Journal of the Neurological Sciences最新文献

{"title":"Headache attributed to transient ischemic attack: Assessment of its characteristics, associated factors and considerations on the diagnostic criteria","authors":"Pedro A. Sampaio Rocha-Filho ,&nbsp;Felipe A.A. de Oliveira","doi":"10.1016/j.jns.2024.123350","DOIUrl":"10.1016/j.jns.2024.123350","url":null,"abstract":"<div><h3>Background</h3><div>Between 10 % and 36 % of patients with transient ischemic attack present with headache. Little is known regarding the characteristics of this headache.</div></div><div><h3>Objectives</h3><div>To assess the frequency of headache attributed to transient ischemic attack, its characteristics, and its associated factors, and whether the third edition of the International Classification of Headache Disorders criteria are adequate for diagnosing this headache.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study that included patients consecutively admitted within 72 h of the onset of transient ischemic attack. A semi-structured questionnaire was used and all patients underwent magnetic resonance imaging.</div></div><div><h3>Results</h3><div>A total of 44 patients with a median age of 66 years (P₂₅₋ P₇₅: 59.5–77) were included in the study, of whom 55 % were male. The frequency of headache attributed to transient ischemic attack was 34.1 % (95 % CI: 20.5–49.9 %), and the most common characteristics were insidious onset (67 %), often after focal neurological symptoms (47 %), was bilateral (60 %), of moderate intensity, with a pattern similar to tension-type headache (67 %). One patient reported experiencing a thunderclap headache. Headache attributed to transient ischemic attack was not associated with any sociodemographic variables, any previous headaches, or the severity or etiology of transient ischemic attack. Only 13 % of patients with headache met the International Classification of Headache Disorders criteria for headache attributed to transient ischemic attack.</div></div><div><h3>Conclusions</h3><div>There is a high frequency of headache attributed to transient ischemic attack. The current diagnostic criteria for this headache are inadequate for its characteristics.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123350"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic therapy for secondary Stroke prevention in patients with symptomatic large artery atherosclerosis and atrial fibrillation (FIB-CAS study) A single-center experience","authors":"Ghada A. Mohamed ,&nbsp;Ahmad Abu Qdais ,&nbsp;Mckay Hanna ,&nbsp;Evangelos Pavlos Myesrlis ,&nbsp;Maryam Zulfiqar ,&nbsp;Tanya N. Turan","doi":"10.1016/j.jns.2024.123352","DOIUrl":"10.1016/j.jns.2024.123352","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AF) and large artery atherosclerotic diseases are major causes of ischemic stroke and their coexistence increases the risk of stroke and mortality. Research on antithrombotic strategies for AF patients with symptomatic large artery atherosclerosis is limited. This study aims to report a single center’s experience regarding the antithrombotic regimens prescribed for this population and the association with stroke recurrence and hemorrhagic events.</div></div><div><h3>Methodology</h3><div>This retrospective cohort study included AF patients admitted to the Medical University of South Carolina with stroke due to symptomatic intracranial (sICAS) or extracranial atherosclerosis (sECAS). Patients were grouped based on prescribed antithrombotic regimens and compared according to their outcomes.</div></div><div><h3>Results</h3><div>Of 1,924 ischemic stroke patients with AF, 114 (6%) met the inclusion criteria. At discharge, the majority of patients were prescribed anticoagulants alone (sAC) or combined with a single antiplatelet (sAC + sAP) 26% and 34% respectively. Stroke recurrence was highest during the first 90-days after index stroke (11%). Patients on combination sAC + sAP had fewer recurrent strokes in the first 90-days compared to sAC (5.5% vs. 22.2%,p = 0.056) without significant increase in symptomatic hemorrhagic events (5.5% vs. 3.7%, <strong>p</strong> = 0.6). However the hemorrhagic risk significantly increased with prolonged therapy beyond 90-days (18% vs. 0%,p = &lt;0.02). Early deaths were also high with 37% of total deaths occurring within 90-days after index stroke.</div></div><div><h3>Conclusion</h3><div>In this cohort, AF patients with stroke due to sICAS or sECAS had early stroke recurrence and mortality. While combination AC + sAP may reduce short-term stroke recurrence they may increase the hemorrhagic risk in the long-term.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123352"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable machine learning on clinical features to predict and differentiate Alzheimer's progression by sex: Toward a clinician-tailored web interface","authors":"Fabio Massimo D'Amore ,&nbsp;Marco Moscatelli ,&nbsp;Antonio Malvaso ,&nbsp;Fabrizia D'Antonio ,&nbsp;Marta Rodini ,&nbsp;Massimiliano Panigutti ,&nbsp;Pierandrea Mirino ,&nbsp;Giovanni Augusto Carlesimo ,&nbsp;Cecilia Guariglia ,&nbsp;Daniele Caligiore","doi":"10.1016/j.jns.2024.123361","DOIUrl":"10.1016/j.jns.2024.123361","url":null,"abstract":"<div><div>Alzheimer's disease (AD), the most common neurodegenerative disorder world-wide, presents sex-specific differences in its manifestation and progression, necessitating personalized diagnostic approaches. Current procedures are often costly and invasive, lacking consideration of sex-based differences. This study introduces an explainable machine learning (ML) system to predict and differentiate the progression of AD based on sex, using non-invasive, easily collectible predictors such as neuropsychological test scores and sociodemographic data, enabling its application in every day clinical settings. The ML model uses SHapley Additive explanations (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) to provide clear insights into its decision-making, making complex outcomes easier to interpret. The system includes a user-friendly graphical interface designed in collaboration with clinicians, supporting its integration into medical practice. The study extends the cohort to include healthy and Mild Cognitive Impairment subjects, aiming to support early diagnosis in AD pre-clinical stages. The ML system was trained on a large dataset of 2407 subjects from the ADNI open dataset, enhancing its robustness and applicability. By focusing on sex-specific features and utilizing longitudinal data, the system aims to improve prediction accuracy and early detection of AD, ultimately advancing personalized diagnostic and therapeutic approaches. Key findings highlight the significance of the Mini-Mental State Examination, Rey Auditory Verbal Learning Test, Logical Memory - Delayed Recall, and educational attainment in AD diagnosis and progression, with sex-based disparities. Despite performance metrics based on precision, recall, and weighted F1-score demonstrating model efficacy, future research should address the limitations of relying on a single dataset.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123361"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895959","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":"Faster and better than a physician?: Assessing diagnostic proficiency of ChatGPT in misdiagnosed individuals with neuromyelitis optica spectrum disorder","authors":"Kevin Shan ,&nbsp;Mahi A. Patel ,&nbsp;Morgan McCreary ,&nbsp;Tom G. Punnen ,&nbsp;Francisco Villalobos ,&nbsp;Lauren M. Tardo ,&nbsp;Lindsay A. Horton ,&nbsp;Peter V. Sguigna ,&nbsp;Kyle M. Blackburn ,&nbsp;Shanan B. Munoz ,&nbsp;Katy W. Burgess ,&nbsp;Tatum M. Moog ,&nbsp;Alexander D. Smith ,&nbsp;Darin T. Okuda","doi":"10.1016/j.jns.2024.123360","DOIUrl":"10.1016/j.jns.2024.123360","url":null,"abstract":"<div><h3>Background</h3><div>Neuromyelitis optica spectrum disorder (NMOSD) is a commonly misdiagnosed condition. Driven by cost-consciousness and technological fluency, distinct generations may gravitate towards healthcare alternatives, including artificial intelligence (AI) models, such as ChatGPT (Generative Pre-trained Transformer). Our objective was to evaluate the speed and accuracy of ChatGPT-3.5 (GPT-3.5) in the diagnosis of people with NMOSD (PwNMOSD) initially misdiagnosed.</div></div><div><h3>Methods</h3><div>Misdiagnosed PwNMOSD were retrospectively identified with clinical symptoms and time line of medically related events processed through GPT-3.5. For each subject, seven digital derivatives representing different races, ethnicities, and sexes were created and processed identically to evaluate the impact of these variables on accuracy. Scoresheets were used to track diagnostic success and time to diagnosis. Diagnostic speed of GPT-3.5 was evaluated against physicians using a Cox proportional hazards model, clustered by subject. Logistical regression was used to estimate the diagnostic accuracy of GPT-3.5 compared with the estimated accuracy of physicians.</div></div><div><h3>Results</h3><div>Clinical time lines for 68 individuals (59 female, 42 Black/African American, 13 White, 11 Hispanic, 2 Asian; mean age at first symptoms 34.4 years (y) (standard deviation = 15.5y)) were analyzed and 476 digital simulations created, yielding 544 conversations for analysis. The instantaneous probability of correct diagnosis was 70.65% less for physicians relative to GPT-3.5 within 240 days of symptom onset (<em>p</em> &lt; 0.0001). The estimated probability of correct diagnosis for GPT-3.5 was 80.88% [95% CI = (76.35%, 99.81%)].</div></div><div><h3>Conclusion</h3><div>GPT-3.5 may be of value in recognizing NMOSD. However, the manner in which medical information is conveyed, combined with the potential for inaccuracies may result in unnecessary psychological stress.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123360"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The real-world safety assessment of Siponimod: A systematic analysis based on the FAERS database","authors":"Ying Jiang,&nbsp;Rongrong Lu,&nbsp;Zhiqiang Du,&nbsp;Yuan Shen,&nbsp;Qin Zhou,&nbsp;Peipei Luan,&nbsp;Haohao Zhu","doi":"10.1016/j.jns.2024.123364","DOIUrl":"10.1016/j.jns.2024.123364","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123364"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrete event simulation model of an acute stroke treatment process at a comprehensive stroke center: Determining the ideal improvement strategies for reducing treatment times","authors":"Gizem Koca ,&nbsp;John Blake ,&nbsp;Gordon Gubitz ,&nbsp;Noreen Kamal","doi":"10.1016/j.jns.2024.123369","DOIUrl":"10.1016/j.jns.2024.123369","url":null,"abstract":"<div><h3>Background</h3><div>Fast treatment is crucial for ischemic stroke patients; the probability of good patient outcomes increases with faster treatment. Treatment times can be improved by making changes to the treatment process. However, it is challenging to identify the benefits of changes prior to implementation. Simulation modelling, which mimics the treatment process, can be used to evaluate changes without patient involvement. This study models the acute stroke treatment process using discrete event simulation (DES) and identifies improvement strategies to reduce treatment times.</div></div><div><h3>Method</h3><div>The model was developed for a comprehensive stroke center in Nova Scotia, using Python. All treatment pathways and sub-tasks were identified via an observational time and motion study conducted in the center. Nine process change scenarios were tested individually and in combinations. The primary outcome measures were door-to-CT time (DTCT), door-to-needle time (DNT), and door-to-groin puncture time (DGPT). The model simulated 500 patients 30 times.</div></div><div><h3>Results</h3><div><em>Collecting patient history on the way to the radiology department (rather than in ED)</em> showed the highest reduction among individual scenarios for DTCT (14.2 vs 12.4 min, <em>p</em> &lt; 0.001). Combining all scenarios in the door-to-CT process resulted in a reduction of the DTCT by approximately 28 %. <em>Thrombolysing patients in the imaging department's waiting area</em> resulted in the lowest DNT (39.4 vs 34.8 min, <em>p</em> &lt; 0.001) among all individual scenarios. The highest reduction in DGPT, among all individual scenarios, was achieved by implementing <em>Rapid angiosuite preparation</em> (67.7 vs 51.4 min, <em>p</em> &lt; 0.001). The combinations of all scenarios resulted in the lowest DTCT (14.2 vs 10.1 min, <em>p</em> &lt; 0.001), DNT (39.4 vs 23.0 min, p &lt; 0.001), and DGPT (67.9 vs 38.5 min, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The study identified various improvement strategies in the acute stroke treatment process through a discrete-event simulation model. Combining all scenarios resulted in significant reductions for all outcome measures.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123369"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915241","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":"Cervical lower motor neuron syndromes: A diagnostic challenge","authors":"Andrea Fortuna,&nbsp;Gianni Sorarù","doi":"10.1016/j.jns.2024.123357","DOIUrl":"10.1016/j.jns.2024.123357","url":null,"abstract":"<div><div>Cervical lower motor neuron (LMN) syndromes, also known as brachial paresis, are characterized by muscle atrophy, weakness, and decreased reflexes in the upper limbs, devoid of sensory symptoms. These syndromes can stem from various factors, including degenerative conditions, immune-mediated diseases, infections, toxic exposures, metabolic disorders, and vascular anomalies.¹ Clinical presentations vary, with motor neuron involvement potentially limited to the cervical area or extending to other regions, affecting prognosis.</div><div>Misdiagnosis is a significant issue, particularly in lower motor neuron presentations, with an error rate nearing 20 %.² This review proposes a classification system based on magnetic resonance imaging (MRI) findings, the onset timing of symptoms (acute, subacute, or chronic), the symmetry and distribution of atrophy, and the etiology (sporadic or hereditary). Acute conditions may include spinal ischemia,³ whereas subacute or chronic forms can manifest as symmetric (e.g., cervical spondylogenic myelopathy)⁴ or asymmetric (e.g., Hirayama disease)⁵ presentations.</div><div>Neurophysiological assessments and cervical MRI are crucial for accurate diagnosis, as they reveal patterns that provide lesion localization and additional clues to the underlying cause. A systematic diagnostic approach is essential for navigating the complexities of these syndromes.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123357"},"PeriodicalIF":3.6,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and care practices for rare neurologic diseases among senior neurologists: A global survey","authors":"Dae-Gyu Jang ,&nbsp;Antonio Federico ,&nbsp;Masha G. Savelieff ,&nbsp;Wolfgang Grisold ,&nbsp;Michelangelo Mancuso ,&nbsp;Maria J. Molnar ,&nbsp;Eva L. Feldman ,&nbsp;Evan L. Reynolds ,&nbsp;on behalf of the World Federation of Neurology Subspecialist Group on Rare Neurologic Diseases","doi":"10.1016/j.jns.2025.123395","DOIUrl":"10.1016/j.jns.2025.123395","url":null,"abstract":"<div><h3>Objective</h3><div>Rare neurologic diseases (RNDs) are difficult to diagnose and treat due to their low prevalence and complex nature. This survey evaluated awareness and current care status of RNDs among esteemed neurologists affiliated with the World Federation of Neurology (WFN).</div></div><div><h3>Methods</h3><div>A 34-question survey was distributed to renowned neurologists, including delegates from national neurology societies in the WFN Assembly, various WFN committees, and members of the Rare Neurologic Diseases Specialist group. Responses were stratified by geographical regions, including Africa, the Americas, Asia/Oceania, and Europe, and into four income groups based on the World Bank Indicator. Descriptive statistics summarized responses, stratified by geographical regions or income groups, and significant differences were assessed by Fisher's exact test.</div></div><div><h3>Results</h3><div>Of 190 invited neurologists, 64 responded (34 % response rate). Among respondents, 89 % agreed that RND patients should receive timely and effective care on par with more common neurological conditions. Additionally, 77 % of respondents overall thought most RNDs could be accurately diagnosed in their country. However, there were significant differences in the perceived ability of respondents' country of practice to diagnose RNDs by region, specifically in Africa (25 %), and by income of country of practice, specifically in the lower-income group (17 %).</div></div><div><h3>Conclusions</h3><div>This global survey highlights varying RND diagnosis and care by country socioeconomic status, suggesting potential disparities in resources and preparedness. To improve outcomes and quality-of-life for RND patients, efforts should focus on improving diagnostic capabilities, fostering collaboration among neurology centers, and promoting education on the unique challenges and treatment options of RNDs.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"470 ","pages":"Article 123395"},"PeriodicalIF":3.6,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo imaging markers of glymphatic dysfunction in amyotrophic lateral sclerosis: Analysis of ALPS index and choroid plexus volume","authors":"Yangsean Choi ,&nbsp;Hee-Jae Jung ,&nbsp;Ha-Kyung Jung ,&nbsp;Eunseon Jeong ,&nbsp;Shina Kim ,&nbsp;Ji-Yon Kim ,&nbsp;Eun-Jae Lee ,&nbsp;Young-Min Lim ,&nbsp;Hyunjin Kim","doi":"10.1016/j.jns.2025.123393","DOIUrl":"10.1016/j.jns.2025.123393","url":null,"abstract":"<div><h3>Background</h3><div>The glymphatic system, essential for brain waste clearance, has been implicated in neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). Emerging imaging markers, such as the analysis along the perivascular space (ALPS) index and choroid plexus volume (CPV), may provide insights into glymphatic function, but their relevance to ALS remains unclear.</div></div><div><h3>Objective</h3><div>To assess glymphatic dysfunction in ALS patients using the ALPS index and CPV.</div></div><div><h3>Methods</h3><div>In this prospective single-center study, we analyzed 51 ALS patients and 51 age- and sex-matched healthy controls (HC). The ALPS index was calculated using diffusion tensor imaging, and 3D T1-weighted MRI was used for automated estimation of CPV and its fraction (CPV/total intracranial volume). Diagnostic performance was assessed using area under the receiver operating curve (AUC). Correlations between imaging markers and clinical parameters were also examined.</div></div><div><h3>Results</h3><div>ALS patients had a significantly lower ALPS index (ALS: 1.45 ± 0.15; HC: 1.55 ± 0.16; <em>p</em> = 0.002) and higher CPV fraction (ALS: 0.12 ± 0.04 %; HC: 0.10 ± 0.02 %; <em>p</em> &lt; 0.001). The ALPS index and CPV fraction had AUCs of 0.70 and 0.72, respectively. A significant inverse correlation was observed between the ALPS index and CPV fraction (<em>r</em> = −0.31, <em>p</em> = 0.002). Both markers correlated with aging but not with clinical disability or progression rate.</div></div><div><h3>Conclusion</h3><div>This study identifies glymphatic dysfunction in ALS, as evidenced by changes in the ALPS index and CPV. Larger studies are warranted to validate these findings and assess their potential as biomarkers for ALS.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"469 ","pages":"Article 123393"},"PeriodicalIF":3.6,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic clues in herpes encephalitis following radiation therapy","authors":"Tal Benoliel Berman ,&nbsp;Max Bauer ,&nbsp;Samuel Moscovici ,&nbsp;Alexander Lossos","doi":"10.1016/j.jns.2025.123394","DOIUrl":"10.1016/j.jns.2025.123394","url":null,"abstract":"<div><h3>Introduction</h3><div>Herpes encephalitis is known to affect patients undergoing brain radiotherapy, but early diagnosis and treatment, the foremost determinants of disease outcome, remain challenging in this patient population. This can be due to attribution of symptoms to the brain tumor and radiation side effects, as well as patients' atypical clinical presentation. Here we sought to highlight pearls and pitfalls in the clinical course and diagnostic workup which may facilitate timely diagnosis and improve disease outcome.</div></div><div><h3>Methods</h3><div>Six patients with post radiation herpes encephalitis were identified in a retrospective review of Hadassah Medical Center medical records of between 2007 and 2022. Their clinical course, brain imaging, labs and EEG findings were included in the study.</div></div><div><h3>Results</h3><div>All six patients presented with fever and a confusional state and four had seizures. Lumbar puncture showed mild CSF pleocytosis in two of five patients, and PCR was positive for HSV1 in four out of five. MRI showed typical findings in all patients, though they were misinterpreted in two of six as disease exacerbation. EEG showed non convulsive status epilepticus in three patients. Outcome was favorable in half of patients.</div></div><div><h3>Discussion</h3><div>In patients undergoing radiotherapy to the brain and neck, fever and confusional state accompanied by new onset seizures, seizure exacerbation, changes in seizure lateralization and status epilepticus should lead one to consider a diagnosis of herpes encephalitis. A high index of suspicion, a timely workup and empiric treatment in this patient population can alter disease outcome.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"470 ","pages":"Article 123394"},"PeriodicalIF":3.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029097","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}