Clinical Neurology and Neurosurgery最新文献

{"title":"Modified Five-item Frailty Index (mFI-5) versus Grip Strength as predictors of length of stay, discharge to home, and early surgical complications in patients undergoing long segment fusion","authors":"Yamenah Ambreen ,&nbsp;Cole Veliky ,&nbsp;Joshua H. Weinberg ,&nbsp;Joshua Wang ,&nbsp;Stephanus Viljoen ,&nbsp;David S. Xu ,&nbsp;Vikram Chakravarthy ,&nbsp;Siri Sahib Khalsa ,&nbsp;Bryan Ladd ,&nbsp;Andrew J. Grossbach","doi":"10.1016/j.clineuro.2025.108864","DOIUrl":"10.1016/j.clineuro.2025.108864","url":null,"abstract":"<div><h3>Objectives</h3><div>In this paper, the authors aim to compare the ability of grip strength and the Modified Five-Item Frailty Index (mFI-5) to predict outcomes and complications in patients undergoing long segment spinal fusion.</div></div><div><h3>Methods</h3><div>An IRB-approved chart review was conducted to collect data on patient grip strength, comorbidities, and post-operative course. Hand grip strength was measured with the Camry Digital Hand Dynamometer. Descriptive statistics were performed with IBM SPSS Statistics Software and required Student’s t-test, Pearson’s correlation coefficient, and Spearman’s correlation coefficient.</div></div><div><h3>Results</h3><div>Patients with an increased grip strength were significantly more likely to be discharged to home as opposed to a rehabilitation facility, while patients with decreased frailty had no increased likelihood of being discharged home. Both grip strength and frailty predicted neurocritical care unit (NCCU) and total hospital stay length. Although the average grip strength was not strongly correlated with days to ambulation, right-hand strength and frailty were.</div></div><div><h3>Conclusion</h3><div>Although both increased grip strength and decreased frailty are correlated with decreased NCCU stay, only increased grip strength is associated with a higher likelihood of patients returning home postoperatively. Therefore, maximal grip strength is likely a superior predictor of postoperative outcomes than a frailty index such as the mFI-5. Given the ease of grip strength measurement and its reflection of a patient’s present physical state, it is likely a very robust measure of a patient’s individual preparedness for the physiologic toll of surgery and can be easily incorporated into a pre-operative evaluation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108864"},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784035","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":"Assessing a dose-response relationship: Preoperative opioid daily MME and duration on lumbar spine surgery patient-reported outcomes","authors":"Joseph Tingen,&nbsp;Andrew D’Amico,&nbsp;Matthew Kanter,&nbsp;Ron I. Riesenburger,&nbsp;James Kryzanski","doi":"10.1016/j.clineuro.2025.108865","DOIUrl":"10.1016/j.clineuro.2025.108865","url":null,"abstract":"<div><h3>Objective</h3><div>It has been posited that preoperative opioid use can be a detrimental factor in prognosis, although its association with patient-reported outcomes (PROs) remains unclear. We aimed to examine complication rates, satisfaction, return to work, and improvement in back/leg pain with Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) considering preoperative opioid use utilizing a national, prospective registry.</div></div><div><h3>Methods</h3><div>From 40,321 lumbar spine surgery patients, chronicity of preoperative use was defined as opioid-naive (no use), new (&lt;6 wk), short-term (6 wk-3 mo), intermediate (3–6 mo), long-term (6 mo-1 yr), and chronic use (&gt;1 yr). Daily use was defined according to an established morphine milliequivalent (MME) threshold. Multivariate regression models were constructed.</div></div><div><h3>Results</h3><div>Long-term use was associated with lower improvement in VAS for back pain at 3- (p &lt; .005) and 12-months (p = 0.026), as well as for leg pain at 12-months (p = 0.012). There were lower odds of achieving VAS back pain (p = .021) and ODI (p = .032) MCID at 3-months for those with high daily MME, though 12-month outcomes were comparable. All preoperative opioid use durations and MME levels were associated with higher postoperative use (p &lt; .005), yet return to work rates and satisfaction were comparable.</div></div><div><h3>Conclusions</h3><div>Chronic preoperative opioid use is associated with worse PROs yet satisfaction, complication rates, and return to work were largely unaffected. Daily opioid burden in MME showed little impact on long-term outcomes. Most patients with preoperative opioid use benefit from lumbar spine surgery, yet preoperative opioid counseling remains necessary.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108865"},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715664","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":"Cyclophosphamide as initial treatment of aggressive MS (Marburg variant) in resource limited settings – A case report","authors":"Foziah Jabbar AlShamrani","doi":"10.1016/j.clineuro.2025.108857","DOIUrl":"10.1016/j.clineuro.2025.108857","url":null,"abstract":"<div><div>The Marburg variant of multiple sclerosis (MS), first described in 1906 by Otto Marburg, an Austrian neurologist, is characterized by a fulminant monophasic course with rapid disease progression, often leading to death within weeks or months. Due to its rarity, no established treatment guidelines exist. A 34-year-old man was diagnosed with MS after presenting with acute-onset numbness and weakness in the right lower limb. Magnetic resonance imaging (MRI) revealed a significant burden of numerous supra- and infratentorial white matter plaques. The patient was treated with steroid pulse therapy. However, the patient’s condition continued to deteriorate clinically and radiologically despite receiving intravenous immunoglobulin and plasma exchange. An extensive workup was performed to exclude other differential diagnoses that were significant for the presence of oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF). A diagnosis of Marburg variant MS was considered, and high-dose cyclophosphamide (HiCy) (50 mg/kg/d IV) was initiated on alternate days for 4 days. Twenty-six days after treatment completion, the patient exhibited significant clinical improvement, with an Expanded Disability Status Scale (EDSS) score of 5. This case contributes to the growing evidence that cyclophosphamide may be an effective therapeutic option for patients with Marburg variants of MS who do not achieve satisfactory clinical improvement with conventional acute treatments.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108857"},"PeriodicalIF":1.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735050","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":"Optimal timing of cerebrospinal fluid shunting in patients needing cranioplasty","authors":"Netta Urvas ,&nbsp;Tommi K. Korhonen ,&nbsp;Sami Tetri ,&nbsp;Harry Mee ,&nbsp;Gemma Whiting ,&nbsp;Edoardo Viaroli ,&nbsp;Angelos Kolias ,&nbsp;Ivan Timofeev ,&nbsp;Adel Helmy ,&nbsp;Peter Hutchinson","doi":"10.1016/j.clineuro.2025.108863","DOIUrl":"10.1016/j.clineuro.2025.108863","url":null,"abstract":"<div><h3>Background</h3><div>Cranioplasty is performed to repair the cranium after injury or surgery. Cerebrospinal fluid shunts are commonly required to treat associated hydrocephalus. Single-stage shunt and cranioplasty surgery have been associated with increased risks compared with a staged approach. We aimed to assess whether the timing of cerebrospinal fluid (CSF) shunting (pre- or post-cranioplasty) affects complication rates.</div></div><div><h3>Methods</h3><div>We retrospectively identified all cranioplasty procedures conducted between 11/2017–12/2021 and 1/2004–3/2022 from the Cambridge and Oulu University Hospitals, respectively. The primary and secondary outcomes were implant removal and complications, respectively.</div></div><div><h3>Results</h3><div>Four-hundred-and-thirty-three cranioplasties were performed in 379 patients. Sixty-eight (16 %) cranioplasties were performed in patients requiring a shunt. Forty-three (63 %) shunts were inserted before, three (4 %) during, and 22 (32 %) after cranioplasty. Overall complication rates excluding hydrocephalus were 47 % and 41 % among those shunted before and after cranioplasty, respectively (OR 0,74, 95 % CI 0,24–2,28). SSIs (26 % vs. 18 %) and CSF leaks (7 % vs. 0 %) were slightly more common among those shunted before cranioplasty compared to those shunted after cranioplasty, respectively, but rates of post-operative haematomas were similar (5 % vs. 5 %, respectively). Overall implant removal rates were statistically similar between patients with shunts cited pre-cranioplasty and those with shunts cited after cranioplasty (26 % vs. 32 %, respectively, OR 1,26, 95 % CI 0,44–3,55).</div></div><div><h3>Conclusion</h3><div>Although patients who underwent CSF shunting before cranioplasty had 6 % more complications than those who had been shunted after cranioplasty, those shunted after cranioplasty had 6 % more implant failures. Delaying CSF shunt insertion after cranioplasty should be preferable, not least because CSF absorption can improve on cranioplasty insertion. Single-stage surgery should be avoided.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108863"},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747126","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":"Liver fibrosis associated with more severe motor deficits in early Parkinson’s disease","authors":"Aryeh Zolin ,&nbsp;Hwai Ooi ,&nbsp;Manqi Zhou ,&nbsp;Chang Su ,&nbsp;Fei Wang ,&nbsp;Harini Sarva","doi":"10.1016/j.clineuro.2025.108861","DOIUrl":"10.1016/j.clineuro.2025.108861","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the impact of hepatic dysfunction on the motor manifestations of Parkinson’s disease.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Parkinson’s Progression Markers Initiative. Liver fibrosis was defined using the Fibrosis-4 score. Our primary outcome was the association of baseline Fibrosis-4 score with the Movement Disorders Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III score. Additional outcomes were MDS-UPDRS part II, MDS-UPDRS part IV, Hoehn and Yahr stage, and levodopa equivalent daily dose. We used linear regression models to evaluate associations at baseline and 5 years after enrollment. We used linear mixed models to evaluate the association of liver fibrosis with the progression of motor dysfunction. Models were adjusted for demographics, comorbidities, alcohol use, time since Parkinson’s disease diagnosis, levodopa equivalent daily dose, and genetic predisposition.</div></div><div><h3>Results</h3><div>We included 360 people with Parkinson’s disease with a mean age of 61.8 years (standard deviation 9.7) and 41.1 % women. There was a significant association between liver fibrosis and baseline MDS-UPDRS part III score (β=2.3, 95 % CI: 0.2, 4.5). Liver fibrosis was also correlated with higher interhemispheric signal asymmetry on DAT-SPECT scans in the anterior putamen (p &lt; 0.05 by Wilcoxon rank sum test). There was no correlation with Fibrosis-4 score and any other motor assessment at baseline or after 5 years. Patients with elevated Fibrosis-4 scores had a slower rate of progression in MDS-UPDRS part III scores.</div></div><div><h3>Conclusion</h3><div>In people with Parkinson’s disease, the presence of comorbid liver fibrosis was associated with more severe motor dysfunction early, but not later, within their disease course.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108861"},"PeriodicalIF":1.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715450","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":"Investigating discharge predictors for stroke patients with active cancer after endovascular therapy","authors":"Yasaman Pirahanchi ,&nbsp;Constance McGraw ,&nbsp;Russell Bartt ,&nbsp;David Bar-Or ,&nbsp;Amy Nieberlein ,&nbsp;Christian Burrell","doi":"10.1016/j.clineuro.2025.108862","DOIUrl":"10.1016/j.clineuro.2025.108862","url":null,"abstract":"<div><h3>Objective</h3><div>Current cancer diagnosis is not an exclusion from treatment with endovascular therapy (EVT) in patients with acute ischemic stroke (AIS). There are insufficient studies to determine whether outcomes, based on modified Rankin Scale (mRS), differ for cancer and non-cancer patients, and what factors affect a favorable outcome. This study aims to identify predictors of discharge outcome in AIS patients with active cancer who have undergone EVT.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients (age ≥ 18) admitted from 07/01/2018–10/01/2020 with AIS and treated with EVT. Patients were grouped according to the presence or absence of active cancer diagnosis. Multivariable logistic regression determined independent predictors of favorable outcomes (discharge mRS 0–2) in patients with and without active cancer. The predictive utility of admission National Institutes of Health Stroke Scale (NIHSS) was further explored using receiver operating characteristic (ROC) curve analysis to determine area under the curve (AUC) and optimal cut points for favorable outcomes.</div></div><div><h3>Results</h3><div>Of 463 patients who received EVT, 10 % had cancer. Patients with cancer had significantly higher rates of hypercoagulation-related stroke mechanisms, prior clots, renal failure, and thromboembolic events during hospitalization (all p &lt; 0.01), compared to patients without cancer. Favorable discharge outcomes did not differ significantly between groups (24 % vs. 35 %, p = 0.13). In patients with cancer after adjustment, admission NIHSS independently predicted favorable discharge outcomes (adjusted odds ratio (AOR): 0.81, 95 % confidence interval (CI) 0.69–0.99, p = 0.01), with a 19 % decrease in odds per 1-unit increase in NIHSS. The optimal threshold for NIHSS was 6, with strong fit (AUC: 0.88, p = 0.002). For non-cancer patients, NIHSS (AOR: 0.91, 95 % CI 0.88–0.93, p &lt; 0.001), age, and diabetes history were independent predictors, with a 9 % decrease in odds per unit increase for NIHSS. The threshold for NIHSS in non-cancer patients was 21, with moderate fit (AUC: 0.77, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Admission NIHSS is an important predictor of favorable discharge outcomes in AIS patients with active cancer treated with EVT. Incorporating NIHSS into risk stratification, alongside patients' medical history, may improve the ability to assess the likelihood of favorable discharge outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108862"},"PeriodicalIF":1.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143706189","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":"Exploring the link between clinical, cognitive status, and telerehabilitation experiences in multiple sclerosis: A cross-sectional study","authors":"Fatih Özden ,&nbsp;Mehmet Özkeskin ,&nbsp;Ece Ekici ,&nbsp;İsmet Tümtürk ,&nbsp;Özgül Ekmekci ,&nbsp;Nur Yüceyar ,&nbsp;Miray Başer","doi":"10.1016/j.clineuro.2025.108859","DOIUrl":"10.1016/j.clineuro.2025.108859","url":null,"abstract":"<div><h3>Purpose</h3><div>Evaluating the opinions of patients with multiple sclerosis (MS) about telerehabilitation services and investigating them in detail about their clinical and cognitive status is important for determining and discussing the expectations related to telerehabilitation. The objective of this study was to evaluate the opinions of patients with MS about telerehabilitation services and to correlate these opinions with the clinical and cognitive status of the individuals in question.</div></div><div><h3>Methods</h3><div>A prospective cross-sectional study was conducted with 101 individuals with MS. All participants were evaluated with the Multiple Sclerosis Impact Scale (MSIS-29), Cognitive Reserve Index questionnaire (CRIq), Telemedicine Patient Questionnaire (TPQ), Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ), Telerehabilitation Beliefs Questionnaire (TBF).</div></div><div><h3>Results</h3><div>TPQ was weakly correlated with MSIS-29 Physical (r = -0.249, p &lt; 0.05), MSIS-29 Psychological (r = -0.339, p &lt; 0.001) and CRIq-Education (r = 0.257, p &lt; 0.001). TSUQ was only weakly correlated with CRIq-Education (r = 0.205, p &lt; 0.05). TBF was weakly correlated with MSIS-29 Psychological (r = -0.209, p &lt; 0.05), CRIq-Education (r = 0.344, p &lt; 0.001), CRIq-Work (r = 0.242, p &lt; 0.05) and CRIq-Total (r = 0.260, p &lt; 0.001). There was a weak positive correlation between TBF and the participant's age (r = 0.219, p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>The views of individuals with MS on telerehabilitation were mostly related to psychological and cognitive (education-related) parameters. Age, educational status, and psychological level should be considered during telerehabilitation services in people with MS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108859"},"PeriodicalIF":1.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698074","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 social deprivation index and deep brain stimulation: A cohort study","authors":"Susanna D. Howard ,&nbsp;Vishnu S. Potluri ,&nbsp;Claudia Hejazi-Garcia ,&nbsp;Pierce Davis ,&nbsp;Gregory G. Heuer ,&nbsp;Maria A. Punchak ,&nbsp;Neil R. Malhotra ,&nbsp;Jesse Y. Hsu ,&nbsp;Iahn Cajigas","doi":"10.1016/j.clineuro.2025.108860","DOIUrl":"10.1016/j.clineuro.2025.108860","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Deep brain stimulation (DBS) is an important treatment option for patients with movement disorders; however, prior studies have demonstrated inequitable access to this important treatment. We used the Social Deprivation Index (SDI), an index of neighborhood affluence, to examine the distribution of DBS cases and to determine the association between the SDI and outcomes.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of all patients who have undergone DBS implantation within the University of Pennsylvania Health System (UPHS) from January 1st, 2013, to April 1st, 2024. SDI values associated with each ZIP code range from zero (no distress/prosperous) to 100 (highest distress) and were dichotomized into low (&lt;50) and high (50−100) categories.</div></div><div><h3>Results</h3><div>The prevalence of DBS cases performed at UPHS across low SDI ZIP codes was 4.8 per 100,000 (95 % CI (confidence interval) 4.4 – 5.2), compared to 2.4 per 100,000 people (95 % CI 2.1 – 2.7) across high SDI ZIP codes, equivalent to a rate ratio of 2.0 (95 % CI 1.7 – 2.3, p &lt; 0.001). Adjusting for age, sex, insurance type, comorbidities, and indication for DBS, people living in more deprived regions had higher odds of readmission, but this was not statistically significant (OR 2.22, 95 % CI 0.91 – 5.45, <em>p</em>-value 0.08).</div></div><div><h3>Conclusion</h3><div>In our single-center study, most people who received DBS at our institution resided in more affluent neighborhoods. In the future, the SDI could be used to effectively target outreach efforts to geographic areas with decreased access to DBS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108860"},"PeriodicalIF":1.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143706188","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 case report of recurrent acute necrotizing encephalopathy with RANBP2 mutation","authors":"Kin Sing Wong,&nbsp;Chong Pak Ip,&nbsp;Cheng Lei","doi":"10.1016/j.clineuro.2025.108858","DOIUrl":"10.1016/j.clineuro.2025.108858","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108858"},"PeriodicalIF":1.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759607","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-neurofascin-186 associated combined central and peripheral demyelination (CCPD): A novel entity","authors":"Aradhya Sekhar Bagchi ,&nbsp;A. Nalini ,&nbsp;M. Netravathi ,&nbsp;Ravi Yadav ,&nbsp;J. Saini ,&nbsp;C.M. Ravindranadh ,&nbsp;Seena vengalil ,&nbsp;Pritam Raja","doi":"10.1016/j.clineuro.2025.108856","DOIUrl":"10.1016/j.clineuro.2025.108856","url":null,"abstract":"<div><h3>Introduction</h3><div>Combined Central and Peripheral Demyelination (CCPD) is a rare yet a novel entity that is increasingly being recognized in clinical practice all over the world. The etiopathogenesis is largely unknown, but antibodies against paranodal proteins are usually incriminated.</div></div><div><h3>Case report</h3><div>A 28-year-old male patient presented with initial relapsing-remitting followed by progressive neurological deficits. MRI of the Brain and spine revealed lesions typical of MS with multiple cranial and peripheral nerve thickening and enhancement. Nerve conduction study revealed demyelinating sensorimotor polyneuropathy. Anti-Neurofascin antibody panel revealed positive anti-NF140 and anti-NF 186.</div></div><div><h3>Conclusion</h3><div>Cases presenting with features suggestive of CNS and PNS demyelination, should be worked up for the presence of anti-neurofascin antibodies along with MRI and electrophysiological studies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"252 ","pages":"Article 108856"},"PeriodicalIF":1.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725234","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}