Neurological Sciences最新文献

{"title":"Clinical features of cough syncope: a systematic review.","authors":"Yanqin Fan, Meng Hou, Haili Wang, Jingke Le, Liming Cao","doi":"10.1007/s10072-026-09467-6","DOIUrl":"10.1007/s10072-026-09467-6","url":null,"abstract":"<p><strong>Background: </strong>Cough syncope (CS) is a rare subtype of syncope that remains underrepresented in evidence-based medicine. We aimed to characterize the clinical features of CS, with the aim of improving recognition and optimizing management strategies.</p><p><strong>Methods: </strong>We present five cases of CS alongside a systematic review of its clinical characteristics based on published literature to improve recognition and optimize management. Reports of eligible patients were screened, and demographic, clinical, diagnostic, treatment, and outcome data were analyzed.</p><p><strong>Results: </strong>This study included 60 patients with a mean age of 56 ± 15 years, 91% of whom were male. The most common underlying triggers were respiratory diseases, including pulmonary infections (35%) and bronchitis (22%). Common comorbidities included hypertension (26%), bronchial asthma (18%), and diabetes mellitus (15%). CS episodes were directly triggered by severe coughing in 93% (26/28) of patients. Episodes occurred at least twice daily in 20% of patients, and limb convulsions accompanied syncope in 22%. Symptoms improved after treatment in 98% of cases. After a median follow-up of 3.75 months (Interquartile Range: 2-12 months), the recurrence rate of syncope was 11%. CS, predominantly triggered by severe coughing, primarily affected middle-aged and older men.</p><p><strong>Conclusions: </strong>CS predominantly affects middle-aged and older men and is frequently associated with pulmonary infections. Acute pulmonary infections serve as a common underlying trigger for CS, and patients are at risk of recurrent syncope and falls. Disease management should be focused on treating chronic airway disease, particularly chronic obstructive pulmonary disease.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indomethacin testing in suspected paroxysmal hemicrania and hemicrania continua: Clinical phenotypes and response patterns in a tertiary headache centre.","authors":"Antoine Bender, Mirela Muresan, Lauriane Joganah, Eric Salvat","doi":"10.1007/s10072-026-09456-9","DOIUrl":"10.1007/s10072-026-09456-9","url":null,"abstract":"<p><strong>Background: </strong>Indomethacin responsiveness is considered the defining diagnostic feature of hemicrania continua and paroxysmal hemicrania. However, the clinical presentation of indomethacin-responsive headaches is often heterogeneous, and practical guidance regarding which patients should undergo an indomethacin trial, the optimal duration of treatment, and the interpretation of partial responses remains limited.</p><p><strong>Cases: </strong>Eighteen patients underwent an indomethacin trial in our pain centre over the last year, of whom eleven (61%) achieved a positive response. Positive responders included patients ultimately diagnosed with probable or definite hemicrania continua (n = 6); and probable or definite paroxysmal hemicrania (n = 5), including secondary forms. Clinical presentations frequently departed from ICHD-3 criteria. Trigeminal autonomic symptoms were absent in several responders, while migrainous features were common. Attack duration in patients with paroxysmal hemicrania frequently exceeded the 30-min upper limit defined by ICHD-3, and some patients presented with pain characteristics suggestive of neuropathic disorders. The median time to a clinically meaningful response was 13 days for hemicrania continua (range 3-35 days) and 11 days for paroxysmal hemicrania (range 4-23 days). Most patients responded to 150 mg/day, although escalation to 225 mg/day or prolonged treatment exceeding four weeks was occasionally required. Seven patients had negative trials, leading to alternative diagnoses including migraine, cluster headache, SUNA, post-traumatic headache, and idiopathic mandibular neuropathy.</p><p><strong>Conclusions: </strong>This case series illustrates the broad clinical spectrum of indomethacin-responsive headaches and highlights the limitations of relying exclusively on ICHD-3 criteria when selecting patients for an indomethacin trial. Clinical suspicion should remain broad, particularly in patients with strictly unilateral headaches, atypical trigeminal autonomic cephalalgias, or refractory unilateral primary headaches.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pontine warning syndrome successfully managed with acute tirofiban infusion.","authors":"Antonio Esposito, Mariagiovanna Castiglia, Eduardo Gragnano, Fiore Manganelli, Emanuele Spina","doi":"10.1007/s10072-026-09465-8","DOIUrl":"10.1007/s10072-026-09465-8","url":null,"abstract":"","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glymphatic function in humans: indicators, modulators, and measurement strategies.","authors":"Thar Htet Nyan, Hanwook Park, Hyun Jae Baek, Eunkyoung Park, Jaegeol Cho","doi":"10.1007/s10072-026-09463-w","DOIUrl":"10.1007/s10072-026-09463-w","url":null,"abstract":"<p><strong>Purpose: </strong>The glymphatic system is an important pathway for brain waste clearance and is increasingly implicated in neurodegenerative, cerebrovascular, traumatic, and sleep-related disorders. Clinical translation remains challenging because glymphatic function cannot currently be comprehensively or directly quantified in vivo in humans, and assessment relies on heterogeneous measures differing in physiological specificity and measurement directness. This review integrates human glymphatic indicators, physiological modulators, and measurement strategies within a unified framework.</p><p><strong>Methods: </strong>A narrative literature review was conducted using human studies and key foundational research identified through PubMed and Google Scholar. Assessment methods were organized according to the authors' proposed three-domain framework of glymphatic physiology (transport, exchange, and clearance outcome), recognizing that modalities may span multiple domains. Major physiological modulators and confounders were summarized, and measurement strategies were evaluated based on feasibility, reproducibility, and translational applicability.</p><p><strong>Results: </strong>Human glymphatic assessment relies on complementary approaches with different levels of measurement directness, including tracer-informed kinetic MRI; neurofluid proxies such as BOLD-CSF coupling and CSF flow MRI; indirect imaging correlates such as DTI-ALPS and enlarged perivascular spaces; and downstream biological correlates such as CSF solute biomarkers. Measurements can be influenced by sleep, circadian timing, respiration, cardiovascular pulsatility, posture, medications, vascular risk factors, and aging. A domain-first, tiered framework is proposed to support multimodal evaluation and interpretation.</p><p><strong>Conclusion: </strong>The proposed framework organizes multimodal glymphatic-related measures according to physiological domain and measurement directness. Standardized acquisition, harmonized analytical methods, rigorous confounder reporting, and prospective validation may improve reproducibility and support future clinical translation.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 46-year-old man with progressive gait impairment and parkinsonism - when a simple diagnosis does not fit all symptoms.","authors":"Giulia Saccardin, Edoardo Monfrini, Davide Fontanesi, Giulia Di Rauso, Alessio Di Fonzo, Vittorio Rispoli","doi":"10.1007/s10072-026-09461-y","DOIUrl":"10.1007/s10072-026-09461-y","url":null,"abstract":"","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The limits of neuroplasticity - or are there any?","authors":"Katerina Poprelka, Maria Stefanatou, Stylianos Gatzonis","doi":"10.1007/s10072-026-09455-w","DOIUrl":"10.1007/s10072-026-09455-w","url":null,"abstract":"","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic inflammatory response syndrome and adverse outcomes in acute intracerebral hemorrhage: a meta-analysis.","authors":"Lang Bu, Honghua Dai, Hao Du, Yu Fan","doi":"10.1007/s10072-026-09462-x","DOIUrl":"10.1007/s10072-026-09462-x","url":null,"abstract":"<p><strong>Objective: </strong>Systemic inflammatory response syndrome (SIRS) frequently complicates acute intracerebral hemorrhage (ICH) and may affect patient prognosis. However, the prognostic value of SIRS in patients with acute ICH remains controversial. This meta-analysis aimed to assess the prognostic significance of SIRS in this patient population.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Web of Science to identify studies investigating the associations between SIRS and adverse outcomes-namely mortality, poor functional outcome (PFO), and hematoma expansion-in patients with acute ICH. Pooled adjusted odds ratios (OR) with 95% confidence intervals (CI) were synthesized using a random-effects model.</p><p><strong>Results: </strong>Nine studies enrolling a total of 6,976 patients with acute ICH were included. Meta-analyses revealed that patients with acute ICH complicated by SIRS exhibited a substantially higher risk of short-term mortality (OR 2.43; 95% CI 1.48-3.99) relative to patients without SIRS. SIRS was also associated with increased risks of PFO at 3 months (OR 1.47; 95% CI 1.15-1.88) and at 12 months (OR 1.76; 95% CI 1.16-2.68), whereas no significant association was observed for PFO at hospital discharge (OR 2.41; 95% CI 0.69-8.44). Moreover, SIRS was associated with a significantly higher risk of hematoma expansion (OR 2.76; 95% CI 1.68-4.54).</p><p><strong>Conclusions: </strong>The development of SIRS is associated with increased risks of short-term mortality, PFO, and hematoma expansion in acute ICH patients. However, these findings should be considered exploratory due to the limited number of prior studies. Large prospective investigations are needed to validate these results and clarify the potential clinical utility of SIRS assessment.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and MRI morphometric characterization of symptomatic cerebellar tonsillar ectopia.","authors":"Enver I Bogdanov, Aisylu T Faizutdinova, John D Heiss","doi":"10.1007/s10072-026-09453-y","DOIUrl":"10.1007/s10072-026-09453-y","url":null,"abstract":"<p><strong>Background: </strong>Cerebellar tonsils normally extend up to 5 mm below the foramen magnum (FM). Some individuals with tonsillar ectopia (TE) measuring under 5 mm may present with symptoms of Chiari type 1 malformation (CM1). We analyzed MRI data of the posterior cranial fossa (PCF) in affected patients to assess TE's impact on clinical manifestations.</p><p><strong>Methods: </strong>The retrospective study examined 83 adults with 2-4 mm symptomatic cerebellar TE without syringomyelia (SM), 16 with syndromic CM1 without SM, and 19 controls. Participants with TE were divided into three groups: syndromic (TEs, n = 15), incomplete syndromic (TEis, n = 37), and non-syndromic (TEns, n = 31). Cranial MRIs assessed TE, obliterated cisterna magna (CM), and small PCF, along with clinical-radiological correlations.</p><p><strong>Results: </strong>TE and CM1 patients had a smaller PCF on MRI than controls, with obliterated CM found in 53% of TEs and 81% of CM1s. Both syndromic groups (TEs and CM1s) showed more abnormal MRI findings than TEis and TEns. All clinically syndromic cases reported exertion-induced occipital headaches. TEs group exhibited reduced PCF volume and reduced area surrounding the FM compared to TEns and had a smaller inferior outlet area FM than TEis. PCF width and FM inferior outlet area negatively correlated with Chiari-associated symptoms in TE cohort.</p><p><strong>Conclusion: </strong>The study found that patients with TE without SM show clinical symptoms related to small PCF traits and congenital hypoplasia near the FM. In patients with TE under 4 mm, CM1-type symptoms are associated with TE at the FM, a constricted CM, and hypoplasia around the FM.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Familial hypomagnesemia with secondary hypocalcemia: a novel TRPM6 mutation associated with treatment-resistant migraine in a North African family.","authors":"Perini Maria Paola, Cutillo Gianni, Micaglio Emanuele, Benedetti Sara, Dallavilla Tiziano, Zanussi Monica, Rossi Sergio Soeren, Stufano Gianluca, Mazzeo Salvatore, Bombaci Alessandro, Anastasia Luigi, Pappone Carlo, Filippi Massimo, Salsone Maria","doi":"10.1007/s10072-026-09441-2","DOIUrl":"10.1007/s10072-026-09441-2","url":null,"abstract":"<p><strong>Background: </strong>Familial hypomagnesemia with secondary hypocalcemia (HSH) is a rare autosomal recessive disorder caused by TRPM6 loss-of-function variants, leading to impaired magnesium absorption and systemic deficiency. Neurological manifestations are typically dominated by seizures and neuromuscular hyperexcitability, whereas headache manifestations have been less characterized.</p><p><strong>Methods: </strong>We performed a clinical, biochemical, and genetic characterization of a consanguineous Moroccan family with hypomagnesemia. The proband underwent neurological assessment, neuroimaging, and electrophysiological studies. Serum electrolytes were evaluated in available relatives. Genetic testing was conducted using a targeted next-generation sequencing panel, followed by segregation analysis. In silico modeling was used to assess the structural impact of the identified variant.</p><p><strong>Results: </strong>The proband, an 18-year-old woman with lifelong hypomagnesemia, presented with a severe migraine attack associated with paresthesias and muscle cramps. Laboratory findings showed marked hypomagnesemia and hypocalcemia. Oral supplementation was insufficient, whereas intravenous magnesium led to rapid clinical and biochemical normalization. Genetic analysis identified a novel homozygous TRPM6 frameshift variant (c.902dup; p.Ser302Valfs*16), predicted to cause premature protein truncation. Family screening confirmed autosomal recessive inheritance, identifying one similarly affected sibling and multiple heterozygous carriers.</p><p><strong>Conclusions: </strong>We report a novel homozygous TRPM6 frameshift variant in a patient with profound hypomagnesemia who experienced a severe migraine attack initially unresponsive to treatment. The rapid response to IV magnesium is consistent with a possible contribution of magnesium depletion to the acute headache phenotype. Our observations raise the possibility of an association between TRPM6-related hypomagnesemia and migraine susceptibility in selected individuals. Additional cases are required better refine TRPM6-related neurological phenotypes.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volumetric analysis of thalamic nuclei in children with vasovagal syncope.","authors":"Hilal Aydin, Adil Aytac","doi":"10.1007/s10072-026-09414-5","DOIUrl":"10.1007/s10072-026-09414-5","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate regional thalamic nuclei volumes in pediatric patients with vasovagal syncope (VVS) using automated MRI-based segmentation and compare these measurements with those of pediatric controls.</p><p><strong>Materials and methods: </strong>This retrospective case-control study included 76 pediatric patients with VVS and 34 age- and sex-comparable controls (total n = 110) who underwent brain magnetic resonance imaging. Thalamic nuclei were segmented using the FreeSurfer automated pipeline. Group differences were assessed using multivariate and univariate analyses of covariance adjusted for age, sex, and total intracranial volume. False discovery rate correction was applied for multiple comparisons.</p><p><strong>Results: </strong>Total right, left, and bilateral thalamic volumes did not differ significantly between groups (P = 0.802, P = 0.267, and P = 0.366, respectively). However, significant regional volumetric differences were identified in selected nuclei. Compared with controls, patients with VVS had larger left medial thalamic (P < 0.001), left pulvinar (P < 0.001), right pulvinar (P < 0.001), and right habenular (P < 0.001) volumes, and smaller right anterior ventral (P = 0.004), left mediodorsal (P = 0.003), and left intralaminar/midline (P = 0.012) volumes. After false discovery rate correction, corresponding q values were < 0.001, < 0.001, < 0.001, 0.002, 0.018, 0.017, and 0.043, respectively.</p><p><strong>Conclusion: </strong>Children with VVS demonstrated regional volumetric differences in specific thalamic nuclei despite preserved total thalamic volume. The clinical and functional significance of these findings and their potential relationship to autonomic regulation remain uncertain. Further prospective studies incorporating functional and multimodal neuroimaging are warranted.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}