BMC Neurology最新文献

Background: Acute stroke is one of the leading causes of mortality and disability worldwide. In recent years, various scoring systems have been introduced to predict the outcomes of acute stroke patients, one of which is the Clot Burden Score (CBS). Therefore, the present study evaluates the prognostic value of the modified CBS in patients presenting with acute ischemic stroke.

Methods: This study was conducted from 2022 to 2024 at Ghaem Hospital, Mashhad. Patients presenting to the hospital's emergency department with symptoms of acute ischemic stroke were identified based on NIHSS clinical examination. NIHSS was assessed at admission, ASPECTS on baseline imaging, and the modified Rankin Scale at admission (mRS0) and 90 days post-stroke (mRS90). CBS, DWI-ASPECTS, mRS, and the modified CBS were measured for each patient. The collected data were analyzed using SPSS statistical software, and the prognostic value of both the original and modified CBS was assessed for predicting different outcomes, including mortality, disability, and severe disease.

Results: A total of 130 patients were included (mean age 64.9 ± 14.1 years; 53.1% male). Compared to CBS, mCBS showed stronger correlations with NIHSS (ρ=-0.569, p < 0.0001) and mRS90 (ρ=-0.568, p < 0.0001). For disability prediction (mRS90 ≥ 2), the AUC of mCBS was 0.807 versus 0.735 for CBS (p = 0.0019). For severity (NIHSS ≥ 15), the AUC was 0.778 versus 0.720 (p = 0.0156). For mortality, AUCs were 0.708 and 0.681, respectively, with no significant difference (p = 0.3821).

Conclusion: Based on the findings of this study, the modified CBS has greater prognostic value than the original CBS for predicting outcomes in acute stroke patients. If confirmed by future studies, the modified CBS may be considered a potential replacement for the conventional CBS scoring system.

Background: Guillian barre syndrome is an autoimmune disease that affects the peripheral nervous system. It is acute disorder, characterized by rapidly progressing muscle weakness and ascending paralysis, and preceding infection is often one of its causes.

Case presentation: A 50-year-old male reported with muscle soreness, sensation of tingling and weakness in both upper and lower limbs. Investigations were done after admission and found that nerve conduction study indicated of acute sensory motor demyelination polyneuropathy. He struggled with his fine motor abilities and walking, making it difficult for him to complete his activities of daily living.

Intervention: A complete interdisciplinary rehabilitation program was started to reduce the patient's symptoms and enhance functional outcomes. The rehabilitation approach consisted of progressive resistance exercises (PRE) targeting the upper and lower extremities, aimed at improving muscle strength and function. Proprioceptive neuromuscular facilitation (PNF) technique was used to improve motor function and coordination, Transcutaneous Electrical Nerve Stimulation (TENS) was utilized to help the patient control his pain and discomfort, stretching exercises were also added to improve flexibility. Fine motor activities, augmented reality-based rehabilitation for hand were also included in order to increase ability and control of smaller muscle groups, which are necessary for day-to-day tasks such as dressing and eating. Outcome assessed were Numerical pain rating scale (NPRS), Functional independence measure (FIM), Upper extremity functional scale, and modified Erasmus GBS outcome scale (MEGOS), Hughes functional grading scale (HFGS), Borg rating of perceived exertion (RPE).

Conclusion: Early incorporation of physiotherapy in patients with Guillain barre syndrome can speed up recovery, reduce number of hospitalization days and improves overall quality of life.

Background: Pneumonia is a serious complication in Guillain-Barre syndrome (GBS) patients, associated with increased mortality, yet its risk factors remain underexplored.

Methods: Our study analyzed clinical factors linked to pneumonia in GBS patients through a retrospective review of 101 individuals admitted to Tianjin Huanhu Hospital between January 2020 and December 2023. Patients were divided into two groups based on pneumonia development after admission: GBS with pneumonia (n = 19) and GBS without pneumonia (n = 82). Clinical and blood parameters were compared between the groups. Logistic regression analysis identified predictive factors for pneumonia in these GBS patients.

Results: Significant associations were found between pneumonia and older age (P = 0.01), bulbar palsy (P = 0.017), mechanical ventilation (MV) support (P < 0.01), hypoalbuminemia (P < 0.01), hyponatremia (P < 0.01), and underlying conditions (P = 0.008). Multivariate logistic regression identified bulbar palsy, MV support and hyponatremia as significant independent risk factors for pneumonia. Finally, GBS patients with pneumonia experienced longer hospital stays and worse functional outcomes.

Conclusions: We initially identified key risk factors for pneumonia in GBS, highlighting its association with poorer prognoses.

Background: Paramedian pontine reticular formation (PPRF) syndrome is characterized by horizontal gaze palsy due to lesions in the PPRF or the abducens nucleus. It is relatively rare and is typically associated with medial longitudinal fasciculus (MLF) syndrome.

Case presentation: A 53-year-old Japanese woman presented with right lateral gaze palsy and facial nerve palsy, with preserved convergence and left lateral gaze. Neurological evaluation confirmed PPRF syndrome and facial nerve palsy, with no involvement of the MLF. Brain MRI showed a lesion in the right dorsal pons, affecting the PPRF, abducens nucleus, and facial nerve. Serum testing revealed positive antinuclear and anti-AQP4 antibodies. The patient responded well to immunotherapy, with substantial clinical and radiological improvements. She was ultimately diagnosed with AQP4 antibody-positive NMOSD.

Conclusion: This is the first documented case of isolated PPRF syndrome in AQP4 antibody-positive NMOSD. The findings expand the known phenotypic spectrum of NMOSD and highlight the importance of considering NMOSD, with targeted AQP4 antibody testing, in patients presenting with isolated PPRF syndrome.