Clinical Neurology and Neurosurgery最新文献

{"title":"Stereotactic radiofrequency thermocoagulation selectively targeting the subiculum for mesial temporal lobe epilepsy –Treatment concept and preliminary results","authors":"Hiroshi Shirozu ,&nbsp;Hiroshi Masuda ,&nbsp;Shigeki Kameyama","doi":"10.1016/j.clineuro.2025.109122","DOIUrl":"10.1016/j.clineuro.2025.109122","url":null,"abstract":"<div><h3>Objective</h3><div>The recently emerging laser interstitial thermal therapy is becoming a substitute treatment for mesial temporal lobe epilepsy (MTLE) due to its less invasiveness, but it offers lower seizure-free rates than traditional open surgery. Another less invasive stereotactic ablation surgery, that is radiofrequency thermocoagulation, is also an alternative surgical procedure. In particular, magnetic resonance imaging-guided stereotactic radiofrequency thermocoagulation (MRgSRFTC) has shown excellent seizure outcomes. Recently, the subiculum has been reported to have a more important role in the epileptic network in MTLE with hippocampal sclerosis. The present study aimed to demonstrate the technical details and feasibility of MRgSRFTC targeting mainly the subiculum for the treatment of MTLE.</div></div><div><h3>Methods</h3><div>Two patients with right MTLE who underwent MRgSRFTC targeting the subiculum were evaluated. MRI-guided frame-based stereotactic surgery using a 2-mm-diameter rigid thermocoagulation probe was performed with a combination of multiple trajectories and coagulations (patient 1, four trajectories and 24 coagulations; patient 2, four trajectories and 20 coagulations) via one burr hole at the temporooccipital area.</div></div><div><h3>Results</h3><div>Both patients achieved good seizure outcomes (patient 1, Engel class IIA, follow-up for 24 months; patient 2, Engel class IA, follow-up for 20 months) without complications except for quadrant hemianopsia without subjective symptoms in patient 1.</div></div><div><h3>Conclusions</h3><div>Tailored ablation of the subiculum by MRgSRFTC with multiple trajectories and coagulations can provide effective seizure control with minimal damage to the surrounding tissues. Further evaluation with more patients is required to confirm the validity of the present surgical strategy and procedure.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109122"},"PeriodicalIF":1.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926251","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":"Middle meningeal artery embolisation reduces chronic subdural haematoma recurrence: A meta-analysis of EMBOLISE, STEM, MAGIC-MT and EMPROTECT trials and cost analysis","authors":"Nithish Jayakumar ,&nbsp;Oliver Kennion ,&nbsp;Ian Coulter","doi":"10.1016/j.clineuro.2025.109128","DOIUrl":"10.1016/j.clineuro.2025.109128","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effectiveness and cost implications of middle meningeal artery embolisation (MMAE) in reducing recurrence of chronic subdural haematoma (CSDH) requiring surgery, through a meta-analysis of the four largest randomized controlled trials (RCTs) published to date.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted on four RCTs (EMBOLISE, STEM, MAGIC-MT, EMPROTECT) comparing MMAE to standard treatment in adult patients with CSDH. The primary outcome was recurrence requiring surgery. Secondary outcomes included modified Rankin Scale (mRS) at follow-up, mortality, adverse events, and hospital stay. A United Kingdom-based cost analysis was performed using National Health Service (NHS) payment tariffs and institutional estimates to evaluate economic viability.</div></div><div><h3>Results</h3><div>MMAE significantly reduced recurrence requiring surgery (pooled risk ratio [RR]=0.40, 95 % CI: 0.28–0.58; p &lt; 0.00001). No significant differences were found in mortality (RR 0.94, p = 0.85), serious adverse events (RR 0.92, p = 0.47), or functional independence at follow-up (OR 0.97, p = 0.88). The estimated number needed to treat was 15. Cost analysis showed that while MMAE could prevent 53 surgical recurrences in a historical cohort of CSDH patients from the United Kingdom, it could incur a net loss of £ 1.6–1.9 million under current NHS tariffs.</div></div><div><h3>Conclusion</h3><div>MMAE is effective and safe in reducing CSDH recurrence but is not currently cost-effective for universal use in the NHS. Selective use in high-risk patients and cost-reduction strategies may enhance its economic viability.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109128"},"PeriodicalIF":1.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916646","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 comprehensive Investigation of the associations between cerebral blood flow and cerebrospinal fluid biomarkers across the Alzheimer’s disease continuum","authors":"Farbod Khosravi ,&nbsp;Hamide Nasiri ,&nbsp;Farzaneh Alvandi ,&nbsp;Melika Kavian ,&nbsp;Maryam Janbazi ,&nbsp;Mohammad Mehdi Gheissari ,&nbsp;Masoud Noroozi ,&nbsp;Ghazaal Atashi ,&nbsp;Zahra Asghari ,&nbsp;Nazanin Ghasemi Majd ,&nbsp;Azadeh Meaimaneh Jahromi ,&nbsp;For the Alzheimer’s Disease Neuroimaging Initiative","doi":"10.1016/j.clineuro.2025.109124","DOIUrl":"10.1016/j.clineuro.2025.109124","url":null,"abstract":"<div><h3>Background</h3><div>Alzheimer’s disease (AD) is characterized by a complex interplay between amyloid-β (Aβ) and tau pathologies, with increasing evidence implicating cerebral blood flow (CBF) alterations as a critical, yet underexplored, contributor to disease progression. This study aimed to investigate the associations between regional CBF and cerebrospinal fluid (CSF) biomarkers— Aβ1–42, total tau (T-Tau), and phosphorylated tau (P-Tau181)—across the AD continuum.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis using data from 416 participants enrolled in the Alzheimer’s Disease Neuroimaging Initiative (ADNI), including cognitively normal individuals, patients with mild cognitive impairment (MCI), and those with AD. CSF biomarker concentrations were measured using the INNO-BIA AlzBio3 immunoassay on the Luminex xMAP platform. Regional CBF was quantified using arterial spin labeling (ASL) MRI. Associations between CSF biomarkers and CBF were assessed using partial correlation and general linear models, adjusting for age and gender. Multiple comparisons were corrected using the false discovery rate (FDR) approach.</div></div><div><h3>Results</h3><div>In CN participants, CBF in the right inferior temporal cortex showed a positive association with Aβ1–42 levels (r = 0.348, p = 0.04). In the MCI group, elevated T-Tau and P-Tau181 levels were inversely associated with CBF in the left temporal pole (T-Tau: r = –0.296, p = 0.016; P-Tau₁₈₁: r = –0.311, p = 0.011). In participants with AD, widespread and robust positive correlations emerged between tau biomarkers and CBF, particularly in the posterior cingulate cortex, corpus callosum, and multiple frontal and parietal regions (e.g., P-Tau181 and posterior cingulate: β = 0.850, p = 0.004).</div></div><div><h3>Conclusion</h3><div>Our findings reveal stage-dependent and region-specific associations between cerebral perfusion and CSF biomarkers. In early stages, tau pathology is linked to hypoperfusion, whereas in established AD, elevated tau levels are paradoxically associated with increased CBF—potentially reflecting compensatory or neuroinflammatory mechanisms. These results underscore the complex neurovascular dynamics in AD and support the vascular hypothesis, suggesting that targeting CBF alterations may offer a viable therapeutic avenue, particularly in preclinical and prodromal stages.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109124"},"PeriodicalIF":1.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911855","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":"Evaluation of preoperative cervical internal carotid artery diameter as a predictor of cerebral hyperperfusion syndrome following revascularization surgery","authors":"Mitsuhiro Anan ,&nbsp;Kohei Onishi ,&nbsp;Masaki Morishige ,&nbsp;Kunpei Takao ,&nbsp;Wataru Matsushita ,&nbsp;Kaito Arimatsu ,&nbsp;So Okuma ,&nbsp;Yukari Kawasaki ,&nbsp;Yasuyuki Nagai ,&nbsp;Yu Takeda ,&nbsp;Nobuhiro Hata ,&nbsp;Minoru Fujiki","doi":"10.1016/j.clineuro.2025.109125","DOIUrl":"10.1016/j.clineuro.2025.109125","url":null,"abstract":"<div><h3>Objective</h3><div>Cerebral hyperperfusion syndrome (CHS) is potentially life-threatening complication after carotid revascularization procedures. This study aims to evaluate whether preoperative cervical internal carotid artery (ICA) diameter can serve as a predictor for CHS following carotid endarterectomy (CEA) or carotid artery stenting (CAS).</div></div><div><h3>Methods</h3><div>A retrospective cohort of 78 patients undergoing CEA or CAS between 2011 and 2024 was analyzed. ICA diameters were measured preoperatively at three standard cervical segments using contrast-enhanced computed tomography or digital subtraction angiography. The association between diameter measurements and postoperative CHS was statistically evaluated.</div></div><div><h3>Results</h3><div>CHS occurred in 4 cases (5.1 %). The CHS group had significantly smaller treated-side ICA diameters (median 2.73 mm vs 3.89 mm, p = 0.019), larger contralateral ICA diameters (4.89 mm vs 4.33 mm, p = 0.047), and high stenosis ratio (0.57 vs 0.88, p = 0.0017). A stenosis ratio 0.677 was identified as a significant predictor of CHS (AUC = 0.97, 95 % CI: 0.924–1.000; sensitivity = 100 %, specificity = 92 %).</div></div><div><h3>Conclusion</h3><div>Preoperative assessment of ICA diameters may help predict the risk of CHS. This anatomical metric should be considered in conjunction with hemodynamic evaluations to enhance perioperative risk stratification.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109125"},"PeriodicalIF":1.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916643","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":"The role of serum biomarkers in differential diagnosis of epileptic seizures, functional/cognitive seizure and syncope: A prospective cohort study","authors":"Elif Banu Soker ,&nbsp;Miray Erdem ,&nbsp;Derya Ozdogru ,&nbsp;Cemre Coddu ,&nbsp;Muge Gulen","doi":"10.1016/j.clineuro.2025.109123","DOIUrl":"10.1016/j.clineuro.2025.109123","url":null,"abstract":"<div><h3>Objective</h3><div>Differentiating epileptic seizures (ES) from other transient loss of consciousness including syncope and Functional/Cognitive Seizure (FCS) poses significant challenges in emergency settings. Laboratory biomarkers have emerged as valuable tools in enhancing diagnostic precision. This study evaluates the diagnostic performance of serum biomarkers, including phosphate, lactate, prolactin, and ammonia, in distinguishing ES from FCS and related conditions.</div></div><div><h3>Methods</h3><div>A cohort of 99 patients presenting with transient loss of consciousness was analyzed. Group 1 included ES patients (n = 56), and Group 2 included FCS and presyncope/syncope cases (n = 43). Serum levels of phosphate, lactate, prolactin, and ammonia were measured within the first hour of admission. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves, and multivariable logistic regression was performed to identify independent predictors.</div></div><div><h3>Results</h3><div>Serum phosphate levels ≤ 2.74 mg/dL demonstrated the highest diagnostic value (sensitivity: 82.1 %, specificity: 79.1 %, AUC=0.835). Lactate &gt; 3.52 mmol/L exhibited high specificity (93.0 %) and moderate sensitivity (60.7 %) for ES (AUC=0.812). Prolactin &gt; 15.55 ng/mL and ammonia &gt; 60 μmol/L were also significant predictors, with specificities of 83.7 % and 88.4 %, respectively. Multivariable analysis confirmed serum phosphate, lactate, prolactin, and ammonia as independent predictors. The combined model achieved an AUC of 0.946, indicating excellent diagnostic performance.</div></div><div><h3>Conclusion</h3><div>This study highlights the diagnostic utility of serum biomarkers in differentiating ES from FCS. The findings underscore the potential for integrating simple, accessible biomarkers into clinical workflows to improve diagnostic accuracy. Further research is warranted to validate these results across diverse populations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109123"},"PeriodicalIF":1.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916642","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":"Overlapping Miller Fisher Syndrome, Bickerstaff Brainstem Encephalitis, and Guillain-Barré Syndrome without glycolipid antibodies-a case report and literature review","authors":"Donghui Shen ,&nbsp;Kang Liu ,&nbsp;Haifeng Wang","doi":"10.1016/j.clineuro.2025.109121","DOIUrl":"10.1016/j.clineuro.2025.109121","url":null,"abstract":"<div><div>We present a rare case of a 56-year-old female presenting with overlapping features of Miller Fisher syndrome (MFS), Bickerstaff’s brainstem encephalitis (BBE) and Guillain-Barré syndrome (GBS), despite seronegativity for anti-GQ1b, GM1, GD1b, GT1a, and GT1b IgG antibodies. The patient developed sequential neurological deficits (ophthalmoplegia, ataxia, tetraparesis, and altered consciousness) following an upper respiratory infection. Electrophysiological studies confirmed acute motor-sensory axonal neuropathy, while cerebrospinal fluid analysis showed albuminocytological dissociation. Dual intravenous immunoglobulin (IVIG) courses and methylprednisolone therapy led to partial recovery, with independent ambulation achieved by day 76. This case underscores the complexity of overlapping anti-GQ1b antibody syndromes and highlights the need for alternative diagnostic biomarkers in seronegative patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109121"},"PeriodicalIF":1.6,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144916644","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":"Morvan syndrome with bilateral basal ganglia hyperintensities and exfoliative skin rashes in a patient with Chronic Hepatitis B: A diagnostic and therapeutic dilemma","authors":"Asish Vijayaraghavan ,&nbsp;Sruthi S. Nair,&nbsp;Lakshmi Priya Lalitha ,&nbsp;Sajith Sukumaran ,&nbsp;Soumya Sundaram","doi":"10.1016/j.clineuro.2025.109119","DOIUrl":"10.1016/j.clineuro.2025.109119","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109119"},"PeriodicalIF":1.6,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911856","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":"Pisa syndrome partly responsive to immunotherapy in IgLON5 disease","authors":"Shreshtha Gupta,&nbsp;Sahil Mehta,&nbsp;Saurabh Mishra,&nbsp;Aastha Takkar,&nbsp;Ritu Shree,&nbsp;Vivek Lal","doi":"10.1016/j.clineuro.2025.109118","DOIUrl":"10.1016/j.clineuro.2025.109118","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109118"},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893853","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":"Predictors of seizures in postoperative traumatic brain injury patients: A single center retrospective study","authors":"Daniel Sconzo ,&nbsp;Aryan Wadhwa ,&nbsp;Kaasinath Balagurunath ,&nbsp;Megan Berube ,&nbsp;Zachary Wetsel ,&nbsp;Naveen Arunachalam Sakthiyendran ,&nbsp;Anirudh Penumaka ,&nbsp;Alejandro Enriquez-Marulanda ,&nbsp;Kristine Ravina ,&nbsp;Emanuela Binello","doi":"10.1016/j.clineuro.2025.109116","DOIUrl":"10.1016/j.clineuro.2025.109116","url":null,"abstract":"<div><h3>Introduction/objectives</h3><div>Seizures are common postoperative complications for patients who have undergone surgical management for traumatic brain injury (TBI). However, little is known regarding preoperative factors that predict them. This study aims to describe preoperative factors that influence the occurrence of seizures after surgery for TBI.</div></div><div><h3>Methods</h3><div>A retrospective study of all operative TBI patients between 2012 and 2021 was performed. Individuals with TBI that received medical management only were excluded. The presence of postoperative seizures was determined according to documentation in the medical record of seizures after the date of surgery for TBI. Individuals who had documented seizures pre-TBI were excluded from the analysis. Univariate comparisons and multivariate logistic regression were performed.</div></div><div><h3>Results</h3><div>200 individuals were included in this study. Forty-six individuals (24.96 %) experienced at least one documented postoperative seizure within one week of surgery. Of those, 97.5 % were on Levetiracetam prophylactic coverage. Factors associated with postoperative seizures included age ≥ 60 years (<em>p</em> = .045) and smoking history (<em>p</em> = .048). A trend towards significance was seen in individuals whose injuries included subdural hematomas (<em>p</em> = .086), as well as those with a history of diabetes (<em>p</em> = .053). There were no differences according to initial GCS at presentation (<em>p</em> = .54), presence of EDH (<em>p</em> = .83), IPH (<em>p</em> = .75), SAH/IVH (<em>p</em> = .51), midline shift (<em>p</em> = .114), procedure type (<em>p</em> = .52) (craniotomy or craniectomy). SDH presence (OR 4.39 CI95 % 1.33 – 14.50) and former smoking status (OR 3.49 CI95 % 1.31 – 9.16) were significant risk factors on multivariate analysis when controlling for age, diabetes, and current smoking history. Former smoking remained significant in patients experiencing siezures greater than 7 days post-surgery as well (OR 4.56; CI 95 % 1.13–18.27).</div></div><div><h3>Conclusion</h3><div>In postoperative TBI patients, former smokers and the presence of SDH significantly increase the risk of experiencing seizures even while on prophylactic ASMs. These factors should be considered when managing postoperative TBI patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109116"},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890777","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":"Anti-IgLON-5 disease presenting with axial dystonia and acetazolamide-responsive apnea","authors":"Gwen Zeigler,&nbsp;Miriam Quinlan,&nbsp;Panayiotis N. Varelas,&nbsp;Matthew Collin,&nbsp;Eric Molho","doi":"10.1016/j.clineuro.2025.109117","DOIUrl":"10.1016/j.clineuro.2025.109117","url":null,"abstract":"<div><div>We present a 67-year-old male with anti-IgLON5 disease with cervical and upper trunk dystonic spasms. Intermittent hallucinations, occurring both with infections and without a precipitant, and hand tremors were also present. The MRI of the brain was nonspecific. The CSF results yielded positivity for IgLON5 antibodies, along with a CSF protein of 98. Treatment involved intravenous immunoglobulin, plasma exchange, and rituximab providing modest improvement in symptoms. The disease progressed to worsening apnea, without stridor or known aspiration, which resolved with acetazolamide. While acetazolamide has long been used for the treatment of sleep-breathing-related disorder, this is the first known case of its effective use in anti-IgLON5-related central hypoventilation. Additionally, this case demonstrates that axial dystonia with painful and disabling anterocollis can be a prominent feature of this disease.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109117"},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880277","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}