BMC Neurology最新文献

Objective: To explore the association between blood pressure (BP) metrics and early neurological deterioration of ischemic origin (END_i) in patients with mild stroke and large vessel occlusion (LVO) undergoing best medical management (BMM).

Methods: Data were collected from consecutive patients with mild stroke and LVO treated with BMM from January 2019 to December 2023. Admission systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and 24-h SBP variability were calculated. END_i was defined as an National Institutes of Health Stroke Scale (NIHSS) score increase of ≥ 4 points within 24 h, excluding intracranial hemorrhage.

Results: Among 347 patients, END_i occurred in 42 (12.1%). The END_i group exhibited higher admission SBP (158 vs. 131 mmHg, P < 0.001), SBP variability (32 vs. 14 mmHg, P < 0.001), and Tmax > 6 s volumes (63 vs. 40 ml, P < 0.001), and a greater proportion had vertebrobasilar occlusion (42.9% vs. 12.1%, P < 0.001). Multivariable analysis indicated that patients in the highest quartile for admission SBP (adjusted odds ratio [aOR] = 2.47, 95% confidence interval [CI] = 1.47-4.29), SBP variability (aOR = 2.57, 95% CI = 1.34-5.18), and Tmax > 6 s volumes (aOR = 2.09, 95% CI = 1.28-5.89) were independently associated with END_i. Significant association also existed between vertebrobasilar occlusion and END_i (aOR = 3.19, 95% CI = 1.76-6.74).

Conclusion: Significantly elevated admission SBP and large SBP variability were associated with the occurrence of END_i in patients with mild stroke and LVO receiving BMM.

Background: Acute respiratory failure is common occurrence in critical care, with varying causes, depending on case mix of the ICU. High flow nasal cannula (HFNC) is commonly utilized in both adult and pediatric population. However, traditionally, neurologically ill patients have been considered unsuitable for HFNC due to poor sensorium and risk of aspiration. Therefore, we conducted a study to assess the effectiveness of HFNC in Neuro ICU.

Methodology: We did a prospective observational study on all adult patients requiring HFNC during their stay in Neuro ICU. Primary aim of the study was to find common indications for use of HFNC in neuro ICU. The secondary objective was to observe if HFNC could prevent re-intubation. The various other factors studied included age, gender, diagnosis (traumatic brain injury, postoperative neurosurgical condition or other neurological conditions), GCS score, HFNC settings, duration and cost of HFNC therapy.

Results: During the period from January 1, 2021- 23, out of 1825 patients admitted to neuro ICU, 98 required HFNC therapy. Mean age was 43.3 years (range 18-85), 75.5% of which were males. Utilization rate of HFNC was 5.3%. HFNC was more commonly used for non-trauma patients, most often to reduce work of breathing following extubation (85%). HFNC helped prevent the need for re-intubation in 76.5% of patients with a failure rate of 23.5% across all subgroups of patients in neuro ICU. Requirements for higher flow rate and FiO₂ were significant predictors of HFNC failure. The mean cost of HFNC usage accounted for only 5.6% of the total inpatient bill.

Conclusion: In neurocritical care, the causes of extubation failures and hypoxemia, differ significantly from other ICUs. In our study, HFNC was used most often to reduce work of breathing following extubation and was useful in preventing re-intubation. The use of HFNC did not significantly increase the cost of healthcare.

Background and aims: Endoscopic surgery (ES) and small bone window craniotomy (SBWC) are commonly used methods for hematoma removal in cases of intracerebral hemorrhage (ICH). However, their long-term efficacy and safety remain uncertain.

Methods: A systematic search was performed in the PubMed, Embase, and Cochrane Library databases from inception to June 30, 2024. The primary outcomes assessed were the 6-month favorable functional outcome rate and the hematoma evacuation rate. Following the meta-analysis, a trial sequential analysis (TSA) was conducted to validate the findings.

Results: Six randomized controlled trials were included in the meta-analysis. ES demonstrated a higher 6-month favorable functional outcome rate compared to SBWC (56.8% vs. 48.0%, relative risk [RR] 1.20, 95% confidence interval [CI] 1.05-1.38, I² = 28%), with TSA supporting this result. The hematoma evacuation rate was also higher in the ES group (mean difference [MD] 6.41, 95% CI 1.83-10.99, I² = 95%); however, the TSA did not support this result due to the potential false-positive. Additionally, ES was associated with shorter operation times, less blood loss during surgery, and a lower pneumonia rate compared to SBWC (MD -112.35, 95% CI -165.27 to -59.43; MD -151.22, 95% CI -279.60 to -22.84; RR 0.68, 95% CI 0.51-0.91).

Conclusions: The meta-analysis and TSA indicate that ES offers better long-term efficacy, shorter operation times, less blood loss, and a lower rate of pneumonia compared to SBWC. Therefore, prioritizing ES over SBWC for treating ICH appears to be a reasonable approach.

Background: Both vitamin B6 deficiency and vitamin B12 deficiency can present with symptoms that appear like polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome, with painful peripheral neuropathy and sensorimotor dysfunction. There are rare reports of an association between vitamin B12 deficiency and POEMS syndrome, and even rarer reports of an association between vitamin B6 deficiency and POEMS syndrome. To our knowledge, this is the first described case with deficiencies in both vitamin B6 and vitamin B12 in association with POEMS syndrome.

Case presentation: A man in his 40s presented with fatigue, imbalance, and painful numbness and tingling. Initial evaluation revealed low vitamin B12 level, and he received oral and IV supplementation for one month with an improvement in vitamin B12 levels, but without improvement in symptoms. Further evaluation revealed both a vitamin B6 deficiency and an IgA lambda monoclonal spike, prompting further investigation and an eventual diagnosis of POEMS syndrome. He underwent an autologous stem cell transplant and has had improvement in his symptoms.

Conclusions: Patients with POEMS syndrome may have symptoms that are difficult to distinguish from deficiencies in vitamin B6 or vitamin B12. Management of POEMS should include screening of vitamin B6 and B12 to ensure other possible associated causes of symptoms are appropriately treated.

Background: Oculomotor nerve palsy is a common neurological presentation in daily practice.

Case presentation: A 55-year-old man presented with a 3-h history of diplopia and drooping of his bilateral especially left eyelids. Examination revealed an isolated oculomotor nerve palsy consisting of left medial rectus, inferior oblique, superior rectus, inferior rectus with intact pupillary reflexes and bilateral especially left superior palpebral levator. Conventional diffusion weighted imaging (DWI) of the brain showed a suspicious restriction in the left midbrain periaqueductal region. If the clinical symptomatology indicates a lesion in the midbrain, of which a high signal intensity was encountered from neurologically healthy older adults, the limited spatial resolution of conventional axial DWI is an enormous disadvantage. Zonally magnified oblique multislice (ZOOM) DWI correlated with apparent diffusion coefficient map providing higher accuracy for accurate diagnosis can identify signal alterations of mesencephalic interpeduncle area.

Conclusions: This is a rare presentation of isolated oculomotor nerve palsy due to pure mesencephalic infarction especially verified by ZOOM DWI.

Background: Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder characterized by the presence of inclusions within the nuclei of various cell types. The clinical manifestations of patients with NIID are diverse. Here, we present the case of a patient with NIID whose clinical presentation and magnetic resonance features closely resembled those of hydrocephalus.

Case presentation: The patient was 71-year-old woman with no significant family history. Seven years previously, she began to experience tremors in both hands, which occurred at rest and while holding objects; this was accompanied by urinary incontinence. Four years previously, she developed weakness in both lower limbs, an unstable gait, and dizziness. Over the past year, she noticed stiffening at the root of her tongue, cognitive decline, and slower reaction times compared to her previous state. Upon admission, cranial magnetic resonance imaging (MRI) revealed hydrocephalus-like changes. A cerebrospinal fluid drainage test returned negative results. The patient presented with tremors and urinary incontinence. Physical examination indicated pupillary constriction, and electromyography suggested peripheral neuropathy. Genetic testing revealed 91 GGC repeats in the NOTCH2NLC gene, indicating abnormal expansion. The final diagnosis was NIID. We provided symptomatic treatment for the tremor and cognitive impairment, but there was no significant improvement in the clinical symptoms.

Conclusions: Our case suggests that when a patient presents with clinical symptoms and MRI findings resembling hydrocephalus, the possibility of NIID should be considered, especially in the presence of tremors and autonomic symptoms.

Background: Alzheimer's disease (AD) is one of the most common forms of dementia in the elderly, characterized by progressive neurodegeneration. While the exact etiology of AD remains unclear, immune inflammation is known to play a significant role in the disease.

Methods: This study utilized a two-sample Mendelian randomization (MR) approach to assess the causal relationship between different types of immune cells and AD, while considering inflammatory factors as intermediate variables. Data were collected from three sources: immune cell data (731 phenotypes), inflammatory factors (48 cytokines from 8,293 individuals), and AD data (35,274 cases, 59,163 controls). Multiple MR methods were employed to minimize bias, and detailed descriptions of instrumental variable selection and statistical methods were provided.

Results: The study findings suggest potential causal relationships between six different types of immune cells and AD, as well as causal relationships between 13 immune cells and inflammatory factors. Additionally, two statistically significant inflammatory factors were found to have potential causal relationships with AD. Specifically, immune cells CD33-HLA DR + and CD45 on CD33-HLA DR + may further influence AD by regulating Interleukin-2 levels.

Conclusion: This study provides valuable insights into the immunoinflammatory pathogenesis of AD and offers partial guidance for the development of relevant interventions, thereby contributing beneficial information for the prevention and treatment of related diseases.

The COVID-19 pandemic and increased demands for neurologists have inspired the creation of remote, digitalized tests of neurological functions. This study investigates two tests from the Neurological Functional Tests Suite (NeuFun-TS) smartphone application, the "Postural Sway" and "Pronator Drift" tests. These tests capture different domains of postural control and motoric dysfunction in healthy volunteers (n = 13) and people with neurological disorders (n = 68 relapsing-remitting multiple sclerosis [MS]; n = 21 secondary progressive MS; n = 23 primary progressive MS; n = 13 other inflammatory neurological diseases; n = 21 non-inflammatory neurological diseases; n = 4 clinically isolated syndrome; n = 1 radiologically isolated syndrome). Smartphone accelerometer data was transformed into digital biomarkers, which were filtered in the training cohort (~ 80% of subjects) for test-retest reproducibility and correlations with subdomains of neurological examinations and validated imaging biomarkers. The independent validation cohort (~ 20%) determined whether biomarker models outperformed the best single digital biomarkers. Postural sway acceleration magnitude in the eyes closed and feet together stance demonstrated the highest reliability (ICC = 0.706), strongest correlations with age (Pearson r <= 0.82) and clinical and imaging outcomes (r <= 0.65, p < 0.001) and stronger predictive value for sway-relevant neurological disability outcomes than models that aggregated multiple biomarkers (coefficient of determination R² = 0.46 vs 0.38). The pronator drift test only captured cerebellar dysfunction, had less reproducible biomarkers, but provided additive value when combined with postural sway biomarkers into models predicting global scales of neurological disability. In conclusion, a simple 1-min postural sway test accurately measures body oscillations that increase with natural aging and differentiates them from abnormally increased body oscillations in people with neurological disabilities.