Clinical Neurology and Neurosurgery最新文献

{"title":"Real-world data on the effect of long-term treatment with nusinersen over > 4 years in a cohort of Swiss patients with spinal muscular atrophy","authors":"Anne Tscherter ,&nbsp;Leonie Steiner ,&nbsp;Philip Julian Broser ,&nbsp;Cornelia Enzmann ,&nbsp;Elea Galiart ,&nbsp;Bettina Cornelia Henzi ,&nbsp;David Jacquier ,&nbsp;Andrea Maria Mathis ,&nbsp;Christoph Neuwirth ,&nbsp;Gian Paolo Ramelli ,&nbsp;Paolo Ripellino ,&nbsp;Olivier Scheidegger ,&nbsp;Bettina Schreiner ,&nbsp;Esther Irene Schwarz ,&nbsp;Georg Martin Stettner ,&nbsp;Andrea Klein ,&nbsp;on behalf of the Swiss-Reg-NMD Group","doi":"10.1016/j.clineuro.2025.108983","DOIUrl":"10.1016/j.clineuro.2025.108983","url":null,"abstract":"<div><h3>Introduction</h3><div>Current disease-modifying treatments for spinal muscular atrophy (SMA) have been shown to significantly improve the course of the disease, but data on long-term real-world outcomes remain scarce.</div></div><div><h3>Methods</h3><div>This prospective multicentre, observational study investigated 28 patients treated with nusinersen for 4.1–6.2 years. Motor function was assessed with the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND), Hammersmith Functional Motor Scale (Expanded) (HFMS/E) and the Revised Upper Limb Module (RULM). Patient global impression of improvement scale, respiratory and nutritional support were assessed.</div></div><div><h3>Results</h3><div>Eight patients were 0–2.5 years old at treatment start and median gain of motor scores was 31.5 points in the CHOP-INTEND and 10 points in the HFMS/E. Three patients started part-time non-invasive ventilation and/or nutritional support during observation period. Fourteen patients were 3.5–16 years old and showed a median gain of 1 point in the HFMS/E. Four patients required non-invasive ventilation and/or nutritional support at treatment start, and three started support during observation period. Six patients were aged 16–45 years old and showed a median gain of 3.5 points in the HFMS/E. None needed chronic respiratory or nutritional support. After one year, 84 %, and after 4 years of treatment, 54 % of patients felt their condition had improved in the last 6 months.</div></div><div><h3>Conclusion</h3><div>Our data confirm sustained gains of motor function in early-treated patients and disease stabilisation in patients in the chronic phase under nusinersen treatment.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108983"},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185363","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":"Progression of intracranial hemorrhages in neurotrauma patients: A clinical and radiological comparison of isolated versus multiple areas of hemorrhage and associated transfusion treatment strategies","authors":"Cody J. Orton ,&nbsp;Samuel A. Tenhoeve ,&nbsp;Matthew C. Findlay ,&nbsp;Sarah Nguyen ,&nbsp;Sarah T. Menacho","doi":"10.1016/j.clineuro.2025.108984","DOIUrl":"10.1016/j.clineuro.2025.108984","url":null,"abstract":"<div><h3>Purpose</h3><div>The similar presentation of patients with multiple simultaneous (mICHs) or isolated (iICH) intracranial hemorrhages prompted investigation of clinical and radiological ICH progression during hospitalization in these cohorts. We also examined the role of aggressive transfusion and acute interventions on patient morbidity and mortality.</div></div><div><h3>Methods</h3><div>Adult (&gt;18 years) neurotrauma patients treated at our Level 1 trauma center between January 1, 2002, and December 31, 2022, with an iICH or mICH were included based on meeting 5 criteria: isolated neurotrauma; ICH injury beyond subarachnoid hemorrhage; repeat head CT available; no anticoagulant usage; and survivable injuries. Data collected retrospectively included demographics, potential risk factors for ICH, injury type, management details, transfusion characteristics, and outcomes. The primary outcome was the clinical and radiological progression of ICH during hospitalization, and the secondary outcome was the role of aggressive transfusion and acute interventions on patient morbidity and mortality.</div></div><div><h3>Results</h3><div>Among the 596 patients, 242 had iICH and 354 had mICH. Other than age (p = .01) and Glasgow Coma Scale score (p &lt; .001), most presentation characteristics, including comorbidities, were similar in the two groups. Although patients with iICH were less likely to have subarachnoid hemorrhage (p &lt; .001), epidural hematoma (p = .03), intraparenchymal hematoma (p &lt; .001), and hemorrhagic contusions (p &lt; .001), subdural hematomas were equally likely to occur in both groups (p = .52). There were no significant differences in neurosurgical treatment by ICH type. There were no significant differences in progression on imaging or transfusions received between the two groups.</div></div><div><h3>Conclusion</h3><div>Although our data are limited as a single-center retrospective analysis, these results highlight the similarities between patients with iICH and mICH and indicate that treatment may be independent of the number of bleeds.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108984"},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168195","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":"Identifying associated comorbidities in the development of trigeminal neuralgia: A propensity-matched analysis of the National Inpatient Sample","authors":"Megan Tang,&nbsp;Alex Devarajan,&nbsp;Lily Huo,&nbsp;Tony Chung,&nbsp;Vikram Vasan,&nbsp;Jack Y. Zhang,&nbsp;Rui Feng,&nbsp;Emily Chapman,&nbsp;Joshua Bederson,&nbsp;Raj K. Shrivastava","doi":"10.1016/j.clineuro.2025.108985","DOIUrl":"10.1016/j.clineuro.2025.108985","url":null,"abstract":"<div><h3>Introduction</h3><div>Trigeminal neuralgia (TN) is an uncommon disorder that leads to debilitating pain and interference with daily life. While often attributed to neurovascular compression, limited research has explored the underlying etiology and risk factors for TN. This study uses the National Inpatient Sample (NIS), the largest publicly-available administrative inpatient database in the United States, to examine demographics and comorbidities associated with TN, aiming to identify potential risk factors and vulnerable inpatient populations.</div></div><div><h3>Methods</h3><div>NIS data from 2016 to 2019 was searched for patients with a primary diagnosis of TN (ICD-10 G50.0). Demographics and comorbidities were identified. A 1:1 propensity match was performed between TN and non-TN patients based on demographics, hospital characteristics, and Charlson Comorbidity Index scores. Multivariable regression was performed to identify factors associated with TN and calculate adjusted odds ratios (OR).</div></div><div><h3>Results</h3><div>The final cohort included 38,300 patients, of whom 19,150 (50.0%) had TN. After matching, TN was significantly associated with multiple sclerosis (p &lt; 0.001), other neurovascular compression disorders (NCD) including glossopharyngeal neuralgia and hemifacial spasm (p &lt; 0.001), stroke (p &lt; 0.001), systemic lupus erythematosus (p = 0.003), hyperlipidemia (p = 0.006), and complex diabetes (p &lt; 0.001). Risk factors with the highest ORs included other NCDs (OR: 60.60, p &lt; 0.001), multiple sclerosis (OR: 8.92, p &lt; 0.001), and lupus (OR: 2.84, p = 0.003).</div></div><div><h3>Conclusion</h3><div>TN requiring hospitalization was independently associated with several comorbidities, including multiple sclerosis, lupus, stroke, hyperlipidemia, diabetes, and other NCDs. Notably, this is the first population-level study to identify an association between lupus and TN, highlighting a potential inflammatory component in TN pathophysiology. Prospective studies are warranted to further elucidate these associations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108985"},"PeriodicalIF":1.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185708","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":"Altered default mode network connectivity in basal ganglia intracerebral hemorrhage: A resting-state fMRI study","authors":"Lichao Wei ,&nbsp;Jun Zhang ,&nbsp;Fengyuan Zhou ,&nbsp;Dewen Ru ,&nbsp;Caihua Xi ,&nbsp;Zhuoyin Du ,&nbsp;Biwu Wu ,&nbsp;Gang Wu ,&nbsp;Qiang Yuan ,&nbsp;Jin Hu","doi":"10.1016/j.clineuro.2025.108987","DOIUrl":"10.1016/j.clineuro.2025.108987","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the impact of basal ganglia intracerebral hemorrhage (ICH) on default mode network (DMN) connectivity and its relationship with cognitive impairment using resting-state functional magnetic resonance imaging (rs-fMRI).</div></div><div><h3>Method</h3><div>DMN differences between left/right basal ganglia ICH patients and healthy controls were analyzed respectively. Co-altered brain region were obtained by overlapping the differential brain regions of bilateral basal ganglia ICH. Gene and functional decoding analyses validated the role of co-altered brain regions in cognition. Whole-brain functional connectivity (FC) analysis was conducted using the co-altered brain region as a seed, and correlation analysis was performed with the Mini-Mental State Examination (MMSE) to obtain the cognitive representation brain network of patients in basal ganglia ICH. Finally, it was nested with the DMN of basal ganglia ICH patients to obtain the important brain regions regulating cognitive function in the DMN of basal ganglia ICH patients.</div></div><div><h3>Result</h3><div>A total of 89 basal ganglia ICH patients were enrolled. Compared to healthy controls, bilateral basal ganglia ICH patients showed significant alterations in DMN connectivity. The co-altered brain region mainly involved the medial prefrontal cortex (mPFC). Additionally, gene and functional decoding analyses revealed strong association with chemical synaptic transmission, synaptic signaling, cognition, and intelligence. The left parahippocampal gyrus, the left superior temporal gyrus, right temporal regions, the cerebellar, and posterior cingulate cortex exhibited significant correlation with MMSE. Furthermore, the left parahippocampal gyrus emerged as a key node in the DMN of basal ganglia ICH patients involved in cognitive regulation.</div></div><div><h3>Conclusion</h3><div>The mPFC-left parahippocampal circuit in the DMN plays a crucial role in cognitive regulation following basal ganglia ICH. These findings provide new insights into neural mechanisms underlying cognitive changes after basal ganglia ICH and suggest potential therapeutic targets for cognitive rehabilitation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108987"},"PeriodicalIF":1.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138517","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":"Validation of the SHELTER score after aneurysmal subarachnoid hemorrhage cohort: An observational retrospective study","authors":"Marzia Savi ,&nbsp;Eva Vitali ,&nbsp;Gaia Furlan ,&nbsp;Chiara Faso ,&nbsp;Zoe Demailly ,&nbsp;Martina Polato ,&nbsp;Alessia Degrassi ,&nbsp;Ana Carolina Damsceno ,&nbsp;Marcos Vinicius Tavares de Magalhães ,&nbsp;Vinicius William Costa Dumont ,&nbsp;Fabio Silvio Taccone ,&nbsp;Elisa Gouvêa Bogossian","doi":"10.1016/j.clineuro.2025.108980","DOIUrl":"10.1016/j.clineuro.2025.108980","url":null,"abstract":"<div><h3>Objective</h3><div>Early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (aSAH) occurs in the first 3 days after bleeding is associated with long-term complications and poor neurological outcomes. The aim of this study was to externally validate the SHELTER score, which has been developed to quantify the severity of EBI.</div></div><div><h3>Methods</h3><div>This is a retrospective single center study of adult aSAH patients consecutively admitted to the Intensive Care Department of Hôpital Universitaire de Bruxelles between January 2015 and December 2023.We calculated the SHELTER score using data from the first 72 h after admission, including age, the World Federation of Neurological Surgeons grade, prehospital cardiopulmonary resuscitation, mydriasis, midline shift, early clinical deterioration, and early ischemia. Unfavorable functional outcome was defined as the modified Rankin scale 3–6 at 6 months.</div></div><div><h3>Results</h3><div>We included 250 aSAH patients with a mean age of 55 (± 13) years. The SHELTER score demonstrated high predictive accuracy for unfavorable functional outcome with an area under the receiver operating characteristic of 0.80 [95 % confidence interval (CI) 0.75–0.86]. The optimal cut-off point for predicting unfavorable functional outcome was &gt; 5.0, with a sensitivity of 0.57, specificity of 0.88, positive predictive value of 0.77 and negative predictive value of 0.75. In a multivariable analysis, the SHELTER score was independently associated with unfavorable functional outcome (OR 1.70, 95 % CI 1.37–2.10).</div></div><div><h3>Conclusions</h3><div>The SHELTER score can help identify aSAH patients at high risk of unfavorable functional outcome with good discriminative performance. This score could be used to better stratify patients in future studies investigating interventional strategies aiming at enhancing recovery and long-term prognosis after aSAH.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108980"},"PeriodicalIF":1.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168196","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":"Cerebral microbleeds and renal dysfunction: Degenerative neurobiological shared mechanisms within intracerebral hemorrhage","authors":"Iulia-Ioana Enache ,&nbsp;Maria Mirabela Manea ,&nbsp;Sorin Tuță ,&nbsp;Carmen-Adella Sîrbu","doi":"10.1016/j.clineuro.2025.108981","DOIUrl":"10.1016/j.clineuro.2025.108981","url":null,"abstract":"<div><div>Intracerebral hemorrhage (ICH) is a significant global source of morbidity and mortality, with a frequently grim prognosis. Microvascular dysfunction in the form of small vessel disease appears to cause the vast majority of spontaneous cerebral hemorrhages. Cerebral microbleeds, hemorrhagic markers of small vessel disease, seem prevalent in ICH patients. The cerebral microvasculature resembles the renal microvasculature and therefore, the two may share common, complex degenerative mechanisms of frailty, and renal impairment appears to be an additional burden on ICH cases. There could be a potential neurobiological interplay between cerebral microbleeds and renal dysfunction in the context of ICH, with possible bidirectional influences on a molecular and cellular level. Separately, the two entities appear to influence ICH occurrence, recurrence and prognosis. Our review sheds light on the fact that when cerebral microbleeds and renal impairment are brought together, there is potential for clinically relevant pathophysiological feedback mechanisms.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108981"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168193","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":"Selected risk factors for motor fluctuations in Parkinson's disease: a meta-analysis","authors":"Qiaoying Huang ,&nbsp;Huayu Weng ,&nbsp;Xiaobai Weng ,&nbsp;Zhen-Hua Zhao","doi":"10.1016/j.clineuro.2025.108921","DOIUrl":"10.1016/j.clineuro.2025.108921","url":null,"abstract":"<div><h3>Background</h3><div>Motor fluctuations are a common and disabling complication of Parkinson's disease (PD), impairing patients’ quality of life and imposing a healthcare burden. Our study aimed to comprehensively assess the risk factors for motor fluctuations in patients with PD.</div></div><div><h3>Methods</h3><div>We conducted a systematic search up to September 2023, utilizing PubMed, Embase, Web of Science, SCOPUS and Google Scholar. Cohort and case–control studies that clearly defined motor fluctuations and presented relevant data were included. The data were analyzed to generate a pooled effect size and 95 % confidence interval (CI).</div></div><div><h3>Results</h3><div>Our meta-analysis included 13 studies involving a total of 3346 patients with PD, of whom 1194 (35.7 %) had motor fluctuations. The development of motor fluctuations was positively associated with female sex (HR 1.44, 95 % CI 1.12–1.86), levodopa dose (HR 1.20, 95 % CI 1.14–1.27), years of education (OR 1.34, 95 % CI 1.06–1.69), and higher Unified Parkinson's Disease Rating Scale (UPDRS) motor score (HR 1.02, 95 % CI 1.00–1.04). Conversely, age at diagnosis (HR 0.95, 95 % CI 0.94–0.97) and age at PD onset (HR 0.92, 95 % CI 0.86–0.99) were inversely associated with motor fluctuations. No significant associations were found between motor fluctuations and Hoehn &amp; Yahr stage III, disease duration, tremor-dominant subtype, smoking (ever vs. never), caffeine intake or longer levodopa treatment duration.</div></div><div><h3>Conclusions</h3><div>Several factors were identified as associated with motor fluctuations in PD. These findings may aid in discerning patients who are at risk of developing motor fluctuations and optimizing their treatment strategies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108921"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185159","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":"Headache as an indication for surgery in non-functioning pituitary adenoma and Rathke's cleft cyst: A systematic review","authors":"Adrianna Wierzbicka ,&nbsp;Hediye Gholamshahi ,&nbsp;Alireza Soltani Khaboushan ,&nbsp;Farhang Rashidi ,&nbsp;Mohammadmahdi Sabahi ,&nbsp;Mohammad Mofatteh ,&nbsp;Anam Baig ,&nbsp;Arnaldo Neves Da Silva ,&nbsp;Badih Adada ,&nbsp;Hamid Borghei-Razavi","doi":"10.1016/j.clineuro.2025.108976","DOIUrl":"10.1016/j.clineuro.2025.108976","url":null,"abstract":"<div><h3>Purpose</h3><div>Headaches are a common presentation in clinical practice, often necessitating further evaluation and management. This study aims to comprehensively analyze available literature regarding headaches as an absolute surgical indication for patients with nonfunctioning pituitary adenomas (NFPAs) and Rathke's cleft cysts (RCCs), shedding light on postoperative headache resolution, and surgical complications.</div></div><div><h3>Method</h3><div>Following PRISMA guidelines, PubMed, Scopus, Embase, and Web of Science were searched until October 10th, 2023, using specified keywords. Inclusion criteria involved studies describing patients with NFPA or RCC, where headache was the sole surgical indication. Data were extracted, and quality assessed using the Joanna Briggs Institute (JBI) checklist.</div></div><div><h3>Results</h3><div>A total of 13 studies met the inclusion criteria, comprising 183 individuals who underwent surgical intervention for headaches caused by NFPA (n = 111) or RCC (n = 75). The majority of patients experienced headache improvement (75.8 %), while persistent headaches were noted in 19.8 %, and worsening in 4.3 %. Headache recurrence was infrequent (7.1 %), and postoperative complications including transient diabetes insipidus (29.4 %), cerebrospinal fluid leak (17.6 %), postoperative infection (17.6 %), and adrenal insufficiency (17.6 %) were reported. Quality assessment using JBI checklists indicated variable risk of bias across studies.</div></div><div><h3>Conclusion</h3><div>Surgical interventions significantly improved headache resolution in patients with NFPAs and RCCs, especially with few recurrences and manageable complications. Further prospective research with standardized protocols and long-term follow-up is essential to validate headaches as a sole indication for surgery in these patients and optimize outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108976"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168192","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":"Spinal CSF leaks in spontaneous intracranial hypotension: A single-institution analysis of incidence, typology and treatment outcomes","authors":"Bala McRae-Posani ,&nbsp;Andrew Kim ,&nbsp;David Edasery ,&nbsp;Sara Strauss ,&nbsp;Michelle Roytman ,&nbsp;John K. Park ,&nbsp;Gayle Salama","doi":"10.1016/j.clineuro.2025.108978","DOIUrl":"10.1016/j.clineuro.2025.108978","url":null,"abstract":"<div><h3>Objective</h3><div>To report incidence, typology and treatment outcomes of spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH).</div></div><div><h3>Methods</h3><div>In this IRB approved study, consecutive SIH patients with myelogram-confirmed spinal CSF leak location, who underwent treatment between 2021 and 2023 at a single institution were retrospectively analyzed. The outcome variable was definitive treatment of SIH, defined as clinical and/or radiographic resolution of symptoms. Leak type classification was: Type 1 = ventral dural tear, Type 2 = lateral dural nerve root sleeve tear, Type 3 = CSF-venous fistula (CVF).</div></div><div><h3>Results</h3><div>32 SIH patients (average age 48 ± 15, 28 % male, 72 % female) were analyzed. A majority of them had a Type 1 CSF leak (59 %), followed by Type 3 (31 %) and Type 2 (9 %) leaks. Thoracic spine was the predominant location of the leaks (84 %); notably all CSF-venous fistulas were located there. Following trials of conservative management, all patients underwent treatment with EBP after leak site localization. 22/32 patients (69 %) had at least some resolution of symptoms following the first EBP. For 2/32 (6 %, both Type 2 leak), one targeted EBP provided definitive treatment. 30/32 (94 %, all leak types) had persistent clinical symptoms and had additional EBP(s). The mean number of EBPs per patient was 1.4 (range = 1–3). Following treatment failure of EBP(s), 10 patients with Type 3 leaks had transvenous embolization, which resulted in definitive treatment for 9 (90 %); 16 patients (leak Type 1 = 15, Type 2 = 1) had open dural surgery, which resulted in definitive treatment for 15 (94 %, all Type 1 leaks).</div></div><div><h3>Conclusion</h3><div>Overall, our analysis is consistent with recent data demonstrating that SIH incidence is higher among female patients and that CVFs are slightly more prevalent than previously reported, seen in nearly a third of our patients. Thoracic spine is the predominant location of CSF leaks; all our CVFs were located there. On treatment modalities, while EBP remains an important tool offering immediate symptom relief to SIH patients in the short term, permanent closure of the CSF leak and complete resolution of symptoms is rarely achieved with EBP. Definitive treatment is more likely with targeted endovascular and surgical modalities.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108978"},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125270","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":"Circulating miR-425 can be a biomarker for depression in patients with Parkinson’s disease","authors":"Hong Liu ,&nbsp;Haonan Zhao ,&nbsp;Dongya Huang","doi":"10.1016/j.clineuro.2025.108969","DOIUrl":"10.1016/j.clineuro.2025.108969","url":null,"abstract":"<div><h3>Introduction</h3><div>Depression, a common comorbidity in patients with Parkinson's disease (PD), is often underdiagnosed and undertreated. Circulating microRNAs (miRNAs) have been proved to be promising biomarker candidates for PD. However, no miRNAs are currently available as biochemical markers of depression in PD.</div></div><div><h3>Method</h3><div>Serum samples from 52 healthy controls, 69 non-depressed PD patients (PD-ND), and 62 depressed PD patients (PD-D) were analyzed using qPCR to measure miR-425 levels. All the participants were assessed using detailed clinical scales.</div></div><div><h3>Results</h3><div>miRNA-425 (miR-425) expression in PD-D patients was downregulated compared with that in PD-ND patients, with an area under the curve of 0.867 in receiver operating characteristic curve analysis. miR-425 levels were negatively correlated with the severity of depression (HAMD, r = -0.423, p &lt; 0.001) and anxiety (HAMA, r = -0.469, p &lt; 0.001). Additionally, PD-D patients scored higher in H-Y, MDS-UPDRS (I, II, and III), NMSS (1, 3, 5, and 9), HAMD, HAMA, RBDSQ, ESS, and ADL and lower in NMSS7, MMSE, SS-16, and PDQ-39 than PD-ND patients. Binary logistic regression analysis identified that cognitive impairment (MMSE, p = 0.001) and anxiety (HAMA, p &lt; 0.001) were significantly associated with depression in PD.</div></div><div><h3>Conclusion</h3><div>Circulating miR-425 shows significant potential as a biomarker for depression in PD, with distinct downregulation in PD-D patients and a strong correlation with depression severity. Our findings suggest a unique potential for improving PD-D diagnosis and understanding its pathophysiology.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"255 ","pages":"Article 108969"},"PeriodicalIF":1.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138518","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}