BMC Neurology最新文献

Background: Infantile esotropia may interfere with white matter maturation during early childhood, a critical period of brain development. Surgical correction not only restores ocular alignment but may also influence neurodevelopmental trajectories. However, the role of age in modulating white matter recovery after surgery remains unclear. This study aimed to investigate the effects of age on white matter rehabilitation following surgical intervention in children with infantile esotropia, with the goal of identifying the optimal therapeutic window to maximize both neurodevelopmental and clinical outcomes.

Methods: We included 29 typically developing children (F/M = 14/15) and 30 children with IE (F/M = 13/17), 17 of whom provided longitudinal data following surgical intervention. All participants underwent MRI scanning and clinical assessments. Diffusion tensor imaging (DTI) was performed to quantify white matter integrity using fractional anisotropy (FA) and mean diffusivity (MD). Automated fiber quantification was applied to analyze microstructural properties across 20 major white matter tracts. Cross-sectional and longitudinal analyses were conducted to evaluate developmental trajectories in patients versus controls.

Results: Preoperatively, IE patients exhibited significantly elevated MD across multiple tracts, including the thalamic radiation and forceps minor. Following surgery, MD values decreased significantly in most tracts. FA alterations were less pronounced, with preoperative reductions and postoperative improvement limited to only a few tracts. In controls, age was negatively correlated with MD and FA changes. Longitudinal analysis revealed that surgical intervention was associated with accelerated growth in white matter microstructure compared to typical development, particularly in younger children.

Conclusions: Surgical correction of IE facilitates white matter restoration through mechanisms that operate independently of, and synergistically with, typical neurodevelopment. Earlier intervention is associated with faster rates of microstructural recovery, suggesting a higher sensitive period during which surgery can maximize white matter repair and optimize functional outcomes.

Background: Paraneoplastic cochleovestibulopathy (PCVP) is a rare, atypical neurological paraneoplastic syndrome of the nervous system that is often misdiagnosed and mistreated.

Case presentation: We report two cases of middle-aged women who presented with bilateral sensorineural hearing loss (SNHL) as the initial symptom. Pure-tone audiometry (PTA) demonstrated bilateral hearing impairment, while brainstem auditory evoked potentials (BAEP) and cochlear electrograms were within normal limits. Otoacoustic emissions indicated bilateral cochlear dysfunction. Cranial imaging excluded intracranial organic and vascular lesions. After corticosteroid therapy proved ineffective, positron emission tomography/computed tomography (PET/CT) combined with histopathological examination confirmed the presence of breast cancer, leading to a diagnosis of PCVP. Despite receiving endocrine therapy (Case 1) or surgical excision (Case 2), neither patient exhibited significant improvement in PTA during one year of follow-up.

Conclusion: PCVP should be considered in middle-aged patients who present with progressive bilateral hearing loss, often accompanied by vestibular dysfunction and clinical signs of cerebellar or brainstem involvement. Regular monitoring with PET/CT is recommended, and female patients in particular should undergo screening for breast cancer.

Introduction: Migraine is a common neurological disease that limits daily life. Researchers have proposed various mechanisms in the pathogenesis of migraine, including vascular dysfunction, neurogenic inflammation, oxidative stress, and stimulation of the trigeminovascular system. Studies consistently demonstrate the impact of oxidative stress and neurogenic inflammation on lipid metabolism. Although causality cannot be definitively established, several studies suggest that migraine may be associated with alterations in lipid metabolism, potentially resulting in an atherogenic lipid profile. This study aimed to investigate the status of oxidative stress and inflammation during the interictal phase of migraine and explore their potential impact on lipid metabolism.

Methods: The Neurology outpatient clinic included fifty-seven migraine patients and thirty control cases. Migraine diagnosis and classification were made according to the International Classification of Headache Disorders (ICHD-3), with clear categorization into episodic or chronic migraine and migraine with aura (MWA) or without aura (MWoA). Serum levels of malondialdehyde (MDA, a marker of lipid peroxidation), glutathione (GSH, an antioxidant), NOD-like receptor family pyrin domain containing 3 (NLRP3, an inflammasome component), and nuclear factor kappa B (NF-κB, a proinflammatory transcription factor), as well as lipid parameters and headache characteristics, were assessed. CRP levels were measured via standard turbidimetric method; MDA and GSH were determined using spectrophotometric methods; NLRP3 and NF-κB were analyzed using ELISA kits per manufacturer protocols.

Results: In migraine patients, MDA and CRP levels significantly increased, while GSH and NLRP3 levels significantly decreased (p < 0.05). Subgroup analysis revealed that CRP and NLRP3 levels were significantly different between MWA and MWoA groups. Additionally, LDL levels were higher in patients with MWA.

Conclusions: This study demonstrates a statistically significant association between elevated oxidative stress (increased MDA, decreased GSH), altered inflammatory response (elevated CRP, reduced NLRP3), and migraine. Differences between MWA and MWoA suggest subtype-specific pathophysiological mechanisms. Although this study supports a potential link between oxidative stress, inflammation, and lipid metabolism in migraine, they do not establish causality. These biomarkers may represent targets for future diagnostic and therapeutic strategies.

Background: Stroke-associated pneumonia (SAP) significantly impacts mortality and functional outcomes in acute stroke care. While multiple risk prediction scores have been developed internationally, their performance in Japanese healthcare settings-characterized by high nurse-to-patient ratios and systematic multidisciplinary protocols-remains unexplored. This study aimed to determine SAP incidence in Japanese acute stroke care and validate established risk prediction scores.

Methods: We conducted a retrospective cohort study of consecutive patients with first-ever acute stroke admitted within 7 days of onset to a 199-bed acute care hospital with a dedicated 24-bed stroke care unit (April 2022-March 2023). SAP was diagnosed using modified CDC criteria requiring radiographic evidence. Three validated risk scores (A²DS², Pneumonia score, ISAN) were calculated and compared using receiver operating characteristic analysis. Independent predictors were identified through multivariable logistic regression using directed acyclic graph-based variable selection.

Results: Among 847 patients analyzed (median age 75 years, 54.2% male), SAP developed in 22 patients (2.6%, 95% CI 1.5-3.7). Most cases (77.3%) occurred within 72 h. All three scores demonstrated good discrimination: A²DS² achieved the highest AUROC of 0.825 (95% CI 0.78-0.88), followed by Pneumonia score and ISAN (both AUROC 0.798). No statistically significant differences were observed between scores. An A²DS² cutoff ≥ 6 provided optimal balance (sensitivity 86.4%, specificity 65.8%, NPV 99.5%). Independent predictors included male sex (OR 3.87, 95% CI 1.41-10.61), NIHSS score (OR 1.08 per point, 95% CI 1.03-1.12), dysphagia (OR 5.31, 95% CI 1.16-24.34), and mechanical ventilation (OR 5.33, 95% CI 1.28-22.18).

Conclusions: SAP incidence in Japanese acute stroke care (2.6%) was substantially lower than international reports, likely reflecting high nursing standards and systematic preventive protocols. Despite low baseline risk, the A²DS² score demonstrated excellent discrimination and high negative predictive value, enabling reliable risk stratification. The predominance of early SAP onset supports intensive monitoring during the critical first 72 h. These findings support implementation of A²DS²-based risk stratification protocols in Japanese stroke care settings.

Background: We aimed to investigate the safety and efficacy of early elastic bandage in treating subdural effusion after decompressive craniectomy.

Methods: We searched Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP, and Wanfang databases for randomized controlled trials assessing the effects of early use of elastic bandages on subdural effusion. Studies published from the establishment of the database to March 2024 were retrieved. A risk of bias assessment tool, Cochrane was independently used by two researchers to assess the quality of the included studies. The analysis was conducted using RevMan 5.4 software. Heterogeneity was determined using I² test and P-value. Publication bias was evaluated based on the funnel plot.

Results: Ten studies with 954 patients were included. The results of the meta-analysis showed that the risk of subdural effusion elastic bandage group was lower than the conventional treatment group (HR = 0.46, 95% CI: 0.23-0.92, P = 0.03). In addition, risk of adverse events in the experimental group was lower than that in the control group (HR = 0.46, 95% CI: 0.23-0.92, P = 0.03), and there was no significant difference in GOS ≥ 3 between the experimental group and the control group after treatment (HR = 1.12, 95% CI: 0.89-1.42, P = 0.34). Moreover, the number of patients with hospitalization length ≤ 30 days in the experimental group was better than that in the control group (HR = 1.90, 95% CI: 1.31-2.77, P = 0.0007).

Conclusions: This analysis suggests early elastic bandaging is a promising, low-cost intervention for preventing subdural effusion and reducing hospitalization after decompressive craniectomy, though not for improving neurological function. It's definitive role in clinical practice should be established by future multinational trials that address the current limitations in evidence quality.

Trial registration: CRD42024551332 (06/06/2024).

Background: There is an extensive and growing body of knowledge regarding disease-modifying treatment (DMT) in multiple sclerosis (MS) regarding their effects, impact on functioning and potential side-effects. Few studies have, however, investigated the patients' perspectives regarding their experiences of DMT in daily life.

Aim: To investigate and describe the experience of DMT in the daily lives of patients with MS.

Methods: A qualitative design was applied using semi-structured interviews with eight patients with MS on different types of DMT. The interviews were analyzed using qualitative content analysis.

Results: Three themes emerged from the analysis; Fulfilled expectations in the light of previous treatments, Continuous need for treatment and side effect management, and Need for personalized feedback from the MS care team.

Conclusion: The patients' described experiences and hopes for personalized treatment plans, procedures, and feedback on DMT outcome implicate the need for further development of person-centred interventions. Development of such care interventions should consider the patients' perspectives on e.g., treatment preferences and procedures, social support, and the professionalism and expert-knowledge of MS care team professionals. The knowledge derived from this study may also inform the development of patient-reported experience- and outcome measures regarding daily life with DMT in MS.

Background: Cerebral vasospasm and delayed cerebral ischemia were significant complications in patients undergoing Clipping Intracranial Aneurysm surgery. The impact of intraoperative hypercapnia on postoperative brain function and cognitive outcomes in this patient population was an area of increasing interest. This study aimed to investigate the effects of intraoperative hypercapnia on postoperative brain functional network connectivity and cognitive function in adult patients undergoing Clipping Intracranial Aneurysm.

Methods: Adult patients who underwent Clipping Intracranial Aneurysm surgery were included in this retrospective cohort study and were divided into the No Hypercapnia group (PaCO₂ = 35-45 mmHg, n = 65) and the Hypercapnia group (PaCO₂>45 mmHg, n = 68) based on the occurrence of intraoperative hypercapnia. Various parameters including baseline characteristics, intraoperative parameters, anesthetic doses, postoperative brain functional network connectivity, and cognitive function were compared between the two groups.

Results: Baseline characteristics revealed no significant differences between the two groups. Anesthetic doses did not differ significantly between the groups. Postoperative brain functional network connectivity showed significant differences between the groups, with lower connectivity in the Hypercapnia group. Postoperative Mini-Mental State Examination scores were significantly higher in the Hypercapnia group.

Conclusion: The study provides novel insights into the effects of intraoperative hypercapnia on postoperative brain functional network connectivity and cognitive function in adult patients undergoing Clipping Intracranial Aneurysm surgery.

Trial registration: Not applicable.

Background: Headaches, sleep disturbances, and hypertension are common and interrelated conditions that significantly affect quality of life. This study aimed to assess the prevalence and sociodemographic predictors of these conditions among non-psychotic patients in Afghanistan.

Methods: A prospective cross-sectional survey was conducted from September 5, 2024, to September 1, 2025, in Herat province (N = 875). Sleep disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI), with scores ≥ 5 indicating poor sleep quality. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Headache was defined as the presence of any clinically diagnosed headache type. Multivariable logistic regression models were used to identify independent predictors of sleep disturbances, hypertension, and headache.

Results: Poor sleep quality was reported by 72.7% of participants, and 54.7% met criteria for hypertension. Female sex, widowhood, and rural residency predicted poor sleep quality. Older age (≥ 36 years), widowhood, smoking, and sleep disturbance were independent predictors of hypertension. Female sex and widowhood were significant predictors of headache, with widowed individuals showing the highest odds across all three conditions.

Conclusion: Sleep disturbances, hypertension, and headaches were highly prevalent in this Afghan clinical population. Older age, female gender, widowhood, and smoking emerged as key predictors, with widowhood representing the strongest vulnerability factor. Targeted interventions addressing psychosocial stress, sleep quality, and cardiovascular risk in socioeconomically disadvantaged groups-particularly widows-are urgently needed.