Clinical Neurology and Neurosurgery最新文献

{"title":"The effect of frailty on mortality and functional outcomes in spontaneous intracerebral haemorrhage","authors":"","doi":"10.1016/j.clineuro.2024.108539","DOIUrl":"10.1016/j.clineuro.2024.108539","url":null,"abstract":"<div><h3>Introduction</h3><p>Limited data in patients with spontaneous intracerebral haemorrhage (SICH) showed that frailty was associated with mortality; however, there was insufficient data on functional outcomes. This study aimed to investigate the effect of frailty on overall mortality and 90-day functional outcomes in SICH.</p></div><div><h3>Materials and methods</h3><p>We conducted a retrospective study of 1223 patients diagnosed with SICH from January 2014 to December 2020. Frailty was defined as a clinical frailty scale (CFS) score of 4–9. Binary cut-offs were defined using receiver operating curve analysis. 90-day poor functional outcomes (PFO) were defined as modified Rankin Scale (mRS) ≥3, and utility-weighted mRS (UW-mRS) were based on previous validated studies respectively. Regression analyses were conducted to investigate the association between frailty and outcomes. Confounders adjusted for included demographics, cardiovascular risk factors and haematoma characteristics.</p></div><div><h3>Results</h3><p>1091 patients met the inclusion criterion. 167 (15.3 %) had 30-day mortality and 730 (66.9 %) had 90-day PFO. Frailty was significantly associated with lower overall survival (HR: 1.54; 95 % CI: 1.11–2.14, p=0.010), 90-day PFO (OR: 1.90; 95 % CI: 1.32–2.74; p&lt;0.001) and poorer UW-mRS (β: −0.06; 95 % CI: (-0.08 to −0.04); p&lt;0.001) even after adjusting for confounders.</p></div><div><h3>Conclusions</h3><p>Frailty was significantly associated with greater mortality and PFO after incident SICH, even after adjusting for a priori confounders. Frail male individuals may be predisposed to poorer outcomes from higher prevalence of cortical atrophy. The use of CFS in younger individuals may aid management by predicting outcomes after incident SICH. Identifying frail individuals with incident SICH could aid in decision-making and the surgical management of SICH.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151214","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":"Letter to the editor: A multidimensional pre-operative planning method of unruptured vertebral artery dissecting aneurysms using three-dimensional AWE mapping and hemodynamic simulation","authors":"","doi":"10.1016/j.clineuro.2024.108526","DOIUrl":"10.1016/j.clineuro.2024.108526","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142173303","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":"Microsurgical treatment of spinal intradural capillary hemangioma: A consecutive case series of 18 patients and literature review","authors":"","doi":"10.1016/j.clineuro.2024.108527","DOIUrl":"10.1016/j.clineuro.2024.108527","url":null,"abstract":"<div><h3>Purpose</h3><p>Intradural capillary hemangioma is a rare condition with unclear etiology. Although intradural capillary hemangiomas are benign, they exhibit significant proliferative activity, and their clinical significance should not be underestimated.</p></div><div><h3>Methods</h3><p>We report a series of spinal intradural capillary hemangiomas to illustrate the characteristics, surgical management, and outcomes.</p></div><div><h3>Methods</h3><p>A total of 18 consecutive patients who underwent microsurgical treatment were retrospectively reviewed. Patient characteristics were recorded in each case, including presenting symptoms, imaging findings, neurologic status, a surgical procedure performed and follow-up.</p></div><div><h3>Results</h3><p>There were 11(61.1 %) male and 7(38.9 %) female patients, with the ages ranging from 25 to 62 years. The thoracic spine was the most commonly affected site, accounting for 77.8 % (14/18) of the cases. 9 tumors were identified as intradural extramedullary, 3 tumors as intramedullary, and 2 tumors as both extramedullary and intramedullary. There were also 4 cases of tumors localized to the cauda equina. Clinical presentations included back pain, sensory deficits, weakness and gait ataxia with a duration of symptoms ranging from 1 to 12 months. The lesion was hypointense or isointense with the spinal cord on T1- weighted images and hyperintense on T2-weighted images and showed intense enhancement after contrast medium injection. All patients underwent surgical treatment, and no significant postoperative complications were observed. Postoperatively, patients were followed up for an average of 44 months. Follow-up showed that the majority of patients experienced significant improvement in neurological function, with no cases of recurrence.</p></div><div><h3>Conclusion</h3><p>Surgical resection is typically the preferred method for treating spinal intradural capillary hemangiomas. Complete resection can relieve spinal cord compression and minimize the risk of recurrence.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135837","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":"Transradial approach for middle meningeal artery embolization is a safe alternative to transfemoral approach in patients with chronic subdural hematoma: A single-center retrospective comparative study","authors":"","doi":"10.1016/j.clineuro.2024.108525","DOIUrl":"10.1016/j.clineuro.2024.108525","url":null,"abstract":"<div><h3>Background</h3><p>Transradial approach (TRA) has been increasingly utilized in various neuroendovascular interventions as a safe alternative to the transfemoral approach (TFA). As middle meningeal artery (MMA) embolization emerges as an effective therapy for treating chronic subdural hematomas (cSDH), some studies have explored using TRA. In this study, we compared procedural times and post-operative outcomes between those with TRA and TFA.</p></div><div><h3>Methods</h3><p>This is a single-institution retrospective study of patients undergoing MMA embolization for cSDH. The cohort was divided into the TRA and TFA subgroups. Baseline characteristics, procedural times, and immediate outcomes were compared. Univariate analysis was performed.</p></div><div><h3>Results</h3><p>We performed 62 MMA embolizations for treatment of cSDH, of which 37 (59.7 %) were performed transradial and 25 (40.3 %) were performed transfemoral. Those who underwent TRA were significantly younger than those who had TFA (<em>p = 0.02</em>). For patients who underwent unilateral MMA embolization, those with TRA had significantly shorter duration of procedure compared to the TRF group (<em>p = 0.01</em>). This difference was not observed in the bilateral MMA embolization subgroup. Only three patients had access site complications, and all were in the TFA group. There was no significant difference in length of hospital stay.</p></div><div><h3>Conclusion</h3><p>As MMA embolization for cSDH becomes more prevalent, efforts to optimize the safety and efficacy of the technical aspects become critical. In this study we demonstrate that TRA is a safe and efficient alternative to traditional TFA in those undergoing unilateral MMA embolization.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145306","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":"Functional hearing impairment common in Parkinson’s disease: Insights from a pilot study","authors":"","doi":"10.1016/j.clineuro.2024.108524","DOIUrl":"10.1016/j.clineuro.2024.108524","url":null,"abstract":"<div><h3>Introduction</h3><p>Hearing impairments in Parkinson’s Disease (PD) have received limited attention in the past, possibly because PD patients often report no perceived hearing disability, yet negative consequences of hearing impairment might aggravate communication difficulties and social withdrawal.</p></div><div><h3>Objective</h3><p>Our aim was to investigate functional hearing (speech in noise recognition) in PD and evaluate its relationship to neuropsychiatric symptoms, cognition and quality of life.</p></div><div><h3>Methods</h3><p>Participants with PD were recruited in a tertiary movement disorder clinic. Demographic, audiological, neuropsychiatric and quality of life data were collected. Participants underwent pure tone audiometry (PTA) and Hearing in Noise test (HINT) as a part of their audiological evaluation.</p></div><div><h3>Results</h3><p>A total of 29 participants (mean age: 65.8±8.3 years, M:F= 1.6:1, mean disease duration 5.2 ± 4.0 years) completed the study. All assessments were done in the ON state. 19/29 (65.5 %) participants had normal tone audiometry for age; functional hearing loss, however, was present in 17/29 (58.6 %) according to the HINT. 65 % (11/17) of the affected participants had a disease duration of &lt;4 years. The majority (72.4 %) with poor functional hearing did not perceive any hearing impairment. Hearing deficits did not correlate with non-motor symptoms (NMS), including cognition or other quality of life measures.</p></div><div><h3>Conclusions</h3><p>Functional hearing loss is common in PD, often presents early in the disease and the majority of PD patients are unaware of their functional hearing loss. Its potential impact on cognition, communication and quality of life requires further investigation and tailored treatment.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0303846724004116/pdfft?md5=4abee363d096fd475b2102a3ca7137eb&pid=1-s2.0-S0303846724004116-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological long-COVID: Associations among fatigue, dysautonomia, depression, and subjective memory complaints","authors":"","doi":"10.1016/j.clineuro.2024.108522","DOIUrl":"10.1016/j.clineuro.2024.108522","url":null,"abstract":"<div><h3>Introduction</h3><p>Long-COVID is a multisystem disease characterized by a varied presentation of symptoms. According to most recent research, the most common symptom of long-COVID is fatigue, which up to this date lacks a universally accepted definition. This study aimed to investigate neurocognitive and physical manifestations of neurological long-COVID, particularly fatigue and its relation with autonomic disfunction, cognitive impairment (known as, brain fog), and depressive symptoms. Furthermore, the study provided insights into predictors of fatigue in long-COVID.</p></div><div><h3>Methods</h3><p>The included patients (n=141) were referred to the neuro-long-COVID ambulatory service of Trieste from 30 September 2021–02 March 2022. Patients were given self-reporting questionnaires to screen for fatigue, autonomic dysfunction, cognitive impairment and depressive symptoms. The questionnaires adopted for these conditions to be assessed were Fatigue Severity Scale (FSS), COMPASS-31, Prospective-Retrospective Memory Questionnaire (PRMQ), and Beck Depression Inventory (BDI). Participants were divided into two groups, fatigued and non-fatigued patients, based on FSS scoring (scores &gt; 4.67 indicate fatigued patients). The questionnaire scores of the two groups were then compared.</p></div><div><h3>Results</h3><p>Fatigued patients had significantly higher scores in COMPASS (p&lt;0.001, Cohen’s d=1.077), BDI (p&lt;0.001, Cohen's d=0.862), and PRMQ ( p&lt;0.001, Cohen's d=1.159).</p><p>Furthermore, the multivariate regression analysis showed that predictors of fatigue in long-COVID were symptomatological burden in acute infection (OR=1.38, 95 % CI 1.020–1.887, p=0.037) and in long-COVID (OR=1.78, 95 % CI 1.133–2.2824, p=0.013), COMPASS-31&gt;16 (OR=3.44, 95 % CI 1240–9.560, p=0.018) and BDI&gt;15 (OR=5.1, 95 % CI 1.715–15.164, p=0.003).</p></div><div><h3>Conclusion</h3><p>This study showed associations between fatigue, dysautonomia and depression, as well as with symptom burden in acute and long-COVID.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142228425","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":"Utility of combining frailty and comorbid disease indices in predicting outcomes following craniotomy for adult primary brain tumors: A mixed-effects model analysis using the nationwide readmissions database","authors":"","doi":"10.1016/j.clineuro.2024.108521","DOIUrl":"10.1016/j.clineuro.2024.108521","url":null,"abstract":"<div><h3>Objective</h3><p>The escalating healthcare expenditures in the United States, particularly in neurosurgery, necessitate effective tools for predicting patient outcomes and optimizing resource allocation. This study explores the utility of combining frailty and comorbidity indices, specifically the Johns Hopkins Adjusted Clinical Groups (JHACG) frailty index and the Elixhauser Comorbidity Index (ECI), in predicting hospital length of stay (LOS), non-routine discharge, and one-year readmission in patients undergoing craniotomy for benign and malignant primary brain tumors.</p></div><div><h3>Methods</h3><p>Leveraging the Nationwide Readmissions Database (NRD) for 2016–2019, we analyzed data from 645 patients with benign and 30,991 with malignant tumors. Frailty, ECI, and frailty + ECI were assessed as predictors using generalized linear mixed-effects models. Receiver operating characteristic (ROC) curves evaluated predictive performance.</p></div><div><h3>Results</h3><p>Patients in the benign tumor cohort had a mean LOS of 8.1 ± 15.1 days, and frailty + ECI outperformed frailty alone in predicting non-routine discharge (AUC 0.829 vs. 0.820, p = 0.035). The malignant tumor cohort patients had a mean LOS of 7.9 ± 9.1 days. In this cohort, frailty + ECI (AUC 0.821) outperformed both frailty (AUC 0.744, p &lt; 0.0001) and ECI alone (AUC 0.809, p &lt; 0.0001) in predicting hospital LOS. Frailty + ECI (AUC 0.831) also proved superior to frailty (AUC 0.809, p &lt; 0.0001) and ECI alone (AUC 0.827, p &lt; 0.0001) in predicting non-routine discharge location for patients with malignant tumors. All indices performed comparably to one another as a predictor of readmission in both cohorts.</p></div><div><h3>Conclusion</h3><p>This study highlights the synergistic predictive capacity of frailty + ECI, especially in malignant tumor cases, and further suggests that comorbid diseases may greatly influence perioperative outcomes more than frailty. Enhanced risk assessment could aid clinical decision-making, patient counseling, and resource allocation, ultimately optimizing patient outcomes.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135836","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":"Stroke pattern in giant-cell arteritis mostly involves watershed areas","authors":"","doi":"10.1016/j.clineuro.2024.108520","DOIUrl":"10.1016/j.clineuro.2024.108520","url":null,"abstract":"<div><h3>Context</h3><p>Stroke related to giant cell arteritis (GCA) is rare and is associated with a poor outcome. One of the putative ischemic mechanisms is narrowing of the arterial lumen due to wall infiltration by inflammation and intimal proliferation, leading to reduced distal blood flow. It was hypothesized that GCA-related stroke could predominate in watershed areas (WA).</p></div><div><h3>Methods</h3><p>Literature review including all cases of GCA-related stroke with brain images.</p></div><div><h3>Results</h3><p>Among 75 cases of GCA-related stroke, the anterior and posterior territories were involved in 48 % and 62.6 %, respectively. Up to 88.9 % of cases of anterior stroke probably involved WA. WA lesions in the posterior territories were as follows: uni/bilateral middle cerebellar peduncle (MCP) lesions in 25.5 %, and with less confidence, non-wedge-shaped cerebellar lesions in 46.8 %, or combined lesions in 61.7 %. Stenosis or occlusion of the afferent artery was almost always observed. A few lesions were not easily explained by low flow.</p></div><div><h3>Discussion</h3><p>Despite the limitations of arterial territory allocation especially in the posterior circulation, ischemic lesions mainly occurred in WA. MCP lesions, which were typically WA, were highly characteristic of GCA. Low flow downstream focal stenosis was the main, but not the unique, ischemic mechanism of GCA stroke.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089057","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":"Brain disorders in euthyroid Hashimoto’s thyroiditis patients","authors":"","doi":"10.1016/j.clineuro.2024.108519","DOIUrl":"10.1016/j.clineuro.2024.108519","url":null,"abstract":"<div><p>Hashimoto’s thyroiditis (HT) is an autoimmune disorder characterized by the destruction of thyroid follicular cells by thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), leading to hypothyroidism. Hashimoto’s encephalopathy (HE) is associated with elevated levels of antithyroid antibodies. An important question is whether brain alterations precede the development of HE and are present in euthyroid patients with HT, and what pathomechanisms could be responsible for these changes. A PubMed search was conducted to identify studies addressing this issue. Numerous questionnaire studies confirmed impairments in cognitive functioning, mental and physical health, and overall well-being in euthyroid HT patients. Additionally, some imaging and mouse model studies indicate that euthyroid patients with HT likely have central nervous system alterations. Antibodies may be involved in the development of these changes. Some research suggests the role of TPOAb and TgAb, while other studies highlight the involvement of coexisting antibodies. Determining whether antibodies are assessed in serum or cerebrospinal fluid (CSF) is crucial. Antibody-specific indices (ASIs) can differentiate between antibodies passively diffusing from the serum and brain-derived antibodies, and could serve as biomarkers for brain alterations in HT patients. Much more research is needed to identify reliable biomarkers and treatments that could improve the quality of life for these patients.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0303846724004062/pdfft?md5=da7c0d53deea9634b1644a2ba5c879b7&pid=1-s2.0-S0303846724004062-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral venous thrombosis after lumboperitoneal shunting: A case report","authors":"","doi":"10.1016/j.clineuro.2024.108518","DOIUrl":"10.1016/j.clineuro.2024.108518","url":null,"abstract":"<div><p>Lumboperitoneal shunt (LPS) has been an effective treatment of idiopathic normal pressure hydrocephalus (iNPH) but sometimes causes serious complications. Here we present the first reported case of cerebral venous thrombosis (CVT) after LPS. A 76-year-old man underwent LPS for iNPH and a week later developed weakness of the right arm and a generalized tonic-clonic seizure. Brain computed tomography and magnetic resonance imaging showed bilateral subdural hematoma (SDH) and left cortical vein thrombosis. Intravenous heparin was administered, followed by surgical evacuation of the SDH. The patient experienced gradual improvement and was subsequently discharged. It is conceivable that overdrainage of cerebrospinal fluid led to the development of both SDH and CVT. CVT is potentially fatal and should be recognized early as a possible complication after LPS to allow prompt treatment.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095075","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}