Acta neurologica Belgica最新文献

Traumatic brain injury (TBI) is a widespread, serious public health concern with substantial lasting effects, such as impacting the endocrine system. Here, we review the complications and consequences of TBI on the hypothalamic-pituitary axis (HPA) and connected endocrine glands, which are essential for maintaining body balance. Endocrine dysfunctions caused by TBI, especially hypopituitarism, can result in hormonal imbalances that impact various physiological systems, such as growth, metabolism, reproduction, and stress responses. These dysfunctions can cause issues like adrenal insufficiency, hypothyroidism, and hypogonadism, greatly affecting the quality of life of survivors. In cases of moderate to severe TBI, up to 40% of individuals may suffer from post-TBI hypopituitarism, leading to extended morbidity. The introduced treatment methods concentrate on different therapeutic options, including hormone replacement therapies (HRTs) (corticosteroid, growth, thyroid, and sex hormones replacement therapies), emerging plant-based bioactive compounds, and other options to address particular deficiencies. Simultaneously, there is a growing interest in novel bioactive compounds derived from plants because of their neuroprotective and anti-inflammatory properties. In addition, certain populations, such as veterans and children, are more likely to develop endocrine dysfunction due to TBI. Comprehensive, cross-disciplinary care and individualized treatment plans are crucial to improve outcomes and long-term recovery for TBI patients. Further investigation is needed to enhance diagnostic instruments, explore novel therapies, and establish predictive biomarkers for early intervention in TBI-induced endocrine disorders.

A 23-year-old male presented with a 6-month history of left eyelid swelling and a 2-week history of headaches following a road traffic accident. Examination revealed left eye proptosis (23 mm vs. 19 mm on the right, normal 16 mm), limited abduction of the right eye, incomplete closure of the right upper eyelid, and right facial nerve weakness. No relative afferent pupillary defect (RAPD) was noted. Musculoskeletal ultrasound of the left eyelid identified an elongated subcutaneous cystic lesion with intense vascularity, indicative of a vascular lesion. CT of the facial bones with 3D reconstruction revealed bilateral proptosis, dilated superior ophthalmic veins, and enlarged cavernous sinuses, consistent with bilateral carotid-cavernous fistulas (CCFs). Otomastoiditis with facial nerve canal dehiscence was also noted, suggesting facial nerve involvement. MRI brain and orbit with gadolinium contrast demonstrated multiple dilated tortuous vascular structures communicating with the cavernous sinuses, dilated bilateral superior ophthalmic veins (left > right), and left eye proptosis, consistent with high-flow fistulas. High-flow characteristics were supported by early arterial filling of the cavernous sinuses, retrograde venous drainage, and superior ophthalmic vein dilation on MR angiogram. Bilateral CCFs are rare, typically resulting from trauma, and often present with proptosis, cranial nerve deficits, and orbital symptoms. Fundus examination revealed engorged retinal veins and mild optic disc swelling in the left eye, consistent with venous stasis. Endovascular surgery is the gold standard for treatment; however, this patient was managed symptomatically with analgesics due to financial constraints. This case demonstrates the importance of imaging in diagnosis and highlights the challenges of managing CCFs in resource-limited settings.

Background and objectives: Acute traumatic subdural hematomas (aTSDH) represent a frequent and critical neurosurgical emergency, associated with a significant risk of mortality. Elderly patients with symptomatic aTSDH may benefit from early antifibrinolytic therapy (EAFT). We aim to investigate whether EAFT can improve clinical outcomes in aTSDH patients and to explore the factors influencing mortality, using data from a nationwide, multicenter, prospective cohort study.

Methods: Multicenter, prospective cohort study at 30 trauma centers from 2023 to 2024 enrolled 963 patients diagnosed aTSDH. After screening, 297 patients aged 60 years or older met inclusion criteria. The primary outcome was 90-day mortality. Secondary outcomes included vascular occlusion, brain rebleeding, sepsis, gastrointestinal bleeding, and renal failure.

Results: A total of 297 aTSDH patients were identified, of whom 195 received EAFT, and 102 were in the control group. After propensity score matching (PSM), 80 patients in each group were compared. There were no significant differences in 90-day mortality (before PSM, P = 0.439; after PSM, P = 0.828). The difference between the two group in the incidence of brain rebleeding, sepsis, gastrointestinal bleeding, and renal failure were similar before and after PSM. The EAFT group had a significantly higher incidence of vascular occlusion compared to the control group (before PSM, P = 0.014; after PSM, P = 0.027). In multivariate logistic regression (odds ratio [95% confidence interval]), increased 90-day mortality was predicted by larger hematoma volume (2.329 [1.123-4.830], P = 0.023) and greater midline shift (2.251 [1.065-4.755], P = 0.034). Sensitivity analysis indicated that there was heterogeneity in the treatment effects between the two groups across different midline shift categories (before PSM, P = 0.012; after PSM, P = 0.043).

Conclusion: EAFT may not significantly reduce mortality in elderly aTSDH patients and could potentially increase the risk of vascular occlusion. Therefore, its use in this population should be approached with caution, carefully assessing the potential risks.

Background: Parkinson's disease (PD) is one of the most common progressive neurological disorders characterized by the loss of dopaminergic neurons in the substantia nigra of the midbrain. In recent years, PIAS family proteins have been proposed as key factors in the development of neurodegenerative diseases. The aim of this study was to investigate the expression levels of PIAS family genes in patients with PD and compare them with those in the healthy control group.

Methods: The expression of PIAS family genes in the peripheral blood cells was investigated by RT-qPCR technique and the results were statistically analyzed using R software.

Results: PIAS4 gene expression was significantly lower in PD patients compared to the control group (p = 0.016), while we found no significant change in the expression of other PIAS genes between PD patients and healthy control group. Considering gender, the expression of PIAS3 was higher in males than that in females (p = 0.024). Also, significant downregulations in PIAS3 and PIAS4 genes were observed with increasing age, especially in men regardless of being patient or healthy (p = 0.04 and 0.001, respectively). In the correlation analysis, there were significant positive pairwise correlations between PIAS family members. Also, significant negative correlations between the expression of PIAS3 and PIAS4 genes with age were found.

Conclusion: These findings show that part of the disruption of immune system regulation occurring in PD is probably related to the expression of PIAS family genes and that these proteins, especially PIAS4, can play an important role in the inflammatory and pathophysiological mechanisms of PD.

Background: Botulinum toxin is now used to treat a variety of neurological and non-neurological disorders. Despite the fact that injections of botulinum neurotoxin may significantly reduce the involuntary muscular contractions associated with focal dystonia and hemifacial spasm (HFS), it is less certain whether the motor effect would result in an improvement in health-related quality of life (HR-QoL).Our goal was to evaluate how botulinum toxin affected individuals with cervical dystonia and hemifacial spasm in terms of their quality of life, self-esteem, pain, sleep, and depression.

Methods: This is a prospective study that included 40 patients diagnosed with cervical dystonia or hemifacial spasm treated with Botulinum toxin. Quality of life, self-esteem, pain, sleep and depression were all assessed in the studied patients by self-reporting questionnaires to assess the impact of botulinum toxin on them.

Results: The quality of life with its components (physical, physical role, emotional role, vitality, mental health, social functioning and pain) showed significant improvement at the end of follow up compared to baseline with p values ≤ 0.001. Also, there was a significant improvement of self-esteem score, depression score, at the end of follow up period compared to baseline assessment with p value 0.012, < 0.001 respectively. Moreover, there was a significant improvement of all pain scales and sleep quality scores with p values < 0.05 except the habitual sleep efficiency.

Conclusion: botulinum toxin is an effective therapy for motor and non-motor manifestations associated with focal cervical dystonia and hemifacial spasm as well as the quality of life and to conclude that its effectiveness is dependent not only on the elimination of physical symptoms, but also on improving the patients' and their families' emotional and social status to help providing the drug to all eligible patients.

Background: Scales and questionnaires measure various variables, such as health symptoms, functionality, and quality of life. The Headache Needs Assessment (HANA) survey evaluates the chronic impact of migraine on quality of life, focusing on frequency and bothersomeness.

Objective: This study aimed to adapt and validate the Turkish version of the HANA, a concise and practical tool for assessing tension-type headache-related needs.

Methods: A total of 86 individuals with tension-type headaches were included in the test phase, while 79 participants with tension-type headaches were involved in the retest phase. Exploratory and Confirmatory Factor Analyses (EFA and CFA) were used to assess structural validity. Reliability was evaluated using Intraclass Correlation Coefficients (ICC) and Cronbach's α, and convergent validity was tested by correlating HANA scores with the Henry Ford Hospital Headache Disability Inventory (HDI) and Headache Impact Test-6 (HIT-6).

Results: Test-retest reliability was strong (ICC 0.789-0.840), and internal consistency was high (α = 0.882-0.913). Good correlations with HDI (r = 0.545; p = 0.000) and HIT-6 (r = 0.484; p = 0.000) supported convergent validity, while it was observed a low correlation with Visual Analog Scale (r = 0.342; p = 0.001). There were no floor or ceiling effects observed.

Conclusion: The Turkish version of the HANA is a valid and reliable tool in individuals with tension-type headache that is easy to administer in both clinical and research contexts.

Clinicaltrials:

Gov number: NCT06675292.