European Journal of Neurology最新文献

{"title":"Corrigendum to “Tremor After Solid Organ Transplantation: Results From the TransplantLines Biobank and Cohort Study”","authors":"","doi":"10.1111/ene.70105","DOIUrl":"https://doi.org/10.1111/ene.70105","url":null,"abstract":"<p>van der Stouwe AMM, Riemersma NL, Knobbe TJ, et al. Tremor after solid organ transplantation: Results from the TransplantLines Biobank and Cohort Study. Eur J Neurol. 2024; 31:e16412. doi:10.1111/ene.16412</p><p>The ‘TransplantLines Investigators’ are missing in the Acknowledgement section and added as the last co-author. The complete list can be found below:</p><p>TransplantLines Investigators: C Annema, SJL Bakker, SP Berger, H Blokzijl, FAJA Bodewes, MT de Boer, K Damman, MH de Borst, A Diepstra, G Dijkstra, RM Douwes, CSE Doorenbos, MF Eisenga, ME Erasmus, CT Gan, AW Gomes Neto, AM Posthumus, E Hak, BG Hepkema, J Jonker, F Klont, TJ Knobbe, D Kremer, HGD Leuvenink, WS Lexmond, VE de Meijer, GJ Nieuwenhuis-Moeke, HGM Niesters, LJ van Pelt, RA Pol, AV Ranchor, JSF Sanders, MJ Siebelink, RJHJA Slart, JC Swarte, DJ Touw, MC van den Heuvel, C van Leer-Buter, M van Londen, Charlotte A te Velde-Keyzer, EAM Verschuuren, MJ Vos, RK Weersma.</p><p>The authors apologize for this error.</p>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179057","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":"A Transfer Strategy Utilizing a Helicopter and a Ground Ambulance Together Does Not Prolong Door-In-Door-Out Times in Thrombectomy Patients: A Retrospective Analysis","authors":"Pauli Vuorinen,&nbsp;Joonas Kiili,&nbsp;Markku Grönroos,&nbsp;Ilkka Virkkunen,&nbsp;Heini Huhtala,&nbsp;Piritta Setälä,&nbsp;Sanna Hoppu","doi":"10.1111/ene.70148","DOIUrl":"https://doi.org/10.1111/ene.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>An interfacility transfer should commence immediately to a hospital with endovascular capability to perform mechanical thrombectomy when a patient is diagnosed with a large vessel occlusion (LVO) stroke. The turnaround time in the primary stroke center (PSC) is called door-in-door-out time (DIDO). We investigated DIDOs from two PSCs and how the implementation of a helicopter emergency medical service (HEMS) unit for patient transportation together with a ground ambulance affected the DIDO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively identified thrombectomy candidates transferred to Tampere University Hospital from two PSCs, Seinäjoki and Kanta-Häme Central Hospitals, from February 2019 until October 2022. A HEMS unit was dispatched to transport the patients from Seinäjoki after June 2020. Patient medical records and DIDOs were also analyzed and compared with ground transport and air transport between the two PSCs. Factors for faster DIDOs were determined by linear regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The DIDOs of 129 patients were analyzed. The median (interquartile range) DIDO in the total population was 50 (35–71) minutes, and the PSCs achieved equal DIDOs. The strongest factors of the DIDO were the prehospital prenotification (<i>B</i> = −55.6, <i>p</i> &lt; 0.001), the same ambulance continuing the interfacility transport (<i>B</i> = −33.8, <i>p</i> &lt; 0.001), and the patient's age (<i>B</i> = 0.65, <i>p</i> = 0.039). HEMS dispatch or transport was not associated with any delays in DIDO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prehospital prenotification of a stroke patient to a PSC should include a discussion of whether the patient is a thrombectomy candidate. The same ambulance should be engaged for the mission and continue with the same patient to the thrombectomy facility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171602","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":"Prognostic Value of Cerebral Hemodynamics Assessment on 24-h Transcranial Color-Coded Doppler Following a Successful Thrombectomy","authors":"Sabrina Rossi,&nbsp;Matteo Paolucci,&nbsp;Giorgia Arnone,&nbsp;Guido Bigliardi,&nbsp;Marco Longoni,&nbsp;Giuseppe Pulito,&nbsp;Cristiano Azzini,&nbsp;Lorenzo Coppo,&nbsp;Monia Russo,&nbsp;Georgios Tsivgoulis,&nbsp;Odysseus Kargiotis,&nbsp;Vincenzo Inchingolo,&nbsp;Vittoria Maria Sarra,&nbsp;Daniela Monaco,&nbsp;Ludovica Migliaccio,&nbsp;Riccardo Ricceri,&nbsp;Michele Romoli,&nbsp;Donatella Mastria,&nbsp;Maura Pugliatti,&nbsp;Mauro Gentile,&nbsp;Andrea Zini,&nbsp;Giovanni Malferrari,&nbsp;The HYs Study Group","doi":"10.1111/ene.70224","DOIUrl":"https://doi.org/10.1111/ene.70224","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>This study evaluates the distribution and prognostic role of transcranial color-coded Doppler (TCCD) spectral patterns following a successful endovascular thrombectomy (EVT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter prospective study included patients with internal carotid or middle cerebral artery (MCA) occlusion treated in the early time window (&lt; 6 h) with a successful EVT (mTICI ≥ 2b), without symptomatic hemorrhagic transformation within 24 h. TCCDs were performed 24–48 h and 7 days from EVT. TCCD flow was graded by Consensus on Grading Intracranial Flow Obstruction (COGIF) score (1: no flow; 2–3: low flow; 4a: normal; 4b: residual stenosis; 4c: hyperperfusion). MCA flow velocities were compared between sides and time points. Outcomes were clinical improvement (decrease of 8 points/30% on day 7 NIHSS vs. baseline) and three-month mRS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>188 ischemic stroke patients were included (48% female, median age 77). The median NIHSS was 16 at admission and 3 at day 7. Day 1 TCCD showed slightly higher velocities in the treated MCA compared to the contralateral MCA, without significant differences between day 1 and day 7. Despite mTICI ≥ 2b, 13/187 (7%) patients showed a partial recanalization or residual stenosis at 24 h. Clinical improvement was lacking in 27 patients (14.4%). COGIF scores 3 and 4b at day 1 were significantly associated with lack of improvement at day 7 (aOR 0.03, 95% CI 0.01–0.16, <i>p</i> &lt; 0.001) and worse mRS score at 3 months (mRS ordinal shift analysis, aOR 7.78, 95% CI 2.16–28.54, <i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Day 1 post-EVT TCCD COGIF score, but no flow velocities alone, are associated with clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171603","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":"Can Pure Thalamic Strokes Lead to Severe Impairment of Arousal?","authors":"Elina Jaakkola,&nbsp;Olli Likitalo,&nbsp;Katri Niinivirta-Joutsa,&nbsp;Juho Joutsa","doi":"10.1111/ene.70106","DOIUrl":"https://doi.org/10.1111/ene.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The thalamus has been considered critical for maintaining consciousness, but it is not clear if thalamic strokes can lead to severe impairment of arousal. The aim of this study was to investigate whether thalamic damage alone is sufficient to cause severe impairment of arousal in stroke patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with new-onset ischemic stroke without mass effect, leading to severe impairment of arousal, were identified retrospectively from the electronic medical records of patients treated 2004–2019 at Turku University Hospital. In addition, 500 stroke patients without impairment of arousal were included as controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified nine patients with coma or stupor following an acute stroke involving the thalamus. Five of these patients remitted following endovascular therapies but had residual lesions intersecting the thalamus. In the four patients with long-term coma or stupor, the thalamic lesions extended into the brainstem and overlapped in regions considered part of the reticular formation. These brainstem regions were specific for patients with long-term coma or stupor, as none of the five patients who remitted following endovascular therapy or 500 control stroke patients (including 39 patients with stroke lesions intersecting the thalamus) had lesions intersecting these regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results demonstrate that thalamic strokes without extension into the brainstem are not sufficient to cause severe impairment of arousal.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148605","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":"Accelerated Biological Aging and Longitudinal Progression of Cardiometabolic Disease, Subsequent Dementia, and Death: A Multistate Analysis","authors":"Ning Zhang,&nbsp;Haojiang Zuo,&nbsp;Jiajie Cai,&nbsp;Yi Xiang,&nbsp;Yuan Zhang,&nbsp;Hongmei Zhang,&nbsp;Yifan Hu,&nbsp;Hao Xu,&nbsp;Xiong Xiao,&nbsp;Xing Zhao","doi":"10.1111/ene.70221","DOIUrl":"https://doi.org/10.1111/ene.70221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of biological age (BA) acceleration in longitudinal disease progression from health to cardiometabolic disease (CMD), then to post-CMD dementia (including vascular dementia (VaD) and Alzheimer's disease (AD)), and finally to death remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from 284,723 UK Biobank participants, two established BA measures (Klemera-Doubal Method Biological Age [KDM-BA] and PhenoAge) were generated on the basis of baseline clinical biomarkers. Post-CMD dementia was defined as dementia that occurred after the first occurrence of CMD. Multistate analysis was constructed to examine the association between BA accelerations and longitudinal progression of post-CMD dementia. We further explored the role of two BA accelerations in CMD-specific transitions and dementia-specific transitions, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a median follow-up of 13.7 years, 47,150 participants developed CMD, and 999 developed post-CMD dementia. Biologically older participants demonstrated robustly higher risks from healthy to CMD, then to post-CMD dementia, and finally to death. For the transition from baseline to CMD, adjusted HRs (95% CI) were 1.34 (1.32, 1.35) for each SD increase in KDM-BA acceleration and 1.19 (1.18, 1.20) for PhenoAge acceleration. For the transition from CMD to post-CMD dementia, HRs were 1.12 (1.04, 1.20) for KDM-BA acceleration and 1.10 (1.04, 1.17) for PhenoAge acceleration. Both BA accelerations were more strongly associated with the transition from CMD to post-CMD VaD than with the transition to post-CMD AD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BA accelerations hold promise for identifying the disease progression of post-CMD dementia in routine clinical practice and slowing down disease progression through the interventions that slow down biological aging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148612","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":"Global Health Inequalities in the Burden of Ischemic Stroke From 1990 to 2021","authors":"Chao Yang,&nbsp;Xiao Liu,&nbsp;Jinyu Huang","doi":"10.1111/ene.70219","DOIUrl":"https://doi.org/10.1111/ene.70219","url":null,"abstract":"&lt;p&gt;We read with great interest the study by Hou et al. [&lt;span&gt;1&lt;/span&gt;], which was based on the Global Burden of Disease (GBD) Study 2021 and provided a comprehensive analysis of the burden of ischemic stroke at the global, regional, and national levels from 1990 to 2021. The findings revealed an overall declining trend in the incidence, mortality, and disability-adjusted life years (DALYs) associated with ischemic stroke worldwide. Notably, the study also identified a significant inverse association between the burden of ischemic stroke and gross domestic product. Therefore, leveraging existing data to quantitatively assess disparities and inequalities in the distribution of ischemic stroke across 204 countries and territories is crucial for promoting health equity and optimizing the allocation of healthcare resources.&lt;/p&gt;&lt;p&gt;The socio-demographic index (SDI), a composite of education, income, and fertility rates, reflects the link between socioeconomic development and public health [&lt;span&gt;2&lt;/span&gt;]. Following World Health Organization (WHO) recommendations, we used the slope index of inequality and concentration index to assess absolute and relative inequalities in ischemic stroke burden across countries in relation to SDI [&lt;span&gt;3&lt;/span&gt;]. The slope index was derived from a weighted regression of national DALYs rates against relative SDI ranks to account for heteroskedasticity. The concentration index was calculated by integrating the area under the Lorenz curve, based on cumulative population and DALYs distributions ranked by SDI.&lt;/p&gt;&lt;p&gt;Globally, significant absolute and relative inequalities persist in the burden of ischemic stroke across 204 countries and territories, disproportionately affecting nations with higher SDI levels. Over time, these inequalities have decreased. This reduction is particularly evident regarding absolute inequalities, as demonstrated by the decline in ischemic stroke DALYs rates from 668.5 (95% confidence interval [CI], 482.0–885.0) per 100,000 population in 1990 to 413.0 (95% CI, 270.9–555.0) in 2021 between the highest and lowest SDI countries (Figure 1A). Similarly, relative inequalities measured by the concentration index have slightly decreased from 0.24 (95% CI, 0.18–0.29) in 1990 to 0.21 (95% CI, 0.16–0.25) in 2021 (Figure 1B).&lt;/p&gt;&lt;p&gt;Overall, the positive values of the slope and concentration indices indicate that the burden of ischemic stroke remains primarily concentrated in relatively affluent countries and regions. The decreasing absolute values of these indices from 1990 to 2021 suggest a reduction in health inequalities and reflect a narrowing gap in disease burden between high- and low-income countries. However, significant disparities persist. This unequal distribution may be attributed to earlier population aging, a higher prevalence of lifestyle-related risk factors (such as high-salt diets, physical inactivity, and smoking), and greater access to healthcare services and diagnostic capacity in more ","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148504","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":"Clinical Findings in Temporal Lobe Epilepsy Associated With Isolated Amygdala Enlargement","authors":"Annika Kirscht,&nbsp;Johann Philipp Zöllner,&nbsp;Nadine Conradi,&nbsp;Elisabeth Neuhaus,&nbsp;Elke Hattingen,&nbsp;Marcus Belke,&nbsp;Susanne Knake,&nbsp;Laurent Willems,&nbsp;Jennifer Wichert,&nbsp;Andreas Jansen,&nbsp;Felix Rosenow,&nbsp;Adam Strzelczyk","doi":"10.1111/ene.70225","DOIUrl":"https://doi.org/10.1111/ene.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mesial temporal lobe epilepsy (mTLE) infrequently presents with isolated amygdala enlargement (AE), but its relevance remains ambiguous. We therefore investigated clinical, imaging, and histopathological findings in mTLE-AE compared to non-lesional mTLE (mTLE-NL) patients, and additionally strategies for identifying AE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We detected AE by automated volumetry of otherwise unremarkable magnetic resonance images of mTLE patients, compared with a healthy comparator. Autoimmune inflammation as an AE cause was excluded using the Graus criteria. We compared clinical and neuropsychological variables between mTLE-AE and mTLE-NL. Secondary assessment of AE was by neuroradiologist visual detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 63 mTLE patients, 15 had mTLE-AE. In these, normalized mean volume was 1857.58 mm³ (SD = 207.38) for the left, 1973.09 mm³ (SD = 214.91) for the right amygdala, 2003.34 mm³ (SD = 218.85) for the larger and 1827.34 mm³ (SD = 179.85) for the smaller amygdala. Mean volume in the healthy control subjects was 1853.4 mm³ for the left (SD = 212.44) and 1895.2 mm³ for the right amygdala (SD = 224.29). Clinical parameters including age, sex, epilepsy duration, history of febrile convulsions, drug resistance, neuropsychological performance, surgical outcome, and medications did not differ significantly between mTLE-AE and mTLE-NL. Histopathological findings in mTLE-AE included dysmorphic neurons, potential tumors, and focal cortical dysplasia. Neuroradiologists independently described AE in 37 of 63 mTLE patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>mTLE-AE has no specific clinical profile compared to non-lesional mTLE and features diverse underlying pathologies. Volumetric detection appears more conservative than conventional qualitative visual analysis, but may miss cases of subtle AE. Combining automated volumetry with visual assessment may improve AE detection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148585","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":"Cardiac Events After Mechanical Thrombectomy in Acute Ischemic Stroke: A Nation-Wide Cohort Study","authors":"Nicolaj Grønbæk Laugesen,&nbsp;Jakob Nebeling Hedegaard,&nbsp;David Gaist,&nbsp;Claus Ziegler Simonsen,&nbsp;Boris Modrau,&nbsp;Klaus Hansen,&nbsp;Søren Paaske Johnsen,&nbsp;Thomas Truelsen","doi":"10.1111/ene.70223","DOIUrl":"https://doi.org/10.1111/ene.70223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Mechanical thrombectomy (MT) markedly improves the outcome in patients with large vessel occlusion stroke. Given the cardiovascular risk profile of these patients, we wanted to investigate their post-MT risk of cardiac events compared to other patients with acute ischemic stroke (AIS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All hospitalizations for AIS in Denmark from 2014 to 2021 were included in this registry-based cohort study. Patients were categorized by reperfusion treatment: MT with or without intravenous thrombolysis (IVT), IVT alone, or no reperfusion treatment (NRT). Cardiac events included ischemic heart disease, heart failure, or cardiac death within 6 months of AIS. Pair-wise group comparisons were performed after inverse probability treatment weighting (IPTW).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 76,092 AIS patients, 4.4% received MT, 15.2% received IVT alone, and 80.4% received NRT. In the MT group, 9.6% of patients experienced cardiac events. After IPTW, MT patients had the highest risk of cardiac events compared to IVT (absolute risk difference [ARD] 4.6%, cause-specific hazard rate ratio [HRR] 1.42 [95% CI: 1.27–1.60]) and NRT (ARD 4.6%, HRR 1.35 [95% CI: 1.22–1.49]). Pre-existing cardiac disease was similar across groups (9.2%–11.8%) and after exclusion of patients with prior cardiac disease, the HRR of cardiac events remained consistent with the primary analysis (MT vs. IVT: HRR 1.48 [95% CI: 1.31–1.68]; MT vs. NRT: 1.39 [95% CI: 1.24–155]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>10% of patients with AIS undergoing MT experienced cardiac events within 6 months compared to 5% of other AIS patients. This study identified an unrecognized burden of cardiac disease in this group of AIS patients treated with MT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148586","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":"Neurotoxicity at the Tides: A Call to Action on Marine Microplastics and Brain Health","authors":"Raffaele Marfella,&nbsp;Ulf Kallweit","doi":"10.1111/ene.70181","DOIUrl":"https://doi.org/10.1111/ene.70181","url":null,"abstract":"&lt;p&gt;The ubiquity of plastic waste in our oceans has long served as a stark reminder of human impact on the environment and the unreflective approach to nature. But a more insidious threat is now surfacing—literally. Microplastics (MPs), once considered primarily a marine ecological issue, are now increasingly linked to human health concerns, more precisely to brain health. Recent findings by Makwana et al. published in this issue of the &lt;i&gt;European Journal of Neurology&lt;/i&gt;, mark a critical turning point: the demonstration of a population-level association between exposure to marine microplastics and neurological and functional disabilities [&lt;span&gt;1&lt;/span&gt;]. In their analysis of 218 coastal counties in the United States, the authors observed a striking pattern. Communities exposed to very high levels of marine microplastics showed a significantly elevated prevalence of cognitive, mobility, self-care, and independent living disabilities—even after adjusting for age, socioeconomic vulnerability, comorbidities, and access to healthcare. They also accounted for other exposures, such as air pollution. While causation cannot be established from this cross-sectional data, the consistency of associations and biological plausibility make the findings difficult to ignore [&lt;span&gt;1&lt;/span&gt;]. Microplastics—defined as plastic particles smaller than 5 mm—are not benign environmental remnants. Experimental studies have shown that they can cross the intestinal barrier, enter the bloodstream, and penetrate the blood–brain barrier (BBB) [&lt;span&gt;2, 3&lt;/span&gt;]. Once in neural tissue, microplastics can trigger oxidative stress, disrupt neurotransmitter systems, and activate pro-inflammatory cascades [&lt;span&gt;4&lt;/span&gt;]. Most concerning, they appear to promote the aggregation of misfolded proteins such as α-synuclein and amyloid-β, which are hallmark pathologies in Parkinson's and Alzheimer's diseases, respectively [&lt;span&gt;5, 6&lt;/span&gt;]. The implications for neurology are profound. For decades, environmental risk factors such as delicate particulate matter (PM2.5) have been linked to stroke, cognitive decline, and neurodevelopmental disorders. The mechanistic parallels between air pollution and microplastic exposure—both of which involve systemic inflammation, blood–brain barrier (BBB) disruption, and proteinopathy—suggest that we may be witnessing the emergence of a new environmental neurotoxin [&lt;span&gt;4, 7&lt;/span&gt;]. Recent evidence underscores the urgency of this issue. In a 2024 &lt;i&gt;New England Journal of Medicine&lt;/i&gt; study, micro- and nanoplastics were identified in atherosclerotic plaques and were associated with increased cardiovascular events, including stroke—further linking plastic exposure to neurovascular injury [&lt;span&gt;8&lt;/span&gt;]. Even more compelling, a 2025 &lt;i&gt;study in Nature Medicine&lt;/i&gt; by Nihart and Campen et al. demonstrated microplastic accumulation in human post-mortem brain tissue, with significantly higher concentrations in individuals diagnosed with dementia [&lt;","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118190","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":"Glial Fibrillary Acid Protein Reflects Disease Activity in Autoimmune Encephalitis","authors":"Johannes Piepgras,&nbsp;Marlene L. Piepgras,&nbsp;Falk Steffen,&nbsp;Laura Ehrhardt,&nbsp;Martin A. Schaller-Paule,&nbsp;Yavor Yalachkov,&nbsp;Frauke Zipp,&nbsp;Stefan Bittner","doi":"10.1111/ene.70207","DOIUrl":"https://doi.org/10.1111/ene.70207","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Management of autoimmune encephalitis (AE) is challenging due to a lack of reliable biomarkers. We here assess the combination of glial fibrillary acid protein (GFAP) and neurofilament (NfL) as biomarkers for diagnosis and disease monitoring of AE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>GFAP and NfL CSF levels (cGFAP, cNfL) of 42 AE patients were correlated with CSF markers of neuroinflammation. NfL/GFAP ratios were compared between patients with stable and active AE, stable and active multiple sclerosis (MS), and patients undergoing diagnostic lumbar puncture without evident pathological alterations (controls).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In patients with AE, cGFAP levels showed strong correlations with albumin and IgG quotients and moderate correlations with CSF cell count; cNfL levels showed weak correlations with albumin quotients. cGFAP and cNfL levels showed no significant differences between patients with and without epileptic activity or inflammatory MRI lesions. Both sNfL and sGFAP correlated with the Clinical Assessment Scale in Autoimmune Encephalitis. Compared to NfL or GFAP alone, the NfL/GFAP ratio from CSF or serum led to a clearer separation of AE from MS patients and controls. Furthermore, serum NfL/GFAP ratios better discriminated active from stable AE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>cGFAP levels indicate intrathecal inflammatory processes in patients with active AE to a stronger degree than cNfL levels. Serum NfL/GFAP ratios recognize active AE, suggesting this ratio identifies AE patients with CNS-compartmentalized neuronal injury (autoantibody-mediated or cytotoxic) behind a relatively intact blood–brain barrier. Our findings indicate that the NfL/GFAP ratio can function as a blood-based biomarker, aiding clinicians with diagnosis and disease management of AE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118193","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}