Clinical Neurology and Neurosurgery最新文献

{"title":"C-reactive protein levels at admission among stroke patients - A comparative analysis","authors":"Alexander Bastian Koldborg ,&nbsp;Malini Vendela Sagar ,&nbsp;Christina Kruuse","doi":"10.1016/j.clineuro.2025.109142","DOIUrl":"10.1016/j.clineuro.2025.109142","url":null,"abstract":"<div><h3>Objective</h3><div>Severity and outcome of stroke may be associated with a concomitant or subsequent inflammatory response. C-reactive protein (CRP) may correlate with length of stay (LOS) in hospital, indicating increased complexity of stroke patients with an ongoing inflammatory reaction upon admission.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study used data from admissions to the non-comprehensive Stroke Unit, which receives patients ineligible for revascularization therapy at Herlev-Gentofte hospital, in 2019 and 2020. We extracted data from electronic health records, including age, sex, diagnosis upon discharge (ICD-10), comorbidities, CRP-level, date and time of admission and discharge. CRP-levels were subcategorized as normal (&lt;10 mg/L), moderate elevation (10–40 mg/L) and high elevation (&gt; 40 mg/L). Discharge diagnosis was subcategorized as acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or transient ischemic attack (TIA). Statistical analyses were performed in R 4.3.3.</div></div><div><h3>Results</h3><div>2077 patients were included, whereof 1169 had AIS, 831 had TIA and 77 had ICH. 97 had CRP &gt; 40 mg/L, 249 had CRP 10–40 mg/L and 1574 had normal CRP-levels, whereas CRP-levels were unavailable in 157 cases. Our adjusted analysis revealed that CRP-levels &gt; 40 mg/L were associated with longer LOS compared to CRP-levels 0–10 mg/L. No significant association was found between CRP-levels 10–40 mg/L and a longer LOS. Age ≥ 65 years and ICH were associated with prolonged LOS, whereas TIA and COVID-19 lockdown periods were associated with shorter LOS.</div></div><div><h3>Conclusion</h3><div>The study demonstrates the potential of CRP as a prognostic marker for increased LOS in hospital among patients with acute stroke or TIA.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109142"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004889","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":"Prediction of severe aneurysmal subarachnoid hemorrhage before rupture: Insights from a retrospective study","authors":"Li Song ,&nbsp;Marvin Darkwah Oppong ,&nbsp;Xingyun Quan ,&nbsp;Philipp Dammann ,&nbsp;Adrian Engel ,&nbsp;Yahya Ahmadipour ,&nbsp;Meltem Gümüs ,&nbsp;Thiemo Florin Dinger ,&nbsp;Laurèl Rauschenbach ,&nbsp;Yan Li ,&nbsp;Benedikt Frank ,&nbsp;Ulrich Sure ,&nbsp;Ramazan Jabbarli","doi":"10.1016/j.clineuro.2025.109140","DOIUrl":"10.1016/j.clineuro.2025.109140","url":null,"abstract":"<div><h3>Objective</h3><div>Accurate prediction of the initial severity of aneurysmal subarachnoid hemorrhage (aSAH) is important for effective management of unruptured intracranial aneurysms (IA). This study aims to investigate patient and IA characteristics as pre-rupture predictors of severe aSAH.</div></div><div><h3>Methods</h3><div>This retrospective analysis included all patients aged 18 years or older diagnosed with acute aSAH at our center between January 2003 and June 2016. Severe aSAH was defined on the patient’s initial condition as World Federation of Neurosurgical Societies Scale Grade 4–5 and the original Fisher Scale grade 3–4 on CT imaging. We recorded demographic, clinical, and radiological parameters assessable prior to rupture, and utilized univariate and multivariate regression analyses to identify predictors of severe aSAH.</div></div><div><h3>Results</h3><div>932 patients were included in the final analysis, with a median age of 55 years. Severe aSAH occurred in 404 patients (43.35 %). Multivariate analysis identified that age &gt; 55 years (adjusted odds ratio [aOR]= 1.33, 95 % CI: 1.01–1.76) and IA size &gt; 6 mm (aOR= 1.90, 95 % CI: 1.45–2.50) as independent predictors of severe aSAH. In contrast, smoking (aOR= 0.49, 95 % CI: 0.36–0.67) and migraine (aOR= 0.26, 95 % CI: 0.10–0.70) were associated with reduced severity. Other examined factors, including blood pressure and medication use, were not significantly associated with aSAH severity.</div></div><div><h3>Conclusion</h3><div>aSAH severity can be predicted prior to IA rupture. The identified patient and IA characteristics provide valuable insights for risk stratification and indicate directions for further investigation. Future studies should explore additional risk factors beyond those directly related to aneurysm rupture, incorporating them into treatment decision-making to enhance personalized management strategies and optimize patient outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109140"},"PeriodicalIF":1.6,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020392","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":"Risk factors for angiographic vasospasm and delayed cerebral ischemia subsequent to aneurysmal subarachnoid hemorrhage: A multicenter, registry study","authors":"Masahiro Hosogai ,&nbsp;Fusao Ikawa ,&nbsp;Daizo Ishii ,&nbsp;Masashi Kuwabara ,&nbsp;Yuyo Maeda ,&nbsp;Kazunori Toyoda ,&nbsp;Shotai Kobayashi ,&nbsp;Nobutaka Horie ,&nbsp;Japan Stroke Data Bank investigators","doi":"10.1016/j.clineuro.2025.109136","DOIUrl":"10.1016/j.clineuro.2025.109136","url":null,"abstract":"<div><h3>Objective</h3><div>Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbidity and mortality. Symptoms of DCI can be categorized as temporary or permanent; however, the relationship between DCI and angiographic vasospasm (AVS) remains unclear. Therefore, this study aimed to clarify the relationship between DCI and AVS and to identify the factors associated with DCI in patients with aSAH.</div></div><div><h3>Methods</h3><div>Data from patients with acute aSAH who underwent surgical clipping or endovascular coiling within 72 h of onset in Japan between December 2016 and December 2020, were analyzed retrospectively. Univariable and multivariable logistic regression analyses were performed to identify factors associated with temporary or permanent DCI and AVS.</div></div><div><h3>Results</h3><div>AVS was identified in 27.3 % of 1066 patients with aSAH. Among these, 65.8 % did not develop DCI. DCI occurred in 13.4 % of patients, and 37.3 % of those with DCI did not experience AVS. AVS was associated with both temporary and permanent DCI in multivariable logistic regression analyses. Older age was associated with permanent DCI. Poor outcomes (defined as a modified Rankin Scale score of 3–6) at discharge were also associated with permanent (OR: 7.51, 95 % CI: 3.12–22.31) but not with temporary DCI or AVS.</div></div><div><h3>Conclusion</h3><div>Although AVS was significantly associated with both temporary and permanent DCI, DCI can occur without AVS. Older age was a risk factor for permanent DCI, which was associated with poor outcomes. This study may suggest the importance of management for DCI particularly in older patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109136"},"PeriodicalIF":1.6,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020394","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":"Glymphatic function, deep medullary veins, and cognitive impairment in cerebral small vessel disease: A mediation analysis","authors":"Xiao-Li Yang ,&nbsp;Yu-Fan Luo ,&nbsp;Tian-Yao Wang ,&nbsp;Meng-Xiang Wang ,&nbsp;Wen-Mei Lu ,&nbsp;Joseph Zongen Shen ,&nbsp;Hu-Lie Zeng ,&nbsp;Dan-Hong Wu","doi":"10.1016/j.clineuro.2025.109143","DOIUrl":"10.1016/j.clineuro.2025.109143","url":null,"abstract":"<div><h3>Background</h3><div>The glymphatic system and deep medullary veins (DMV) are closely linked to cognitive impairment in patients with cerebral small vessel disease (CSVD). This study aims to elucidate these complex associations through mediation analysis.</div></div><div><h3>Methods</h3><div>Patients who underwent multimodal magnetic resonance imaging (MRI) scans and the Montreal Cognitive Assessment (MoCA) were recruited. Glymphatic function was assessed using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. DMV was identified on susceptibility-weighted imaging (SWI), and a total DMV score was calculated based on segmental continuity and visibility. Regression models were employed to estimate the impact of the DMV score and DTI-ALPS index on cognitive impairment. Mediation analysis was conducted to examine the effect of the DTI-ALPS on DMV score and cognitive function.</div></div><div><h3>Results</h3><div>A total of 152 participants were included, of whom 65 had normal cognitive function and 87 had cognitive impairment. After adjusting for confounding factors, both the DMV score (OR=1.182, 95 % CI: 1.067–1.308, p = 0.005) and DTI-ALPS index (OR=0.496, 95 % CI: 0.306, 0.806, p = 0.005) were independently associated with cognitive impairment. Mediation analysis revealed that the DTI-ALPS index partially mediated the relationship between the DMV score and cognitive impairment, with an indirect effect of 0.040 (95 % CI: 0.011–0.084, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Both the DMV score and DTI-ALPS index are independent risk factors for cognitive impairment in patients with CSVD. The DTI-ALPS index significantly and partially mediates the relationship between the DMV score and cognitive impairment.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109143"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046350","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":"Radial-first to wrist-first: Transulnar arterial access for diagnostic cerebral angiography and neurovascular intervention","authors":"Aaron A. Anandarajah ,&nbsp;Raghav Mattay ,&nbsp;Luis O. Tierradentro-Garcia ,&nbsp;Mikaeel A. Habib ,&nbsp;Sartaaj Walia ,&nbsp;Hasan Ahmad ,&nbsp;Omar Choudhri","doi":"10.1016/j.clineuro.2025.109141","DOIUrl":"10.1016/j.clineuro.2025.109141","url":null,"abstract":"<div><h3>Purpose</h3><div>Although transradial arterial access has been increasingly used in neurointerventional procedures, anatomical variations, vasospasm, or radial artery occlusion can preclude safe access to the radial artery. This study evaluates the feasibility and safety of transulnar artery access as an alternative route for diagnostic cerebral angiography and neurovascular interventions.</div></div><div><h3>Materials and methods</h3><div>A retrospective review was conducted at a high-volume academic neurovascular center. Consecutive diagnostic and interventional neurovascular procedures performed exclusively via transulnar artery access over a four-year period were reviewed and analyzed. Data collected included case type, arterial measurements (ulnar and radial), access choice rationale, and complications.</div></div><div><h3>Results</h3><div>A total of 161 procedures (111 diagnostic cerebral angiograms, 50 neurovascular interventions) were performed using transulnar access over a 5-year period. The mean patient age was 54.4 years, and 119 patients were female. Ulnar artery access was chosen due to an unfavorable ipsilateral radial artery or the need for a dedicated left vertebral artery injection. Interventions included pipeline flow diversion, aneurysm coiling (with and without adjunctive devices), tumor embolization, and balloon-assisted coiling. All ulnar artery access sites were closed with an inflatable band closure device. Additionally, no conversions to femoral access were required. There were minimal cases of forearm hematoma, hand ischemia, or arm nerve damage.</div></div><div><h3>Conclusion</h3><div>Transradial arterial access has demonstrated a lower rate of access site complications relative to the femoral approach. Our experience suggests that transulnar artery access is also a feasible and safe alternative for diagnostic cerebral angiography and neurovascular intervention. Given the lower complication rates associated with both transradial and transulnar access compared to femoral access in the existing literature, this study further supports shifting from a “radial-first” approach to a broader “wrist-first” approach in neurointerventional procedures.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109141"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933310","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":"Intra-arterial thrombolytics after successful recanalization in endovascular thrombectomy for large-vessel occlusion acute ischemic stroke: A comprehensive meta-analysis of randomized controlled trials","authors":"Wei Jun Lee ,&nbsp;Rafaela Correia Maciel ,&nbsp;Henrique Alexsander Ferreira Neves ,&nbsp;Rahim Abo Kaseem ,&nbsp;Luana Miyahira Makita ,&nbsp;Ong Zhi Inn ,&nbsp;Tam QM Tran ,&nbsp;Tan Ya Wen ,&nbsp;Adam Dmytriw ,&nbsp;Robert Regenhardt","doi":"10.1016/j.clineuro.2025.109139","DOIUrl":"10.1016/j.clineuro.2025.109139","url":null,"abstract":"<div><h3>Background</h3><div>Intra-arterial thrombolytics (IAT) as adjunctive therapy for large vessel occlusion acute ischemic stroke (LVO-AIS) after successful endovascular thrombectomy (EVT) may improve outcomes. This meta-analysis evaluates the efficacy and safety of IAT in this context.</div></div><div><h3>Methods</h3><div>We identified randomized controlled trials (RCTs) comparing IAT versus placebo or no IAT in LVO-AIS patients with successful recanalization post-EVT, including published studies and recent conference data. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days. Secondary outcomes included other mRS 0–2 at 90 days, symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Pooled risk ratios (RRs) with 95 % confidence intervals (CIs) were calculated using a random-effects model; heterogeneity was assessed using the I² statistic.</div></div><div><h3>Results</h3><div>Six RCTs comprising 1972 patients (990 IAT, 982 control) were included. IAT was associated with a higher likelihood of excellent outcome at 90 days (RR = 1.25; 95 % CI: 1.07–1.46; p = 0.01; I² = 16 %). There were no significant differences in functional independence (mRS 0–2) (RR = 1.06; 95 % CI: 0.97–1.17; p = 0.15), sICH (RR = 1.14; 95 % CI: 0.70–1.85; p = 0.52), or 90-day mortality (RR = 1.00; 95 % CI: 0.79–1.27; p = 0.99); heterogeneity was low across these outcomes (I² = 0 %).</div></div><div><h3>Conclusion</h3><div>Adjunct IAT after successful EVT significantly improves excellent functional outcomes at 90 days without increasing sICH or mortality. However, its effect on broader disability outcomes is uncertain. Further trials are needed to refine patient selection.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109139"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020393","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":"Effect of Early Versus Delayed Middle Meningeal Artery Embolization on Clinical Outcomes in Chronic Subdural Hematoma: A Propensity Score-Matched Cohort Study","authors":"Hamza Adel Salim ,&nbsp;Orabi Hajjeh ,&nbsp;Huanwen Chen ,&nbsp;Muhammed Amir Essibayi ,&nbsp;Nimer Adeeb ,&nbsp;Ahmed Msherghi ,&nbsp;Adam A. Dmytriw ,&nbsp;Marco Colasurdo ,&nbsp;Ajay Malhotra ,&nbsp;Vivek S Yedavalli ,&nbsp;Dheeraj Gandhi ,&nbsp;Max Wintermark ,&nbsp;Dhairya A. Lakhani","doi":"10.1016/j.clineuro.2025.109126","DOIUrl":"10.1016/j.clineuro.2025.109126","url":null,"abstract":"<div><h3>Background</h3><div>Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate following surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive or standalone treatment, but the optimal timing of embolization remains unclear. We evaluated whether early MMAE (≤2 days) versus delayed MMAE (3-7 days) is associated with improved clinical outcomes.</div></div><div><h3>Methods</h3><div>In this retrospective, multicenter cohort study, we identified adult patients with cSDH who underwent MMAE using de-identified real-world patient data from the TriNetX platform. Patients were stratified into early versus delayed MMAE groups, defined relative to the date of surgery (surgical cohort) or diagnosis (non-surgical cohort). Propensity score matching (1:1) was performed based on demographics and comorbidities. The primary outcome was all-cause mortality and secondary outcomes included repeat surgical evacuation (for surgical cohort) and need for surgical evacuation (for non-surgical cohort) at 6-months.</div></div><div><h3>Results</h3><div>In the matched surgical cohort (n=326), early MMAE was associated with a lower, but not statistically significant, rate of mortality compared to delayed MMAE (6.1% vs. 11.0%; OR, 0.527; 95% CI, 0.235 to 1.178; P=0.114). Similar rates were observed for repeat surgery for both groups. In the matched non-surgical cohort (n=450), early MMAE was not associated with significant differences in mortality or need for surgery.</div></div><div><h3>Conclusions</h3><div>Among patients with cSDH, early MMAE was associated with numerically lower rates of mortality in the surgical cohort. These findings support further investigation of early MMAE as a potential strategy to improve outcomes in surgical cSDH cases.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109126"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004887","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":"Analysis of safety of carotid endarterectomy in nonagenarians and the implications of frailty - A National surgical quality improvement program analysis","authors":"Christine Y. Nguyen ,&nbsp;Anthony V. Nguyen ,&nbsp;Laura K. Reed ,&nbsp;Jose M. Soto ,&nbsp;Awais Z. Vance ,&nbsp;Chitra K. Hamilton","doi":"10.1016/j.clineuro.2025.109138","DOIUrl":"10.1016/j.clineuro.2025.109138","url":null,"abstract":"<div><h3>Background</h3><div>Carotid artery stenosis prevalence increases with age, and carotid endarterectomy (CEA) is a possible treatment option. However, nonagenarians are at high risk of experiencing postoperative complications and are often not considered surgical candidates. We aimed to identify risk factors associated with postoperative myocardial infarction (MI), stroke, and death within 30 days for nonagenarians undergoing CEA and to analyze the predictive ability of modified frailty indices (mFI) in predicting adverse outcomes for this population.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective cohort study of patients aged 90 + years who underwent CEA from 2015 to 2019 utilizing the validated multi-institutional National Surgical Quality Improvement Program (NSQIP) vascular targeted registry. Multivariable logistic regression was used to analyze and identify factors associated with incidence of MI, stroke, and death within 30 days of surgery. The utility of 2-factor mFI consisting of functional dependence and dyspnea in predicting these complications was separately tested with univariable logistic regression.</div></div><div><h3>Results</h3><div>Of 191 patients meeting study criteria, 2.1 % had strokes, 3.7 % MIs, and 3.7 % died. Preoperative aspirin use (OR 0.09, 95 % CI:0.01–0.8, p = .02) was associated with lower odds of stroke. Functional status (OR 14.1, 95 % CI:1.4–151.0, p = .02) and dyspnea (OR 22.6, 95 % CI:2.1–309.3, p &lt; .01) were associated with higher odds of MI, while statin use (OR 0.07, 95 % CI:0.007–0.5, p = .01) was associated with lower odds. Death was less frequent in elective cases (OR 0.1, 95 % CI:0.005–0.6, p = .04). The 2-factor mFI was not predictive of stroke but did predict MI and death and outperformed an existing 5-factor mFI.</div></div><div><h3>Conclusion</h3><div>The risk profile of CEA can be acceptable in highly select nonagenarians. Functionally independent, non-dyspneic nonagenarians with preoperative aspirin and statin use who are scheduled electively have the lowest risk for a 30-day complication following CEA. Functional dependence and dyspnea are reasonable surrogate measures of frailty and may indicate a high complication risk for nonagenarians being considered for CEA.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109138"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004888","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":"Involvement of the right lentiform nucleus is an independent predictor of poor outcomes in large vessel occlusion strokes with small infarct volumes","authors":"Hend M. Abdelhamid ,&nbsp;Mahmoud H. Mohammaden ,&nbsp;Diogo C. Haussen ,&nbsp;Alhamza R. Al-Bayati ,&nbsp;Mona Hussein ,&nbsp;Ahmed Elbassiouny ,&nbsp;Rasha Soliman ,&nbsp;Raul G. Nogueira","doi":"10.1016/j.clineuro.2025.109137","DOIUrl":"10.1016/j.clineuro.2025.109137","url":null,"abstract":"<div><h3>Background</h3><div>Final infarct volume (FIV) is a strong predictor of stroke outcomes. Although smaller FIV are associated with better outcomes, many patients fail to achieve functional independence. We aimed to identify poor outcome predictors in patients with anterior large vessel occlusion stroke (LVOS) who underwent mechanical thrombectomy (MT) and had small FIV.</div></div><div><h3>Methods</h3><div>We reviewed a prospective MT database from October 2010 to December 2020. Patients with intracranial ICA or MCA-M1/2 occlusions, premorbid mRS ≤ 2, underwent MT, and had FIV ≤ 30 ml on follow-up MRI were included. The cohort was divided into: good (mRS≤2) and poor (mRS&gt;2) outcomes at 90 days. Multivariable analysis identified the poor outcome predictors and the association between e-ASPECTS regions and outcomes.</div></div><div><h3>Results</h3><div>Among 2370 thrombectomies, 555 had FIV ≤ 30 ml. After exclusions, 398 patients were analyzed. The median age was 65 years, with 54 % female, median NIHSS was 15, and the median ASPECTS was 9. Poor outcome was associated with older age, female sex, atrial fibrillation (AF), hypertension (HTN), coronary artery disease (CAD), and prior strokes. Right lentiform nucleus involvement is an independent predictor of poor outcome in patients with small FIV, along with age, CAD, cardioembolic stroke, number of MT attempts and FIV.</div></div><div><h3>Conclusion</h3><div>Involvement of right lentiform nucleus is an independent predictor of poor outcomes in LVOS with small FIV. Other predictors included age, CAD, cardioembolic stroke, the number of passes during MT, and FIV. Future strategies are needed to improve outcomes in these patient populations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109137"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004890","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":"Neurofunctional divergence between classical and idiopathic trigeminal neuralgia: A large-cohort resting-state fMRI study of 139 patients","authors":"Gaoquan Lv ,&nbsp;Zihao Zhang ,&nbsp;Qingpei Hao ,&nbsp;Qiang Di ,&nbsp;Zheng Wang ,&nbsp;Zhentao Li ,&nbsp;Ruen Liu","doi":"10.1016/j.clineuro.2025.109127","DOIUrl":"10.1016/j.clineuro.2025.109127","url":null,"abstract":"<div><h3>Background</h3><div>Resting-state functional MRI (rs-fMRI) has advanced our understanding of trigeminal neuralgia (TN), but the neural distinctions between its classical (CTN) and idiopathic (ITN) subtypes are poorly understood. This study aims to investigate differential brain activity and connectivity patterns between CTN and ITN to elucidate their underlying central mechanisms and identify potential neuroimaging biomarkers.</div></div><div><h3>Methods</h3><div>This prospective study included rs-fMRI data from 139 TN patients (84 CTN, 55 ITN) and 49 matched healthy controls (HCs). We analyzed the amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and functional connectivity (FC). Group comparisons were performed using two-sample t-tests with cluster-level family-wise error (FWE) correction. Correlations between imaging metrics and clinical variables were assessed.</div></div><div><h3>Results</h3><div>Compared to HCs, TN patients exhibited decreased ReHo in the right fusiform gyrus and increased ReHo in the right thalamus. Subtype analysis revealed that ITN patients, compared to CTN, showed significantly increased ALFF in the right hippocampus and decreased fALFF in the bilateral postcentral gyrus. Clinically, ReHo in the right fusiform gyrus negatively correlated with pain intensity (VAS; r = -0.255, p = 0.002), while right thalamic ReHo showed a positive correlation (r = 0.208, p = 0.014). In the CTN subgroup, connectivity between the left supramarginal gyrus and right perigenual cingulate gyrus was inversely correlated with disease duration (r = -0.267, p = 0.014).</div></div><div><h3>Conclusion</h3><div>Our findings reveal divergent rs-fMRI profiles for TN patients versus HCs, and notably, between CTN and ITN subtypes. These distinctions, particularly the hippocampal hyperactivity in ITN, suggest different central pathophysiological mechanisms. These quantifiable neurofunctional alterations may serve as potential biomarkers to differentiate TN subtypes and guide personalized therapeutic strategies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109127"},"PeriodicalIF":1.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916645","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}