BMC Neurology最新文献

Objective: Cholesterol, High-density lipoprotein, and Glucose (CHG) index has recently been proposed as a marker of metabolic dysfunction. However, the association of CHG and CHG modified indices with the risk of stroke remains unclear.

Methods: We analyzed 8908 participants aged 45 years or older from the CHARLS. Baseline CHG and its modified forms (CHG-WC, CHG-BMI, CHG-BRI, CHG-WWI, CHG-WHtR, CHG-ABSI, and CHG-CVAI) were collected. Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline (RCS) analyses were applied to assess associations with incident stroke.

Results: During a 9-year follow-up period, 828 (9.3%) participants had occurred strokes. Our analysis found a significant positive association between CHG, CHG-WC, CHG-BMI, CHG-BRI, CHG-WWI, CHG-WHtR, CHG-ABSI, CHG-CVAI, with stroke risk. The adjusted HR for the highest quartile compared to the lowest were: CHG 1.57 (95% CI:1.18-2.10), CHG-WC 1.72 (95% CI:1.34-2.20), CHG-BMI 1.62 (95% CI:1.26-2.08), CHG-BRI 1.65 (95% CI:1.29-2.10), CHG-WWI 1.71 (95% CI:1.32-2.23), CHG-WHtR 1.67 (95% CI:1.29-2.16), CHG-ABSI 1.41 (95% CI:1.10-1.80), and CHG-CVAI 1.99 (95% CI:1.54-2.57), with CHG-CVAI showing strongest associations. The RCS revealed a significant linear association between CHG, CHG-WC, CHG-BMI, and CHG-CVAI with the risk of stroke, whereas CHG-BRI, CHG-WWI, CHG-WHtR, and CHG-ABSI showed significant nonlinear associations with stroke risk. According to ROC analysis, CHG-CVAI had the highest predictive power for stroke risk (C-index:0.618).

Conclusions: Elevated CHG and its modified indices were strongly associated with stroke risk in middle-aged and older Chinese populations. CHG-related indices combined with obesity measures may help enhance the identification of individuals at higher risk of stroke.

Background: This study investigates how structural changes in deep medullary vein (DMV), glymphatic system dysfunction, and cognitive decline are interconnected in cerebral small vessel disease (CSVD), with a focus on whether impaired glymphatic function acts as a mediator in this relationship.

Methods: Clinical and MRI data from 93 CSVD patients were retrospectively analyzed. DMV burden was assessed using a semiquantitative scoring system (0-3 points per region), based on the visibility of DMVs in six anatomical regions on susceptibility-weighted imaging, yielding a total score ranging from 0 to 18. Glymphatic system function was evaluated using the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index. Global cognitive function was assessed with the Montreal Cognitive Assessment (MoCA). Spearman correlation analysis, general linear modeling, and mediation analysis were conducted to examine the relationships among the variables.

Results: DMV scores(which higher scores indicate poorer venous visibility)were significantly negatively correlated with MoCA scores (r = -0.48, p< 0.001) and with the DTI-ALPS index (r = -0.28, p < 0.001), while the DTI-ALPS index was positively correlated with MoCA scores (r= 0.35, p < 0.05). Mediation analysis indicated that the DTI-ALPS index partially mediated the effect of DMV burden on cognitive performance, accounting for 14.08% of the total effect.

Conclusions: This study suggests that DMV structural abnormalities may exacerbate CSVD-related cognitive impairment by disrupting glymphatic function. DMV scoring may serve as a potential imaging biomarker, providing a foundation for early identification and intervention.

Background: Physical activity and exercise have been classified as safe and effective in mild to moderate cases of myasthenia gravis (MG) across various studies. Subsequently, adequate physical activity is generally recommended. Nevertheless, individuals with MG remain less physically active than the general population, without a precise definition of the low-activity group so far.

Methods: In this prospective single-center study, individuals with MG completed a questionnaire assessing general mobility, weekly physical activity levels, and beliefs toward specific statements about physical exercise. These data were contextualized with clinical parameters and MG-specific scores.

Results: Among 84 individuals (50% female), 73.8% reported general positive effects, and 77.4% noted improvements in mood and well-being due to physical activity. No significant differences in physical activity levels were found depending on sex, BMI or age. Weekly physical activity averaged 94.6 min (SD: 85.6), falling below current recommendations. Physical activity was inversely correlated with lower QMG (p = 0.019) and MG-ADL scores (p = 0.004). Despite the reported positive impact of physical activity on quality of life, no relevant connection was detected between physical activity and MG-QoL15 scores. Barriers preventing individuals affected by MG from engaging in physical activity included muscle pain (35.4%) and motivational challenges (22%). Individuals with motivational problems were younger (mean age 55.5 vs. 66.6 years, p = 0.011) and more frequently reported depressive symptoms; no other significant differences were observed in gender or disease severity in this subgroup.

Conclusion: Individuals with MG perceive physical activity as beneficial to their physical well-being, mood, and overall quality of life. Those with less severe disease tend to be more active. However, barriers such as motivational issues and post-exercise pain must be addressed. Clinicians should aim to identify individuals with low activity levels, encourage engagement in physical activity, highlight its benefits, and alleviate patient concerns.

Trial registration: Study approval by the Ethics Committee of the University Medical Center Göttingen was granted (number 33/12/21). The study was retrospectively registered at the German Clinical Trial Registry (DRKS) under the study ID DRKS00033171 (Date of trial registration December 1st, 2023).

Background: Posterior cerebral artery (PCA) infarctions represent 5-10% of all acute ischemic strokes, often manifesting with visual and cognitive deficits that can substantially impair quality of life. Although endovascular thrombectomy (EVT) is an established treatment for large-vessel occlusions, its role in isolated PCA occlusion remains uncertain, with limited evidence and heterogeneous outcomes across studies. We conducted this systematic review and meta-analysis to compare the effictiveness and safety of EVT versus medical management (MM) in patients with acute PCA occlusion.

Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, Scopus, and Web of Science were searched until July 2025. Eligible studies included randomized or cohort studies comparing EVT with MM in PCA occlusion. Primary outcomes were excellent (modified Rankin Scale [mRS] 0-1) and favorable (mRS 0-2) functional outcomes at 90 days. Secondary outcomes included change in National Institutes of Health Stroke Scale (NIHSS), symptomatic intracranial hemorrhage (sICH), and all-cause mortality. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models.

Results: Nine high-quality cohort studies including 57,287 patients (EVT = 2475; MM = 54,812) were analyzed. EVT was not associated with significant improvement in excellent (RR = 1.05; 95% CI, 0.91-1.21) or favorable (RR = 0.94; 95% CI, 0.84-1.05) functional outcomes compared to MM. Mortality (RR = 1.33; 95% CI, 0.99-1.80) and sICH (RR = 1.60; 95% CI, 0.87-2.93) rates were comparable between groups. However, EVT was associated with short-term neurological improvement on NIHSS at discharge (MD=-1.21; 95% CI, -1.96 to -0.46; p = 0.002).

Conclusions: EVT for PCA was associated with short-term neurological improvement versus MM, with mortality and sICH remaining comparable. However, these benefits did not translate into superior long-term functional outcomes as measured by mRS. The unique clinical features of PCA stroke, particularly visual and cognitive impairments not adequately captured by global disability scales, may contribute to this discrepancy. High-quality randomized trials incorporating domain-specific outcomes are warranted to define the role of EVT in PCA occlusion.

Background: Non-contrast CT (NCCT) is first-line imaging for suspected acute ischemic stroke (AIS) but has limited early sensitivity; deep learning (DL) may improve patient-level detection.

Objectives: To estimate the diagnostic accuracy of DL applied to NCCT for patient-level AIS detection and to examine prespecified sources of between-study heterogeneity.

Methods: We searched MEDLINE, Embase, and Web of Science (January 2010-May 2025). Eligible prospective or retrospective diagnostic studies evaluated DL on NCCT against an appropriate reference standard and reported (or allowed reconstruction of) patient-level 2 × 2 data. Two-gate case-control and lesion-only reports were excluded. Dual reviewers screened/extracted data; risk of bias was assessed with QUADAS-2, and AI-reporting against items adapted from STARD-AI/CLAIM/CONSORT-AI. Bivariate random-effects/HSROC models summarized sensitivity and specificity. Prespecified moderators were posterior-fossa inclusion, reference-standard robustness, and validation type. Sensitivity analyses included external-only cohorts, robust standards, posterior-fossa inclusion, and a "Direct AIS" construct subset.

Results: Of 1,899 records, 16 studies met inclusion; 13 contributed patient-level data to meta-analysis. Summary sensitivity was 0.91 (95% CI, 0.81-0.96) and specificity 0.90 (0.85-0.94). Sensitivity was lower for externally validated models than internally validated ones (0.82 [0.67-0.91] vs. 0.95 [0.89-0.98]) with similar specificity (0.88 [0.83-0.92] vs. 0.93 [0.82-0.97]). Findings were directionally robust across sensitivity analyses. QUADAS-2 frequently indicated concerns in patient selection and index-test domains; AI-reporting quality was mostly moderate, and explicit external validation remained uncommon.

Conclusions: DL applied to NCCT shows high accuracy for patient-level AIS detection. However, generalizability is the principal gap; broader external validation and guideline-concordant reporting are needed to support safe clinical adoption.

Sleep disorders are the most common non-motor symptoms in patients with Parkinson's disease (PD) and can significantly impact quality of life. However, the pharmacological treatments for sleep disorders in patients with PD remain controversial. Databases (PubMed, Embase, Web of Science, and the Cochrane Library) were searched up to 20 January 2025. Randomized controlled trials were included if they investigated the efficacy of pharmacological interventions for sleep disorders in populations with PD. The weighted mean difference (WMD) and standardized mean difference (SMD) were used as effect size. The random-effects model was applied due to the heterogeneity between studies. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. A total of 23 studies were included in the systematic review and meta-analysis. Seven trials focused on the treatment of rapid eye movement sleep behavior disorder (RBD), seven on excessive daytime sleepiness (EDS), six on insomnia, and three on sleep disorders that were not specifically classified. The meta-analysis showed that pharmacological interventions were effective in improving EDS (SMD: -0.36; 95% CI: -0.63, -0.10) and insomnia in patients with PD (SMD: -0.53; 95% CI: -0.82, -0.24). However, pharmacological interventions did not show significant benefits for managing RBD (SMD: -0.19; 95% CI: -0.54, 0.16). The certainty of evidence across all studies ranged from very low to moderate. In population with PD, pharmacological interventions were effective in improving EDS and insomnia. However, the management of RBD with pharmacological treatments remains challenging. In the future, strong evidence is needed to address this challenge.

Background: Studies often investigated risk factors for post-stroke depression (PSD) at a single timepoint, neglecting its dynamic nature. We aimed to identify distinct trajectories of depressive symptoms over the first-year post-stroke and explore their early predictors.

Methods: We conducted a prospective cohort study at a stroke center in China from 2022 to 2024. Stroke patients with HAMD assessments at 3-, 6-, and 12-months were included. We identified trajectories using group-based trajectory modeling. The optimal number was determined by statistical criteria and interpretability. To explore predictors of trajectory membership, we conducted two separate binary logistic regression analyses, adjusted for covariates, to differentiate subtypes within favorable (Resilient vs. Recovering) and unfavorable (Fluctuating vs. Worsening) outcome clusters. We also conducted a separate analysis to identify predictors for developing any form of post-stroke depression (Recovering, Fluctuating, or Worsening) versus remaining in the Resilient group.

Findings: The analysis comprised 634 participants. We identified four distinct trajectories: Resilient (50.8%, n = 322), Recovering (9.6%, n = 61), Fluctuating (18.8%, n = 119), and Worsening (20.8%, n = 132). Compared to Recovering, Resilient patients were less likely to be smokers (OR = 0.48, 95% CI: 0.25-0.93) and have hypertension (OR = 0.40, 95% CI: 0.17-0.92), and had lower nutritional risk. Comparing unfavorable trajectories, smoking (OR = 4.17, 95% CI: 1.75-9.96) and hyperlipidemia (OR = 3.83, 95% CI: 1.97-7.47) predicted the Fluctuating group versus Worsening. Functional improvement pace was also significantly associated. A subsequent analysis of overall risk, conducted on 553 participants with complete data, found that male sex was the only significant independent predictor, and was strongly associated with a reduced likelihood of developing any form of PSD (OR = 0.35, 95% CI: 0.17-0.73).

Interpretation: The course of PSD is heterogeneous and classifiable into four trajectories. Our primary analysis identified male sex as a strong protective factor against any form of PSD. Concurrently, secondary analyses suggest that early modifiable factors, particularly smoking and metabolic status, are significant predictors differentiating unfavorable subtypes. The novel association observed with VTE risk scores should be considered exploratory and requires further validation. These findings highlight the value of using clinically accessible markers for early risk stratification, though underscore the complexity of PSD prediction. This study was limited to a single center.

Purpose: Indices for the diagnosis of cerebral infarction (CI) and the prediction of prognosis are essential for timely and appropriate management. Plasma PSD95 levels, as a novel biomarker, have not yet been utilized for the diagnosis and prognosis of cerebral infarction. The purpose of this study was to investigate the correlation between plasma PSD95 levels and clinical characteristics as well as prognosis in patients with CI.

Methods: A total of 105 patients diagnosed with CI and 80 control group (CP) were enrolled. Plasma samples were collected and PSD95 levels were measured using enzyme-linked immunosorbent assay (ELISA). Neurological deficits in patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS). Statistical analyses were conducted to assess the associations between plasma PSD95 levels, clinical parameters, and prognostic outcomes.

Results: Plasma PSD95 levels were significantly elevated in CI patients compared to CP (p < 0.01). Furthermore, within the CI group, PSD95 levels exhibited a negative correlation with activated partial thromboplastin time (APTT) (p < 0.05) and a significant positive correlation with NIHSS scores assessed 6 months post-onset (p < 0.05).

Conclusion: Plasma PSD95 may serve as a potential diagnostic and prognostic biomarker for cerebral infarction.

Purpose: The use of right transradial approach (TRA) in cerebral angiography has been mature, but it is still limited by anatomical variation of the right radial artery or left-sided vertebral artery lesions. This study aimed to compare outcomes between right and left TRA for cerebral angiography and evaluate the safety of left TRA.

Methods: The study cohort comprised 80 patients who underwent cerebral angiography via TRA. The patients' clinical data were analyzed retrospectively. Bilateral proximal and distal radial artery diameters were measured preoperatively using ultrasonography. Puncture site complications and radial artery patency were assessed using ultrasonography 1 day postoperatively. Hand ischemia was followed up by telephone or in clinic 30 days postoperatively.

Results: The overall procedural success rate was 92.5% (74/80); 92.0% (46/50) in the right TRA group and 93.3% (28/30) in the left TRA group, with no significant differences between the groups (p > 0.05). Left TRA was associated with a significantly longer procedure time compared with right TRA in the secondary outcomes (35.50 ± 15.62 min vs. 45.50 ± 16.04 min, respectively; p = 0.008). Linear regression analysis adjusted for confounders confirmed this difference (mean difference: 8.516 min; 95% CI, 1.178-15.853; p = 0.024). No hand ischemia events occurred during ultrasonography and follow-up.

Conclusions: We found no significant differences in the safety and efficacy of cerebral angiography performed via right vs. left TRA. Left TRA can be applied to anatomical variations of the right radial artery or to treat left-sided vertebral artery lesions.

Background: Cerebral digital subtraction angiography (DSA) is increasingly utilized in the diagnosis of cerebrovascular disorders. We report a rare case of a ruptured dissecting aneurysm involving the anterior radiculomedullary artery of the cervical spinal cord, precipitated by angiography of a hypoplastic vertebral artery.

Case presentation: Cerebral computed tomography angiography (CTA) revealed severe stenosis of the M1 segment of the right middle cerebral artery in a 70-year-old woman who presented with paroxysmal weakness affecting the left upper and lower limbs. Dual antiplatelet therapy with aspirin and clopidogrel was initiated. On day 3, cerebral digital subtraction angiography (DSA) was performed. During continuous contrast injection into the right hypoplastic vertebral artery, the anterior radiculomedullary artery-a branch of the vertebral artery at the C6 vertebral level-underwent luminal dilation and subsequently ruptured, resulting in extensive extravasation of contrast medium into the spinal subarachnoid space. Non-contrast head CT confirmed widespread subarachnoid hemorrhage. Following 10 days of conservative medical management, follow-up head CT demonstrated complete resolution of the hemorrhage. The patient was discharged without significant neurological deficits and remained free of recurrent subarachnoid hemorrhage during a 3-year clinical follow-up period.

Conclusions: The occurrence of a ruptured dissecting aneurysm of the anterior radiculomedullary artery induced by vertebral angiography is exceedingly rare. We hypothesize that the sustained high-pressure and high-volume injection of contrast medium was responsible for the arterial dissection and subsequent rupture. During interventional procedures, neurointerventional radiologists should avoid selective angiography of small, hypoplastic vertebral arteries whenever possible to minimize the risk of such complications.