Neurology最新文献

{"title":"Use of the Brain Care Score to Estimate the Risk of Incident Cerebrovascular Events in Middle-Aged Women.","authors":"Devanshi Choksi,Leidys Gutiérrez-Martínez,Pamela M Rist,Julie E Buring,Jasper R Senff,Sandro Marini,Christina Kourkoulis,Zeina Chemali,Amy Newhouse,M Brandon Westover,Rudolph E Tanzi,Gregory Fricchione,Sanjula Singh,Jonathan Rosand,Christopher D Anderson,Nirupama Yechoor","doi":"10.1212/wnl.0000000000213674","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213674","url":null,"abstract":"BACKGROUND AND OBJECTIVESIn the United States, stroke is the third leading cause of death among women, with 1 in 5 women aged 55 to 75 years expected to experience a stroke. The Brain Care Score (BCS) is an evidence-based tool designed to motivate lifestyle changes, with higher scores associated with reduced risk of stroke, dementia, and depression. We aim to measure the association of the BCS and incident cerebrovascular events (CVEs), including stroke and transient ischemic attack (TIA), in the Women's Health Study (WHS).METHODSThe WHS comprises women health professionals aged 45 and older in the United States. Participants without history of CVE and complete data available to calculate a BCS and covariates 5 years after enrollment were included. Higher BCS reflects better risk factor control, with the minimum score being 0 and the maximum score being 20. Cox proportional hazard models examined the association between BCS and incident CVE adjusted for potential confounders.RESULTSA total of 21,271 women were eligible with a median age of 57.9 years (interquartile range: 53.9-63.8) and median BCS of 15 (interquartile range [IQR]:13-16). There were 1,294 incident CVE cases (6.1%) during a median follow-up of 22.4 (IQR: 15.9-23.5) years. A five-point higher baseline BCS was associated with a 37% decrease in the risk of incident CVE after adjusting for age, menopausal status, use of hormonal replacement therapy, and other known cardiovascular disease risk factors (hazard ratio [HR] 0.63, 95% CI 0.56-0.71). This association remained significant after adjusting for race, educational attainment, and income (HR 0.64, 95% CI 0.57-0.72). There was a 28% decreased risk of incident CVE among those with a BCS equal to or above the median compared with those with a BCS below the median, in a fully adjusted model (HR 0.72, 95% CI 0.64-0.80).DISCUSSIONHigher baseline BCS was associated with a decreased risk of incident CVE in the WHS. Future studies are needed to study the BCS in more diverse populations and to investigate how changes in BCS across the lifespan affect risk of CVE.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"54 1","pages":"e213674"},"PeriodicalIF":9.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Status Epilepticus Protocol Variation Across Accredited National Association of Epilepsy Centers Members.","authors":"Laura K Lamberta,Melissa Asmar,Megan M Fredwall,Stephanie M Ahrens,Shasha Bai,Mariah Eisner,Fred Alexander Lado,Stephan U Schuele,Dave F Clarke,Ahmed T Abdelmoity,Kathryn A Davis,Jennifer L Hopp,Mohamad Z Koubeissi,Meriem K Bensalem Owen,Susan T Herman,Adam P Ostendorf,","doi":"10.1212/wnl.0000000000213689","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213689","url":null,"abstract":"OBJECTIVESStatus epilepticus (SE) is a neurologic emergency that requires urgent recognition and medical management. SE management remains heterogeneous across centers.METHODSWe analyzed SE treatment protocols from level 3 and level 4 epilepsy centers. Discrete data including stabilization measures, timing of treatment phases, medications, doses, and routes of administration were collected from each protocol and described using frequency for categorical variables and median for continuous variables. The distribution of treatment times and dosing were compared with the AES guideline.RESULTSA total of 256 SE treatment protocols were included. Only 66% of SE protocols detailed treatment times. Doses below recommendations occurred in 4% of protocols for initial benzodiazepine (BZD) and 14% for first non-BZD medications. Infusion therapy was outlined in 61% of protocols.DISCUSSIONDespite the importance of timeliness in SE management, one third of institutional protocols did not specify treatment times. This analysis of US hospital inpatient SE protocols provides expert opinion regarding infusion therapy management and highlights gaps and targets for improvement in SE treatment.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"54 1","pages":"e213689"},"PeriodicalIF":9.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Whole-Brain Focal Cortical Dysplasia Detection Using MR Fingerprinting With Deep Learning.","authors":"Zheng Ding,Spencer Morris,Siyuan Hu,Ting-Yu Su,Joon Yul Choi,Ingmar Blümcke,Xiaofeng Wang,Ken Sakaie,Hiroatsu Murakami,Andreas V Alexopoulos,Stephen E Jones,Imad M Najm,Dan Ma,Zhong Irene Wang","doi":"10.1212/wnl.0000000000213691","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213691","url":null,"abstract":"BACKGROUND AND OBJECTIVESFocal cortical dysplasia (FCD) is a common pathology for pharmacoresistant focal epilepsy, yet detection of FCD on clinical MRI is challenging. Magnetic resonance fingerprinting (MRF) is a novel quantitative imaging technique providing fast and reliable tissue property measurements. The aim of this study was to develop an MRF-based deep-learning (DL) framework for whole-brain FCD detection.METHODSWe included patients with pharmacoresistant focal epilepsy and pathologically/radiologically diagnosed FCD, as well as age-matched and sex-matched healthy controls (HCs). All participants underwent 3D whole-brain MRF and clinical MRI scans. T1, T2, gray matter (GM), and white matter (WM) tissue fraction maps were reconstructed from a dictionary-matching algorithm based on the MRF acquisition. A 3D ROI was manually created for each lesion. All MRF maps and lesion labels were registered to the Montreal Neurological Institute space. Mean and SD T1 and T2 maps were calculated voxel-wise across using HC data. T1 and T2 z-score maps for each patient were generated by subtracting the mean HC map and dividing by the SD HC map. MRF-based morphometric maps were produced in the same manner as in the morphometric analysis program (MAP), based on MRF GM and WM maps. A no-new U-Net model was trained using various input combinations, with performance evaluated through leave-one-patient-out cross-validation. We compared model performance using various input combinations from clinical MRI and MRF to assess the impact of different input types on model effectiveness.RESULTSWe included 40 patients with FCD (mean age 28.1 years, 47.5% female; 11 with FCD IIa, 14 with IIb, 12 with mMCD, 3 with MOGHE) and 67 HCs. The DL model with optimal performance used all MRF-based inputs, including MRF-synthesized T1w, T1z, and T2z maps; tissue fraction maps; and morphometric maps. The patient-level sensitivity was 80% with an average of 1.7 false positives (FPs) per patient. Sensitivity was consistent across subtypes, lobar locations, and lesional/nonlesional clinical MRI. Models using clinical images showed lower sensitivity and higher FPs. The MRF-DL model also outperformed the established MAP18 pipeline in sensitivity, FPs, and lesion label overlap.DISCUSSIONThe MRF-DL framework demonstrated efficacy for whole-brain FCD detection. Multiparametric MRF features from a single scan offer promising inputs for developing a deep-learning tool capable of detecting subtle epileptic lesions.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"41 1","pages":"e213691"},"PeriodicalIF":9.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bobble-Head Doll Syndrome in a Child.","authors":"Ashwini Chityala,Pradeep Kumar Gunasekaran,Rahul Gupta,Sarbesh Tiwari,Lokesh Saini","doi":"10.1212/wnl.0000000000213694","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213694","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"141 1","pages":"e213694"},"PeriodicalIF":9.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching Video NeuroImage: Rapidly Progressive Nonfluent Aphasia as Initial Presentation of Probable Prion Disease.","authors":"Raul Medina-Rioja,Luis Enrique Vega Ramirez,Sarah Ticehurst-Corona,Brenda Dzul-Garcia,Juan Carlos Lopez Hernandez,Ramiro Ruiz-Garcia","doi":"10.1212/wnl.0000000000213710","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213710","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"166 1","pages":"e213710"},"PeriodicalIF":9.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Brain Health in Women: Validation of the Brain Care Score and Incident Cerebrovascular Events.","authors":"Cheryl D Bushnell,Seana L Gall","doi":"10.1212/wnl.0000000000213777","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213777","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"16 1","pages":"e213777"},"PeriodicalIF":9.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Response: Association Between Time to Treatment With Endovascular Thrombectomy and Home-Time After Acute Ischemic Stroke.","authors":"Raed A Joundi,Michael D Hill,Amy Ying Xin Yu,Eric E Smith","doi":"10.1212/wnl.0000000000209979","DOIUrl":"https://doi.org/10.1212/wnl.0000000000209979","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"128 1","pages":"e209979"},"PeriodicalIF":9.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Predicted Visceral Fat Percentage With Dementia Risk in Older Adults: The Role of Genetic Risk and Lifestyle.","authors":"Hao-Wen Chen,Shi-Ao Wang,Zheng-Yun Xu,Zhan-Hui Shao,Qi Zhong,Yan-Fei Wei,Bi-Fei Cao,Kuan Liu,Xian-Bo Wu","doi":"10.1212/wnl.0000000000213630","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213630","url":null,"abstract":"BACKGROUND AND OBJECTIVESObesity is a modifiable dementia risk factor, but body mass index does not account for fat distribution, particularly visceral fat, which is more strongly linked to metabolic and cardiovascular health. Despite its relevance, research on visceral fat and dementia is limited, especially in large-scale prospective studies. The aim of this study was to assess the association between visceral fat and dementia risk, its interaction with genetic predisposition, and the impact of healthy lifestyle adherence.METHODSUsing data from the UK Biobank (UKB) cohort, we computed baseline, sex-specific visceral fat percentage (VFP), defined as the ratio of visceral fat mass to total body fat mass. Nonlinear associations between VFP and incident dementia were initially assessed using restricted cubic splines. The relationship between VFP and incident dementia was further examined using Cox proportional hazard models. In addition, stratified and interaction analyses were conducted to assess dementia incidence across VFP levels, lifestyle factors, and genetic risk.RESULTSThe study included 63,042 women (mean age: 63.96 years) and 74,001 men (64.20 years) aged 60 years and older from the UKB, with a median follow-up of 14.07 years for men and 14.09 years for women. During follow-up, 2,805 men and 1,893 women developed dementia. A U-shaped association between VFP and dementia risk was observed in both sexes. In men, each SD increase in VFP below the median value of 8.1% was associated with a reduced risk of dementia (HR: 0.90, 95% CI 0.85-0.96), whereas above the median, the risk increased (1.06, 1.00-1.11). Similarly, in women, below the median VFP value of 3.1%, each SD increase was linked to a decreased dementia risk (0.89, 0.83-0.96), and above the median, the risk increased (1.14, 1.07-1.22). No significant interactions were found between VFP and genetic risk or lifestyle factors.DISCUSSIONAmong nondemented, community-dwelling older Britons, atypical VFP was associated with higher dementia risk in both sexes. The lack of interaction between VFP and genetic risk highlights the complexity of dementia pathogenesis. In addition, a healthy lifestyle may mitigate the dementia risk associated with atypical VFP levels.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"63 1","pages":"e213630"},"PeriodicalIF":9.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editors' Note: Further Insights About the Benefits of Rapid Endovascular Thrombectomy for Acute Ischemic Stroke.","authors":"Aravind Ganesh,Steven L Galetta","doi":"10.1212/wnl.0000000000213597","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213597","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"10 1","pages":"e213597"},"PeriodicalIF":9.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching NeuroImage: Differentiating Radiation-Induced Brain Injury and Tumor Recurrence.","authors":"Zhen Luo,Xianglong Kong,Zhibo Liu,Jingzhe Liu","doi":"10.1212/wnl.0000000000213627","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213627","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"42 1","pages":"e213627"},"PeriodicalIF":9.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}