BMC Neurology最新文献

Background: Ischemic stroke is a major public health concern, contributing significantly to global morbidity and mortality. Recent studies have suggested that alterations in liver enzymes may be linked to the risk of developing a stroke. However, the relationship between liver enzymes and ischemic stroke remains unclear.

Objective: To examine the potential role of liver enzymes as biomarkers for ischemic stroke.

Methods: We systematically searched four databases for articles investigating the association between liver enzymes and ischemic stroke up to March 20th, 2024. Newcastle Ottawa Scale judged the quality of included studies. Risk ratio (RR), hazard ratio (HR), or odds ratio (OR) were extracted and statistically analyzed by RevMan and R software. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessed the certainty of evidence.

Results: Increased levels of gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) have shown statistically significant association with increased ischemic stroke risk (RR: 1.43, 95% CI: [1.30 to 1.57], P > 0.00001) and (RR: 1.60, 95% CI: [1.22 to 2.10], P = 0.0006), respectively. Conversely, increased levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) showed no significant association with ischemic stroke risk (RR: 0.92, 95% CI: [0.68 to 1.24], P = 0.58) and (RR: 1.43, 95% CI: [0.83 to 2.49], P = 0.20), respectively. The evidence for all outcomes had a low or very low level of certainty.

Conclusion: GGT and ALP could be potential biomarkers for increased ischemic stroke risk, which necessitates careful follow-up. However, AST and ALT did not show such association.

Background: Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up.

Methods: Patients with acute ischemic stroke classified as ESUS were included. All patients underwent transthoracic echocardiography and Holter to detect the source of embolism. Structural, electrophysiological markers of left atrial cardiopathy (i.e., left atrial enlargement [LAE], non-sustained tachycardia [NSAT]) as well as lesion patterns of ischemic stroke were examined. Implantable loop recorder (ILR) was implanted in selective patients. Sensitivity and positive predictive value analysis was used to assess the predictive value for AF detection.

Results: Among 312 patients with ESUS, AF was detected in 24 (7.7%) patients during follow-up. Patients with AF had a higher prevalence of LAE, NSAT, and the imaging pattern of confluent plus additional lesions in a single vascular territory. Multivariable analysis showed that ILR implantation (hazards ratio 11.497 [95% confidence interval 3.795-34.818]), LAE (3.204 [1.096-9.370]), NSAT (4.070 [1.378-12.018]), and confluent plus additional lesions (4.977 [1.649-15.019]) were independent predictors of AF detection. The sensitivity of detecting AF in those with LAE, NSAT, or confluent plus additional lesions pattern was 91.7%. The positive predictive value of detecting AF in those with LAE, NSAT and confluent plus additional lesions pattern was 40.0%.

Conclusion: In conclusion, patients with LAE, NSAT, or confluent plus additional lesions may benefit from ILR monitoring detecting new AF.

Background: Cerebral venous sinus thrombosis (CVST) is a rare yet significant neurological disorder with high mortality. Understanding its evolving characteristics, risk factors, and outcomes, particularly in Chinese patients after the COVID-19 pandemic, is critical for developing effective preventive and therapeutic strategies.

Methods: A retrospective analysis was conducted on 471 CVST cases from Xuanwu Hospital, comparing data before (2013-2017, n = 243) and after (2021-2023, n = 228) the COVID-19 pandemic. Data on demographics, clinical features, risk factors, and outcomes were evaluated, with subgroup analyses based on gender and age.

Results: The mean patient age was 38 ± 14 years, with a female preponderance (55.0%). After the COVID-19 pandemic, significant changes in symptoms and neuroimaging findings were observed, including increased visual impairment and decreased headache, neurological deficits, and seizures. Infection emerged as a prominent risk factor, including eight cases related to COVID-19 or vaccination. At discharge, favorable outcomes (mRS 0-2) were noted in 86.6% of patients. Poor outcomes were associated with central nervous system (CNS) infection, oral contraceptive use or hormone replacement therapy (HRT), hematologic disorders, anemia, and prothrombotic conditions. Anemia was identified as an independent predictor of survival.

Conclusions: The pandemic has significantly altered the clinical and epidemiological profile of CVST in China. Infections have emerged as key risk factors, while anemia remains a critical prognostic indicator. These findings highlight the need for targeted clinical strategies to improve outcomes.

Trial registration: This study protocol was reviewed and approved by the ethics committee of Xuanwu Hospital, Capital Medical University (No. 2022-004, dated on November 20, 2022). The clinical trial was registered at Chinese Clinical Trial Registry (ChiCTR2200057621).

Sarcoid-like reaction is an immunological reaction that can affect lymph nodes and organs but does not meet the diagnostic criteria for systemic sarcoidosis. Anti-CD20 auto-antibodies have been reported to be responsible for such reactions. There are several reported associations between Chronic lymphocytic leukaemia (CLL), Amyotrophic lateral sclerosis (ALS) and Sarcoid-like reactions (SLR). We report a case of ALS developing in a patient with treated CLL and drug related SLR one day after exposure to Venetoclax and Rituximab. A 60-year-old male presented with lower limb rash, left leg weakness followed by bulbar symptoms which progressed over 12-months. Workup demonstrated a Cerebrospinal fluid (CSF) pleocytosis and inguinal lymphadenopathy. Skin and inguinal lymph node biopsies showed non-necrotising granulomata. Electromyography met diagnostic criteria for ALS. He was treated for presumed neurosarcoidosis mimicking ALS. Despite prednisolone and infliximab treatment, the motor symptoms rapidly progressed; Hence, we made a clinical diagnosis of ALS. We discuss the diagnostic and treatment challenges of this case.

Background: Malignant brain tumors are among the most lethal cancers. Recent studies emphasized the crucial involvement of the immune system, especially T cells, in driving tumor progression and influencing patient outcomes. The emerging field of immunometabolism has shown that metabolic pathways play a pivotal role in regulating immune responses within the tumor microenvironment. This study aims to clarify the relationships between specific T cell phenotypes, circulating metabolites, and malignant brain tumors.

Methods: We utilized a multiple mendelian randomization approach to investigate the associations between T cell phenotypes and malignant brain tumors, as well as the role of plasma metabolites in mediating these interactions. Instrumental variables were selected based on stringent criteria, and multiple mendelian randomization methods were utilized to identify causal pathways and metabolites potentially mediating these effects.

Results: Our analysis identified significant associations between seven distinct T cell phenotypes, including various CD8 + and regulatory T cell subsets, and the presence of malignant brain tumors. We also identified 87 plasma metabolites correlated with these tumors. Notably, metabolites such as octadecanedioylcarnitine (C18-DC) and eicosanedioate (C20-DC) were implicated in modulating the risk of developing malignant brain tumors. Furthermore, metabolites such as 5-dodecenoate (12:1n7) and arachidonate (20:4n6) were found to influence tumor risk, particularly in relation to CD28 - CD8 + T cells.

Conclusion: The study identifies key T cell phenotypes and plasma metabolites involved in the pathogenesis of malignant brain tumors, offering potential biomarkers and therapeutic targets for future interventions.

Background: Trigeminal neuralgia (TN) is a prevalent and debilitating craniofacial pain disorder characterized by severe, unilateral, shock-like pain. Standard treatments include anti-epileptic drugs and surgical interventions, but many patients experience limited relief or adverse effects. Non-invasive therapies, such as transcutaneous electrical nerve stimulation (TENS), have emerged as alternative options. This systematic review and meta-analysis aimed to evaluate the efficacy of TENS in managing primary trigeminal neuralgia.

Methods: A comprehensive search of PubMed, Cochrane Library, and Google Scholar was conducted, yielding 89 papers. Following selection criteria, five clinical trials involving 101 patients with primary TN and TENS treatment were included. Data on pain severity, TENS parameters, and outcomes were extracted. Statistical analysis was performed using RevMan software, with outcomes assessed using Visual Analogue Scale (VAS) scores before and after TENS treatment.

Results: Pre-treatment VAS scores averaged 8.75 ± 0.18, indicating severe pain. Post-treatment, the mean VAS score significantly decreased to 1.17 ± 0.55, demonstrating substantial pain relief. The meta-analysis revealed a mean difference of 7.49 (95% CI: 7.05 to 7.93) in VAS scores, with a p-value < 0.05, indicating statistically significant pain reduction. Heterogeneity among studies was moderate (I² = 57%). Complications were infrequently reported, with one study noting paresthesia in a small number of patients.

Conclusion: TENS appears to be an effective and safe intervention for reducing pain in patients with primary trigeminal neuralgia. Despite variability in treatment protocols and follow-up periods, the overall evidence supports TENS as a viable option for managing TN pain. Future research should focus on standardizing TENS protocols and evaluating long-term efficacy and safety.

Objective: This study aimed to investigate the relationship between the unique weather change and acute ischemic stroke (AIS) in the southern Zhejiang Province of China and to provide evidence for better predicting and preventing stroke.

Methods: We retrospectively collected 14,996 ischemic stroke patients data and weather data from January 2019 to December 2021 in the southern Zhejiang Province of China. The correlation and risk between meteorological factors and the number of AIS daily cases were calculated. Wilcoxon rank sum test was used to calculate the difference in the number of cases between typhoon-affected and non-affected periods. A prediction model obeying Poisson regression was established, and the accuracy of the correlation factors in predicting the number of cases was verified.

Results: In southern Zhejiang Province, the number of AIS was the highest in summer and the lowest in spring. Stroke onset is associated with temperature, water vapor pressure and typhoons (P < 0.05). The presence of typhoon (RR 0.882; 95% CI 0.834 to 0.933, P < 0.001) was a protective factor, while maximum temperature (RR 1.021; 95% CI 1.008 to 1.033, P = 0.043) and the water vapor pressure (RR 1.036; 95% CI 1.006 to 1.067, P = 0.036) were risk factors. The occurrence under the influence of typhoons was lower than that without the influence of typhoons (P < 0.05). The prediction model can predict the occurrence of stroke.

Conclusion: An association was observed between the occurrence of AIS, temperature, water vapor pressure and typhoon in the southern Zhejiang Province of China. Typhoon occurrence was associated with fewer cases. The predictive model may help high-risk populations prevent diseases early and assist hospitals in allocating resources promptly.

Background and objectives: Poststroke pain (PSP) is a prevalent and severe consequence of stroke, encompassing central, neuropathic, and nonneuropathic pain. In this study, we aimed to investigate clinical factors associated with PSP three months after stroke and concurrently explore the association between PSP and one-year mortality.

Methods: This registry-based study comprised data from stroke patients admitted to three hospitals in Sweden between November 2014 and June 2019. The outcome was PSP three months after stroke. Twelve (out of 28) predictor variables were selected by three machine learning methods, and a multivariable binary logistic regression model was fitted for predicting PSP. The association between PSP and one-year poststroke mortality was examined using Cox proportional hazards models.

Results: Among 4,160 stroke patients participating in the three-month follow-up, 54.7% reported PSP. Antiplatelet use, diabetes, hemiparesis, sensory deficits, and need for assistance before stroke were significant predictors of PSP. Male sex, being born in Sweden, higher income, and regular prestroke physical activity predicted the absence of PSP. After adjustment for age, sex, region of birth, and stroke severity, patients experiencing PSP had a significantly higher one-year mortality rate than those without pain, and the most severe level of pain (constant pain) was associated with the highest cumulative mortality.

Conclusion: The study findings indicate treatable factors associated with PSP, which highlight areas of improvement in management strategies. Clinicians should recognize that PSP is associated with increased one-year mortality, emphasizing the importance of pain prevention and treatment for enhanced poststroke outcomes.

Introduction: Cerebral ischemic strokes cause brain damage, primarily through inflammatory factors. One of the regions most affected by middle cerebral artery occlusion (MCAO) is the hippocampus, specifically the CA1 area, which is highly susceptible to ischemia. Previous studies have demonstrated the anti-inflammatory properties of quercetin. Therefore, this study aimed to investigate the neuroprotective effects of quercetin on hippocampal CA1 neurons following MCAO.

Materials and methods: Fifty-six male Albino Wistar rats were divided into seven groups (intact, sham, stroke, vehicle, and three quercetin-treated groups receiving 5, 10, and 20 mg/kg, respectively), each containing 8 rats. Various assessments, including brain water content, the rotarod test, the Bederson neurological score, the Morris water maze (MWM) test, the shuttle box test, histopathological evaluations, and measurements of interleukin-10 (IL-10) and interleukin-1β (IL-1β) levels, were conducted across the groups.

Results: Compared with control rats, 5 and 10 mg/kg quercetin-treated rats presented significant improvements in brain water content, neurological function, and motor function and improved performance in the MWM and shuttle box tests. Histopathological analyses revealed better preservation of CA1 neurons in these groups. Additionally, IL-10 levels significantly increased, whereas IL-1β levels significantly decreased. However, the group receiving 20 mg/kg quercetin showed no statistically significant changes in the parameters assessed (P > 0.05).

Conclusion: Quercetin may help prevent or ameliorate brain injuries caused by acute stroke, suggesting its neuroprotective effects. The reduction in IL-1β and increase in IL-10 may play key roles in quercetin's protective mechanism.