European Neurology最新文献

{"title":"Disorders of Arousal and Sleep-Related Hypermotor Epilepsy in adults: a challenging but necessary and critical distinctive diagnosis.","authors":"Daniela Cimatti, Greta Mainieri, Luca Baldelli, Federica Provini","doi":"10.1159/000551918","DOIUrl":"https://doi.org/10.1159/000551918","url":null,"abstract":"<p><strong>Background: </strong>Sleep-related Hypermotor Epilepsy (SHE) and Disorders of Arousal (DoA) are two conditions that, despite originating from distinct etiological mechanisms, share the manifestation of complex motor behaviours emerging from sleep. Their overlapping clinical features have long posed challenges for differential diagnosis, particularly in adults.</p><p><strong>Summary: </strong>Both SHE and DoA exhibit a close relationship with sleep physiology; consequently, increasing attention has recently been devoted to the neurophysiological mechanisms underlying these motor phenomena, with a specific focus on sleep microstructure and arousal system dynamics. K-complexes may play a key role in the onset of SHE seizures, as evidenced by the tendency of seizures to occur in quasi-periodic clusters at frequencies consistent with K-complexes and other physiological oscillations during light sleep. Analyses of the Cyclic Alternating Pattern (CAP), an EEG marker of sleep instability, have shown that epileptic activity is not uniformly distributed across NREM sleep but is instead enhanced during specific CAP subtypes. A similar pattern has been observed in DoA, with episodes frequently arising during CAP phase A. The sleep instability observed in both SHE and DoA suggests that transient cortical activations may act as triggers for motor events, facilitating the expression of innate motor patterns through subcortical circuit activation. Although distinct in origin, physiological in DoA and epileptic in SHE, both disorders reflect altered arousal regulation and disrupted cortical-subcortical interactions.</p><p><strong>Key messages: </strong>This review aims to provide an integrated neurophysiological perspective on SHE and DoA, emphasising their distinctive mechanisms and the broader implications for understanding sleep-related motor behaviours.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-20"},"PeriodicalIF":2.4,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688948","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":"Historical and Clinical Analysis of a Case of Progressive Muscular Atrophy (1853-1871).","authors":"Emmanuel Drouin, Yann Pereon","doi":"10.1159/000550658","DOIUrl":"10.1159/000550658","url":null,"abstract":"<p><strong>Background: </strong>Progressive muscular atrophy (PMA) emerged in the mid-19th century as a distinct clinical entity within the evolving field of French neurology, notably through the work of François Amilcar Aran, Duchenne de Boulogne, and later Jean-Martin Charcot. During this period, uncertainties persisted regarding its nosological status, pathophysiology, and relationship to amyotrophic lateral sclerosis (ALS). Longitudinal clinical observations from this era remain rare but are essential for understanding both the natural history of motor neuron diseases and the historical construction of neurological knowledge.</p><p><strong>Summary: </strong>This article presents a historical and clinical analysis of a unique case of PMA observed for over nearly 2 decades (1853-1871) in Parisian hospitals. The case concerns Auguste-Joseph Bellinghen, whose condition was first documented in an unpublished handwritten manuscript in 1853 and later published with photographic illustrations in 1871. Through a comparative analysis of these two observations, the study traces the slow, asymmetrical, and irreversible progression of muscular atrophy, marked by early fasciculations, the absence of sensory disturbances, and eventual severe motor disability. The case is examined within its institutional, nosological, and therapeutic contexts, highlighting hospital circulation, the role of medical interns, and the empirical treatments of the time, including electrotherapy and thermal baths. Reinterpreted in light of contemporary neurology, this historical observation likely corresponds to a spinal-onset motor neuron disease closely related to ALS. Beyond its clinical significance, the case illustrates the transition from descriptive clinical medicine to anatomoclinical correlation and contributes to the historiography of neurology by illuminating how individual patient trajectories shaped medical knowledge in the 19th century.</p><p><strong>Key messages: </strong>(1) Long-term historical clinical observations provide valuable insights into the natural history of PMA and motor neuron diseases. (2) The Bellinghen case illustrates the evolution of neurological semiology, particularly the early recognition of fasciculations and asymmetrical muscle wasting. (3) This case highlights the transition from Aran's initial clinical description of PMA to Charcot's anatomopathological framework linking PMA to ALS. (4) Historical medical archives offer not only scientific data but also a window into the social consequences of chronic neurological disease in the 19th century. (5) Integrating historical and clinical analysis enriches contemporary understanding of motor neuron disease nosology and medical memory.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-8"},"PeriodicalIF":2.4,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484999","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":"Sex-Specific Phenotypic Characteristics in Obstructive Sleep Apnea: A Comprehensive Analysis of Anthropometric, Hematological and Metabolic Profiles Stratified by Disease Severity.","authors":"Hui Xu, Jun Yang, Junqian Yang, Zihan Yao, Xinyuan Zhang, Xiaoli Li, Yijing Guo","doi":"10.1159/000551587","DOIUrl":"https://doi.org/10.1159/000551587","url":null,"abstract":"<p><strong>Introduction: </strong>Given the limited exploration of sex differences in OSA, this study aims to systematically compare the clinical presentation, hematological features, and metabolic profiles between male and female patients.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 1567 adults (1173 men and 394 women) at the Sleep Center of Zhongda Hospital, Southeast University. Participants were categorized into mild (AHI 5-14), moderate (AHI 15-29), severe (AHI ≥30) OSA groups, and healthy controls (HC). Data included demographic characteristics, blood routine, metabolic panels, thyroid function tests, and comorbidity prevalence.</p><p><strong>Results: </strong>Females with OSA were significantly older than males (p < 0.001). Males had higher rates of traditional risk factors like smoking, alcohol use, and loud snoring (p < 0.005), while females reported more insomnia. Hematologically, males with OSA showed progressively increasing red blood cell counts, hematocrit, monocyte counts, and systemic inflammation with disease severity (p < 0.01). Metabolically, males exhibited more pronounced dyslipidemia, higher glycosylated hemoglobin, and uric acid levels in severe OSA (p < 0.05). In contrast, females demonstrated significant alterations in thyroid hormones (free triiodothyronine, free thyroxine) with increasing OSA severity (p < 0.01).</p><p><strong>Conclusions: </strong>OSA shows significant sex dimorphism. Men are characterized by \"metabolic disorders, aggravated inflammation, high severity of OSA\". Women are characterized by \"atypical symptoms, advanced age, thyroid abnormalities\". These findings underscore the critical necessity for gender-tailored approaches in OSA screening, diagnosis, and therapeutic management.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-17"},"PeriodicalIF":2.4,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485076","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":"Effect of CPAP Therapy in Poststroke Patients with Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis.","authors":"Jeppe Suusgaard, Nikolaj Folke la Cour Karottki, Anders Sode West, Katrin Rauen, Helle Klingenberg Iversen, Trine Ibsen, Nikolaj Bjerg Bendsen, Christina Kruuse, Poul Jørgen Jennum","doi":"10.1159/000551243","DOIUrl":"10.1159/000551243","url":null,"abstract":"<p><strong>Introduction: </strong>Sleep-disordered breathing (SDB), particularly obstructive sleep apnea, increases the risk of first and recurrent stroke. SDB is common after stroke or transient ischemic attack (TIA) and is linked with fatigue, sleepiness, and poorer cognitive and functional outcomes. Continuous positive airway pressure (CPAP) therapy may mitigate these effects, but its efficacy in post-stroke populations remains uncertain.</p><p><strong>Methods: </strong>Following a preregistered PROSPERO protocol (CRD420251078235), we systematically searched MEDLINE, Embase, and Cochrane CENTRAL. Eligible studies included adults with stroke or TIA and SDB, comparing CPAP with sham, usual care, or nonadherence. Primary outcomes were recurrent stroke or TIA and all-cause mortality; secondary outcomes included cardiac events, functional recovery, cognition, sleepiness, and fatigue. Random effects models were used separately for randomized controlled trials (RCTs) and observational studies.</p><p><strong>Results: </strong>From 7,132 records, 30 studies (19 RCTs, 11 observational studies; n = 3,381) met inclusion criteria. Seven RCTs assessed recurrent stroke or TIA and showed CPAP reduced the odds of re-stroke (OR: 0.49, 95% CI: 0.25-0.95; I2 = 0%). All-cause mortality was unchanged in short-term RCTs, but long-term unadjusted observational data showed lower all-cause mortality with CPAP (OR: 0.50, 95% CI: 0.39-0.63; I2 = 0%). High CPAP adherence was linked to improved functional and cognitive outcomes and reduced sleepiness, though data on fatigue and cardiac events were limited.</p><p><strong>Conclusion: </strong>CPAP therapy after stroke or TIA may reduce stroke recurrence and all-cause mortality, while improvements in sleepiness and functional and cognitive outcomes appear less consistent and largely adherence dependent.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-14"},"PeriodicalIF":2.4,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369268","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":"Global Perspectives on the Link between REM Sleep Behavior Disorder and Neurodegenerative Disorders.","authors":"Haixia Fan, Lu Zhai, Shudan Deng, Limantian Wang, Yan Li, Huiyan Niu, Bomeng Zhao, Jie Gao, Xiaoling Gao","doi":"10.1159/000550504","DOIUrl":"10.1159/000550504","url":null,"abstract":"<p><strong>Introduction: </strong>Rapid eye movement sleep behavior disorder (RBD) represents a parasomnia marked by impaired muscle inhibition during REM sleep, commonly manifesting as vivid dream enactment with potentially violent movements. Its strong association with neurodegenerative diseases, particularly α-synucleinopathies such as Parkinson's disease (PD), has drawn increasing attention. This study presents a bibliometric overview of global RBD research from 2010 to 2025.</p><p><strong>Methods: </strong>We analyzed 4,204 publications from the Web of Science Core Collection and Scopus databases. Tools including CiteSpace, VOSviewer, Python, R (bibliometrix), Excel, and Charticulator were used to examine publication trends, geographic and institutional distribution, author influence, journal preferences, co-citation networks, and keyword evolution.</p><p><strong>Results: </strong>RBD-related publications increased steadily, with a marked rise after 2015. The USA, China, and Canada were leading contributors, and institutions such as the University of Toronto, Mayo Clinic, and Peking University showed strong productivity and collaboration. Key researchers included Schenck CH, Boeve BF, and Postuma RB. Top journals were Sleep, Neurology, and Movement Disorders. Research has shifted from clinical characterization to biomarker identification and early intervention. Recent themes include α-synuclein pathology, prodromal PD, and melatonin therapy.</p><p><strong>Conclusion: </strong>RBD research has progressed toward translational approaches focused on early detection and neurodegenerative risk prediction, supported by global collaboration and growing interest in mechanistic insights.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-19"},"PeriodicalIF":2.4,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347813","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":"When Neurology Meets Art History: Tetanus (or Rabies) in a 19th-Century Painting (Neurology and Art).","authors":"Alexis Demas","doi":"10.1159/000551292","DOIUrl":"10.1159/000551292","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-3"},"PeriodicalIF":2.4,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343469","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":"Perivascular Space Progression in Patients with Cerebral Amyloid Angiopathy.","authors":"Qi Li, Maria Clara Zanon Zotin, Andrew D Warren, Susanne J van Veluw, Valentina Perosa, M Edip Gurol, Joshua N Goldstein, Anand Viswanathan, Steven M Greenberg","doi":"10.1159/000550942","DOIUrl":"10.1159/000550942","url":null,"abstract":"<p><strong>Introduction: </strong>Dilated perivascular spaces (PVS) are associated with small vessel disease in the aging population. We sought to investigate the incidence and dynamic evolution of magnetic resonance imaging (MRI)-detectable PVS progression in patients with cerebral amyloid angiopathy (CAA).</p><p><strong>Methods: </strong>Patients with symptomatic CAA who underwent baseline and follow-up MRI scans >2 years apart were included. The severity of both basal ganglia (BG) and centrum semiovale (CSO) PVS were rated. Multivariable logistic regression was used to determine the risk factors for PVS progression.</p><p><strong>Results: </strong>We included 90 patients with CAA (mean age 72.6 years, standard deviation 8.0 years), of which 53 (58.9%) had intracerebral hemorrhage (ICH) at baseline. During a median follow-up of 4.8 years (interquartile range: 3.6-6.6 years), PVS progression was observed in 24 patients (26.7%) at follow-up MRI. After adjusting for age, hypertension, and time between baseline and follow-up MRI, cerebral microbleed (CMB) progression (OR: 4.12, 95% CI: 1.31-12.95; p = 0.015) and presence of ICH at baseline (OR: 8.61, 95% CI: 2.09-35.52; p = 0.003) were independent predictors of PVS progression. In multivariable regression analysis, presence of ICH (OR: 8.78, 95% CI: 1.74-44.35; p = 0.009) and hypertension (OR: 5.73, 95% CI: 1.25-26.29; p = 0.025) were associated with BG-PVS progression. However, only CMB progression (OR: 10.17, 95% CI: 1.84-56.35; p = 0.008) was associated with CSO-PVS progression.</p><p><strong>Conclusion: </strong>PVS progression occurs in a subset of CAA patients reimaged after a median of 4.8 years and is associated with CMB progression. PVS progression might be a useful neuroimaging marker for visualizing CAA-related vascular changes.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-8"},"PeriodicalIF":2.4,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149500","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":"Plasma Brain-Derived Neurotrophic Factor Levels, Brain-Derived Neurotrophic Factor Val66Met Polymorphism, and Their Association with Phenoconversion in Isolated REM Sleep Behavior Disorder.","authors":"Yajie Zang, Hui Zhang, Zheng Ruan, Ting Wang, Yuan Li, Yuan Yuan, Qian Yu, Yanning Cai, Wei Mao","doi":"10.1159/000550711","DOIUrl":"10.1159/000550711","url":null,"abstract":"<p><strong>Introduction: </strong>Brain-derived neurotrophic factor (BDNF) plays an important role in the survival of dopaminergic neurons. Clinical studies have suggested that serum BDNF levels are reduced in patients with Parkinson's disease (PD). However, no study has investigated peripheral BDNF levels and BDNF Val66Met polymorphism in the prodromal stage of PD and their relationship with disease conversion.</p><p><strong>Methods: </strong>In total, 120 patients with video-polysomnography confirmed isolated REM sleep behavior disorder (iRBD) and 120 healthy controls (HCs) were enrolled. Genetic analyses were performed, and plasma levels of BDNF were measured. All patients with iRBD underwent comprehensive clinical testing, and 107 iRBD patients were prospectively followed up.</p><p><strong>Results: </strong>Plasma BDNF levels were significantly lower in the iRBD group than in HCs (18,878.85 pg/mL vs. 24,649.85 pg/mL, p = 0.002), but no differences were observed in BDNF Val66Met carrier rates between the two groups. Plasma BDNF levels did not differ significantly between BDNF Val66Met carriers and noncarriers. Notably, higher plasma BDNF levels were associated with an increased risk of short-term disease conversion (hazard ratio = 3.418, 95% CI: 1.520-7.684, p = 0.003), whereas BDNF Val66Met carrier rates showed no such association.</p><p><strong>Conclusion: </strong>Our findings suggest that plasma BDNF is significantly associated with iRBD and may likely serve as a prognostic biomarker for the development of neurodegenerative disease. However, the BDNF Val66Met polymorphism may not be involved in the pathogenesis of iRBD as well as phenoconversion in the studied population.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-9"},"PeriodicalIF":2.4,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092527","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":"Falls Prevalence and Fear of Falling in Multiple Sclerosis: A Systematic Review and Meta-Analysis.","authors":"Vasileios Giannopapas, Vassiliki Smyrni, Dimitrios K Kitsos, Sophia Stasi, Athanasios K Chasiotis, Konstantina Stavrogianni, Alexandra Akrivaki, Evangelia-Makrina Dimitriadou, Dimitrios Tzanetakos, Daphne Bakalidou, John S Tzartos, Georgios Tsivgoulis, Sotirios Giannopoulos","doi":"10.1159/000549066","DOIUrl":"10.1159/000549066","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 50-70% of people with multiple sclerosis (MS) experience at least one fall event during their lifetime. These events can have debilitating consequences in the quality of life of the individuals' experiencing them, as they can often result in injury, extending beyond physical harm, which may negatively impact the rehabilitation process as well as their psychological well-being.</p><p><strong>Methods: </strong>This systematic review and meta-analysis aimed to determine the proportion of one-time and repeated falls among patients with MS within a year and investigate any potential associations with demographic and disease-specific characteristics. Adhering to PRISMA guidelines, a systematic search of the MEDLINE, PubMed, Scopus, and Google Scholar databases was conducted.</p><p><strong>Results: </strong>Results from 4,342 patients were included. The pooled proportion of one fall within a year was estimated at 28.03% (95% CI [20.21, 36.57]), and for repeated falls, 31.74% (95% CI [23.73, 40.31]). Subgroup analyses revealed significant heterogeneity, while meta-regression showed no significant associations between fall prevalence and age, EDSS, or disease duration.</p><p><strong>Conclusion: </strong>42.5% of patients experienced a one-time fall, while 44.7% reported repeated falls. These findings, demonstrate the significant prevalence of falls among individuals with MS, underlying the need for targeted interventions to mitigate fall risk.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-12"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457653","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":"Developing a Predictive Model for Ischemic Stroke Onset Time Using Transfer Learning.","authors":"Yang Du, Shuai Wang, Weidong Wang, Wenming Zhang, Xiang Chen, Yuan Li, Jie Li, Lili Zhang, Xin Ding","doi":"10.1159/000549892","DOIUrl":"10.1159/000549892","url":null,"abstract":"<p><strong>Introduction: </strong>Identification of acute ischemic stroke (AIS) patients within the 4.5-h therapeutic window is critical for therapy. Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences are an approach to determine whether the time since stroke (TSS) is within 4.5 h. However, interobserver variability and limited accuracy are observed in visual assessments. We aimed to develop a transfer learning model for predicting AIS onset within 4.5 h.</p><p><strong>Materials and methods: </strong>A total of 266 AIS patients with known TSS who underwent imaging scans before treatment were retrospectively analyzed, divided into a training set (n = 211) and a validation set (n = 55). The model was built using DWI and FLAIR sequences. After image preprocessing and data augmentation, a 3D ResNet-18 pretrained on the Kinetics dataset was selected and adapted via transfer learning with DWI-FLAIR input. The model performance was compared with human visual assessment, which was based on the DWI-FLAIR mismatch principle. Partial mismatch was defined as hyperintense infarct on DWI with a smaller corresponding hyperintense area on FLAIR.</p><p><strong>Results: </strong>Baseline characteristics did not differ between the training and validation sets. On the validation set, the model achieved sensitivity of 0.833 (0.703-0.941), specificity of 0.880 (0.737-1.000), and AUC of 0.929 (0.758-0.935), outperforming human visual assessment (sensitivity 0.767 [0.613-0.903]; specificity 0.360 [0.185-0.560]; AUC 0.563 [0.451-0.693]). For partial DWI-FLAIR mismatch cases, the model correctly classified all 15 cases, whereas humans classified 4.</p><p><strong>Conclusion: </strong>The 3D ResNet-18 model shows promise in identifying AIS within 4.5 h, including partial DWI-FLAIR mismatch, but requires multicenter validation before use.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"33-44"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707871","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}