Neurologist最新文献

Introduction: Symptomatic carotid artery disease (CAD) represents an uncommon but treatable cause of corticobasal syndrome.

Case report: We present the clinical details and successful management of a previously healthy 77-year-old patient who presented with 1-year cognitive dysfunction, alien limb syndrome, limb kinetic apraxia, and ipsilateral cortical sensory deficit, fulfilling the criteria of the diagnosis of probable corticobasal syndrome. Imaging modalities, including magnetic resonance imaging and time-of-flight magnetic resonance angiography, revealed acute external borderzone infarcts of the right hemisphere due to symptomatic CAD causing near occlusion of the vessel. The patient underwent a right carotid endarterectomy, leading to a marked improvement in mobility and neuropsychological evaluation.

Conclusion: This case highlights the importance of swift diagnosis of symptomatic CAD in patients with corticobasal syndrome. Moreover, it emphasizes the efficacy of carotid endarterectomy in achieving symptom improvement in such cases.

Objectives: Research on the association between stroke severity and day-by-day blood pressure variability (BPV) in acute ischemic stroke (AIS) is rare as the majority focus on the blood pressure (BP) or the short-term BPV. Our study aims to explore the exact roles of daily BPV through the 7-day commencement on stroke severity in AIS.

Methods: The study included 633 patients with AIS, defining AIS as the time from the beginning of symptom up to 7 days with recording BP twice a day as well as calculating the daily BPV, and then matching them to the stroke severity. The logistic regression models were used to evaluate associations between stroke severity and day-by-day BPV. We used the smooth curve fitting to identify whether there was a nonlinear association. In addition, the subgroup analyses were performed using the logistic regression.

Results: According to the modified National Institutes of Health Stroke Scale score, 301 (47.5%) patients were allocated to the mild stroke group and 332 (52.5%) to the moderate-to-severe stroke group. In terms of stroke categories, we found no significant difference between BP at admission or mean BP. However, the moderate-to-severe stroke group exhibited higher daily BPV. The multiple logistic regression analysis indicated that day-by-day BPV was positively correlated to stroke severity [odds ratio (OR)=1.05, 95% CI:1.01-1.1, P =0.03 for SBP-SD; OR=1.08, 95% CI:1.01-1.15, P =0.03 for SBP-CV; OR=1.04, 95% CI:1.01-1.07, P =0.015 for SBP-SV).

Conclusions: High day-by-day BPV in AIS was associated with more severe stroke independent of BP levels.

Objective: To study the correlation between risk factors, degree of vascular restenosis, and inflammatory factors after interventional treatment for stroke.

Methods: The clinical data of 96 stroke patients who received interventional therapy in our hospital from April 2020 to June 2021 were selected for retrospective study, and the postoperative follow-up was 1 year. Univariate and multivariate regression were used to analyze identified factors associated with interventional stroke efficacy. At the same time, the value of inflammatory factor levels in predicting vascular restenosis after interventional stroke was analyzed.

Results: According to our findings, several risk factors, including body mass index ≥ 25.51 kg/m 2 , smoking, drinking, hypertension, and diabetes, were identified as contributors to poor postoperative efficacy following stroke intervention ( P <0.05). Furthermore, a notable association was observed between the severity of vascular stenosis ( P <0.001) and the levels of interleukin 6, interleukin 2, TNF-α, and C-reactive protein. The combined assessment of these serum inflammatory factors exhibited excellent predictive capability for postoperative vascular restenosis and stenosis severity, yielding a sensitivity of 84.30%, a specificity of 81.20%, and an area under the curve of 0.882.

Conclusions: Obesity, smoking, alcohol consumption, hypertension, and diabetes have been found to be associated with suboptimal outcomes following interventional treatment for stroke. The assessment of preoperative levels of inflammatory factors holds promise in predicting the likelihood of postoperative restenosis to a certain degree.

Objective: Acute unilateral peripheral vestibulopathy (AUPVP) is a frequent form of peripheral vestibular vertigo characterized by unilateral vestibular organ dysfunction. Diagnostic challenges in anamnesis and bedside examination can lead to potential misdiagnoses. This study investigated the sensitivity of bedside examinations in diagnosing AUPVP.

Methods: This retrospective analysis examined 136 AUPVP inpatients at a level 3 university hospital between 2017 and 2019. Demographic data and bedside test results were collected. Instrumental otoneurological tests included caloric testing and video head impulse test (HIT). The sensitivity of each bedside parameter was computed based on the instrumental diagnostics, and statistical analyses were performed.

Results: The study included 76 men and 60 women, with a mean age of 59.2 years. Spontaneous nystagmus exhibited a sensitivity of 92%, whereas the absence of skew deviation was identified with a sensitivity of 98%. Abnormal bedside HIT showed a sensitivity of 87%. The combined HINTS (HIT, nystagmus, and test of skew) had a sensitivity of 83%. The Romberg test and Fukuda test demonstrated sensitivities of 26% and 48%, respectively.

Conclusion: The sensitivity of bedside tests varied from 26% to 98%. This aligns with previous literature, highlighting the challenge of differentiating AUPVP from vestibular pseudoneuritis solely through bedside examination. Although the tests excel in excluding central causes, they are insufficient for diagnosing AUPVP with certainty. In addition, the bedside examination sensitivities vary widely, and early radiological imaging can be misleading. Therefore, this study underlines the necessity of prompt otoneurological testing for accurate exclusion of vestibular pseudoneuritis and thus improve patient outcomes.

Objectives: This study aims to investigate the significance of insulin resistance markers in predicting poor prognosis in acute ischemic stroke (AIS) patients after intravenous thrombolysis and to establish the corresponding nomogram.

Methods: From January 2019 to March 2023, the data of 412 patients with AIS who received intravenous alteplase thrombolytic therapy in the Affiliated Taizhou People's Hospital of Nanjing Medical University were selected. Patients were randomly divided into training groups (70%, 288 cases) and validation groups (30%, 124 cases). In the training group, multivariate logistic regression analysis was used to establish the best nomogram prediction model. The predictive ability of the nomogram was further evaluated by the area under the receiver operating characteristic curve, calibration curve, decision curve analysis, and reclassification analysis. Furthermore, the model was further validated in the validation set.

Results: Multivariate logistic regression analysis showed that systolic blood pressure, diabetes, National Institutes of Health Stroke Scale score, triglyceride-glucose index, triglyceride-glucose-body mass index, ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol were associated with poor prognosis in AIS patients after intravenous thrombolysis ( P <0.05). Compared with conventional factors, the nomogram showed stronger prognostic ability, area under receiver operating characteristic curves were 0.948 (95% CI: 0.920-0.976, P <0.001) and 0.798 (95% CI: 0.747-0.849, P <0.001), respectively.

Conclusions: Triglyceride-glucose index, triglyceride-glucose-body mass index, and low-density lipoprotein cholesterol to high-density lipoprotein cholesterol levels upon admission can serve as markers for poor prognosis in AIS patients after intravenous thrombolysis. The nomogram enables a more accurate prediction of poor prognosis in AIS patients after intravenous thrombolysis.

Objective: We sought to determine whether the initial Systemic Inflammatory Response Index (SIRI) was associated with pneumonia after spontaneous intracerebral hemorrhage (SICH) in hospitalized patients.

Patients and methods: Patients with SICH admitted to Taizhou People's Hospital between January 2019 and December 2021 were retrospectively analyzed. Baseline variables were compared between stroke-associated pneumonia (SAP) and non-SAP groups. Multivariable logistic regression analyses were utilized to calculate the relationship between SIRI and SAP risk.

Results: Of 495 patients included in this research, 192 (38.79%) developed SAP ultimately. The SIRI values exhibited the highest area under the curve value for SAP incidence (area under the curve = 0.736, 95% CI: 0.692-0.781), with respective sensitivity and specificity values of 0.646 and 0.749 at the optimal cutoff threshold of 2.53. In multivariate analysis, high SIRI (≥2.53) was a significant independent predictor of post-SICH SAP even after controlling for other possible confounding variables (odds ratio: 5.11, 95% CI: 2.89-9.04, P < 0.001). According to the restricted cubic splines model, SAP risk increases as SIRI increases.

Conclusions: We observed that SIRI values may offer high diagnostic utility as a predictor of SAP risk among patients with SICH during the early stages of the disease.

Introduction: Solitary fibrous tumors (SFTs) of the central nervous system represent a unique entity with limited data on best treatment practices.

Case report: Here, we present a case of multiply recurrent central nervous system SFT treated with radiation and immunotherapy. Immunotherapy was chosen based on mutations of genes encoding DNA repair enzymes detected through next-generation sequencing of the tumor, DNA polymerase epsilon catalytic subunit ( POLE ) and mutL homolog 1. The use of radiation and immunotherapy led to slight shrinkage and no recurrence of the tumor for over 2 years.

Conclusion: The presence of somatic DNA repair enzyme gene mutations in SFT may suggest a benefit from a combination of radiotherapy and immunotherapy. This may serve as a biomarker for guiding management in patients with this rare tumor.

Introduction: Arterial thoracic outlet syndrome (aTOS) is the least common among the 3 subtypes of thoracic outlet syndrome and can be the cause of posterior circulation infarction due to thrombus from a secondary thrombosed subclavian-axillary artery aneurysm.

Case report: Here, we report a case of a 51-year-old man who presented to our institute with sudden onset vertigo, dizziness, vomiting, gait imbalance, and visual field defects immediately after strenuous exercise. Computed tomography angiography revealed bilateral cervical ribs with aneurysmal dilatation of the left distal subclavian and proximal axillary arteries. The computed tomography also revealed subacute infarcts in the bilateral cerebellar hemispheres, as well as in the bilateral occipital lobes. Color Doppler evaluation of the subclavian artery after hyperabduction of the ipsilateral arm revealed a continuous reversal of flow in the subclavian artery, which reached the vertebral ostia. The left cervical rib was resected, aneurysm was repaired, and the patient remained asymptomatic on follow-up.

Conclusion: Posterior circulation stroke caused by the ipsilateral thrombosed subclavian artery aneurysm in an adult patient with aTOS due to a complete cervical rib is rare. A high index of suspicion should be present for thoracic outlet syndrome in patients with stroke and upper-limb arterial claudication symptoms. Dynamic Doppler evaluation in such patients can be used to demonstrate the underlying pathomechanism, and definitive surgical treatment can prevent further ischemic episodes. Posterior circulation stroke caused by partially thrombosed distal subclavian and axillary artery aneurysms due to aTOS is rare.

Introduction: Glioblastoma is a uniformly lethal primary central nervous system neoplasm. Despite the increased understanding of its pathophysiology and treatment advancements, median overall survival for patients with glioblastoma, IDH-wild type remains 14 to 21 months from diagnosis.

Case report: We present the case of a 48-year-old female who presented with a focal seizure and was found to have a right frontal lobe mass on the brain magnetic resonance imaging. She underwent gross total resection and received a histological diagnosis of glioblastoma. She received radiotherapy and 6 cycles of carmustine (BCNU). Seventeen months later, she developed left hemiparesis. Imaging was concerning for tumor progression, and she was treated with 1 cycle of mechlorethamine, vincristine (oncovin), procarbazine, and prednisone (MOPP). Subsequent surveillance imaging demonstrated a therapeutic response. Twenty-seven years after her glioblastoma diagnosis, she developed status epilepticus and died from respiratory failure. Neuropathology on autopsy demonstrated extensive treatment-related changes but no evidence of recurrent glioblastoma. Genomic testing performed over 30 years after her original diagnosis revealed a profile diagnostic of glioblastoma, IDH-wild type per 2021 World Health Organization criteria.

Conclusions: This patient is one of the longest-known survivors of glioblastoma, IDH-wild type, with pathologic confirmation of glioblastoma at the time of her resection and no evidence of residual disease 26 years after her last treatment. She presented with multiple factors associated with long-term glioblastoma survivorship, including female sex, young age, high Karnofsky score, and multimodal therapy. This case shows that long-term survival after glioblastoma diagnosis is possible and likely mediated through a combination of individual, tumor, and treatment factors.

Background: The feasibility and clinical outcome predictors of mechanical thrombectomy (MT) for strokes caused by distal arterial occlusion (DAO) remain the subject of debate.

Methods: A retrospective analysis was conducted of patients with consecutive acute ischemic stroke treated using MT. Clinical and procedural-associated factors were studied to compare the efficacy, safety, and short-term and long-term outcomes of MT between the proximal arterial occlusion (PAO) and DAO groups. The predictors of a good functional outcome in the DAO group were also identified.

Results: A total of 116 patients were included in this study, of whom 23 (19.8%) underwent MT for DAO. A higher complete recanalization rate was independently associated with PAO in adjusted models [adjusted odds ratio, 0.596; 95% CI, 0.377-0.941]. The measures of safety and clinical outcome showed no significant differences between the DAO and PAO groups. The National Institute of Health stroke scale (NIHSS) score on admission, hybrid technique use, and complete recanalization rate emerged as independent predictors of a good functional outcome in the DAO group.

Conclusions: The efficacy, safety, and short-term and long-term outcomes of DAO thrombectomy were similar to those of PAO thrombectomy. The good functional outcome predictors of MT in DAO included NIHSS on admission, hybrid technique use, and complete recanalization. Overall, the findings lead us to propose that MT may be considered a feasible option for treating DAO after a careful risk-benefit analysis.