Clinical Neurology and Neurosurgery最新文献

{"title":"Phase angle and nutrition in the acute phase are associated with the subsequent recovery of activities of daily living ability after stroke","authors":"Hiroki Tanaka ,&nbsp;Gakuto Kitamura ,&nbsp;Mayu Tamura ,&nbsp;Manabu Nankaku ,&nbsp;Masashi Taniguchi ,&nbsp;Kenichiro Shide ,&nbsp;Miharu Fujita ,&nbsp;Megumi Ida ,&nbsp;Shinobu Oshima ,&nbsp;Takayuki Kikuchi ,&nbsp;Takakuni Maki ,&nbsp;Ryosuke Ikeguchi ,&nbsp;Susumu Miyamoto ,&nbsp;Ryosuke Takahashi ,&nbsp;Nobuya Inagaki ,&nbsp;Shuichi Matsuda ,&nbsp;Noriaki Ichihashi","doi":"10.1016/j.clineuro.2025.109168","DOIUrl":"10.1016/j.clineuro.2025.109168","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the factors predicting the recovery of post-stroke activities of daily living during the entire hospitalization period, focusing on skeletal muscle characteristics, nutrition, and physical activity in the acute phase.</div></div><div><h3>Materials and methods</h3><div>This prospective observational study included 55 stroke patients (72.4 ± 8.9 years). The primary outcome measures were relative functional gain (RFG) and efficiency (RFE) calculated using the Functional Independence Measure motor items. The FIM was assessed upon admission to the acute hospital and on discharge from the acute or convalescent hospital. Phase angle upon admission were evaluated using a bioimpedance analyzer (InBody S10). The energy sufficiency ratio was evaluated using nutritional intake surveys for two weeks from the onset. Metabolic equivalents were measured using a tri-axial accelerometer (ActiGraph wGT3X-BT). Hierarchical multiple regression analyses were performed with RFG and RFE as the dependent variables.</div></div><div><h3>Results</h3><div>The FIM motor score increased from 34.7 ± 22.1 at admission to 81.5 ± 10.2 at discharge. Multiple regression analysis revealed that phase angle (β = 0.529) was significantly associated with RFG (R² = 0.223). The phase angle (β = 0.314) and the energy sufficiency ratio (β = 0.312) were significantly associated with RFE (R² = 0.319). The interaction between nutrition and physical activity was observed, with energy sufficiency ratio emerging as a significant predictor in participants with low levels of physical activity.</div></div><div><h3>Conclusions</h3><div>Phase angle and nutritional management during the acute phase are important factors for improving activities of daily living during total hospital stay in stroke patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109168"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154865","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":"CSF pressures in spontaneous intracranial hypotension due to CSF-venous fistula: A retrospective analysis","authors":"Bala McRae-Posani ,&nbsp;Sara Strauss ,&nbsp;Matthew S. Robbins ,&nbsp;Gayle Salama","doi":"10.1016/j.clineuro.2025.109169","DOIUrl":"10.1016/j.clineuro.2025.109169","url":null,"abstract":"<div><h3>Objective</h3><div>To report CSF pressure (P_csf) and its correlations in patients with SIH due to CSF-venous fistula (CVF).</div></div><div><h3>Methods</h3><div>Following IRB approval, consecutive SIH patients undergoing myelography between 2021 and 2025 at a single center were retrospectively analyzed. P_csf was defined as opening pressure (OP) during myelography, with patient in decubitus positioning with mild hip elevation. Low OP was defined as &lt; 6 cm H₂O; elevated OP as &gt; 20 cm H₂O.</div></div><div><h3>Results</h3><div>Of the 86 SIH patients analyzed, 35 (41 %) had a CVF [average age 59 ± 13; 12/35 (34 %) male; 23/35 (66 %) female]. Of the 35, OP was reported for 32 patients. The mean ± SD OP was 13.97 ± 3.91 cm H₂O (range: 6–25 cm H₂O). None (0 %) of the patients had low OP. 29/32 (91 %) had OP in normal range, 3/32 (9 %) had elevated OP. P_csf was positively correlated with BMI (p = 0.045); but not correlated with age, sex, prior epidural blood patching, symptom duration, or mean arterial pressure. High variability in P_csf values was not fully accounted for by predictors included in our model (pseudo-R² = 0.188).</div></div><div><h3>Conclusions</h3><div>An absence of low P_csf should not be used to rule out SIH, as all our patients with SIH due to CVF had normal or elevated P_csf. Such P_csf readings in patients with active CSF leaks suggest that the development of CVF and post-treatment rebound headaches may be due to pre-existing intracranial hypertension. While BMI is positively correlated with P_csf, limited explanatory power of our model suggests influence of other factors.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109169"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118480","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":"Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): Iranian normative values and correlates of cognitive function","authors":"Sadra Habibi Moini ,&nbsp;Zahra Sarvestani ,&nbsp;Majid Hamidi ,&nbsp;Zahra Azizan ,&nbsp;Seyed Ehsan Mohammadianinejad ,&nbsp;Nahid Beladi Moghadam ,&nbsp;Mohammad Hossein Harirchian","doi":"10.1016/j.clineuro.2025.109156","DOIUrl":"10.1016/j.clineuro.2025.109156","url":null,"abstract":"<div><h3>Background</h3><div>The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an easy instrument for accurate cognitive assessment in multiple sclerosis (MS) patients. Although previously validated in Persian, the tests lack established normative values. This study aims to determine regression-based normative values for the Iranian population and explore the factors associated with BICAMS scores.</div></div><div><h3>Materials and methods</h3><div>MS patients and healthy individuals (HI) who were group-matched by age, sex, and education years underwent BICAMS assessment consisting of the Symbol Digit Modalities Test (SDMT), Brief Visual Memory Test (BVMT-R), and the California Verbal Learning Test (CVLT-II). Depression was assessed with Beck Depression Inventory-Fast Screen (BDI-FS) questionnaire.</div></div><div><h3>Results</h3><div>We obtained 68 MS patients and 68 HI samples. The mean raw scores for HI were as follows: SDMT: 51.24 ± 9.77; CVLT-II: 52.04 ± 8.06; and BVMT-R: 27.70 ± 4.96. The MS group scored significantly worse on the SDMT and BVMT tests, but not on the CVLT-II. Normative data were developed by converting raw scores to scaled scores using multivariate regression models. According to the models, 30 (44.1 %) of patients had cognitive impairment (CI) in at least one domain.</div></div><div><h3>Conclusions</h3><div>Our study introduced the first Iranian normative values for BICAMS. Using normative data can enhance utility and precision in assessing cognitive function in both research and clinical practice.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109156"},"PeriodicalIF":1.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118481","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":"Genetic perspectives on transient global amnesia: A narrative review","authors":"Christodoulos Komiotis ,&nbsp;Vasiliki Poulidou ,&nbsp;Antonia Tsika ,&nbsp;Ioannis Liampas ,&nbsp;Chrysa Marogianni ,&nbsp;Elli Zoupa ,&nbsp;Polyxeni Stamati ,&nbsp;Triantafyllos Ntoskas ,&nbsp;Efthimios Dardiotis ,&nbsp;Vasileios Siokas","doi":"10.1016/j.clineuro.2025.109163","DOIUrl":"10.1016/j.clineuro.2025.109163","url":null,"abstract":"<div><div>Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of anterograde amnesia that can last up to 24 h, in the absence of other neurological symptoms. The pathophysiology of TGA is still unknown and comprehensive studies exploring the genetic basis of TGA are lacking. The primary objective of this review is to examine the incidence and characteristics of familial TGA. A secondary objective is to identify any genes that may be associated with the condition. A literature search of Medline and Embase identified 19 relevant articles, including 6 prospective or retrospective cohort studies, 12 case reports/case series, and one study investigating a single nucleotide polymorphism in TGA patients. Cohort studies included 1648 TGA patients, with 55 familial cases reported, and showed no significant associations. Nevertheless, available data suggest that patients with familial TGA frequently exhibit migraine-related symptoms, with clinical characteristics comparable to those observed in sporadic TGA cases. Case reports and case series described 35 familial cases, further supporting the existence of multiple familial TGA cases -an observation unlikely to be coincidental given the rarity of this condition. Migraine appears to be the most common comorbidity in familial TGA, rather than ischemic risk factors. Finally, a genetic analysis of the Val66Met polymorphism in the brain-derived neurotrophic factor gene, implicated in memory and hippocampal function, was performed in 98 patients and found no association with TGA. In conclusion, although no strong genetic associations have been identified to date, familial clustering suggests a potential heritable component in TGA pathogenesis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109163"},"PeriodicalIF":1.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154863","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":"Operative versus nonoperative management of type II odontoid fractures in the elderly: A systematic review and meta-analysis of comparative studies","authors":"Guy Awad ,&nbsp;Marc Boutros ,&nbsp;Gebrane Abou Mjahed ,&nbsp;Jad Bou Monsef","doi":"10.1016/j.clineuro.2025.109165","DOIUrl":"10.1016/j.clineuro.2025.109165","url":null,"abstract":"<div><h3>Background</h3><div>Type II odontoid fractures (OFs) are common cervical spine injuries in elderly patients. Management strategies remain controversial, as both operative and nonoperative approaches carry distinct risks and benefits.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was conducted through August 2025. Studies comparing patients aged ≥ 65 years with Type II OFs treated either operatively or nonoperatively were included. Outcomes were analyzed based on follow-up periods and included clinical measures (length of hospital stay (LOS), residual pain), radiological outcomes (nonunion and instability), and complication and survival rates, graded using the adapted Clavien–Dindo classification for trauma.</div></div><div><h3>Results</h3><div>Twenty comparative studies were included, encompassing 8296 patients (3754 operative and 4542 nonoperative). Surgical treatment was associated with significantly lower nonunion rates at 1-year follow-up (p = 0.03) and showed a non-significant trend toward reduced post-treatment instability, also at 1 year (p = 0.12). The nonoperative group demonstrated a significantly shorter LOS (p &lt; 0.001) and fewer grade III–IV complications, observed both early postoperatively and at 2–3 years, including cardiopulmonary, neurological, and digestive events (p &lt; 0.001). Mortality or grade V complication showed a lower risk at 3 years in the nonoperative group (p = 0.04). Residual pain outcomes, reported at 9 months, was comparable between groups (p = 0.40).</div></div><div><h3>Conclusions</h3><div>Operative management improves union and stability, while nonoperative treatment offering fewer complications. These findings support the importance of individualized treatment decisions based on patient comorbidities, fracture characteristics and stability, and surgical risks.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109165"},"PeriodicalIF":1.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096207","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":"Normalised longitudinal data on thoracic disc herniation surgical repair approaches","authors":"Tsung-Chiao Wu,&nbsp;Joshua Wang","doi":"10.1016/j.clineuro.2025.109161","DOIUrl":"10.1016/j.clineuro.2025.109161","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109161"},"PeriodicalIF":1.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085270","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":"Amplitude of brain low-frequency fluctuation and functional connectivity changes based on fMRI study in first-episode major depressive disorder","authors":"Yanting Zheng ,&nbsp;Huai Tu ,&nbsp;Danian Li ,&nbsp;Jing Wang ,&nbsp;Baohua Cheng ,&nbsp;Jie Zhou ,&nbsp;Shijun Qiu ,&nbsp;Yujie Liu","doi":"10.1016/j.clineuro.2025.109157","DOIUrl":"10.1016/j.clineuro.2025.109157","url":null,"abstract":"<div><h3>Objective</h3><div>Recent functional connectivity (FC) studies have proved the potential value of resting-state functional magnetic resonance imaging (rs-fMRI) in the study of major depressive disorder (MDD). This study investigates alterations of amplitude of low-frequency fluctuations (ALFF) in first-episode major depressive disorder (FED) using rs-fMRI, and then explore the abnormalities of FC.</div></div><div><h3>Methods</h3><div>A total of 66 FED patients and 66 healthy controls were recruited for this study. The amplitude of low frequency fluctuations (ALFF) method was employed to assess changes in brain activity across the entire brain in both groups. Subsequently, the identified brain regions were used as seeds to examine whole-brain functional connectivity (FC) changes. Additionally, we conducted partial correlation analyses to investigate the relationship between functional connectivity values in FED patients and clinical variables, such as the 17-item Hamilton Depression Rating Scale (HAMD-17) scores and illness duration.</div></div><div><h3>Results</h3><div>FED patients exhibited increased ALFF values in the right fusiform and the right parahippocampal gyrus compared to controls <em>(P</em> &lt; 0.05, GRF correction). Enhanced FC was observed between the right parahippocampal gyrus and the right precentral gyrus, with reduced connectivity to the brainstem (<em>P</em> &lt; 0.05, GRF correction). The FC values of the right parahippocampal gyrus and right precentral gyrus positively correlated with the HAMD-17 scores (r = 0.314, <em>P</em> = 0.012).</div></div><div><h3>Conclusion</h3><div>Abnormal ALFF and FC in several brain regions of FED patients suggest these areas could serve as biological markers for identifying FED.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109157"},"PeriodicalIF":1.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096215","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":"A transradial approach directly using a distal access catheter for symptomatic intracranial vertebral artery and basilar artery stenosis: A single-center study","authors":"Tao Peng ,&nbsp;Hao Tian ,&nbsp;Bifeng Zhu ,&nbsp;Jianlin Liu ,&nbsp;Lei Zhang ,&nbsp;Yu Xie ,&nbsp;Bitang Dan","doi":"10.1016/j.clineuro.2025.109154","DOIUrl":"10.1016/j.clineuro.2025.109154","url":null,"abstract":"<div><h3>Purpose</h3><div>This study primarily reports our single-center experience and technical procedures involving the direct use of a distal access catheter (DAC) via the transradial approach (TRA) for treating symptomatic intracranial vertebral (VA) and basilar (BA) artery stenosis and to evaluate factors influencing the success rate of establishing a TRA.</div></div><div><h3>Method</h3><div>A retrospective analysis was conducted on 62 patients who underwent endovascular treatment for symptomatic intracranial VA and BA stenosis between June 2021 and March 2023. Patients were divided into TRA and transfemoral approach (TFA) groups. Patient characteristics and radiographic and clinical information were reviewed. In the TRA group, subgroup analysis was performed based on whether the DAC was shaped to compare the significant differences between the two groups.</div></div><div><h3>Results</h3><div>There were no significant differences in procedural success rates or complication rates between the two groups. However, the proportion of smokers and the rate of access catheter use were higher in the TRA group than in the TFA group. The VA take-off angle was also greater in the TRA group. The TRA subgroup analysis showed that the VA take-off angle of the subgroup whose DACs did not require shaping was greater (109.57 ± 28.63° vs. 62.8 ± 21.57°, p &lt; 0.001), and the subclavian artery height was shorter (6.13 ± 4.31 mm vs. 13.58 ± 7.35 mm, p = 0.002). The VA take-off angle and subclavian artery height cutoff values were 68.7° and 8.64 mm, respectively.</div></div><div><h3>Conclusions</h3><div>This study reveals that directly using a DAC via the TRA without guiding support is safe and effective for treating symptomatic intracranial VA and BA stenosis. A higher success rate of TRA can be achieved when the VA take-off angle is greater than 68.7° and the ipsilateral subclavian artery height is less than 8.64 mm.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109154"},"PeriodicalIF":1.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079629","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":"Unsupervised machine learning identifies clinically relevant patterns of CSF dynamic dysfunction in normal pressure hydrocephalus","authors":"Emanuele Camerucci ,&nbsp;Petrice M. Cogswell ,&nbsp;Jeffrey L. Gunter ,&nbsp;Matthew L. Senjem ,&nbsp;Matthew C. Murphy ,&nbsp;Jonathan Graff-Radford ,&nbsp;Ignacio Jusue-Torres ,&nbsp;David T. Jones ,&nbsp;Jeremy K. Cutsforth-Gregory ,&nbsp;Benjamin D. Elder ,&nbsp;Clifford R. Jack Jr ,&nbsp;John Huston III ,&nbsp;Hugo Botha","doi":"10.1016/j.clineuro.2025.109162","DOIUrl":"10.1016/j.clineuro.2025.109162","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic normal pressure hydrocephalus (iNPH) is a common and debilitating condition whose diagnosis is made challenging due to the unspecific and common clinical presentation. The aim of our study was to determine if data driven patterns of cerebrospinal fluid (CSF) distribution can be used to predict iNPH diagnosis and response to treatment.</div></div><div><h3>Methods</h3><div>We established a cohort of iNPH patients and age/sex-matched controls. We used Non-negative Matrix Factorization (NMF) on CSF probability maps from segmentation of T1-weighted MRI to obtain patterns or components of CSF distribution across participants and a load on each component in each participant. Visual assessment of morphologic phenotype was performed by a neuroradiologist, and clinical symptom improvement was assessed via retrospective chart review. We used the NMF component loads to predict diagnosis and clinical outcome after ventriculoperitoneal shunt placement for treatment of iNPH. Similar models were developed using manual Evan’s index and callosal angle measurements.</div></div><div><h3>Results</h3><div>We included 98 iNPH patients and 98 controls split into test (20 %) and train (80 %) sets. The optimal NMF decomposition identified 7 patterns of CSF distribution in our cohort. Accuracy for predicting a clinical diagnosis of iNPH using the automated NMF model was 96 %/97 % in the train/test sets, which was similar to the performance of the manual measure models (92 %/97 %). Visualizing the voxels that contributed most to the NMF models revealed that the voxels most associated with a disproportionately enlarged subarachnoid space hydrocephalus (DESH) were the ones with higher probability of iNPH diagnosis. Neither NMF nor manual metrics performed well for prediction of qualitative clinical outcomes.</div></div><div><h3>Conclusions</h3><div>NMF-generated patterns of CSF distribution showed high accuracy in discerning individuals with iNPH from controls. The patterns most relying on DESH features showed highest potential for independently predicting NPH diagnosis. The algorithm we proposed should not be perceived as a replacement for human expertise but rather as an additional tool to assist clinicians in achieving accurate diagnoses.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109162"},"PeriodicalIF":1.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091254","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":"Indicators associated with outcomes of in-hospital ischemic stroke","authors":"Kenta Kaneyoshi ,&nbsp;Tomohisa Nezu ,&nbsp;Shiro Aoki ,&nbsp;Daizo Ishii ,&nbsp;Eiji Imamura ,&nbsp;Ryo Shimomura ,&nbsp;Tatsuya Mizoue ,&nbsp;Hiroshi Yamashita ,&nbsp;Naoyuki Hara ,&nbsp;Toshinori Matsushige ,&nbsp;Eiichi Nomura ,&nbsp;Tomoyuki Kono ,&nbsp;Nobuyuki Hirotsune ,&nbsp;Kazuhide Ochi ,&nbsp;Hiromitsu Naka ,&nbsp;Naoto Kinoshita ,&nbsp;Atsushi Tominaga ,&nbsp;Yoshihiro Kiura ,&nbsp;Nobutaka Horie ,&nbsp;Hirofumi Maruyama","doi":"10.1016/j.clineuro.2025.109160","DOIUrl":"10.1016/j.clineuro.2025.109160","url":null,"abstract":"<div><h3>Background</h3><div>In-hospital ischemic stroke (IHIS) has been reported to be associated with various comorbidities and often leads to poor outcomes. We aimed to investigate the clinical characteristics and indicators of outcomes of patients with IHIS via a multicenter stroke registry.</div></div><div><h3>Methods</h3><div>Consecutive acute ischemic stroke patients were enrolled from five primary stroke centers between July 2020 and Dec 2022. For IHIS patients, data about various underlying conditions and biological markers, such as hemoglobin, albumin, C-reactive protein, and D-dimer levels, were retrospectively collected. Additionally, stroke outcomes, namely, 3-month modified Rankin scale (mRS) scores indicating poor functional outcomes (mRS score of 3–6), were assessed.</div></div><div><h3>Results</h3><div>Of the 3614 consecutive acute ischemic stroke patients, 168 patients (4.6 %) were enrolled in the IHIS group. The most common diagnosis leading to hospitalization was cardiovascular disease (n = 55), followed by cancer (n = 45) and infections (n = 24). The time from recognition to assessment was longest for patients with cardiovascular disease who underwent surgery, followed by patients with infections and patients with cancer who did not undergo surgery, and the reperfusion therapy rate was lower in these groups. Multivariable analysis revealed that increased D-dimer levels were independently associated with poor stroke outcomes (odds ratio: 1.12, 95 % CI: 1.02–1.23) after adjusting for baseline clinical characteristics, including initial stroke severity.</div></div><div><h3>Conclusion</h3><div>The conditions underlying IHIS are diverse, with differences in the time from recognition to assessment and varying rates of reperfusion therapy. The D-dimer level was identified as a factor that is independently associated with poor outcomes, regardless of the underlying conditions.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109160"},"PeriodicalIF":1.6,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091225","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}