Neurology. Clinical practice最新文献

{"title":"A Qualitative Analysis of Physician Communication During Brain Death Conversations: Dead With a Heartbeat.","authors":"Anoushka Rao, Jason X Shen, Paul Graham Fisher, David Magnus","doi":"10.1212/CPJ.0000000000200484","DOIUrl":"10.1212/CPJ.0000000000200484","url":null,"abstract":"<p><strong>Background and objectives: </strong>In recent decades, many legal cases have resulted from physicians ineffectively communicating to a family that their loved one is brain dead (brain dead/death by neurologic criteria [BD/DNC]). Although the definition of BD/DNC has recently undergone revision, little research has been conducted to establish optimal approaches in communicating BD/DNC status to families. The aim of this study was to characterize what highly experienced physicians perceive to be the best communication practices and language choices during BD/DNC conversations.</p><p><strong>Methods: </strong>In this qualitative study, we conducted semistructured, in-depth interviews with physician leaders in the field of BD/DNC between September 2023 and January 2024. All interviews were conducted through Zoom. Twenty expert physician participants were recruited from multiple institutions across the United States through convenience sampling. Participants were current or former attending physicians whose practices at academic institutions involved communication with families about BD/DNC in either the pediatric or adult setting. Participants completed a Qualtrics form containing questions about their demographic background and practice characteristics, including an estimate of the number of times they communicated BD/DNC to patient families. Semistructured interviews were conducted with each of the participants and included hypothetical scenarios and views about best practices.</p><p><strong>Results: </strong>Using 20 qualitative interview transcripts, we identified multiple areas of agreement and disagreement among expert physicians regarding best practices in communicating BD/DNC status. While physicians concurred on specific language to use and avoid, they differed on whether to use the word \"coma,\" on when to introduce the possibility of brain death, and on whether to analogize with cardiac death. There was strong agreement on the utility of visualization through imaging and family attendance at BD/DNC testing. Finally, physicians were in consensus that multiple family meetings with the same providers are crucial for successful BD/DNC communication.</p><p><strong>Discussion: </strong>This study described main convergences and divergences in physician language during BD/DNC conversations and used qualitative data to present a \"train journey\" theory of ideal physician communication with families. By investigating and improving physician communication styles during BD/DNC conversations, the medical community may ameliorate the legal and medical fallout that results from clinical miscommunication.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200484"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285779","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 Impact of Social Determinants of Health on Morbidity and Mortality Outcomes in Patients With Intracerebral Hemorrhage: Nationwide Study.","authors":"Tatiana Abou-Mrad, Syed Ibad Khalid, Pranav Mirpuri, Fady T Charbel","doi":"10.1212/CPJ.0000000000200494","DOIUrl":"10.1212/CPJ.0000000000200494","url":null,"abstract":"<p><strong>Background and objectives: </strong>Understanding the impact of social determinants of health (SDoH) on clinical outcomes in conditions such as intracerebral hemorrhage (ICH) is crucial for enhancing patient management and improving health policy. The aim of this study was to assess the impact of SDoH on the prognosis and clinical outcomes of patients with ICH.</p><p><strong>Methods: </strong>This retrospective study used the MARINER165 national administrative database, encompassing medical and surgical claims from January 2010 to October 2022. It adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Patients with ICH were identified using International Classification of Diseases and Current Procedural Terminology codes. Propensity score matching generated 2 cohorts based on SDoH presence. Primary outcomes focused on functional status at 30 days and survival rates at 90 days and 1 year. Functional outcomes included the rates of tracheostomy and gastronomy tube placement, wheelchair dependency, mobility scores, and readmission within 30 days after ICH. Kaplan-Meier survival analysis was used to determine survival rates at 90 days and 1 year after index event. A significance level of <i>p</i> < 0.05 was applied.</p><p><strong>Results: </strong>A total of 481,754 patients with ICH were included, with 240,877 individuals in each cohort after matching. Gender distribution was balanced (50.5% female), and common comorbidities included hypertension (89%), depression (47%), and diabetes mellitus (45%). The SDoH group demonstrated pronounced disparities in food security (87%), social integration (14.2%), and physical environment (8.3%). At 30 days, this group experienced worse functional outcomes with higher rates of tracheostomy (2% vs 0.9%, <i>p</i> < 0.001) and G-tube placement (3.2% vs 1.5%, <i>p</i> < 0.001), increased wheelchair dependency (3.2% vs 2.5%, <i>p</i> < 0.001), and lower mobility scores (3.5 vs 2.7, <i>p</i> < 0.001), alongside higher readmission rates (9.8% vs 6.2%, <i>p</i> < 0.001). Despite these challenges, the SDoH cohort demonstrated better survival rates at both 90 days (78.1% vs 72.6%, <i>p</i> < 0.001) and 1 year (62.1% vs 57.6%, <i>p</i> < 0.001).</p><p><strong>Discussion: </strong>This study underscores significant disparities in functional outcomes and survival rates associated with SDoH among patients with ICH. It highlights the paradox where individuals with SDoH, despite facing greater health-related challenges and higher readmission rates, tend to survive longer. Integrating socioeconomic factors into patient management strategies is crucial for addressing these differences and improving overall health care outcomes.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200494"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528937","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":"Community Disadvantage Is Associated With More Severe Motor Symptoms in Parkinson Disease.","authors":"Emily J Hill, Samuel Blaise Marcucci, Kelly DeLano, Jesus Abanto, Russell P Sawyer, Luca Marsili, Kevin R Duque, Qin Sun, Daniel Woo, Carl D Langefeld, Deborah A Hall, Dawn Skirpan, Nathaly Chinchihualpa Paredes, Cynthia Spikes, Deepa Agrawal Bajaj, Nathan Gregor, Shea Stivers, Abhimanyu Mahajan, Jessica G Woo, Alberto J Espay","doi":"10.1212/CPJ.0000000000200506","DOIUrl":"10.1212/CPJ.0000000000200506","url":null,"abstract":"<p><strong>Background and objectives: </strong>The relationship between socioeconomic factors and Parkinson disease (PD) is unclear. Previous literature suggests a potential disconnect between the effect of socioeconomic status (SES) on PD risk and severity. A recent study found that people with PD in the United States were more likely to come from well-resourced communities. Multiple possible explanations were proposed, including that lower SES could be protective against PD risk. Other studies have found worsened PD symptoms and outcomes associated with lower individual SES. If environmental factors associated with lower SES influence PD biology in a way that worsens symptoms, those processes should also increase PD risk. We set out to determine whether community disadvantage, rather than individual SES, is associated with motor or cognitive symptom severity in PD and atypical parkinsonisms.</p><p><strong>Methods: </strong>Community disadvantage was defined using the Material Community Deprivation Index, a compound score of multiple poverty markers. In our Cincinnati Cohort Biomarkers Program, a cohort that includes PD and atypical parkinsonisms, we tested for associations between community disadvantage and motor symptom severity (Movement Disorders Society Unified PD Rating Scale part III; MDS-UPDRS III), motor disability (Hoehn and Yahr stage [HY]), and cognition (Montreal Cognitive Assessment [MoCA]). We considered age, sex, disease duration, levodopa equivalent daily dose, education years, and race as covariates in multiple regression analyses.</p><p><strong>Results: </strong>A total of 565 people with PD or atypical parkinsonisms were included (458 idiopathic PD and 107 atypical parkinsonisms). Their mean age was 69 years, and 65% were men. The mean disease duration was 7 years, and the mean MDS-UPDRS III score was 30. The majority (75%) were HY stage 2, and the mean cognitive screening score was nondemented (MoCA 25/30). Worse community disadvantage was significantly associated with worse MDS-UPDRS III score (β 1.58, <i>p</i> = 0.01; adjusted for age, sex, and disease duration) and HY stage (OR 1.27, <i>p</i> = 0.04, adjusted for age, sex, disease duration, and education years). Community disadvantage was not significantly associated with MoCA score (<i>p</i> = 0.45).</p><p><strong>Discussion: </strong>Community disadvantage was associated with worse motor symptom severity and motor disability in PD, suggesting that there are modifiable social and environmental factors that can affect parkinsonian symptom severity.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200506"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528931","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":"Let Our Patients Sleep: A Plea for Common Sense.","authors":"Barbara C Jobst","doi":"10.1212/CPJ.0000000000200515","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200515","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200515"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12253962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626771","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":"Understanding Racial and Ethnic Disparities in Myasthenia Gravis Outcomes: EXPLORE-MG Registry Experience.","authors":"Nilay P McLaren, Bhaskar Roy, Richard J Nowak","doi":"10.1212/CPJ.0000000000200503","DOIUrl":"10.1212/CPJ.0000000000200503","url":null,"abstract":"<p><strong>Background and objectives: </strong>Past studies have reported racial and ethnic differences in patients with myasthenia gravis (MG) but either are over a decade old or only examine small samples. To better understand these differences, using the EXPLORE-MG registry, we conducted a retrospective cohort study of racial and ethnic differences in the characteristics and long-term outcomes of patients with MG.</p><p><strong>Methods: </strong>Patients with a diagnosis of MG confirmed by one or more of the assessments such as antibody seropositivity, positive single-fiber electromyography, or decremental repetitive nerve stimulation between January 2001 and October 2023 were included in the analysis. For logistic regression models, we performed a complete case analysis, therefore excluding patients with unknown age at onset or history of thymoma. Only patients with 2 years of follow-up data were included in the long-term outcome analysis.</p><p><strong>Results: </strong>Of 594 study participants, the clinical features of 473 White, 48 African American (AA), 42 Hispanic, and 523 non-Hispanic patients were compared. Hispanic patients (mean age 41.5 ± 20.3 years vs 58.9 ± 19.9 years; <i>p</i> < 0.001) were significantly younger at onset compared with non-Hispanic patients, and AA patients were significantly younger at onset compared with White patients (mean age 38.6 ± 17.1 years vs 60.7 ± 19.4 years; <i>p</i> < 0.001). AA patients underwent thymectomy more frequently (63.6% vs 29.5%; <i>p</i> < 0.001) compared with White patients. After adjusting for covariates, AA patients were approximately 3 times more likely to experience hospitalization for MG crisis or exacerbation compared with White patients (odds ratio 2.77; 95% CI 1.19-6.50; <i>p</i> = 0.018).</p><p><strong>Discussion: </strong>Despite variations in disease severity and clinical profiles, long-term outcomes of patients did not differ. Our findings identify the areas of MG care that vary across racial and ethnic groups, which should be further addressed by clinicians.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200503"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529017","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":"Changes of a Cerebral Cavernous Malformation Associated With Lecanemab Therapy in a Patient With Alzheimer Disease.","authors":"Nicholas U Schwartz, Connor D Dietz, Igor Prufer Araújo, Javier E Villanueva-Meyer, Winston Chiong, Courtney Lane-Donovan, Lawren Vandevrede, Peter A Ljubenkov, Yingbing Wang, David N Soleimani-Meigooni, Renaud La Joie, Julio C Rojas","doi":"10.1212/CPJ.0000000000200508","DOIUrl":"10.1212/CPJ.0000000000200508","url":null,"abstract":"<p><strong>Background and objectives: </strong>Antiamyloid immunotherapies are associated with increased risk of intracerebral hemorrhage, particularly in the setting of <i>APOE</i>-ε4 carriership, anticoagulation, thrombolytics, and other lesions at risk of hemorrhagic conversion. It is not known whether patients with cavernous malformations are at increased risk of complication because patients with these lesions were excluded from clinical trials.</p><p><strong>Methods: </strong>We describe a case of a patient with Alzheimer disease (AD) with an incidental cavernous malformation treated with lecanemab.</p><p><strong>Results: </strong>A 73-year-old <i>APOE</i> ε4 heterozygous woman with mild cognitive impairment and CSF biomarker evidence of AD underwent treatment with intravenous lecanemab. Baseline MRI revealed 3 lobar microhemorrhages and an asymptomatic left orbitofrontal cavernous malformation. This cavernous malformation exhibited gross radiologic stability at surveillance brain MRI before the 5th and 7th infusions, but on surveillance MRI after infusion 13 exhibited an asymptomatic increase in size with subacute blood products without additional new amyloid-related imaging abnormalities (ARIA), resulting in treatment discontinuation.</p><p><strong>Discussion: </strong>Lecanemab therapy was associated with asymptomatic expansion of an incidental cavernous malformation in a patient with AD and without evidence of ARIA.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200508"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528930","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":"Provider Experiences With Systematically Administered Patient-Reported Outcome Measures in Multiple Sclerosis: A Qualitative Sub-Study.","authors":"Nathan Y Chu, Aila Jamali, Yazid N Al Hamarneh, Kaitlyn E Watson, Ross T Tsuyuki, Penelope S Smyth","doi":"10.1212/CPJ.0000000000200486","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200486","url":null,"abstract":"<p><strong>Background and objectives: </strong>There has been interest in using patient-reported outcome measures (PROMs) to capture and systematically assess patients' perceptions of their multiple sclerosis (MS) experience and feed this information back to the clinician, but PROMs are not routinely used in MS outpatient clinics. We explored the perspectives of providers caring for persons with MS (PwMS) on the integration of PROMs into clinical practice.</p><p><strong>Methods: </strong>This was a qualitative substudy of a separate randomized controlled trial (ClinicalTrials.gov: NCT0497954) examining the effect of PROM use on depression and anxiety levels in PwMS. We conducted semistructured interviews with 10 providers caring for participants enrolled in the study and explored their experiences using PROMs with PwMS. Thematic analysis through a mixed inductive and deductive approach was performed using verbatim interview transcriptions.</p><p><strong>Results: </strong>Seven neurologists, 2 specialty MS nurse practitioners, and 1 MS registered nurse were interviewed. Providers expressed several facilitating factors with PROM usage, including engaging with patient-specific symptoms, initiating patient goal setting, and improving visit efficiency and patient satisfaction. However, providers also expressed barriers such as clinical workflow disruptions and technological barriers, skepticism toward the validity of results, and moral/ethical obligations to information gained from PROMs. Future opportunities elicited were the introduction of previsit PROMs and direct integration of PROMs into the electronic health record.</p><p><strong>Discussion: </strong>From an MS provider's perspective, PROMs offer useful information but barriers continue to exist. PROMs have promise as an adjunct tool in the care of PwMS to optimize their functioning and experiences as health care system users, and these results may inform future strategic implementation of routine PROMs in MS clinics.</p><p><strong>Trial registration information: </strong>This trial was registered on July 28, 2021, at the NIH United States National Library of Medicine, ClinicalTrials.gov. Clinical Trial ID: NCT04979546.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200486"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12253963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626773","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":"Use of an Electronic Medical Record Alert to Prevent Iatrogenic Interventions in Patients With Psychogenic Nonepileptic Seizures.","authors":"Serena Yin, Lydia Wolkiewicz, Bichun Ouyang, Adriana Bermeo-Ovalle","doi":"10.1212/CPJ.0000000000200457","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200457","url":null,"abstract":"<p><strong>Background and objectives: </strong>Seizures are a common presentation to the emergency department and the hospital setting. Psychogenic or functional seizures are often misdiagnosed as epileptic seizures or status epilepticus, and patients are subject to aggressive interventions including sedation, intubations, and prolonged hospital admissions. An electronic medical record (EMR) best practice alert (BPA) was implemented in 2016 for all patients with a confirmed diagnosis of psychogenic nonepileptic seizures (PNES) at Rush University Medical Center. It informs health care providers of the diagnosis and provides education on interacting with the patient's chart. This study evaluates the effectiveness of an EMR BPA in preventing iatrogenic interventions for patients with a diagnosis of PNES.</p><p><strong>Methods: </strong>A retrospective chart review was performed on all patients who presented to Rush University Medical Center between January 2017 and December 2019 and had a PNES BPA triggered. Data on emergency department (ED) visits and inpatient admissions for these patients from the year before and the year after the first BPA trigger were compared. A Wilcoxon signed-rank test and McNemar test were used for analysis.</p><p><strong>Results: </strong>A PNES BPA was triggered in 178 patients. One hundred and forty-three (80%) were female. The mean age was 41 (18-81) years. There was a decrease in the number of ED visits; hospital admissions; intensive care unit (ICU) admissions; and interventions such as intubations and rescue benzodiazepine use in the year after the BPA was first triggered compared with the previous year (<i>p</i> < 0.05). No adverse events were identified in relation to the BPA.</p><p><strong>Discussion: </strong>This study demonstrates that the use of an EMR BPA can be safe and effective in preventing potential iatrogenic interventions and reducing acute health care utilization in patients with PNES. These BPAs can also be used as an educational tool to communicate the presentation, risks, and needs of these patients within the hospital setting.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200457"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021247","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":"Grounded in Evidence.","authors":"Lyell K Jones","doi":"10.1212/CPJ.0000000000200470","DOIUrl":"10.1212/CPJ.0000000000200470","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200470"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780654","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":"Prevention of Cerebrovascular Emergencies in Spaceflight: A Review and a Proposal for Enhanced Medical Screening Guidelines.","authors":"Mark J Rosenberg, Brian F Saway, William J Tarver, James H Pavela, Jacob Hall, Sami Al Kasab, Guilherme Porto, Donna R Roberts","doi":"10.1212/CPJ.0000000000200445","DOIUrl":"10.1212/CPJ.0000000000200445","url":null,"abstract":"<p><strong>Purpose of review: </strong>A growing number of opportunities for paying customers to travel to space are becoming available. Preflight medical screening of these potential private astronauts will likely be performed by local physicians, with referral to specialists in aerospace medicine as required for more in-depth evaluation before flight qualification. Neurologic concerns contribute a portion of the potential medical risks for these private astronauts, especially with the participation of more diversified crews than traditional governmental astronauts. The objective of this article was to review the current knowledge base concerning cerebrovascular adaptation to spaceflight to inform risk factor assessment for flight-associated cerebrovascular emergencies by the neurologic community when performing initial medical screening of potential private astronauts.</p><p><strong>Recent findings: </strong>A review of published human spaceflight studies and medical guidelines regarding cerebrovascular risks for spaceflight was conducted. Most of the available literature describes cohorts of a small number of astronauts undergoing spaceflight missions of various flight profiles. While there are gaps in the literature, cerebrovascular adaptation to spaceflight occurs, which may alter the medical risk profile in susceptible individuals. The occurrence of an inflight cerebrovascular emergency could have devastating consequences; therefore, additional screening tests may be required, based on risk level and mission profile, in assessing the more diverse commercial spaceflight population expected over the next decade.</p><p><strong>Summary: </strong>With increasing interest in commercial space tourism among diverse participant populations, the stroke risk in microgravity/reduced gravity environments is unknown. Furthermore, stresses of rocket ascent/descent, abnormal fluid dynamics in microgravity, altered atmospheric conditions, and other unknown occupational hazards add additional complexity. Because inflight emergency management protocols have yet to be developed, the most effective tool to ensure spaceflight participant safety is comprehensive preflight preventative screenings. Determining neurologic risk factors is critical for developing evidence-based guidelines for preventative measures and treatment protocols in the future.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200445"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780660","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}