comprehensive, multidisciplinary approach tailored to the specific needs of each condition. Adherence to evidence-based guidelines not only ensures patient safety but also enhances recovery, reducing morbidity and mortality in this vulnerable patient population.

Introduction: The diagnosis of psittacosis is still challenging due to the high risk of underdiagnosis and misdiagnosis. Here, we reported our diagnostic experience with psittacosis in combination with central nervous system (CNS) infection and acute cerebral infarction (CI).

Case report: A 62-year-old gentleman presented to our department due to episodic vertigo for 4 hours. Pulmonary CT scan revealed high-density shadows in the right upper lobe, and brain MRI initially excluded new CI lesions. Seven days later, the patient began to show fever, with the highest temperature of 39.3°C. Pulmonary CT scan showed pneumonia. Cerebral MR was performed as the patient showed loss of consciousness and convulsion, which indicated pontine infarction. The patient was eventually transferred to the ICU due to severe pneumonia complicated by type I respiratory failure and acute respiratory distress syndrome (ARDS). Metagenomic next-generation sequencing (mNGS) confirmed psittacosis, and then the patient was treated with a regimen of piperacillin-tazobactam, moxifloxacin, and minocycline. However, the patient continued to have a fever and exhibited irritability after withdrawal of sedative medication, thereby, CNS infection was suspected. Upon cerebrospinal fluid collection following lumbar puncture, mNGS sequencing indicated Candida albicans infection. MR revealed progression of infarction featured by increased lesions in the right cerebellum, right pons, right fronto-parietal-temporal-occipital, and right corona radiata.

Conclusion: We reported a case report of psittacosis combined with CNS infection based on the mNGS sequencing, along with acute CI based on conventional imaging technique.

Objectives: There is a bidirectional relationship between stroke and infection, with stroke increasing susceptibility to infections and contributing to poorer clinical outcomes and higher mortality rates. Stroke-induced dysmotility, impaired gut barrier integrity, and systemic dissemination of resident gut microbiota have recently been implicated in the pathogenesis of poststroke infections. We hypothesize that early modulation of the gut microbiota within the first week of acute stroke may help prevent or mitigate post-stroke infections, mortality, and morbidity.

Methods: This prospective study was conducted between 2020 and 2024 and included patients with moderate-to-severe acute stroke who were monitored in the intensive care unit (ICU) for at least 4 weeks. Probiotic agents containing Saccharomyces Boulardii were administered to the study group either orally or through a nasogastric tube. National Institutes of Health Stroke Scale (NIHSS) scores, patient survival rates, and poststroke infections were recorded during the first month and compared with those of the control group, who were not given probiotics.

Results: The study group had significantly lower rates of poststroke infection and mortality ( P= 0.010 and P= 0.023, respectively). In addition, NIHSS scores were significantly higher in the control group ( P =0.032). Laboratory analyses revealed significantly higher neutrophil and platelet counts, C-reactive protein (CRP), and total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels were also significantly higher in the control group ( P <0.05).

Conclusion: This study demonstrated that probiotic administration may reduce the risk of poststroke infections, improve functional outcomes, and decrease both mortality and morbidity in patients with acute ischemic stroke.

Objectives: High-resolution vessel wall imaging (HRVWI) has emerged as a crucial diagnostic method for improving the etiological classification of ischemic strokes, especially in younger patients. This study seeks to identify the factors that influence neurologists' decisions to recommend HRVWI for young individuals experiencing posterior circulation strokes.

Methods: In this retrospective study, we assessed the effect of HRVWI on the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification among patients aged 45 years or younger with acute ischemic strokes in the posterior circulation. Logistic regression analysis was performed to determine the factors that predict HRVWI recommendations.

Results: Among 135 young stroke patients, 57 underwent HRVWI. The patients who received HRVWI were slightly younger (mean age 35.75 vs. 37.85 y; P =0.07). The use of HRVWI significantly changed the TOAST classification, increasing the identification of strokes attributed to other determined causes (ODC) from 28.2% to 50.9% and decreasing strokes of undetermined causes (UDC) from 18.0% to 7.0%. Notably, vertebrobasilar artery dissections (VBADs) were more frequently detected in the HRVWI group (82.8%) compared with the non-HRVWI group (21.1%). Multivariate logistic regression identified younger age, vertebrobasilar artery tortuosity, and stenosis or occlusion as significant predictors for HRVWI scans (age: P =0.044; tortuosity: P =0.006; stenosis or occlusion: P =0.021; respectively).

Conclusions: HRVWI may be considered for young stroke patients with abnormal arterial structures in the posterior circulation, as it significantly enhances the etiological classification of ischemic strokes.

Objectives: Cerebral infarction is an acute ischemic cerebrovascular disease; elderly patients with cerebral infarction often have frailty syndrome. Therefore, the aim of this study was to analyze the risk factors and their diagnostic value of frailty in elderly patients with cerebral infarction.

Methods: In this retrospective cohort study, the medical records (from October 2017 to September 2020) of patients with cerebral infarction (n=395) were analyzed. According to different frailty statuses, patients were divided into the health group (n=166) and the prefrailty group (n=229). The diagnostic value of various parameters for the occurrence of pre-frailty was assessed by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). The risk factors were analyzed by single-factor and multi-factor analyses.

Results: Interleukin-6 (IL-6, P <0.001), C-reactive protein (CRP), prealbumin (PA, P <0.001), albumin (ALB, P <0.001), and brain natriuretic peptide (BNP, P <0.001) had higher diagnostic value for the occurrence of prefrailty in elderly patients with cerebral infarction. Single-factor and multi-factor analysis results revealed that the length of stay (LOS), comorbidity with nervous system diseases, high Charlson comorbidity index (CCI), high National Institute of Health stroke scale score, IL-6, BNP, ALB, PA, and creatine kinase might risk the factors for prefrailty occurrence ( P <0.05). After the elimination of interference factors, LOS, high CCI, IL-6, and ALB were confirmed to be key risk factors for the occurrence of prefrailty ( P <0.05).

Conclusion: LOS, high CCI, IL-6, and ALB are the underlying risk factors for the occurrence of prefrailty in elderly patients with cerebral infarction, which provides a theoretical basis for clinical disease diagnosis.

Introduction: Posterior reversible encephalopathy syndrome (PRES) results from the failure of cerebrovascular autoregulation with subsequent extravasation of intravascular fluid into the cerebral interstitial space. PRES may rarely affect the spinal cord, termed PRES with spinal cord involvement (PRES-SCI).

Case report: A 34-year-old woman with untreated treated systemic lupus with lupus nephritis presented with altered mental status, blurred vision, and seizures. Initial blood pressure was 189/120 mm Hg. The neurological exam was notable for encephalopathy, but otherwise there were no focal motor or sensory deficits. Brain magnetic resonance imaging (MRI) showed posterior predominate T2-hyperintense lesions in a pattern suggestive of PRES. Spine MRI revealed a nonenhancing longitudinally extensive lesion involving most of the cervical and thoracic spinal cord. Investigations for alternative causes of myelitis, including serum antimyelin oligodendrocyte glycoprotein and antiaquaporin-4 antibodies, were negative. The patient's encephalopathy, blurred vision, and seizures gradually resolved with blood pressure control.

Conclusions: PRES-SCI is a relatively rare but likely under-recognized variant of PRES. This diagnosis should be considered in patients with severe acute hypertension and nonenhancing longitudinally extensive T2-hyperintense spinal cord lesions. Patients may exhibit signs and symptoms of myelopathy or, conversely, may demonstrate minimal myelopathic features despite striking MRI abnormalities. Early recognition of PRES-SCI may obviate the need for further testing or empiric myelitis treatment.

Objectives: Acute isolated dizziness often presents diagnostic challenges, as peripheral vestibular disorders (PVD) and acute ischemic stroke (AIS) symptoms overlap. This study aimed to evaluate the diagnostic effectiveness of the TriAGe+ score, serum neuron-specific enolase (NSE), and their combination in differentiating AIS from PVD.

Methods: A retrospective analysis was conducted on patients hospitalized for acute isolated dizziness in our hospital. Propensity score matching (PSM) was used to balance general demographic characteristics between patient groups. Univariate and multivariate logistic regression analyses were conducted to investigate the associations of TriAGe+ scores and NSE levels with acute cerebral infarction. The predictive performance of these parameters was assessed using receiver operating characteristic (ROC) curves.

Results: A total of 256 eligible patients were enrolled, and 78 pairs were successfully matched using PSM. After PSM, these covariates were well balanced. Logistic regression analysis revealed that NSE level (OR=1.409, 95% CI: 1.233-1.611, P <0.001) and TriAGe+ score (OR=1.938, 95% CI: 1.244-1.851, P <0.001) were independent risk factors. ROC analysis demonstrated that NSE alone had a sensitivity of 74.36%, specificity of 84.62%, and an AUC of 0.82, while the TriAGe+ score had a sensitivity of 67.95%, specificity of 69.23%, and an AUC of 0.74. Combining NSE level and TriAGe+ score resulted in a sensitivity of 74.36%, specificity of 84.62%, and an improved AUC of 0.87.

Conclusion: Elevated TriAGe+ scores and serum NSE levels are associated with an increased risk of AIS in patients with acute isolated dizziness. Their combination may enhance predictive accuracy.

Background: Radiologically Isolated Syndrome (RIS) is defined as incidentally found MRI abnormalities that are radiographically indistinguishable from multiple sclerosis (MS) and is considered a presymptomatic disease state of MS. Age <37 years, infratentorial or spinal cord lesions, gadolinium-enhancing lesions on index imaging, and positive cerebrospinal fluid oligoclonal bands have been identified as risk factors for conversion to MS. There are no existing guidelines regarding the role of disease-modifying therapy (DMT) in RIS patients.

Objective: The objective of this study was to critically assess the current evidence regarding the impact of initiating DMT for patients with RIS on the time to first clinical attack of MS.

Methods: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, medical librarian, and content experts in the field of neuroimmunology.

Results: A multicenter, prospective, randomized, double-blind, placebo-controlled trial was chosen for critical appraisal. This trial examined the impact of treatment with dimethyl fumarate (DMF) versus placebo on the risk of conversion from RIS to MS over a 96-week study period. Patients in the DMF arm were found to have an 82% reduction in risk of clinical attack. DMF patients also had a smaller number of new/newly enlarging T2 hyperintense lesions compared with placebo. No subgroup analyses were performed to elucidate risk factors for conversion.

Conclusions: While initiation of DMT in RIS does appear to reduce the time to first clinical attack of MS, the risk factors that should prompt initiation of DMT in this patient population require further study.