Journal of Central Nervous System Disease最新文献

{"title":"The Influence of Circadian Onset Time on Admission Severity in Acute Ischemic Stroke: A Retrospective Cohort Study.","authors":"Shaoling Li, Shiyu Hu, Yuqi Liao, Manjuan Yao, Lijie Ren","doi":"10.1177/11795735261421368","DOIUrl":"10.1177/11795735261421368","url":null,"abstract":"<p><strong>Background: </strong>Stroke onset demonstrates a circadian pattern, but the relationship between onset time and stroke severity at admission remains insufficiently understood.</p><p><strong>Objectives: </strong>This study aimed to examine the association between time of stroke onset and admission severity in patients with acute ischemic stroke (AIS), and to determine whether this association varies across clinical subgroups.</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study including 14,048 patients diagnosed with AIS and admitted to 36 hospitals in Shenzhen, China, between January 1, 2022, and May 31, 2024. Stroke onset time was classified into 4 periods: Morning (05:00-10:59), Afternoon (11:00-16:59), Evening (17:00-22:59), and Night (23:00-04:59). The primary outcome was neurological severity at admission, measured by the NIHSS score. Associations between onset time and outcomes were evaluated using multivariable ordinal logistic and linear regression models, adjusted for demographic and clinical covariates. Subgroup analyses and sensitivity analyses using multiple imputation were also conducted.</p><p><strong>Results: </strong>Stroke onset in the Morning was associated with lower NIHSS scores (adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI]: 0.82-0.94; <i>P</i> < .001) and lower mRS scores (aOR = 0.81; 95% CI: 0.76-0.86; <i>P</i> < .001). In contrast, Night onset was associated with higher NIHSS scores (aOR = 1.20; 95% CI: 1.09-1.32; <i>P</i> < .001) and mRS scores (aOR = 1.25; 95% CI: 1.15-1.37; <i>P</i> < .001). These associations were consistent across strata defined by age and sex, and among patients with hypertension or diabetes. However, the circadian pattern was attenuated in patients with coronary artery disease, dyslipidemia, or atrial fibrillation.</p><p><strong>Conclusion: </strong>Admission stroke severity follows a circadian pattern, with milder presentations in the Morning and more severe impairments during Night hours. These findings highlight the potential role of circadian biology in stroke pathophysiology and support incorporating time-of-onset considerations into clinical risk stratification and acute management strategies.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"18 ","pages":"11795735261421368"},"PeriodicalIF":2.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case-Based Lessons on Remote Patient Monitoring in Neurology Using Consumer-Grade Wearables.","authors":"Paula Z Epping, Ramona Hagler, Noah M Werner, Jan Voth, Linea Schmidt, Niklas Huntemann, Ariel D Stern, Tobias Ruck, Sven G Meuth, Marc Pawlitzki, Lars Masanneck","doi":"10.1177/11795735261419641","DOIUrl":"10.1177/11795735261419641","url":null,"abstract":"<p><p>Consumer-grade wearables offer promising opportunities for remote patient monitoring (RPM) in neurological disorders, yet their clinical application remains uncertain. In this exploratory analysis, we draw on prospective observational trials using smartwatches in patients with multiple sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, and migraine, who were monitored for 6 to 24 months. Through detailed clinical case narratives, we illustrate both the potential and the limitations of RPM in neurology. Wearable-generated data successfully captured early, clinically meaningful changes, such as the onset of a myasthenic exacerbation, and supported patient engagement in identifying individual triggers, including for migraine. However, external influences such as holidays, infections, or mobility aid use confounded activity signals, underscoring the importance of contextual interpretation. While wearables can enhance neurological care, their integration into clinical workflows is challenged by limited validation and interpretability. Realising their potential requires robust validation in clinical settings and the development of interoperable RPM platforms supported by close collaboration between clinicians, engineers, and patients.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"18 ","pages":"11795735261419641"},"PeriodicalIF":2.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking a Novel Therapeutic Modality: Low-Intensity Transcranial Ultrasound as a Key to CNS Treatment - A Bibliometric and Systematic Review.","authors":"Fuqiang Qiao, Yingao Guo, Yajie Dong, Kunying Song, Bingzi Yan, Jie Zhou","doi":"10.1177/11795735261415705","DOIUrl":"10.1177/11795735261415705","url":null,"abstract":"<p><strong>Objectives: </strong>Over the past decade, low-intensity transcranial ultrasound stimulation (LITUS) has emerged as a promising non-invasive neuromodulation technique for central nervous system (CNS) disorders. This study aims to chart the current research landscape, uncover key trends and challenges, and offer a reference for future investigations.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we sourced data from 3 databases and included 454 literature. We conducted bibliometric analyses using R, VOSviewer, and CiteSpace to explore publication trends, journal/region contributions, keyword co-occurrence networks, research clusters, and emerging frontiers.</p><p><strong>Results: </strong>The United States, China, and South Korea were the most influential countries in the field, while Brain Stimulation was the leading journal. Keyword analysis revealed 7 research clusters, and burst-detection highlighted frontiers such as safety, thalamic stimulation, and frequency. The literature review shows that LITUS is an emerging field with therapeutic promise, but faces challenges in areas like safety and ultrasound parameter standardization.</p><p><strong>Conclusion: </strong>As the first comprehensive bibliometric and systematic review of LITUS in CNS disorders treatment, this work presents a global picture of publication trends, hotspots, and obstacles-providing valuable guidance for future research and clinical translation of LITUS.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"18 ","pages":"11795735261415705"},"PeriodicalIF":2.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Clinical Characteristics and Outcomes in Adults With Encephalitis: A Retrospective Study.","authors":"Sienna Wu, Rodrigo Hasbun, Ralph Habis, Jordan Benderoth, Ivany Patel, Ashutosh Gupta, Megan Goyal, Arun Venkatesan, John C Probasco, Paris Bean, Ashley Heck, Laya Rao, Rajesh K Gupta","doi":"10.1177/11795735251414833","DOIUrl":"10.1177/11795735251414833","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aims to assess whether adult patients with encephalitis from different racial and ethnic backgrounds exhibit significant differences in clinical presentation, diagnostic findings, and outcomes.</p><p><strong>Design and methods: </strong>A retrospective cohort study was conducted by utilizing the electronic health records of encephalitis patients in the greater Houston and Baltimore areas. Patients were categorized by race/ethnicity into White or ethnic minority (including Black, Hispanic, and Asian patients). Data was analyzed for the presence of significant differences in clinical characteristics between the two groups.</p><p><strong>Results: </strong>Among 599 patients, 312 (52.1%) were White and 287 (47.9%) were of an ethnic minority. White patients were more often over sixty years-old upon presentation (43.1% vs 23.9%, <i>P</i> < 0.001) and more likely to present with memory deficits (36% vs 26.3%, <i>P</i> = 0.012). Ethnic minority patients more frequently presented with co-existing HIV (20.3% vs 3.4%, <i>P</i> < 0.001), severe organ dysfunction (44% vs 34.4%, <i>P</i> = 0.028), cerebrospinal fluid (CSF) pleocytosis (white blood cell count ≥5 cells/µL) (83.1% vs 69.3%, <i>P</i> < 0.001), and abnormal electroencephalogram (EEG) findings (84.3% vs 71.9%, <i>P</i> = 0.035). Ethnic minority patients also had worse outcomes on the Glasgow Outcome Scale (GOS) as defined by GOS <4 (59.3% vs 47.2%, <i>P</i> = 0.005). Binary logistic regression identified abnormal magnetic resonance imaging (MRI) and Glasgow Coma Scale (GCS) <13 as independent predictors of an adverse clinical outcome (GOS <4) with an adjusted odds ratio [95% confidence interval] (<i>P</i> value) of 1.609 [1.042-2.486] (<i>P</i> = 0.032) and 2.689 [1.675-4.317] (<i>P</i> < .001), respectively.</p><p><strong>Conclusion: </strong>Ethnic minority patients with encephalitis present at a younger age and are more likely to have co-existing HIV, severe initial organ dysfunction, CSF pleocytosis, abnormal EEG findings, and worse clinical outcomes. Abnormal MRI and GCS <13 are independent predictors of an unfavorable clinical outcome and may aid in risk stratification.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"18 ","pages":"11795735251414833"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Brainstem Hemorrhage after Thrombolysis in Ischemic Stroke With Poorly Controlled Hypertension: Insights From Three Clinical Cases.","authors":"Lei Shen, Niao Yang, Dong Sun, Bin Mei, Nao Yan","doi":"10.1177/11795735251409050","DOIUrl":"10.1177/11795735251409050","url":null,"abstract":"<p><strong>Objective: </strong>To report three cases of immediate brainstem hemorrhage following intravenous thrombolysis with tenecteplase (TNK) in patients with minor ischemic stroke, resulting in poor outcomes and death.</p><p><strong>Methods: </strong>We describe the clinical characteristics, imaging findings, and outcomes of three patients who developed brainstem parenchymal hemorrhage immediately after TNK thrombolysis.</p><p><strong>Results: </strong>All three patients had minor ischemic stroke (National Institute of Health stroke scale score ≤5) and presented with elevated blood pressure on admission. Blood pressure was lowered to guideline-recommended levels (<180 mmHg) using intravenous antihypertensives before thrombolysis. Despite rapid brain protection measures, including hematoma evacuation or external ventricular drainage in two cases and conservative management in one, all patients died due to brainstem hemorrhage.</p><p><strong>Conclusion: </strong>These cases suggest that fatal brainstem hemorrhage may occur after TNK thrombolysis in minor stroke. For patients with a history of poorly controlled hypertension, careful risk assessment and aggressive blood pressure management are critical if thrombolysis is considered.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"18 ","pages":"11795735251409050"},"PeriodicalIF":2.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of IOM in Uganda Utilizing the EPIS Framework: Report of a Symbiotic Collaboration.","authors":"Julio Montejano, Betty Nantongo, Tessa Klumpp, Teguo Daniel Djoyumm, Joshua Lahiri, Daniel Watiti, Humphrey Okechi, Emmanuel Wegoye, Colby Simmons","doi":"10.1177/11795735251408597","DOIUrl":"10.1177/11795735251408597","url":null,"abstract":"<p><strong>Objectives: </strong>Low- and lower-middle-income countries (LMICs) bear a disproportionately high burden of neurosurgical disease while facing severe shortages of trained neurosurgeons and anesthesiologists. Access to advanced technologies such as intraoperative neuromonitoring (IONM), crucial for complex neurosurgical procedures, is virtually nonexistent due to infrastructural, educational, and financial barriers. This study describes the development and implementation of Uganda's first IONM program at Cure Children's Hospital of Uganda (CCHU), using the well validated Exploration, Preparation, Implementation, and Sustainment (EPIS) framework.</p><p><strong>Methods: </strong>In collaboration with the University of Colorado, a standardized non-traditional training pathway was created, combining remote and in-person instruction in neurophysiology, technical IONM applications, and anesthetic considerations. Over a 3-year period, the program enabled CCHU to safely perform more than 80 complex pediatric neurosurgical cases across 2 years, incorporating modalities such as somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMG). Surgical and patient outcomes were not tracked for the purposes of this implementation study.</p><p><strong>Results: </strong>Between March 2022 and October 2024, 80 surgeries were performed at CCHU that made use of IONM technologies. The vast majority of the surgeries were intracranial and included one awake tumor resection with direct cortical mapping (DCS). A smaller subsect of patients underwent spine surgery for either tumor removal or correction of spinal cord tethering. Due to the difficulty in patient outreach many patients were lost to follow-up, however, efforts are being made to track patients and examine their clinical outcomes.</p><p><strong>Conclusion: </strong>Despite resource limitations, this initiative demonstrated that IONM can be effectively integrated into LMIC healthcare settings, improving surgical safety and outcomes while contributing to local workforce development. The success of this program underscores the value of international partnerships and implementation science in bridging global neurosurgical disparities and suggests a scalable model for future adoption across similar contexts.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"17 ","pages":"11795735251408597"},"PeriodicalIF":2.8,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12715171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Temporal Associations of Neck Pain and Headache - Implications for the Diagnostic Approach to the Myofascial Involvement in Migraine.","authors":"Corinna Börner-Schröder, Thomas Lachhammer, Paula Behrendt, Theresa Pfeifer, Paulina Kolorz, Sarah Lense, Julie Pompignoli, Miriam Reichert, Severin Schramm, Florian Heinen, Nico Sollmann, Michaela V Bonfert","doi":"10.1177/11795735251404279","DOIUrl":"10.1177/11795735251404279","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Migraine remains a relevant source of disability. Peripheral pathophysiological mechanisms including the involvement of neck musculature are not yet well understood. A temporal association of headache and neck pain, and imaging tools for its assessment are not established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our aim was to explore the association between headache episodes and involvement of neck muscles in patients with episodic migraine and healthy controls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Controlled clinical study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data of 13 migraine patients (26.92 ± 2.47 years, 12 females) and 13 matched healthy controls (26.62 ± 3.43 years) on headache, migraine, and neck pain were collected during an initial 12-week observational period. A cross-sectional examination followed that comprised clinical assessment of the upper trapezius muscle (UTM) including identification of myofascial trigger points (mTrP), algometry (pressure pain thresholds [PPT]), and B-mode (brightness mode) ultrasound measurements of muscle and fascia thickness and gray scale analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Migraine patients reported significantly higher neck pain frequency and duration and significantly lower PPT above the UTM (&lt;i&gt;P&lt;/i&gt; &lt; 0.05) than controls. Mean PPT values of mTrP in patients did not significantly differ from PPT values of reference points on the same side (left: &lt;i&gt;P&lt;/i&gt; = 0.419, right: &lt;i&gt;P&lt;/i&gt; = 0.100). The odds ratio of co-occurring headache or migraine on days with neck pain was 5.64 (95% confidence interval [CI] [4.14;7.69]) and 7.21 (95% CI [4.95;10.49]) times higher than on neck pain-free days. Ultrasound analysis demonstrated significant differences in muscle/fascial thickness in 12 out of 24 measurements. There were no significant differences in gray scale analysis between groups. When comparing same-side ultrasound measurements of pooled reference points and mTrP, all measurements of muscle thickness (&lt;i&gt;P&lt;/i&gt; = 0.002, 0.006, 0.002, 0.012), one measurement of fascial thickness (&lt;i&gt;P&lt;/i&gt; = 0.006), and three measurements of gray scale (&lt;i&gt;P&lt;/i&gt; = 0.009, 0.014; &lt;i&gt;P&lt;/i&gt; &lt; 0.001) yielded significant results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our data may emphasize the relevance of UTM myofascial involvement in migraine patients. This may involve the UTM as a whole, rather than single focalities. The muscular component of migraine and other headache disorders remains an overlooked part of diagnosis and treatment. Consequently, imaging methods, especially low-cost point of care tools such as ultrasound, may provide objectifiable additional data to known clinical findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Registration: &lt;/strong&gt;Clinical trial registration: DRKS (German Clinical Trials Register): \"Neuromodulation by stimulation of cervical afferents in migraine patients - the neurophysiological basis of repetitive peripheral magnetic stimulation (rPMS) in patients with episodic migraine\" ID: DRKS00024470, htt","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"17 ","pages":"11795735251404279"},"PeriodicalIF":2.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Current State of Diagnostics for Neuroimmunological Disorders in Africa.","authors":"Malya Sahu, Mashina Chomba, Fiifi Duodu, Monica M Diaz, Dilraj Sokhi, Deanna Saylor","doi":"10.1177/11795735251385319","DOIUrl":"10.1177/11795735251385319","url":null,"abstract":"<p><p>The epidemiology of neuroimmunological disorders in Africa remains poorly understood. Regional variation in diagnostics and provider knowledge has led to challenges in real-world application of diagnostic criteria. We conducted a cross-sectional survey of clinicians practicing in Africa to characterize the current state of clinical diagnostic resources and developed a clinician-driven prioritized action plan. 130 respondents from 24 out of 54 countries in Africa participated (44% national response rate). Most respondents specialized in neurology (n = 86, 66%) and practiced in an urban setting (n = 84, 65%). While all participating countries had access to a neurologist and ophthalmologist, only half had access to an in-country neuroimmunologist. Three-quarters of respondents had access to an MRI within a 25-kilometer radius with most reporting a maximum magnet strength of 1.5 Tesla (n = 46, 61%). The median cost for an MRI brain was 150 USD, and MRI spine was 160 USD. The most urgent action item selected to improve the timely diagnosis of neuroimmunological conditions was subsidizing the cost of MRI followed by increasing availability of MRI. There were notable gaps in availability of specialists and access to MRI to diagnose neuroimmunological conditions in Africa. Urgent action and regional collaborations focused on addressing MRI cost and availability are needed.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"17 ","pages":"11795735251385319"},"PeriodicalIF":2.8,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12635045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke-Related Changes in Tonic and Phasic Muscle Recruitment During Reaching Reveal Pathway-Specific Motor Deficits.","authors":"Anna S Korol, Amelia Adcock, Valeriya Gritsenko","doi":"10.1177/11795735251394491","DOIUrl":"10.1177/11795735251394491","url":null,"abstract":"<p><strong>Background: </strong>Upper limb motor deficits are common after stroke and often persist despite rehabilitation. While clinical assessments emphasize movement quality, they do not capture the underlying neuromuscular impairments, particularly in individuals with mild deficits. This limits the development of individualized treatment approaches.</p><p><strong>Objectives: </strong>This study aimed to characterize stroke-related changes in muscle recruitment during reaching by separating tonic (gravity-compensating) and phasic (intersegmental dynamics-related) components of EMG activity.</p><p><strong>Design: </strong>Cross-sectional observational study with a comparative design.</p><p><strong>Methods: </strong>We recorded surface EMG from 12 upper limb muscles during goal-directed reaching in 8 individuals with unilateral ischemic stroke, 5 age-matched and 9 young individuals. Using principal component analysis, we extracted tonic and phasic components and compared their amplitude, directional tuning, and coactivation patterns across groups. Group differences were evaluated with generalized linear mixed-effects models, regression, and correlation analyses.</p><p><strong>Results: </strong>Even individuals with mild stroke exhibited abnormal muscle recruitment. Proximal muscles were over-recruited in directions that typically require less activation, indicating altered directional tuning. Phasic activation of distal muscles was significantly reduced and worsened with time post-stroke (R² = 0.52, <i>P</i> = 0.002). Tonic overactivation of proximal muscles was present across all stroke participants. Muscle coactivation patterns were hemisphere-specific: right-hemisphere stroke reduced tonic coactivation in contralateral arms, whereas left-hemisphere stroke increased it. Abnormal phasic coactivation between proximal and distal muscles correlated with impaired intersegmental dynamics compensation (R² = 0.67, <i>P</i> = 0.013). Tonic and phasic impairments were often correlated, suggesting shared disruption of corticospinal and reticulospinal pathways.</p><p><strong>Conclusion: </strong>These findings reveal distinct yet interacting deficits in tonic and phasic muscle recruitment following stroke, including persistent overactivation of proximal muscles for antigravity support and reduced phasic activation of distal muscles. These results suggest that individualized rehabilitation strategies should address both inefficient gravitational support and impaired intersegmental coordination to reduce post-stroke muscle overactivation and improve movement efficiency.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"17 ","pages":"11795735251394491"},"PeriodicalIF":2.8,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12612532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retroclival Epidural Hematoma in Pediatric Head Trauma: A Case Report and Comprehensive Literature Review.","authors":"Christopher Lauren, Ida Bagus Gede Adiguna Wibawa, I Gusti Ketut Agung Surya Kencana, Maria Monica, Denny Japardi, Bagus Dwiki Arya Dharma, Joshua Sutikno, Tiffany Tiffany, Ian Adrianto Limansyah, Made Ratna Dewi, Made Gemma Daniswara Maliawan, Tjokorda Gde Bagus Mahadewa","doi":"10.1177/11795735251391910","DOIUrl":"10.1177/11795735251391910","url":null,"abstract":"<p><p>Retroclival epidural hematoma (EDH) is a rare form of intracranial hemorrhage located between the clivus and the dura mater, predominantly affecting pediatric patients due to the anatomical vulnerability of the craniocervical junction. This case report describes a 4-year-old boy involved in a motorcycle accident who presented with facial trauma and was found to have a retroclival EDH and multiple mandibular fractures. Despite the hematoma measuring 8.7 mm in thickness and 3 cc in volume, the patient remained neurologically intact with a Glasgow Coma Scale of 15. He underwent surgical repair for the mandibular fractures while the retroclival EDH was managed conservatively. The patient recovered fully without neurological deficits at follow-ups extending to 6 months. A comprehensive literature review reveals that retroclival EDH in children is commonly associated with high-energy trauma such as motor vehicle accidents and often results from tectorial membrane stripping injury. While clinical presentations vary, many cases, like the one described, show minimal neurological signs despite the presence of significant hematomas, emphasizing the importance of high clinical suspicion and appropriate neuroimaging. Computed tomography is the initial diagnostic tool, but magnetic resonance imaging is superior for identifying associated ligamentous injuries and differentiating from subdural hematomas. Most pediatric retroclival EDH cases are managed conservatively with excellent outcomes, reserving surgical intervention for cases involving brainstem compression or craniocervical instability. This report reinforces the favorable prognosis of isolated retroclival EDH in neurologically stable pediatric patients and underscores the critical role of imaging and clinical vigilance in trauma assessment.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":"17 ","pages":"11795735251391910"},"PeriodicalIF":2.8,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12612517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}