Clinical Neurology and Neurosurgery最新文献

{"title":"Thoracic facet overgrowth causing radiculopathy – A rare spinal manifestation of Proteus syndrome","authors":"Anish Kosanam , Colllin Labak , Eric Herring , Manish K. Kasliwal","doi":"10.1016/j.clineuro.2025.108730","DOIUrl":"10.1016/j.clineuro.2025.108730","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108730"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher surgical volumes are associated with improved perioperative outcomes for vestibular schwannomas","authors":"Ian A. Ramsay ,&nbsp;Tiffany Eatz ,&nbsp;Vaidya Govindarajan ,&nbsp;Katherine Berry ,&nbsp;Turki Elarjani ,&nbsp;Carolina Benjamin ,&nbsp;Christine Dinh ,&nbsp;Ricardo Komotar ,&nbsp;Michael Ivan ,&nbsp;Evan Luther","doi":"10.1016/j.clineuro.2025.108759","DOIUrl":"10.1016/j.clineuro.2025.108759","url":null,"abstract":"<div><h3>Background</h3><div>Surgical resection remains a primary treatment for vestibular schwannomas (VS). In neuro-oncology, surgical outcomes tend to be better at higher volume centers, but this remains understudied for VS. This study aims to investigate the association of hospital neurosurgical volume with perioperative VS outcomes.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample (NIS) database was queried from 1998 to 2014 for patients undergoing VS resection. Hospitals were classified by quartile of annual surgical VS volume across the study period. Odds ratios (OR) were calculated using a logistic regression model with covariates assessed to be clinically relevant.</div></div><div><h3>Results</h3><div>Patients in the highest quartile of VS resection surgical volume had a lower rate of overall complications (29.4 % vs. 50.2 %, p &lt; 0.001), including neurosurgical complications (26.1 % vs. 46.3 %, p &lt; 0.001) when compared to the lowest quartile. The highest quartile had an OR of 0.46 (p &lt; 0.001) for overall complications and 0.43 (p &lt; 0.001) for any neurosurgical complications, compared to the lowest quartile. The highest quartile also had a lower OR for facial paralysis, vocal cord paralysis, and dysphagia. In addition, overall complications decreased as surgical volume increased, with the lowest odds of complications seen in the 30–40 cases/year group.</div></div><div><h3>Conclusions</h3><div>Hospital neurosurgical volume was inversely related to perioperative surgical and medical complications for patients undergoing VS resection, suggesting surgeons at high volume hospitals may have more experience and skills in performing these surgeries. Long-term investigations are necessary to further quantify the relationship between surgical volume and peri-operative outcomes for patients with VS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108759"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143341341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior circulation stroke mechanical thrombectomy with transradial balloon guide catheter: Single-center pilot study","authors":"Mpuekela Tshibangu,&nbsp;Peter Theiss,&nbsp;Tatiana Abou-Mrad,&nbsp;Laura Stone McGuire,&nbsp;Adrusht Madapoosi,&nbsp;Ali Alaraj","doi":"10.1016/j.clineuro.2024.108670","DOIUrl":"10.1016/j.clineuro.2024.108670","url":null,"abstract":"<div><h3>Objectives</h3><div>This study evaluates the feasibility, safety, and efficiency of using a balloon guide catheter (BGC) through transradial access (TRA) for mechanical thrombectomy (MT) in patients with anterior circulation strokes.</div></div><div><h3>Methods</h3><div>A retrospective case series of patients who underwent MT using BGC through TRA for acute ischemic stroke in the anterior circulation was conducted. Data collected included procedural times (from puncture to revascularization), technical success, complication rates, and clinical outcomes. Patients’ baseline characteristics, stroke severity, and post-procedural outcomes were also analyzed.</div></div><div><h3>Results</h3><div>Thirty patients were included, with a mean age of 64.4 ± 13.6 years. The median admission NIHSS score was 13, and 17 % received intravenous thrombolysis before thrombectomy. Right-sided occlusions were more frequent (57 %). TRA was successful in 27 patients (90 %), with 3 (10 %) requiring conversion to femoral access. The median puncture-to-revascularization time was 32 minutes, and first-pass revascularization was achieved in 40 % of cases. A favorable TICI 2b or higher was accomplished in 97 %, with no access site complications. Hemorrhagic conversion occurred in 20 %, including one symptomatic intracerebral hemorrhage (3 %). At discharge, 57 % of patients had favorable outcomes (mRS 0–2), and by 90 days, 54 % achieved functional independence, with a mortality rate of 3 %.</div></div><div><h3>Conclusion</h3><div>This case series highlights the feasibility of using BGC through TRA in MT for anterior circulation strokes, demonstrating promising safety and efficiency. Future multicenter studies with larger cohorts are necessary to compare clinical outcomes of TRA versus transfemoral access and guide standardized protocols for stroke interventions.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108670"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating prognostic factors for falls in Parkinson's disease: A sex-based analysis","authors":"Ane Murueta-Goyena ,&nbsp;Rocío Del Pino ,&nbsp;Beatriz Tijero ,&nbsp;Naiara Ortuzar ,&nbsp;Marta Ruiz-Lopez ,&nbsp;Tamara Fernández-Valle ,&nbsp;Marian Acera ,&nbsp;Naia Ayo ,&nbsp;Mar Carmona-Abellán ,&nbsp;Iñigo Gabilondo ,&nbsp;Juan Carlos Gómez-Esteban","doi":"10.1016/j.clineuro.2024.108709","DOIUrl":"10.1016/j.clineuro.2024.108709","url":null,"abstract":"<div><h3>Introduction</h3><div>Falls are a common and debilitating complication in Parkinson's disease (PD). Previous studies have primarily focused on cohorts with prevalent falls or advanced disease stages. This study assessed risk factors for falls in early-stage falls-naïve cohort stratified by sex.</div></div><div><h3>Methods</h3><div>A total of 172 PD patients (&lt;5 years disease duration) were selected from a registry-based study that reported no falls at baseline. All patients were assessed with a standardized data extraction form and falls were defined according to UPDRS Item 13. Hazard Ratios were calculated with univariable and stepwise multivariable Cox Proportional Hazard regression models.</div></div><div><h3>Results</h3><div>Among the study sample, 61 (35.4 %) patients were female. At baseline, female and male PD groups were comparable in terms of age, disease duration, and UPDRS scores, although female PD patients had higher scores for UPDRS IV. Over a mean follow-up period of 3.9 (3.0) years, falls were reported in 13 female (21.3 %) and 18 male (16.2 %) PD patients. In female PD, motor fluctuations (HR [95 %] = 1.8 [1.3 – 2.6], p &lt; 0.001) and postural stability (HR [95 %] = 4.2 [1.6 – 10.6], p = 0.003) emerged as significant predictors for falls, whereas in male PD, stepwise Cox regression selected freezing of gait (HR [95 %] = 2.0 [1.0 – 4.2], p = 0.053) and postural instability (HR [95 %] = 2.2 [0.89 – 5.4], p = 0.089) as the primary predictors for falls, although they were non-significant.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that the risk factors for falls differ between female and male early-stage PD patients, which may have important implications for clinical management.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108709"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and predictors of readmission following hospitalization for thoracic disc herniation","authors":"Julius Gerstmeyer ,&nbsp;August Avantaggio ,&nbsp;Anna Gorbacheva ,&nbsp;Clifford Pierre ,&nbsp;Giorgio Cracchiolo ,&nbsp;Neel Patel ,&nbsp;Donald D. Davis ,&nbsp;Bryan Anderson ,&nbsp;Periklis Godolias ,&nbsp;Thomas A. Schildhauer ,&nbsp;Amir Abdul-Jabbar ,&nbsp;Rod J. Oskouian ,&nbsp;Jens R. Chapman","doi":"10.1016/j.clineuro.2024.108698","DOIUrl":"10.1016/j.clineuro.2024.108698","url":null,"abstract":"<div><h3>Objective</h3><div>Symptomatic thoracic disc herniations (TDH) are relatively rare and can be discovered incidentally on neuroimaging. Surgical interventions for TDH represent only 4 % of all surgeries performed for intervertebral disc pathologies, which are most commonly indicated for myelopathy and radiculopathy. Given the absence of publications on rates of readmissions following hospitalization for TDH, we aim to establish baseline metrics for the 90-day all-cause readmission rates and pertinent risk factors.</div></div><div><h3>Methods</h3><div>The 2020 Nationwide Readmissions Database was used to screen for patients with a primary diagnosis of TDH and disc degeneration within the first 9 months of the year. Demographic information, admission details, clinical data, comorbidities, and surgical treatment were extracted. Patients were divided into two groups based on readmission status. A sub-analysis was performed by treatment.</div></div><div><h3>Results</h3><div>Overall, 970 patients met our inclusion criteria. Of these, 183 patients (18.9 %) were readmitted within a mean of 34.58 days. The readmission group was significantly older and more likely to have been admitted non-electively. Surgical treatment was associated with a lower readmission rate. Eight comorbidities differed significantly between the groups. Independent risk factors for readmission included non-surgical treatment, Medicare insurance, hypertension, and depression.</div></div><div><h3>Conclusion</h3><div>We established a 90-day all-cause readmission rate of 18.9 % for TDH. There was no difference in readmission based on patients’ initial neurological presentation. Non-surgical treatment was identified as an independent risk factor for readmission, suggesting that timely surgical interventions may reduce the risk of readmission. Medicare insurance, hypertension and depression were also identified as independent risk factors.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108698"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting the outcomes of tirofiban treatment in posterior circulation stroke","authors":"Weili Chen ,&nbsp;Zhenxiao Chai ,&nbsp;Yichan Ye ,&nbsp;Xiaona Xu,&nbsp;Xuerong Huang,&nbsp;Ruyue Huang","doi":"10.1016/j.clineuro.2024.108694","DOIUrl":"10.1016/j.clineuro.2024.108694","url":null,"abstract":"<div><h3>Objective</h3><div>Tirofiban is an effective treatment for ischemic stroke that is frequently used following early neurological deterioration (END). However, studies investigating the effects of tirofiban on patients with posterior circulation stroke (PCS) are scarce. Thus, this study aimed to explore factors affecting the outcomes of tirofiban in PCS.</div></div><div><h3>Methods</h3><div>The data of patients with PCS treated with tirofiban at our hospital were retrospectively collected. A modified Rankin scale (mRS) of 0–2 at 90 days was defined as a favorable outcome. A reduction in NIHSS after treatment compared with baseline NIHSS was defined as an early response to tirofiban. Patients' clinical characteristics and laboratory findings were analyzed to identify independent factors affecting the outcomes of tirofiban treatment.</div></div><div><h3>Results</h3><div>A total of 113 patients were enrolled in this study. 71 patients (62.8 %) exhibited favorable outcomes, whereas the remaining patients (37.2 %) had unfavorable outcomes. Hypertension and high NIHSS at admission were associated with unfavorable outcomes [(OR: 0.151, 95 % CI: 0.026–0.872; <em>p</em> = 0.035), (OR: 0.645, 95 % CI: 0.491–0.847; <em>p</em> &lt; 0.001)], whereas high early response to tirofiban was significantly associated with favorable outcomes (OR: 1.913, 95 %CI: 1.390–2.631; <em>p</em> &lt; 0.001). The cut-off value of early response to tirofiban to predict a favorable outcome was 0.5, with a sensitivity and specificity of 69 % and a Youden index of 0.38.</div></div><div><h3>Conclusion</h3><div>Early response to tirofiban had the highest predictive value on long-term outcomes of PCS patients treated with tirofiban.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108694"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coagulopathy at admission in traumatic brain injury and its association with hematoma progression: A systematic review and meta-analysis of 2411 patients","authors":"Ibrahim Mohammadzadeh ,&nbsp;Behnaz Niroomand ,&nbsp;Amin Tajerian ,&nbsp;Zahra Shahnazian ,&nbsp;Zahra Nouri ,&nbsp;Ali Mortezaei","doi":"10.1016/j.clineuro.2024.108699","DOIUrl":"10.1016/j.clineuro.2024.108699","url":null,"abstract":"<div><div>Progressive hemorrhagic injury (PHI) is a frequent complication of traumatic brain injury (TBI). This study aims to investigate the impact of coagulation factors (platelet [PLT], prothrombin time [PT], activated partial thromboplastin time [aPTT], international normalized ratio ¹, fibrinogen [Fg], D-dimer [Dd], and fibrin [Fib]) at admission and PHI development through a comprehensive systematic review and meta-analysis based on PRISMA 2020 guideline. Databases including PubMed, Scopus, Web of Science, and Embase were searched up to March 2024. Controlled observational studies examining the relationship between coagulation tests at admission and PHI in isolated TBI cases were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist, and statistical analyses were performed using Stata software, employing Hedge's g to measure effect sizes. Sixteen studies encompassing 2411 TBI patients were included. Significant associations were found between decreased PLT (g = −0.243, P = 0.007), increased aPTT (g = 0.117, P = 0.037), increased INR (g = 0.217, P = 0.0202), elevated Dd levels (g = 1.57, P = 0.0084), and decreased Fg levels (g = −0.26, P = 0.0001) with the risk of developing PHI. PT showed no significant effect on PHI risk (g = 0.19, P = 0.0372). Our results suggest that elevated INR, Dd levels, and aPTT are linked to an increased risk of PHI. Conversely, higher PLT and Fg levels appear to be associated with a reduced PHI risk. Notably, Dd demonstrated stronger predictive power for PHI.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108699"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cracking the code: Are tumor markers the key to unlocking pineal gland lesions diagnostics","authors":"Dhrumil Vaishnav,&nbsp;Bipin Chaurasia","doi":"10.1016/j.clineuro.2024.108716","DOIUrl":"10.1016/j.clineuro.2024.108716","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108716"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress of research on short-chain fatty acids, metabolites of gut microbiota, and acute ischemic stroke","authors":"Jinbao Deng ,&nbsp;Jianrong Li ,&nbsp;Shuangyang Li ,&nbsp;Dechou Zhang ,&nbsp;Xue Bai","doi":"10.1016/j.clineuro.2025.108725","DOIUrl":"10.1016/j.clineuro.2025.108725","url":null,"abstract":"<div><div>Acute ischemic stroke (AIS) significantly impacts the well-being and quality of life of individuals within our population. Short-chain fatty acids (SCFAs), metabolites produced by the intestinal microbiota, are integral to the bidirectional regulatory pathway linking the gut and the brain. SCFAs may significantly influence the risk, prognosis, recurrence, and management of complications associated with AIS. Potential mechanisms underlying these effects include the facilitation of brain-gut barrier repair, the mitigation of oxidative stress, the reduction of neuroinflammatory responses, and the inhibition of autophagy and apoptosis. Consequently, SCFAs hold promise as a prospective target for AIS intervention, with the potential to significantly impact AIS prevention and treatment strategies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108725"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic nutritional index as a predictor of mortality in acute ischemic stroke","authors":"Ömerul Faruk Aydın ,&nbsp;Ali Cankut Tatlıparmak","doi":"10.1016/j.clineuro.2025.108750","DOIUrl":"10.1016/j.clineuro.2025.108750","url":null,"abstract":"<div><h3>Objective</h3><div>Nutritional and immune status have been recognized as important factors influencing the prognosis of acute ischemic stroke. This study aims to evaluate the prognostic value of the Prognostic Nutritional Index (PNI) in predicting 30-day mortality in patients with acute ischemic stroke.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted in a tertiary care hospital emergency department. Patients diagnosed with acute ischemic stroke between January 1, 2019, and January 1, 2024, were included. PNI was calculated using serum albumin levels and total lymphocyte count. Data on demographics, clinical parameters, laboratory results, and 30-day mortality were collected from electronic medical records and patient follow-up via phone calls. Appropriate statistical tests were applied based on the data distribution, and p-values &lt; 0.05 were considered statistically significant.</div></div><div><h3>Results</h3><div>A total of 169 patients were included in the study, with a mean age of 74.2 ± 10.5 years, and 55 % were male. Of these patients, 25 (14.8 %) did not survive within the 30-day follow-up period. PNI was significantly lower in deceased patients compared to survivors (p &lt; 0.001). The area under the receiver operating characteristic (AUROC) curve was 0.831, indicating good predictive accuracy for 30-day mortality. The optimal PNI cut-off of 37.21 demonstrated a sensitivity of 72.0 % and a specificity of 81.2 %.</div></div><div><h3>Conclusion</h3><div>The PNI is a reliable predictor of 30-day mortality in acute ischemic stroke patients. Lower PNI values were associated with higher mortality, highlighting the importance of nutritional and immune status in stroke outcomes. PNI could be used in clinical practice to help identify high-risk patients and inform more appropriate treatment decisions.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108750"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}