European Neurology最新文献

{"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":"83-96"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","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":"The Parkinsonism of Salvador Dalí.","authors":"Jose-Alberto Palma","doi":"10.1159/000552485","DOIUrl":"10.1159/000552485","url":null,"abstract":"<p><p><p>Background: Salvador Dalí (1904-1989), the great Surrealist painter, developed a progressive parkinsonian syndrome during the last decade of his life that ended his artistic career and reduced him to near-total dependence. Multiple physicians documented tremor, rigidity, and progressive disability, yet no clinical account has been published in the neurological literature. Summary: Drawing on contemporaneous press reports, biographies based on primary sources, sworn medical testimony, and a published quantitative analysis of his paintings, this review compiles the chronological evolution of Dalí's neurological symptoms. Non-motor features (including nocturia without urological explanation and erectile dysfunction from at least 1974) were documented years before the onset of visible motor symptoms, a sequence consistent with, but not diagnostic of, prodromal synucleinopathy. The motor phase, beginning around 1980, was characterized by asymmetric resting tremor affecting the right upper extremity, rigidity, gait impairment, and progressive akinesia. Despite examinations by prominent neurologists including Lluís Barraquer Bordas and François Lhermitte, the diagnosis remained contested throughout Dalí's life. Drug-induced parkinsonism was implicated in the initial crisis, but the continued deterioration after drug withdrawal argues against a purely iatrogenic etiology. No autopsy was performed. Key Messages: This case illustrates a problem familiar to practicing neurologists: the difficulty of diagnosing parkinsonism in patients with complex premorbid personalities, where emerging neuropsychiatric symptoms are absorbed into longstanding behavioral patterns. Today, biomarkers detecting α-synuclein aggregates in peripheral tissues would greatly reduce such diagnostic uncertainty; these tools were not available in Dalí's lifetime. </p>.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"184-189"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971722","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":"Honouring the Past, Shaping the Future.","authors":"Cristina Granziera, Laurent Tatu","doi":"10.1159/000553484","DOIUrl":"10.1159/000553484","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"153"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435440","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":"75-82"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","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":"Recovery of Motor Function via Intraspinal Detour Circuits following Unilateral Spinal Cord Injury.","authors":"Hiroshi Nakagawa, Yuki Fujita, Toshihide Yamashita","doi":"10.1159/000549481","DOIUrl":"10.1159/000549481","url":null,"abstract":"<p><p><p>Introduction: Neuroplasticity is the ability of the central nervous system (CNS) to adapt structurally and functionally in response to motor and sensory dysfunction caused by injury and disease. Spinal interneurons are key components of neuroplastic changes that ameliorate impaired motor function after CNS injury. A lateral spinal cord hemisection model exhibited spontaneous motor recovery of the hind limb on the affected side. Hence, neuroplastic changes within the spinal cord on the affected and/or unaffected side may occur during motor recovery following unilateral spinal cord injury (SCI). However, it remains unclear how the spinal neurons on the affected and unaffected side contribute to motor recovery in the ipsilesional hind limb following unilateral SCI. Thus, we aimed to explore whether the thoracic spinal neurons above the lesion were involved in the motor recovery of the ipsilesional hind limb.</p><p><strong>Methods: </strong>In our SCl model, unilateral lesions were made at the tenth thoracic vertebral level.</p><p><strong>Results: </strong>Following unilateral SCI, hind limb motor function on the ipsilateral side was initially impaired but showed spontaneous recovery in the behavioral tests, which was subsequently lost after ablation of thoracic spinal neurons in the ipsilesional spinal cord above the lesion. In contrast, changes in the ipsilesional hind limb motor function were not observed after ablation of the contralesional thoracic spinal neurons.</p><p><strong>Conclusion: </strong>These results suggest that thoracic spinal neurons on the ipsilesional side above the lesion are key components for hind limb motor recovery in a model of unilateral SCI. </p>.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"22-32"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12755886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476917","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":"Neurofilament Light Chain as a Biomarker in Neurology.","authors":"Emilia Szyłak, Agata Czarnowska, Agnieszka Kulczyńska-Przybik, Jan Kopitelow, Barbara Mroczko, Jan Kochanowicz, Alina Kułakowska","doi":"10.1159/000552933","DOIUrl":"10.1159/000552933","url":null,"abstract":"<p><strong>Background: </strong>Neurofilament light chain (NfL) has emerged as a highly sensitive biomarker of neuroaxonal injury across diverse neurological disorders. This narrative review synthesizes current evidence regarding its diagnostic, prognostic, and therapeutic-monitoring utility, while outlining major clinical limitations and emphasizing the complementary role of glial fibrillary acidic protein (GFAP).</p><p><strong>Summary: </strong>NfL concentrations increase following axonal damage and correlate with inflammatory activity, lesion burden, and long-term disability progression in multiple sclerosis. Elevated levels also reflect neurodegeneration in Alzheimer's disease, predict disease severity and survival in amyotrophic lateral sclerosis, and are associated with motor and cognitive decline in Parkinson's disease and multiple system atrophy. In acute neurological conditions, including traumatic brain injury and stroke, NfL serves as a robust indicator of the extent of neuronal injury. Interpretation is constrained, however, by substantial physiological variability related to age, renal function, body mass index, and comorbidities, limiting the utility of absolute cut-off values. GFAP provides complementary information by capturing astrocytic damage, and the GFAP/NfL ratio may aid in differentiating multiple sclerosis from neuromyelitis optica spectrum disorder. Integration of NfL with multimodal biomarkers-such as GFAP, tau proteins, proteomic and metabolomic signatures, and advanced neuroimaging-may enhance diagnostic specificity and prognostic accuracy.</p><p><strong>Key messages: </strong>Future research priorities include establishing age-adjusted reference intervals, validating longitudinal thresholds, and incorporating NfL into therapeutic monitoring frameworks. Advances in these areas are expected to improve diagnostic precision and support broader clinical implementation of NfL.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"190-202"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419894","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":"10.1159/000551587","url":null,"abstract":"<p><strong>Introduction: </strong>Given the limited exploration of sex differences in obstructive sleep apnea (OSA), this study aimed 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 1,567 adults (1,173 men and 394 women) at the Sleep Center of Zhongda Hospital, Southeast University. Participants were categorized into mild (apnea-hypopnea index [AHI] 5-14), moderate (AHI 15-29), severe (AHI ≥30) OSA groups, and healthy controls. Data included demographic characteristics, hematological profiles, 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 tri-iodothyronine, 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":"122-129"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","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":"Artificial Intelligence-Based CTA Software for Real-World Detection of Large-Vessel Occlusion in Acute Ischemic Stroke.","authors":"Nicola Morelli, Eugenia Rota, Marco Spallazzi, Marina Biondi, Paolo Immovilli","doi":"10.1159/000553264","DOIUrl":"10.1159/000553264","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI)-based tools for CT angiography (CTA) have been introduced to support rapid detection of large vessel occlusion (LVO) in acute ischemic stroke. Although regulatory approval has relied mainly on controlled clinical studies, evidence from routine clinical practice remains limited. This study aimed to assess the real-world diagnostic performance and workflow impact of the Brainomix e-CTA software.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center observational study including consecutive patients with suspected acute ischemic stroke who underwent multiphase CTA between May 2023 and May 2025. Automated LVO detection using e-CTA was compared with expert neuroradiologist interpretation as a pragmatic clinical reference standard. Diagnostic performance was evaluated using sensitivity, specificity, and accuracy. Sensitivity was additionally analyzed according to occlusion location. Inter-reader agreement was assessed using Cohen's κ, and time to diagnostic conclusion with and without AI assistance was compared across readers with different experience levels.</p><p><strong>Results: </strong>Among 531 CTA examinations, LVO was identified in 19% of cases. Overall LVO detection showed a sensitivity of 84%, specificity of 95%, and accuracy of 93%. Sensitivity was highest for ICA/proximal M1 occlusions (94%) and progressively decreased for intermediate (87%) and distal M1 occlusions (73%). Agreement between AI output and expert interpretation was excellent for ICA/proximal M1 occlusions (κ = 0.91) and moderate for distal M1 occlusions (κ = 0.48). AI assistance significantly reduced time to diagnostic conclusion across all reader profiles.</p><p><strong>Conclusion: </strong>In routine clinical practice, Brainomix e-CTA showed highest diagnostic performance for ICA/proximal M1 occlusions and reduced time to diagnostic conclusion. However, lower sensitivity for intermediate and distal M1 occlusions and the exclusion of nontarget occlusions from the primary endpoint indicate that e-CTA should be used as an adjunctive workflow tool rather than as a standalone method for treatment decision-making.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"175-183"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419830","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":"Acknowledgement to Reviewers.","authors":"","doi":"10.1159/000549162","DOIUrl":"https://doi.org/10.1159/000549162","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1"},"PeriodicalIF":2.4,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488233","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 History of the Evans Index.","authors":"Kimberley J R Fleuren, Peter J Koehler, Erik I Hoff","doi":"10.1159/000545917","DOIUrl":"10.1159/000545917","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"92-96"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973828","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}