Frontiers in Neurology最新文献

{"title":"Endovascular thrombectomy for isolated posterior cerebral artery occlusion: distinct clinical presentation patterns and neurological outcomes in P1 versus P2 segments.","authors":"Natalie van Landeghem, Daniel van Landeghem, Jordi Kühne Escolà, Benedikt Frank, Martin Köhrmann, Christoph Ziegenfuß, Johannes Harmes, Johannes Haubold, Isabel Wanke, Cornelius Deuschl, Michael Forsting, Yan Li","doi":"10.3389/fneur.2026.1807618","DOIUrl":"https://doi.org/10.3389/fneur.2026.1807618","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) for isolated posterior cerebral artery (PCA) occlusion remains incompletely characterized, particularly regarding segment-specific presentation and outcomes. We aimed to compare clinical profiles, procedural results, and early neurological and imaging outcomes between P1 and P2 PCA occlusions treated with EVT.</p><p><strong>Methods: </strong>We retrospectively analyzed EVT-treated patients with acute ischemic stroke at a tertiary center from 2018-2025 (<i>n</i> = 1,166). Thirty-nine patients with isolated PCA occlusion were included in the final analysis (P1 <i>n</i> = 27; P2 <i>n</i> = 12). Successful reperfusion was defined as mTICI 2b-3. Baseline and 24-h CT were assessed for detecting ischemic change using posterior circulation ASPECTS (PC-ASPECTS). Neurological deficits were analyzed using NIHSS total scores and clinical domain profiles.</p><p><strong>Results: </strong>Patients with P1 occlusion presented with higher admission stroke severity than those with P2 occlusion [NIHSS 12 (7-23) vs. 7 (4-9)] and more frequent motor/sensory deficits and facial palsy, whereas P2 occlusions commonly presented with visual dysfunction. Successful reperfusion was achieved in 72% overall (P1 78% vs. P2 58%). Median 24-h PC-ASPECTS was similar [8 (IQR 8-9)]. Despite successful reperfusion in P1 occlusion, neurological impairment frequently persisted at discharge, particularly in motor, sensory, vigilance, and language-related domains. Infarct demarcation at 24 h remained frequent, including thalamic involvement in 41% (P1) and 36% (P2). For P1 occlusions, successful reperfusion was associated with less thalamic (29% vs. 83%) and occipital (52% vs. 83%) infarct demarcation. Any intracranial hemorrhage occurred in 13% without segment differences; in-hospital mortality was 26%.</p><p><strong>Conclusion: </strong>P1 and P2 segment occlusions showed distinct clinical phenotypes, while EVT was technically feasible with acceptable safety. However, persistent deficits and brain tissue injury were common despite successful reperfusion.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1807618"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic approach to episodic ataxia types 1 and 2: a proposed algorithm for limited resource-settings.","authors":"Claudio M de Gusmao, Lucas H M R Garcia, Jonathan W Mink, Alex R Paciorkowski, Tamara Pringsheim, Bruno Assis Della Ripa, Carolina Silva Rauffus, Ana Carolina Coan, Laura Silveira-Moriyama","doi":"10.3389/fneur.2026.1735246","DOIUrl":"https://doi.org/10.3389/fneur.2026.1735246","url":null,"abstract":"<p><strong>Background: </strong>Episodic ataxias (EA) comprise a heterogeneous group of genetic conditions with spells of gait difficulty and imbalance, for which the main causes are EA1 (<i>KCNA1</i> gene) and EA2 (<i>CACNA1A</i> gene). While EA1 may respond to some antiepileptics and EA2 responds to acetazolamide, no guideline exists to inform decision-making in settings where genetic testing is unavailable.</p><p><strong>Objectives: </strong>We sought to determine distinguishing clinical features between EA1 and EA2 and propose an algorithm based on our findings.</p><p><strong>Methods: </strong>Systematized literature review to identify individuals with confirmed pathogenic variants in <i>KCNA1</i> and <i>CACNA1A,</i> followed by statistical analysis to compose a management algorithm. Subsequently, the algorithm was tested in cases described within the last three years.</p><p><strong>Results: </strong>Attack duration with a cut-off of < 10 min had high sensitivity (75.3%) and specificity (94.0%) for EA1. Additional features with high specificity included symptoms during the attacks (e.g., headaches in EA2, 95.7%) and symptoms between attacks (e.g., myokymia in EA1 99.6%; nystagmus in EA2, 98.8%). Kinesigenic triggers were more frequently reported in EA1 (68.4% vs. 5.3%, <i>p</i> < 0.001). EA1 subjects also had more frequent attacks (Daily 37.9% vs. 15.9%, <i>p</i> < 0.001) and had a lower age of onset (7y, IQR [4-10] vs. 10y, IQR [5-15], <i>p</i> = 0.003). Testing our algorithm in a case cohort yielded a sensitivity of 87.5% in identifying EA2 cases.</p><p><strong>Conclusion: </strong>EA1 and EA2 patients represent clinically different populations. We propose a management algorithm based on features with highest diagnostic accuracy, which may inform decision-making in resource-limited settings.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1735246"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A unified spectrum model for the anti-GQ1b antibody syndromes: from pathophysiology to a new diagnostic framework.","authors":"Khalil El Abdi, Fazeela Bibi, Muhammad Ibrahim, Kanza Ahmed, Suraksha Nagdev, Zulekhan Bibi, Bilal Aslam, Vohra Maham Hassan, Muhammad Sarim Azad Khan, Asghar Shah, Muhammad Saad Sammi, Abdullah Khan, Hania Imran, Said Hamid Sadat","doi":"10.3389/fneur.2026.1763283","DOIUrl":"https://doi.org/10.3389/fneur.2026.1763283","url":null,"abstract":"<p><strong>Background: </strong>Bickerstaff Brainstem Encephalitis (BBE) is a rare, post-infectious autoimmune disorder characterized by ophthalmoplegia, ataxia, and altered consciousness. Its significant clinical and serological overlap with Miller Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS) creates diagnostic challenges, particularly in atypical or seronegative presentations. These conditions are collectively understood as components of the anti-GQ1b antibody syndrome, a spectrum of neuro-immune disorders.</p><p><strong>Aims: </strong>This review provides a clinically focused, integrative synthesis of the anti-GQ1b antibody spectrum, with an emphasis on BBE. We aim to clarify the underlying pathophysiology, delineate the range of clinical phenotypes, provide a structured framework for diagnosis that acknowledges the limitations of ancillary testing, and summarize current evidence for therapeutic strategies.</p><p><strong>Synthesis of evidence: </strong>Pathogenesis is primarily driven by anti-GQ1b IgG antibodies, generated following infection via molecular mimicry, which trigger complement-mediated damage to ganglioside-rich neural structures. The clinical presentation ranges from purely peripheral deficits (MFS) to severe central nervous system dysfunction (BBE), with frequent BBE-GBS overlap syndromes. Diagnosis hinges on clinical recognition, supported by serology, with neuroimaging serving a crucial role in excluding mimics. Approximately one-third of clinically defined BBE cases are seronegative, suggesting alternative mechanisms. Prompt immunotherapy with intravenous immunoglobulin (IVIg) or plasma exchange is the cornerstone of management, extrapolated from GBS trials, while evidence for corticosteroids remains limited.</p><p><strong>Conclusion: </strong>A structured, spectrum-based perspective remains essential for clinicians navigating the diagnostic complexities of the anti-GQ1b antibody syndromes. This updated synthesis is intended to enhance diagnostic accuracy, guide therapeutic reasoning across the full range of phenotypes, and highlight key unresolved questions to inform a future research agenda.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1763283"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic differences in carotid bulb geometry between Asian and White populations.","authors":"Hossam Abdelmageed, Lamia Mbarek, Xuewei Xie, Yongjun Wang, Hui Li, Yang Liu, Huaguang Zheng, Robert Fleischmann, Jens P Dreier, José Manuel Valdueza","doi":"10.3389/fneur.2026.1805941","DOIUrl":"https://doi.org/10.3389/fneur.2026.1805941","url":null,"abstract":"<p><strong>Background: </strong>Carotid bifurcation geometry influences local hemodynamics and may contribute to plaque formation and carotid disease. Interethnic differences in carotid bulb geometry remain incompletely characterized. However, Asian populations are known to have less atherosclerosis burden in the extracranial carotid arteries compared to White populations.</p><p><strong>Methods: </strong>In a cross-sectional study (2022-2025), 200 adults without relevant carotid stenosis were enrolled consecutively (100 White participants in Germany; 100 Asian participants in China). Carotid geometry was assessed bilaterally using predefined diameter ratios; Carotid bulb (CB)/Internal carotid artery (ICA) diameter was the prespecified primary outcome. Linear mixed-effects models accounted for within-subject correlation; adjusted models included age, sex, BMI, diabetes, hypertension, dyslipidemia, smoking, and atrial fibrillation.</p><p><strong>Results: </strong>In unadjusted models, significant ethnic differences were observed across all primary geometry ratios. CB/ICA was lower in Asian versus White participants (EMM 1.57 vs. 1.68; <i>p</i> < 0.001). After adjustment, the CB/ICA difference remained robust (Asian minus White -0.09; 95% CI -0.14 to -0.04; <i>p</i> < 0.001). Additional adjusted differences were observed for CB/CCA, ICA/CCA, ECA/ICA, and outflow/inflow, whereas no significant difference persisted for ECA/CCA. Analyses of absolute diameters showed no significant interethnic difference in ICA diameter, while carotid bulb diameter was smaller in Asian participants.</p><p><strong>Conclusion: </strong>Carotid bifurcation geometry differs between Asian and White adults independent of vascular risk factors. These anatomical differences may have implications for carotid hemodynamics and plaque formation across populations.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1805941"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy and cerebral hemodynamics mechanisms of acupuncture on the posterior circulation ischemic stroke with vertigo: study protocol for a multicenter, randomized, controlled trial.","authors":"Meng Gong, Pei Li, Renyan Xiao, Lina Pang, Xiangyin Ye, Shufang Li, Taijun Jiang, Hong Guo, Hongling Duan, Xuemei Deng, Song Jin","doi":"10.3389/fneur.2026.1768559","DOIUrl":"https://doi.org/10.3389/fneur.2026.1768559","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Posterior circulation ischemic stroke (PCIS) with vertigo is a common central vertigo disease that significantly hinders patients' motivation for rehabilitation and increases the recurrence rate and mortality among stroke patients due to recurrent episodes of vertigo. Acupuncture has shown promising therapeutic effects in the treatment of PCIS with vertigo, but its underlying mechanisms remain unclear. This study is designed to investigate the impact of acupuncture on cerebral hemodynamics and brain structure in PCIS patients vertigo, and to evaluate its clinical effectiveness in managing this condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and design: &lt;/strong&gt;This is a multicenter, randomized, controlled trial that will randomly allocate 234 participants in a 1:1:1 ratio to manual acupuncture group, sham acupuncture group, or western medication group. This trial is primarily designed as an explanatory trial, with the primary comparison being manual acupuncture vs. sham acupuncture to evaluate the specific efficacy of acupuncture; comparisons between acupuncture and western medication are regarded as secondary comparative effectiveness analyses. All groups will receive standard secondary stroke prevention. Manual and sham acupuncture will be administered five times weekly for 3 weeks (30 min/session), while the western medication group will receive oral betahistine mesilate tablets three times daily, 5 days per week, for 3 weeks. Assessments will be conducted at baseline (Week 0), post-treatment (Week 3), and at Week 11. The primary outcome is the Dizziness Handicap Inventory (DHI); secondary outcomes include the Dizziness and Anxiety Rating Scale (DARS), dizziness diaries and adverse event rate during the follow-up period. To test the &lt;i&gt;a priori&lt;/i&gt; hypothesis that acupuncture improves dizziness by modulating posterior circulation hemodynamics and regional cerebral perfusion in vestibular-related brain regions, cerebral hemodynamics and brain imaging changes will be assessed using transcranial Doppler (TCD), structural magnetic resonance imaging (sMRI), and arterial spin labeling MRI (ASL-MRI) at baseline (Week 0) and post-treatment (Week 3). We specifically hypothesize that acupuncture will increase mean flow velocity (MFV) and reduce resistance index (RI) in the vertebral arteries, basilar artery, and posterior cerebral arteries, enhance regional cerebral perfusion in vestibular-related brain areas, and induce structural changes associated with vestibular compensation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This study will provide robust evidence on the safety and efficacy of acupuncture for vertigo with PCIS. In addition, it will test a prespecified biological hypothesis that acupuncture may relieve dizziness by improving vertebrobasilar hemodynamics and regional perfusion within vestibular-related brain networks, with corresponding imaging changes associated with clinical improvement. This research aims to offer novel insigh","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1768559"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Ki-67 index combined with alpha-fetoprotein and lactate dehydrogenase in distinguishing mature from immature ovarian teratomas in children.","authors":"Xiazhe Li, Zhiyong Zhong, Yanwei Qi, Yingxin Gong","doi":"10.3389/fneur.2026.1757328","DOIUrl":"https://doi.org/10.3389/fneur.2026.1757328","url":null,"abstract":"<p><strong>Background: </strong>Accurate differentiation between mature and immature ovarian teratomas in children remains a diagnostic challenge. Current histopathological grading is subjective, and reliable preoperative biomarkers are lacking. This study aimed to evaluate the diagnostic and prognostic value of Ki-67, alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH), individually and in combination.</p><p><strong>Methods: </strong>We retrospectively analyzed 82 pediatric patients (≤18 years) with histologically confirmed ovarian teratomas, including 45 mature and 37 immature cases. Serum AFP and LDH levels and Ki-67 proliferation indices were compared between groups. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors and assess diagnostic performance. Recurrence-free survival (RFS) was evaluated using Kaplan-Meier and Cox regression analyses.</p><p><strong>Results: </strong>AFP, LDH, and Ki-67 levels were significantly higher in the immature group than in the mature group (all <i>p</i> < 0.001). Ki-67 expression increased progressively with higher pathological grades (<i>P</i> for trend < 0.001). In multivariate analysis, Ki-67 > 30% (OR 7.16, 95% CI 3.09-16.58), AFP > 500 ng/mL (OR 5.42, 95% CI 2.31-12.75), and LDH > 300 U/L (OR 3.04, 95% CI 1.32-6.98) were independent predictors of immaturity. The combined model (AFP + LDH + Ki-67) achieved the highest diagnostic accuracy (AUC = 0.96), outperforming any single marker (<i>p</i> < 0.05). During a median follow-up of 38 months, recurrence occurred in 8 patients (10.3%), all with immature teratomas. High Ki-67 expression (>30%) was independently associated with shorter RFS (HR = 4.62, 95% CI 1.48-14.46, <i>p</i> = 0.009).</p><p><strong>Conclusion: </strong>The combined assessment of Ki-67, AFP, and LDH provides a robust biomarker panel for differentiating immature from mature ovarian teratomas in children and predicting recurrence risk. Integration of proliferative and metabolic indicators into pathological evaluation may enhance diagnostic precision and support individualized management in pediatric ovarian germ cell tumors.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1757328"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and biological factors associated with the presence of peripheral neuropathy in patients with rheumatoid arthritis.","authors":"Yannick Fogoum Fogang, Bleriol Fondjo Azemkeu, Claudine Sen Henriette Ngomtcho, Fernando Kemta Lekpa, Michel Noubom","doi":"10.3389/fneur.2026.1755880","DOIUrl":"https://doi.org/10.3389/fneur.2026.1755880","url":null,"abstract":"<p><strong>Objective: </strong>Immune dysfunction in rheumatoid arthritis (RA) is a contributing factor to the development of peripheral neuropathy (PN). The objective of our study was to investigate the biological and clinical factors associated with PN in patients with RA.</p><p><strong>Materials and methods: </strong>We conducted a retro-prospective cross-sectional study. A total of 63 patients with RA were included. They were divided into two groups, 18 with PN and 45 without PN. Participants with PN were those with a pathological electroneuromyogram (ENMG) with or without signs and symptoms of PN. Blood samples were taken for the measurement of rheumatoid factor (RF) and C-reactive protein (CRP). The concentration of anti-citrullinated peptide antibodies (ACPA) were collected from patient records. The significance threshold was set at a <i>p</i>-value <0.05.</p><p><strong>Results: </strong>The majority of participants, 82.5% were female. The mean age was 51.86 ± 13.07 years. PN was present in 28.6% of the participants. RF and ACPA were positive in 71.4 and 77.8% of the participants, respectively. Severely active RA was significantly associated with the presence of PN (<i>p</i> < 0.001, OR = 55.13). RF concentrations were significantly higher in patients with PN. The area under the ROC curve for RF concentration in predicting PN in patients with RA was 0.7 (AUC = 0.7), patients with an RF > 169.10 IU/mL had a significant risk of presenting PN (<i>p</i> = 0.003, OR = 8.20).</p><p><strong>Conclusion: </strong>Severe rheumatoid arthritis is associated with PN. Inflammatory markers may play a key role in the pathogenesis and may provide valuable guidance for the early diagnosis of PN in RA.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1755880"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mean systolic blood pressure upon admission and clinical outcomes after endovascular treatment in patients with large vessel occlusion beyond 24 hours.","authors":"Feixue Yue, Haiqi Li, Kaili Chen, Mingchao Shi, Hengyu Ji, Jinting He, Shouchun Wang","doi":"10.3389/fneur.2026.1789389","DOIUrl":"https://doi.org/10.3389/fneur.2026.1789389","url":null,"abstract":"<p><strong>Background and purpose: </strong>Recently, several clinical studies have shown that higher systolic blood pressure (SBP) upon admission is associated with poor clinical outcomes in patients with ischemic stroke following endovascular treatment (EVT). However, the effect of the mean systolic blood pressure (MSBP) upon admission on patients with acute anterior circulation large vessel occlusion (ACLVO) who underwent EVT after 24 h is unclear. We sought to assess the association between MSBP at admission and clinical outcomes in patients treated with EVT for acute ACLVO beyond 24 h after onset.</p><p><strong>Methods: </strong>Patients with ACLVO treated with EVT more than 24 h after symptom onset were consecutively enrolled during a 3-year period at a tertiary stroke center. MSBP was measured at admission using an automatic cuff recording. The efficacy outcome was a 3-month good functional outcome (modified Rankin Scale score of 0-2). Symptomatic intracerebral hemorrhage (sICH) and mortality at 3 months were the safety outcomes.</p><p><strong>Results: </strong>A total of 57 patients with acute ischemic stroke who met the inclusion criteria were included in the study (mean age 56 ± 12 years, mean National Institute of Health Stroke Scale score 11 ± 5). In the Firth penalized likelihood logistic regression analyses adjusted for confounding factors, higher MSBP levels were significantly negatively correlated with good clinical outcomes (odds ratio: 0.012; 95% confidence interval: 0.000-0.204). There was no significant association between high SBP and sICH or mortality.</p><p><strong>Conclusion: </strong>Our study suggests that higher MSBP at admission is an independent predictor of a poor clinical outcome at 3 months in patients treated with EVT for acute ACLVO beyond 24 h after onset.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1789389"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal machine learning for distinguishing pediatric multiple sclerosis from non-inflammatory conditions using optical coherence tomography.","authors":"Chaojun Chen, Sahar Soltanieh, Sajith Rajapaksa, Farzad Khalvati, E Ann Yeh","doi":"10.3389/fneur.2026.1791696","DOIUrl":"https://doi.org/10.3389/fneur.2026.1791696","url":null,"abstract":"<p><strong>Background and objectives: </strong>Identifying multiple sclerosis (MS) in children early is critical, as early therapeutic intervention can improve outcomes. The anterior visual pathway has been demonstrated to be of central importance in diagnostic considerations for MS and has recently been identified as a fifth topography in the McDonald Diagnostic Criteria for MS. Optical coherence tomography (OCT) provides high-resolution retinal imaging and reflects the structural integrity of the retinal nerve fiber and ganglion cell inner plexiform layers. Whether multimodal deep learning models can use OCT alone to diagnose pediatric onset MS (POMS) is unknown.</p><p><strong>Methods: </strong>We analyzed 3D OCT scans collected prospectively through the Neuroinflammatory Registry of the Hospital for Sick Children (REB#1000005356). Raw macular and optic nerve head images, and 52 automatically segmented features were included. We evaluated three classification approaches: (1) deep learning models (e.g., ResNet, DenseNet) for representation learning followed by classical ML classifiers, (2) ML models trained on OCT-derived features, and (3) multimodal models combining both via early and late fusion.</p><p><strong>Results: </strong>Scans from individuals with POMS (onset 16.0 ± 3.1 years, 51.0% female; 211 scans) and 29 children with non-inflammatory neurological conditions (13.1 ± 4.0 years, 69.0% female, 52 scans) were included. The early fusion model achieved the highest performance (AUC: 0.90, weighted <i>F</i> ₁: 0.87, macro <i>F</i> ₁: 0.77, accuracy: 87%), outperforming both unimodal and late fusion models. The best unimodal feature-based model (SVC) yielded an AUC of 0.84, weighted <i>F</i> ₁ of 0.85, macro <i>F</i> ₁ of 0.73, and accuracy of 85%, while the best image-based model (ResNet101 with SVC) achieved an AUC of 0.79, weighted <i>F</i> ₁ of 0.84, macro <i>F</i> ₁ of 0.70, and accuracy of 87%. Late fusion underperformed, reaching 82% accuracy but failing in the minority class.</p><p><strong>Discussion: </strong>Multimodal learning with early fusion significantly enhances diagnostic performance by combining spatial retinal information with clinically relevant structural features. This approach captures complementary patterns associated with MS pathology and shows promise as an AI-driven tool to support pediatric neuroinflammatory diagnosis.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1791696"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herbal medicine evaluation for reimbursement-based post-stroke sequelae (HERB-PSS): a retrospective analysis using Korean health insurance claim data, 2020-2024.","authors":"Soo-Dam Kim, Man Young Park, Jiyun Cha, Changsop Yang, Eunbyul Cho, Sungha Kim","doi":"10.3389/fneur.2026.1735511","DOIUrl":"https://doi.org/10.3389/fneur.2026.1735511","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of long-term disability, and many patients experience persistent neurological and functional impairments after the acute phase. The Korean government launched a national pilot reimbursement program for herbal decoctions to improve access to Korean Medicine (KM) rehabilitation and generate real-world evidence on its safety and effectiveness. This study aimed to analyze the utilization patterns, clinical outcomes, and safety of herbal medicine (HM) among patients with post-stroke sequelae participating in the pilot program.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using nationwide health insurance claims data from the Health Insurance Review and Assessment Service (HIRA). Patients diagnosed with sequelae of cerebrovascular disease (KCD codes I69 or U234) who received reimbursed HM prescriptions between November 2020 and April 2024 were included. Demographic characteristics, prescription patterns, and symptom severity were analyzed. Symptom changes between the first and last visits were assessed using the Wilcoxon signed-rank test, and adverse events (AEs) were identified from newly added diagnostic codes after HM treatment.</p><p><strong>Results: </strong>A total of 942 eligible patients were analyzed, with a mean age of 73.2 ± 6.0 years. The majority (57%) initiated KM treatment more than 1 year after stroke onset. The most frequently prescribed formulas were Gamidaebo-tang (23.1%), Mangeum-tang (5.8%), and Gagampalmi-hwan (5.1%). Among 609 patients with paired symptom records, 19.4% showed improvement, 71.9% remained stable, and 8.7% worsened (<i>p</i> < 0.001). AEs occurred in 1.03% (10/962) of patients, predominantly gastrointestinal symptoms such as diarrhea (55.6%). All reported AEs were mild and self-limiting.</p><p><strong>Conclusion: </strong>This study provides the first nationwide real-world evidence on the use, effectiveness, and safety of HM for post-stroke sequelae under Korea's pilot reimbursement program. Individualized herbal decoctions were widely prescribed and generally well tolerated, showing meaningful symptom stabilization in chronic stroke care. These findings support the feasibility and clinical safety of reimbursed HM and highlight the need for prospective studies to evaluate long-term outcomes, safety, and cost-effectiveness under the expanded second-phase program.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1735511"},"PeriodicalIF":2.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}