Current Neurology and Neuroscience Reports最新文献

{"title":"Systemic Comorbidities as Modifiers of Outcome After Endovascular Thrombectomy for Acute Ischemic Stroke.","authors":"Brandon J Bond","doi":"10.1007/s11910-025-01427-5","DOIUrl":"https://doi.org/10.1007/s11910-025-01427-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>To evaluate the impact of systemic comorbidities on outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke.</p><p><strong>Recent findings: </strong>Although EVT achieves high rates of large-vessel reperfusion, clinical outcomes are significantly influenced by underlying comorbidities. Chronic hypertension impairs collateral circulation and increases the risk of cerebral edema and mortality. Diabetes mellitus is associated with reduced functional recovery and heightened hemorrhagic risk. Atrial fibrillation often leads to larger infarcts and contributes to higher unadjusted mortality. Chronic kidney disease, particularly in patients with dialysis dependence, predicts poor neurological outcomes and increased procedural complications. Active malignancy substantially elevates mortality, especially in patients with metastatic disease. Systemic comorbidities are important modifiers of outcome after EVT. While technical success rates routinely exceed 80-90%, functional recovery and survival vary significantly across patient subgroups. Meta-analyses and registry data highlight that comorbidities independently increase the risk of futile recanalization, complications, and mortality. EVT remains appropriate for medically complex patients, but optimal results require comorbidity-informed risk stratification and multidisciplinary, goal-concordant care.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"38"},"PeriodicalIF":4.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 Diabetes and SGLT2 Inhibitors in Cerebrovascular Diseases.","authors":"Bayan Moustafa, Gabriela Trifan","doi":"10.1007/s11910-025-01425-7","DOIUrl":"https://doi.org/10.1007/s11910-025-01425-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Diabetes is a well-established risk factor for stroke. Understanding the pathophysiology of this connection is crucial to implementing appropriate prevention strategies. Lately, there has been a paradigm shift in the care of individuals with diabetes toward the use of glucose-lowering medications with potential cardiovascular, cerebrovascular or cardiorenal benefits. The aim of this article is to provide a critical analysis of the role of diabetes in cerebrovascular disease and current evidence and recommendations for the use of glucose-lowering medication with particular focus on the sodium glucose cotransporter-2 inhibitor (SGLT2i) class.</p><p><strong>Recent findings: </strong>Intensive glycemic control in individuals with diabetes reduces the risk of microvascular complications, but there is less clear evidence for decreasing risk of macrovascular events (e.g., stroke). A multifaceted management of diabetes addressing healthy lifestyle practices, glycemic control, and optimization of other cardiovascular risk factors is highly recommended. SGLT2i are the latest class of antihyperglycemic agents available for diabetes management. Canagliflozin and empagliflozin are associated with reduction in major adverse cardiovascular events (MACE). Dapagliflozin did not reduce the rate of MACE but is associated with reduction in heart-failure related death and hospitalization and has the potential to decrease dementia risk. Ertugliflozin decreases rates of hospitalization related to heart failure however it was non-inferior to placebo in reducing MACE. There is increasing evidence that the use of SGLT2i may reduce the risk of stroke, particularly hemorrhagic stroke, in individuals with type 2 diabetes and a high risk of cardiovascular events, and that SGLT2i may also be beneficial for brain health by decreasing risk of cognitive decline and dementia. Antihyperglycemic therapy should be tailored to patients' circumstances. SGLT2i treatment should be considered in patients with type 2 diabetes and established or high-risk cardiovascular disease, heart failure, or chronic kidney disease, to reduce the overall cerebro-cardiovascular and renal risks.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"37"},"PeriodicalIF":4.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Treatments for Obesity: the Role of GLP1 Receptor Agonists on Stroke.","authors":"Melissa Mariscal, Fernando D Testai","doi":"10.1007/s11910-025-01423-9","DOIUrl":"10.1007/s11910-025-01423-9","url":null,"abstract":"<p><strong>Purpose: </strong>Stroke is a leading cause of disability and mortality worldwide. It has been estimated that more than 90% of the risk of stroke is associated with modifiable factors, including diabetes, hypertension, obesity, and heart disease. Glucagon-like peptide 1 receptor agonists (GLP1RAs) have been shown to have a beneficial effect on these major risk factors. In this review, we discuss the evidence supporting the use of GLP1RAs on brain health, particularly in relation to stroke prevention.</p><p><strong>Recent findings: </strong>The results of multiple randomized clinical trials demonstrate that, among patients with type 2 diabetes, GLP1RAs reduce body weight and improve glucose levels and lipid metabolism. In high-risk populations, GLP1RAs also reduce the risk of major adverse cardiovascular events, including all stroke and non-fatal stroke. Mechanistically, GLP1RAs have a beneficial effect on different stroke risk factors, support microvascular function, and reduce inflammation and oxidative stress. GLP1RAs are recommended for the primary prevention of stroke in patients with diabetes and elevated cardiovascular risk.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"36"},"PeriodicalIF":4.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monogenic Epilepsies in Adult Epilepsy Clinics and Gene-Driven Approaches to Treatment.","authors":"Lisa M Clayton, Angeliki Vakrinou, Simona Balestrini, Sanjay M Sisodiya","doi":"10.1007/s11910-025-01413-x","DOIUrl":"10.1007/s11910-025-01413-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Genetic factors play an important contribution to the aetiology of epilepsy and may have implications for management. Whilst the study of monogenic epilepsies has predominantly centred around children, there is a critical need to understand the burden of monogenic epilepsies in adults. This understanding is essential to steer the application of genetic testing and to facilitate access to gene-driven therapies in adults with epilepsy.</p><p><strong>Recent findings: </strong>The yield of diagnostic genetic testing in adults with epilepsy and neurodevelopmental disorders is similar to that in children (ranging from 23-50%). Distinct causal genes underlie the most common monogenic epilepsies identified in adulthood compared to childhood, although SCN1A is the most commonly implicated gene across both populations. Genetic diagnoses made in adults with epilepsy frequently have direct implications for clinical management. However, very few gene-driven therapies are supported by evidence from formal studies. Genetic testing should be considered in adults with unexplained epilepsy and may have important implications for management, including the potential for gene-driven therapies. However, further work is needed to understand the outcomes of gene-driven therapies in adults with epilepsy.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"35"},"PeriodicalIF":4.8,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Vascular Neurology: Applications, Challenges, and a Review of AI Tools for Stroke Imaging, Clinical Decision Making, and Outcome Prediction Models.","authors":"Murad M Alqadi, Sarkis G Morales Vidal","doi":"10.1007/s11910-025-01422-w","DOIUrl":"https://doi.org/10.1007/s11910-025-01422-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Artificial intelligence (AI) promises to compress stroke treatment timelines, yet its clinical return on investment remains uncertain. We interrogate state‑of‑the‑art AI platforms across imaging, workflow orchestration, and outcome prediction to clarify value drivers and execution risks.</p><p><strong>Recent findings: </strong>Convolutional, recurrent, and transformer architectures now trigger large‑vessel‑occlusion alerts, delineate ischemic core in seconds, and forecast 90‑day function. Commercial deployments-RapidAI, Viz.ai, Aidoc-report double‑digit reductions in door‑to‑needle metrics and expanded thrombectomy eligibility. However, dataset bias, opaque reasoning, and limited external validation constrain scalability. Hybrid image‑plus‑clinical models elevate predictive accuracy but intensify data‑governance demands. AI can operationalize precision stroke care, but enterprise‑grade adoption requires federated data pipelines, explainable‑AI dashboards, and fit‑for‑purpose regulation. Prospective multicenter trials and continuous lifecycle surveillance are mandatory to convert algorithmic promise into reproducible, equitable patient benefit.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"34"},"PeriodicalIF":4.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombectomy Selection in the Large Core Era: Implications for Regional Transfers.","authors":"Luigi Cirillo, Mohamad Abdalkader, Piers Klein, Vivek S Yedavalli, James E Siegler, Matthew Kang, Liqi Shu, Fawaz Al Mufti, Shadi Yaghi, Anna Ranta, Thanh N Nguyen","doi":"10.1007/s11910-025-01421-x","DOIUrl":"https://doi.org/10.1007/s11910-025-01421-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to evaluate recent advances in large core stroke management with a focus on diagnostic imaging protocols to select patients for endovascular therapy.</p><p><strong>Recent findings: </strong>Recent randomized controlled trials have shown that thrombectomy can lead to favorable outcomes in patients with large infarcts, contradicting previous assumptions that thrombectomy was not indicated in such patients due to higher risks and very low benefits. Although mechanical thrombectomy remains the gold standard of medical treatment for large vessel occlusions with demonstrated salvageable brain tissue, analysis of the results of recent randomized trials in patients with large ischemic stroke should help us expand patient selection, optimize timing, and explore different management modalities to improve the outcomes of therapy in these patients.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"33"},"PeriodicalIF":4.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sport-Related Concussions in High School Athletes: A Comprehensive Update.","authors":"Annabelle Shaffer, Helen J Kemprecos, Maxwell G Woolridge, Nicholas D Soulakis, Paul M Arnold","doi":"10.1007/s11910-025-01419-5","DOIUrl":"https://doi.org/10.1007/s11910-025-01419-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sport-related concussions (SRC) in high school athletes are a growing public health concern, with recent advancements in epidemiology, pathophysiology, diagnosis, management, and prevention. We concisely summarize SRC in high school athletes, emphasizing current research and clinical implications.</p><p><strong>Recent findings: </strong>Athletes are at significant risk of SRCs, with incidence varying by sport, sex, and competitive setting. Advances in pathophysiology highlight the role of metabolic disruption, inflammation, and axonal injury. Updated diagnostic tools, such as SCAT6, aid clinical evaluation, while advanced neuroimaging and biomarkers remain investigational. Return-to-sport/learn protocols emphasize a gradual, stepwise return. Preventative measures, including policy changes, neuromuscular training, and protective equipment, have reduced SRC incidence. Comprehensive SRC management includes recognition and removal from play followed by a structured return to sport/learning. Future research directions include biomarker validation, optimized prevention strategies, and long-term outcome assessment to reduce the burden of SRC in adolescent athletes.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"32"},"PeriodicalIF":4.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Understanding of the Pathophysiology of Idiopathic Intracranial Hypertension.","authors":"Michael Lowe, Gabriele Berman, Priya Sumithran, Susan P Mollan","doi":"10.1007/s11910-025-01420-y","DOIUrl":"https://doi.org/10.1007/s11910-025-01420-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>Development of safe targeted therapies for idiopathic intracranial hypertension requires a thorough understanding of recent evidence discovering the pathophysiology of the condition. The aim is to provide a review of studies that inform on the underpinning mechanisms that have been associated with idiopathic intracranial hypertension.</p><p><strong>Recent findings: </strong>People living with active idiopathic intracranial hypertension and obesity have been found to have with insulin resistance, hyperleptinaemia, and adverse cardiovascular outcomes. Clinically their adipose tissue is predominantly located in the truncal region and on detailed laboratory analysis the cells are primed for weight gain. There is evidence of androgen excess, altered glucocorticoid regulation and changes in pro-inflammatory cytokines. There are distinct alterations in metabolic pathways found in serum, urine and cerebrospinal fluid, that resolve following disease remission. These findings are associated with raised intracranial pressure and are likely secondary to cerebrospinal fluid hypersecretion. Idiopathic intracranial hypertension has a profile of systemic metabolic changes, endocrine dysfunction and cardiovascular risk profile distinct from that associated with obesity alone. These systemic metabolic changes are likely to contribute to dysregulation of cerebrospinal fluid dynamics, primarily hypersecretion but with a possible additional effect of reduced clearance resulting in the core feature of raised intracranial pressure.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"31"},"PeriodicalIF":4.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use Of Fundus Photography In The Emergency Room-A Review.","authors":"Samuel D Browning, Julia M Costello, Hamish P Dunn, Clare L Fraser","doi":"10.1007/s11910-025-01417-7","DOIUrl":"https://doi.org/10.1007/s11910-025-01417-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>The ocular fundus reveals a wealth of pathophysiological findings which should change patient management in the emergency room (ER). Traditional fundoscopy has been technically challenging and diagnostically inaccurate, but technological advances in non-mydriatic fundus photography (NMFP) have facilitated clinically meaningful fundoscopy. This review presents an update on the literature regarding NMFP and its application to the ER, illustrating pivotal publications and recent advances within this field.</p><p><strong>Recent findings: </strong>NMFP's application in the ER is demonstrably feasible and seamlessly integrates into emergency physicians' (EP) diagnostic workflows in a clinically meaningful and time efficient manner. The images of the ocular fundus (OF) generated by NMFP are consistently high quality, allowing a greater diagnostic accuracy to EP and ophthalmology interpreters alike. Digital NMFP images facilitate effective ophthalmology input via telemedicine to review the images in the ER. NMFP has been shown to change management decisions in the ER, improving patient and departmental outcomes. Interpretation of fundus images remains a medical education challenge, and early research highlights the potential for artificial intelligence (AI) image systems of NMFP to augment image interpretation in the ER. NMFP can change the ER approach to OF assessment, however the factors limiting its routine implementation need further consideration. There is potential for AI to contribute to NMFP image screening systems to augment EPs diagnostic accuracy.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"30"},"PeriodicalIF":4.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological Manifestations Associated with Exercise at Altitude.","authors":"A Marengo, M Tejada, I Hancco Zirena, S Molina","doi":"10.1007/s11910-025-01418-6","DOIUrl":"https://doi.org/10.1007/s11910-025-01418-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>The effects that exercise at altitude has on the neurological system are diverse and still not well studied, and range from metabolic adaptations to modification of cerebral blood flow and neurotransmitters. In this review we summarise changes with exercise intensity, the implications of ascent, cognitive impairment, psychosis-like symptoms, the role of exercise in the development and prevention of AMS, and use of free radical scavengers to enhance sports performance and acclimatization.</p><p><strong>Recent findings: </strong>We discuss the impact of oxidative stress in hypobaric hypoxia and reactive oxygen species (ROS) production and its consequences, with special focus on exercise at altitude. Finally we consider how moderate intensity exercise could help prevent AMS, and the necessity of research on high intensity exercise with elevated rate of ascent, the development of specific tools of cognitive assessment, and the role of free-radical scavengers in the prevention of AMS and neurological symptoms.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"25 1","pages":"29"},"PeriodicalIF":4.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}