Canadian Journal of Neurological Sciences最新文献

Background and objectives: In-hospital strokes comprise a small but high-risk subgroup of patients and are associated with worse outcomes compared to community-onset strokes. We compared clinical characteristics, workflow metrics and clinical outcomes of adult patients with in-hospital strokes and those with community-onset strokes in Alberta.

Methods: We conducted a retrospective cohort study (INPATIENTS: IN-hosPitAl sTrokes InAlbErta iNcidence and ouTcomeS) from Jan 1, 2018-Dec 31, 2022 using provincial administrative data and chart review to compare in-hospital and community-onset acute ischemic and hemorrhagic strokes. We performed multivariable logistic regression to determine the association of stroke onset location (in-hospital vs community-onset) with the following outcomes: in-hospital mortality, prolonged hospital stay and in-hospital complications. Negative binomial regression was conducted to compare workflow metrics between cohorts. All models were adjusted for age, sex, comorbidities, facility type and admission year.

Results: Among 24,039 stroke admissions, 2,545 (10.6%) were in-hospital strokes and 20,895 (86.9%) were ischemic. In-hospital strokes had higher rates of comorbidities and were associated with higher in-hospital mortality (adjusted OR [aOR] 3.09; 95% CI 2.80-3.41), prolonged hospital stays (aOR 5.47; 95% CI 4.89-6.112) and increased in-hospital complications. In-hospital ischemic stroke patients receiving thrombectomy showed lower odds of in-hospital mortality (aOR 0.46; 95% CI, 0.28-0.75) and pneumonia (aOR 0.38; 95% CI, 0.20-0.71) compared to non-treated patients. Workflow times were significantly longer in in-hospital ischemic strokes compared to community-onset strokes.

Discussion: Patients with in-hospital stroke experience higher rates of mortality, poorer clinical outcomes and significant delays in management. Targeted quality improvement efforts are needed to address care gaps and improve outcomes in this population.

Background: Optic neuritis (ON) represents the most common optic neuropathy in young adults; however, longitudinal data on visual recovery, particularly in autoimmune ON subtypes, remain limited. This study aimed to assess long-term visual outcomes in patients with severe ON without multiple sclerosis stratified by autoantibody status: aquaporin-4 (AQP4)-IgG positive, myelin oligodendrocyte glycoprotein (MOG)-IgG positive and double seronegative (DN).

Methods: A retrospective cohort analysis was conducted at a tertiary neurology center in southern India, including severe ON patients (best-corrected visual acuity [BCVA] ≤1.0 logMAR) between January 2016 and April 2024. Serological testing for AQP4 and MOG antibodies was performed via cell-based assays. Visual outcomes were categorized as "good recovery" (≥66.77% improvement in BCVA) and "complete recovery" (return to baseline BCVA).

Results: Among 42 patients, 17 were AQP4-IgG positive, 10 MOG-IgG positive and 15 DN. The median BCVA at nadir was 1.7 logMAR. Compared with that in the MOG-IgG group, the likelihood of complete visual recovery was lower in both the AQP4-IgG (hazard ratio [HR]: 0.18; p = 0.16) and DN (HR: 0.56; p = 0.34) groups. For good recovery, the AQP4-IgG (HR: 0.16; p = 0.001) and DN (HR: 0.24; p = 0.001) groups had significantly lower HR. All MOG-IgG-positive patients achieved good recovery, compared with fewer than half in the other groups.

Conclusion: Antibody status predicted long-term visual outcomes in patients with isolated ON, with MOG-IgG conferring the best recovery, AQP4-IgG the worst and DN intermediate, underscoring the importance of early, antibody-guided management.

Background: Spinal CSF leaks are a known cause of spontaneous intracranial hypotension, often presenting with orthostatic headaches and other neurological symptoms. While epidural blood patches are commonly used as initial treatment, many patients require surgery due to persistent symptoms. This study integrates a retrospective institutional cohort and a systematic literature review to evaluate the safety and efficacy of surgical dural repair for spontaneous spinal CSF leaks.

Methods: A retrospective chart review included all patients who underwent surgery for spontaneous spinal CSF leak at a Canadian center between June 2017 and December 2023. Clinical presentation, imaging findings, surgical approach and postoperative outcomes were assessed. A PRISMA-compliant systematic review identified studies reporting surgical management and outcomes for spinal CSF leaks.

Results: Forty patients (21 females, 19 males; mean age 50.48 ± 11.88 years) were included. Type 1 ventral dural CSF leaks predominated (72.5%), most commonly in the thoracic spine. Spinal longitudinal extradural collection and cranial stigmata were present in 70% and 75%, respectively. Microscopic direct dural repair led to clinical improvement in 82.5%, with headache resolution or improvement in 85.72%. The complication rate was 7.5% with all complications being transient. The systematic review included 20 studies (483 patients), reporting an 84.06% pooled surgical success rate, with transient complications most common in direct suturing techniques.

Conclusion: Surgical repair is a safe and effective treatment for spontaneous spinal CSF leaks, particularly in patients with failed conservative treatment. Favorable outcomes support early, anatomically guided surgical intervention.