Clinical Neurology and Neurosurgery最新文献

{"title":"Screening for Pompe disease in Serbian patients with limb-girdle muscle weakness","authors":"Aleksandar Sekulic ,&nbsp;Vanja Viric ,&nbsp;Teodora Todorovic ,&nbsp;Jovan Pesovic ,&nbsp;Marija Brankovic ,&nbsp;Nikola Andrejic ,&nbsp;Aleksa Palibrk ,&nbsp;Ivo Bozovic ,&nbsp;Vukan Ivanovic ,&nbsp;Ivana Basta ,&nbsp;Stojan Peric","doi":"10.1016/j.clineuro.2025.108950","DOIUrl":"10.1016/j.clineuro.2025.108950","url":null,"abstract":"<div><h3>Introduction/aims</h3><div>Patients with late-onset Pompe disease (LOPD) can be found among individuals with limb-girdle muscle weakness, as well as among individuals with isolated weakness of trunk and respiratory muscles. Some patients with asymptomatic hyperCKemia may have Pompe disease. Aim of this research was analysis of the frequency of LOPD among Serbian patients with unexplained limb-girdle muscle weakness, and/or respiratory muscle weakness, and/or hyperCKemia.</div></div><div><h3>Methods</h3><div>Analysis of acid alpha-glucosidase (GAA) activity was performed using tandem mass spectrometry in a sample of a dry blood spot. In patients who were found to have decreased enzyme activity, DNA was isolated from a dry blood spot and sequencing of the <em>GAA</em> gene was performed.</div></div><div><h3>Results</h3><div>During a 4.5-year period, 138 patients suspected of having LOPD were sent for the analysis. The average age at the time of testing was 44.3 ± 15.7 years, and symptoms duration was 7.3 ± 7.6 years. Mean GAA activity was 4.6 ± 1.9 umol/L/h. Decreased enzyme activity was observed in 10 (7 %) patients. Genetic analysis of the GAA gene was performed in these ten, and four (3 %) were diagnosed with LOPD.</div></div><div><h3>Conclusion</h3><div>In the Serbian cohort of 138 patients with limb-girdle muscle weakness and/or respiratory muscle weakness and/or hyperCKemia, 3 % had genetically confirmed LOPD. All diagnosed patients received enzyme replacement therapy which alters the course of the disease.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108950"},"PeriodicalIF":1.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937271","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":"Traumatic odontoid fracture – Proposal of a treatment algorithm","authors":"Syed Ali Mujtaba Rizvi ,&nbsp;Hege Linnerud ,&nbsp;Pål Andre Rønning ,&nbsp;Tor Brommeland ,&nbsp;Mads Aarhus ,&nbsp;Jalal Mirzamohammadi ,&nbsp;Marianne Efskind Harr ,&nbsp;Vidar Tveit Vasfaret Stenset ,&nbsp;Magnus Evjensvold ,&nbsp;Eirik Helseth","doi":"10.1016/j.clineuro.2025.108951","DOIUrl":"10.1016/j.clineuro.2025.108951","url":null,"abstract":"<div><h3>Background</h3><div>Current management guidelines for odontoid fractures (OFx) lack emphasis on age, comorbidity, and frailty, leading to variability in clinical practice and highlighting the need for guideline reevaluation. We began implementing a new treatment algorithm for OFx management at Oslo University Hospital (OUH) in 2022 with the aim of making it part of standard care for OFx. The main objective of this study was to determine our department’s compliance with the new treatment algorithm for OFx.</div></div><div><h3>Methods</h3><div>In this population-based cohort study, we examine all traumatic OFx diagnosed in Southeast Norway from 2022–2023 and assess the rate of compliance with a new treatment algorithm implemented at OUH. Patient demographics, injury characteristics, treatment decisions, and outcomes, including union rates, rate of conversion from external immobilization to surgery, and long-term disability rates, were collected. Follow-up evaluations included imaging examinations and clinical and functional assessments.</div></div><div><h3>Results</h3><div>One hundred eighty-one patients with acute odontoid fractures (OFx) were registered from 2022 to 2023, and the median age of the patients was 78 years. Most fractures were caused by falls (92.3 %), and 70 % of the patients had some form of vulnerability (ASA ≥ 3 and/or CFS ≥ 4 and/or dependent living). Type II fractures were the most common (55.3 %), and 9.4 % of all OFx patients underwent surgical fixation. The treatment compliance rate was 97.2 %. At follow-up, 77.9 % of patients were alive, and 80.6 % of patients exhibited union, either bony or fibrous. Most patients (79.9 %) reported little neck pain (VAS score ≤3), and 87.8 % reported mild or no neck stiffness. The survival rate was 87 % at 30 days and 78 % at 6 months. There were no significant differences in the rates of disability, pain, bony union or fibrous union between the treatment groups. The new treatment algorithm resulted in favorable clinical outcomes.</div></div><div><h3>Conclusions</h3><div>In this observational cohort study involving 181 consecutive patients with traumatic OFx, 97 % were treated in accordance with the department’s recommended algorithm for OFx management. Of the patients who were 75 years or older with OFx type II, 7/79 (8.9 %) underwent surgical treatment. The patient outcomes and findings presented in this study align with those presented in previous international studies investigating optimal treatment strategies for OFx. We therefore recommend this algorithm as an appropriate treatment approach for OFx.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108951"},"PeriodicalIF":1.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917365","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 factors associated with prognosis after successful thrombectomy after posterior circulation stroke","authors":"Qin Wang ,&nbsp;Wenxuan Zhao ,&nbsp;Junwei Qian ,&nbsp;Ziyu Sun ,&nbsp;Bao He ,&nbsp;Lei Shi ,&nbsp;Xiaojie Lu","doi":"10.1016/j.clineuro.2025.108948","DOIUrl":"10.1016/j.clineuro.2025.108948","url":null,"abstract":"<div><h3>Purpose</h3><div>With the continuous improvement of mechanical thrombectomy (MT) technology, the success rate of vascular recanalization has been significantly improved, and some patients still have poor prognosis based on vascular recanalization. This study aims to find clinical factors affecting prognosis after vascular recanalization and find valuable predictors.</div></div><div><h3>Methods</h3><div>We followed up patients who underwent posterior circulation thrombectomy for up to 180 days. Using univariate and multivariate logistic regression, we identified prognostic factors related to functional outcomes or survival. Cox analysis was further applied to determine the optimal cutoff values for these factors.</div></div><div><h3>Results</h3><div>Modified Thrombolysis in Cerebral Infarction (mTICI) and NIHSS (24 h), as independent prognostic factors, provide a reliable indication of patients' prognostic status within 90 days. Additionally, a lower Posterior Circulation Alberta Stroke Program Early CT Score (pc-ASPECTs) score and a higher NIHSS (24 h) score are closely associated with patients' 90-day survival status.</div></div><div><h3>Conclusion</h3><div>Retrospective analysis after thrombectomy showed that NIHSS (24 h) was a key independent prognostic factor for the rehabilitation prognosis and death of patients, which was helpful for clinical decision-making and postoperative care.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108948"},"PeriodicalIF":1.8,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906320","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":"Vestibular migraine: Onabotulinum toxin effectivity, prospective-randomized study","authors":"Reyhan Surmeli ,&nbsp;Mehmet Surmeli ,&nbsp;Ayse Destina Yalcin ,&nbsp;Ayse Asli Sahin Yilmaz ,&nbsp;Tulay Erden Habesoglu ,&nbsp;Gozde Gunay","doi":"10.1016/j.clineuro.2025.108949","DOIUrl":"10.1016/j.clineuro.2025.108949","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108949"},"PeriodicalIF":1.8,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906393","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":"Novel artificial intelligence approach in neurointerventional practice: Preliminary findings on filter movement and ischemic lesions in carotid artery stenting","authors":"Hirotaka Sagawa ,&nbsp;Yuya Sakakura ,&nbsp;Ryoichi Hanazawa ,&nbsp;Satoru Takahashi ,&nbsp;Hikaru Wakabayashi ,&nbsp;Shoko Fujii ,&nbsp;Kyohei Fujita ,&nbsp;Sakyo Hirai ,&nbsp;Akihiko Hirakawa ,&nbsp;Kenichi Kono ,&nbsp;Kazutaka Sumita","doi":"10.1016/j.clineuro.2025.108930","DOIUrl":"10.1016/j.clineuro.2025.108930","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Embolic protection devices (EPDs) used during carotid artery stenting (CAS) are crucial in reducing ischemic complications. Although minimizing the filter-type EPD movement is considered important, limited research has demonstrated this practice. We used an artificial intelligence (AI)-based device recognition technology to investigate the correlation between filter movements and ischemic complications.</div></div><div><h3>Methods</h3><div>We retrospectively studied 28 consecutive patients who underwent CAS using FilterWire EZ (Boston Scientific, Marlborough, MA, USA) from April 2022 to September 2023. Clinical data, procedural videos, and postoperative magnetic resonance imaging were collected. An AI-based device detection function in the Neuro-Vascular Assist (iMed Technologies, Tokyo, Japan) was used to quantify the filter movement. Multivariate proportional odds model analysis was performed to explore the correlations between postoperative diffusion-weighted imaging (DWI) hyperintense lesions and potential ischemic risk factors, including filter movement.</div></div><div><h3>Results</h3><div>In total, 23 patients had sufficient information and were eligible for quantitative analysis. Fourteen patients (60.9 %) showed postoperative DWI hyperintense lesions. Multivariate analysis revealed significant associations between filter movement distance (odds ratio, 1.01; 95 % confidence interval, 1.00–1.02; p = 0.003) and high-intensity signals in time-of-flight magnetic resonance angiography with DWI hyperintense lesions. Age, symptomatic status, and operative time were not significantly correlated.</div></div><div><h3>Conclusion</h3><div>Increased filter movement during CAS was correlated with a higher incidence of postoperative DWI hyperintense lesions. AI-based quantitative evaluation of endovascular techniques may enable demonstration of previously unproven recommendations. To the best of our knowledge, this is the first study to use an AI system for quantitative evaluation to address real-world clinical issues.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108930"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932166","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":"Racial/ethnic disparities on resource utilization and outcomes for patients undergoing spine surgery: A NSQIP analysis of 402,765 patients","authors":"Aladine A. Elsamadicy ,&nbsp;Paul Serrato ,&nbsp;Shaila D. Ghanekar ,&nbsp;Sina Sadeghzadeh ,&nbsp;Justice Hansen ,&nbsp;Lucas P. Mitre ,&nbsp;Sheng-fu Larry Lo ,&nbsp;Daniel M. Sciubba","doi":"10.1016/j.clineuro.2025.108931","DOIUrl":"10.1016/j.clineuro.2025.108931","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the impact of race/ethnicity on postoperative adverse events (AEs), prolonged length of stay (LOS), non-routine discharge (NRD), and unplanned readmission in spine surgery patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using the 2016–2023 ACS NSQIP database. Adults receiving spine surgery for trauma, degenerative disease, tumor, and infectious causes were identified using CPT codes and stratified based on race/ethnicity. The primary categories included Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Asian, and Hispanic patients. Patient demographics, comorbidities, intraoperative variables, postoperative AEs, and healthcare resource utilization were assessed. Multivariate logistic regression analysis was utilized to identify predictors of AEs, prolonged LOS, NRD, and unplanned admission.</div></div><div><h3>Results</h3><div>In our cohort of 402,765 patients, postoperative outcomes displayed significant ethnic disparities in AEs, with the highest in Non-Hispanic Blacks (<em>p &lt; 0.001</em>). Similarly, Non-Hispanic Blacks had prolonged operation times and increased rates of unplanned readmissions and reoperations (all <em><u>p &lt; 0.001</u></em>). Multivariate analysis showed Non-Hispanic Blacks had an increased risk for extended LOS (<em>aOR: 1.83, 95 % CI: 1.78–1.88, <u>p &lt; 0.001</u></em>) and AEs (<em>aOR: 1.10, 95 % CI: 1.06–1.15, <u>p &lt; 0.001</u></em>). Non-Hispanic Blacks (<em>aOR: 1.84, 95 % CI: 1.78–1.90, <u>p &lt; 0.001</u></em>), Non-Hispanic Asians (<em>aOR: 1.14, 95 % CI: 1.07–1.21, <u>p &lt; 0.001</u></em>), and Hispanics (<em>aOR: 1.48, 95 % CI: 1.43–1.54, <u>p &lt; 0.001</u></em>) had higher odds of NRD. For unplanned readmissions, Non-Hispanic Blacks (<em>aOR: 1.13, 95 % CI: 1.08–1.19, <u>p &lt; 0.001</u></em>) had increased odds, while Non-Hispanic Asians showed decreased odds (<em>aOR: 0.80, 95 % CI: 0.72–0.90, <u>p &lt; 0.001</u></em>).</div></div><div><h3>Conclusion</h3><div>Our study demonstrates prominent racial/ethnic disparities in postoperative outcomes among spine surgery patients, with particularly elevated risks observed in Non-Hispanic Black individuals.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108931"},"PeriodicalIF":1.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899582","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":"Impact of lifetime and current smoking exposure on the rupture status, number, and size of intracranial aneurysms","authors":"Ramazan Jabbarli ,&nbsp;Marvin Darkwah Oppong ,&nbsp;Meltem Gümüs ,&nbsp;Mehdi Chihi ,&nbsp;Thiemo Florin Dinger ,&nbsp;Laurèl Rauschenbach ,&nbsp;Yahya Ahmadipour ,&nbsp;Philipp Dammann ,&nbsp;Yan Li ,&nbsp;Nika Guberina ,&nbsp;Karsten H. Wrede ,&nbsp;Ulrich Sure","doi":"10.1016/j.clineuro.2025.108924","DOIUrl":"10.1016/j.clineuro.2025.108924","url":null,"abstract":"<div><h3>Background</h3><div>Quantitative data on the impact of smoking on genesis of intracranial aneurysms (IA) is sparse. We aimed to analyze the association between lifetime and current smoking exposure and IA characteristics.</div></div><div><h3>Methods</h3><div>In this prospective observational cohort study (07/2016–01/2023, n = 918), all patients or next of kin filled out the questionnaire for assessment of smoking habits including the status (no/former/current) and consumption level (heavy vs light current smoker [≥/&lt;10 cigarettes/day], and lifetime exposure in pack-years). The study endpoints were the ruptured status, size, and presence of multiple IA.</div></div><div><h3>Results</h3><div>The distribution of non-, former, light, and heavy smokers was 23.2 %, 25.6 %, 11.2 % and 40 % respectively. The median lifetime smoking exposure was 20 pack-years. Current smokers were at higher risk of presenting with ruptured (adjusted odds ratio [aOR]=1.71, 95 % confidence interval [CI]=1.29–2.26, p &lt; 0.0001), large (≥7 mm, aOR=1.41, 95 % CI=1.05–1.89, p = 0.022) and multiple IA (aOR=1.34, 95 % CI=1.01–1.77, p = 0.045). In the subgroup analysis among ever smokers, heavy smoking additionally increased the risk of IA rupture (aOR=1.83, 95 % CI=1.33–2.50, p &lt; 0.0001) and larger size (aOR=1.65, 95 % CI=1.19–2.30, p = 0.003). Finally, longer history of smoking (&gt;20 pack-years) was related to higher probability of multiple (aOR=1.61, 95 % CI=1.21–2.13, p = 0.001) and large IA (aOR=1.40, 95 % CI=1.04–1.87, p = 0.025).</div></div><div><h3>Conclusions</h3><div>Our data underline the role of smoking in IA genesis, and the importance of smoking cessation for rupture prevention. Current and particularly heavy smoking increases the risk of IA rupture, whereas the chronic exposure over years more likely results in the development of multiple and large IA.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108924"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913233","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":"Treatment strategies and prognostic analysis of moyamoya disease associated with single intracranial aneurysm","authors":"Jing Lan ,&nbsp;Miao Hu ,&nbsp;Shuang-xiang Xu,&nbsp;Can Xin,&nbsp;Yi-hui Ma,&nbsp;Jian-jian Zhang,&nbsp;Jin-cao Chen","doi":"10.1016/j.clineuro.2025.108914","DOIUrl":"10.1016/j.clineuro.2025.108914","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and Objective&lt;/h3&gt;&lt;div&gt;Moyamoya disease (MMD) with intracranial aneurysm is relatively rare and its treatment is more challenging. There is little agreement regarding the optimal management strategies, treatment modalities and surgical timing for these refractory lesions. This study retrospectively analyzed and summarized the clinical characteristics, treatment strategies, and outcomes of MMD with intracranial aneurysms to further elucidate these issues.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The clinical and angiographic data of 690 patients with MMD were retrospectively collected and analyzed in a single institute from July 2017 to April 2023. Among them, 60 MMD patients with single intracranial aneurysm were included in this study. All patients underwent cerebral revascularization with endovascular embolization, surgical clipping, or aneurysmectomy to eliminate intracranial aneurysms, increase cerebral blood flow, and improve long-term prognosis. In this study, intracranial aneurysms were classified as the proximal aneurysms and the distal aneurysms according to the anatomic location. The patients were divided into a one-stage operation group and a staged operation group based on the different operative procedure. The main endpoint of this study was to summarize the clinical characteristics and treatment experience, and to explore whether there were differences in clinical results between the one-stage operation group and the staged operation group, analysis the potential risk factors for postoperative complications, to further guide the clinic and establish the appropriate treatment strategies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were significant differences in age of onset, presentation of MMD, status of aneurysm and types of hemorrhage between the proximal aneurysms group and the distal aneurysms group. The incidence of the proximal aneurysms was significantly higher than that of the distal aneurysms. Patients with distal aneurysms had a relatively younger age and a higher percentage of cerebral hemorrhage as an initial clinical presentation than patients with proximal aneurysms. The rate of procedure-related complications was significantly higher in the one-stage operation group than in the staged operation group (48.3 % vs. 22.6 %, respectively). Univariate analysis revealed that postoperative complications were significantly correlated with age, operative procedure (one-stage operation or staged operation). Multivariate analysis revealed operative procedure [OR 0.125 (0.023–0.665) p = 0.015] as independent risk factors for postoperative complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;There is no consensus on the optimal treatment strategies and surgical timing for the management of MMD with intracranial aneurysms. In this regard, our results demonstrate that the current treatment strategy of interventional embolization or craniotomy with aneurysm clipping or excision followed by staged cerebral revasculari","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108914"},"PeriodicalIF":1.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913232","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":"Relationships between dysarthria, lesion location, and oral/swallowing function in patients with first-ever stroke","authors":"Masahiro Nakamori ,&nbsp;Eiji Imamura ,&nbsp;Hayato Matsushima ,&nbsp;Keisuke Tachiyama ,&nbsp;Tomoko Ayukawa ,&nbsp;Masami Nishino ,&nbsp;Mineka Yoshikawa ,&nbsp;Mitsuyoshi Yoshida ,&nbsp;Hirofumi Maruyama","doi":"10.1016/j.clineuro.2025.108928","DOIUrl":"10.1016/j.clineuro.2025.108928","url":null,"abstract":"<div><h3>Objective</h3><div>Dysarthria negatively affects quality of life and social communication. This study focused on dysarthria in patients with acute-phase stroke and analyzed the association between lesion locations and oral/swallowing functions.</div></div><div><h3>Methods</h3><div>Patients with first-ever acute stroke were analyzed. Speech assessments included diadochokinesis rates for \"pa,\" \"ta,\" and \"ka,\" along with reading aloud passages. All patients underwent head magnetic resonance imaging, videofluoroscopic (VF) examinations, and tongue pressure measurements to identify stroke lesions.</div></div><div><h3>Results</h3><div>We analyzed 82 patients with acute stroke excluding those with bilateral or multi-regional lesions (mean age 67.6 ± 11.5 years, 32 women, NIHSS median 1.5). Dysarthria was diagnosed in 16 patients (19.5 %). The National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] 1.289, 95 % confidence interval [CI] 1.050–1.616) and lesions in the corona radiata (OR 9.981, 95 % CI 1.871 – 60.092) were significant risk factors for dysarthria. Tongue pressure was significantly lower in patients with dysarthria, with a cutoff value of 28.4 kPa for predicting dysarthria (area under of the receiver operating characteristic curve 0.688, <em>p</em> = 0.006). Swallowing assessments via VF examinations showed no significant differences between patients with and without dysarthria.</div></div><div><h3>Conclusion</h3><div>Lesions in the corona radiata are associated with dysarthria in patients with stroke. Reduced tongue pressure is also linked to dysarthria. These findings underscore the importance of evaluating dysarthria independently of dysphagia.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108928"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899580","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":"NLR and LMR could powerfully predict unfavorable outcomes in patients with acute anterior circulation large vessel occlusion stroke (ALVOS) who underwent mechanical thrombectomy","authors":"Ruijing Xu ,&nbsp;Fei Guo ,&nbsp;Chunshui Yang ,&nbsp;Feiqi Zhu","doi":"10.1016/j.clineuro.2025.108925","DOIUrl":"10.1016/j.clineuro.2025.108925","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the predictive value of Neutrophil to lymphocyte ratio (NLR) and Lymphocyte to monocyte ratio (LMR) on unfavorable outcomes of acute anterior circulation large vessel occlusion stroke (ALVOS) in patients who underwent mechanical thrombectomy (MT).</div></div><div><h3>Material &amp; method</h3><div>We retrospectively recruited 96 cases with ALVOS who underwent MT. These cases were divided into two groups including the favorable outcome group (3-month modified Rankin Scale scores (mRS) of 0–2) and the unfavorable outcome group (3-month mRS of 3-6). Logistic regression analysis was used to examine the independent risk factors of the 3-month unfavorable outcome of ALVOS. Moreover, we conducted a receiver operating characteristic curve (ROC) to estimate the valuable predictor of NLR, LMR, and the combination of NLR and LMR on unfavorable outcomes of ALVOS after MT.</div></div><div><h3>Results</h3><div>46.9 % (45/96) cases had an unfavorable outcome and 53.1 % (51/96) cases had a favorable outcome. In the univariate regression analysis, baseline NIHSS score, symptomatic intracranial hemorrhage, and fasting glucose were included in the multi-factor binary logistic regression, and this revealed that NLR (OR 3.776, 95 %CI 1.067‐13.363, p = 0.039) and LMR (OR 0.092, 95 %CI 0.017‐0.0506, p = 0.006) were independent predictors of unfavorable outcomes (mRS score 3-6) at 3-month. Higher NLR (&gt; 2.984) and lower LMR (&lt; 3.775) were independently associated with unfavorable outcomes, and the combined predictive levels of both NLR and LMR (AUC = 0.941) were higher than single indicators (NLR, AUC = 0.876; LMR, AUC = 0.934).</div></div><div><h3>Conclusions</h3><div>The combination of NLR and LMR was a more powerful predictor of unfavorable outcomes of ALVOS after MT than NLR alone.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"254 ","pages":"Article 108925"},"PeriodicalIF":1.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913231","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}