Neurology最新文献

{"title":"Effects of Blood Pressure Lowering by Hematoma Location in Acute Intracerebral Hemorrhage.","authors":"Xinwen Ren, Xiaoying Chen, Xin Hu, Yapeng Lin, Chen Chen, Jiguang Wang, Thompson G Robinson, Leibo Liu, Paula Munoz Venturelli, Sheila Co Martins, Octavio M Pontes-Neto, Adnan I Qureshi, Lili Song, Craig Anderson, Xia Wang","doi":"10.1212/WNL.0000000000218514","DOIUrl":"10.1212/WNL.0000000000218514","url":null,"abstract":"<p><strong>Background and objectives: </strong>Early intensive blood pressure (BP) lowering is now recognized as an effective approach to improve outcome after acute intracerebral hemorrhage (ICH). However, whether the effect varies by hematoma location is uncertain. We aimed to determine the heterogeneity of the treatment effect of intensive BP lowering on functional outcome by hematoma location.</p><p><strong>Methods: </strong>We conducted a pooled analysis of individual patient-level data (IPD) from all 4 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT) and the second Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trial, which were international, randomized, open, blinded end point assessed, controlled trials that investigated the effectiveness of early intensive BP control in acute ICH. ICH location was classified as lobar or deep hemisphere or infratentorial. The primary outcome was death or disability (modified Rankin Scale scores 3-6) at 90 days or 6 months (for INTERACT3). The heterogeneity of the treatment effect of intensive BP lowering on the primary outcome by ICH location was estimated using generalized linear mixed models with trial as a random effect and adjustment for prespecified clinical covariates and an interaction term of \"treatment-by-location.\"</p><p><strong>Results: </strong>Among 11,288 patients (mean age 62.5 years [SD 12.7]; 4,056 [35.9%] women), 1,141 (10.1%) had lobar ICH, 9,202 (81.5%) had deep ICH and 945 (8.4%) had infratentorial ICH. Compared with deep or infratentorial ICH, lobar ICH occurred in older patients, was less often associated with intraventricular hemorrhage, and had larger hematoma volumes (all <i>p</i> < 0.001). The effect of intensive BP lowering on the primary outcome of death or disability differed by ICH location (<i>p</i> for interaction = 0.033). A clear benefit was only seen in deep ICH (adjusted odds ratio 0.81, 95% CI 0.74-0.89; <i>p</i> < 0.001).</p><p><strong>Discussion: </strong>Hematoma location modifies the treatment effect of intensive BP lowering on functional outcome after ICH, with the benefit observed only in deep ICH.</p><p><strong>Trial registration information: </strong>These trials are registered at ClinicalTrials.gov (INTERACT1 NCT00226096; INTERACT2 NCT00716079; INTERACT3 NCT03209258; INTERACT4 NCT03790800; and ATACH-II NCT01176565).</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218514"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137701","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":"Recanalization After Acute Cervical Artery Dissection: A Multicenter International Study.","authors":"Michele Romoli, Jayachandra Muppa, Elizabeth M Lee, Daniel M Mandel, Wayneho Kam, Brian Mac Grory, Adeel S Zubair, Marwa ElNazeir, Jennifer A Frontera, Setareh Salehi Omran, Faddi G Saleh Velez, Aaron Rothstein, Ossama Khazaal, Malik Ghannam, Mohammad Almajali, Edgar A Samaniego, Reza Bavarsad Shahripour, Sami Al Kasab, Ana Catarina Fonseca, Mirjam Rachel Heldner, Kateryna Antonenko, Giovanna De Marco, Marco Longoni, Claudia Faini, Valentina Tudisco, Marialuisa Zedde, Rosario Pascarella, João Pedro Marto, João André Sousa, Sara Botelho Rosa, Ana Paiva Nunes, Diana Aguiar De Sousa, Ahmad Nehme, Liqi Shu, Shadi Yaghi, Nils Henninger","doi":"10.1212/WNL.0000000000218566","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218566","url":null,"abstract":"<p><strong>Background and objectives: </strong>The rates and factors associated with complete recanalization after cervical artery dissection (CeAD) have not been comprehensively quantified in large cohorts. We sought to determine the 6-month rate of complete recanalization in CeAD, clinical and imaging factors associated with recanalization, and risk of recurrent ischemic stroke based on recanalization status.</p><p><strong>Methods: </strong>This was a planned subanalysis of the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection study, a multicenter retrospective cohort including patients with imaging-confirmed CeAD diagnosed between January 2015 and June 2022 at 63 sites worldwide. For this analysis, we included 1,095 patients with single-vessel CeAD causing stenosis at presentation who had available follow-up vascular imaging at 6 months after CeAD. The primary outcome was complete recanalization within 6 months after CeAD. Clinical and imaging variables, as well as recurrent stroke, were compared between patients with and those without complete recanalization. Factors independently associated with complete recanalization were identified using multivariable logistic regression. Time to complete recanalization was analyzed using an accelerated failure time Weibull model.</p><p><strong>Results: </strong>Among 1,095 included patients (median age 45 years; 46.7% female), 634 (57.9%) achieved complete recanalization by 6 months. In multivariable analysis, each additional year of age was associated with lower odds of complete recanalization (odds ratio [OR] 0.97 per year; 95% CI 0.96-0.98; <i>p</i> < 0.001). Diabetes (OR 0.46; 95% CI 0.27-0.81; <i>p</i> = 0.006), active smoking (OR 0.69; 95% CI 0.50-0.95; <i>p</i> = 0.025), and complete occlusion at presentation (OR 0.44; 95% CI 0.32-0.59; <i>p</i> < 0.001) were independently associated with lower odds of complete recanalization. Complete occlusion at presentation was associated with both longer time to, and lower rates of, complete recanalization. We observed no effect of antithrombotic regimen (antiplatelet therapy vs anticoagulation) on complete recanalization. Incomplete recanalization was associated with a nonsignificant numerically higher proportion of recurrent stroke (5.4% vs 3.5%; <i>p</i> = 0.064).</p><p><strong>Discussion: </strong>Almost 60% of patients with CeAD achieved complete vessel recanalization by 6 months. Older age, diabetes, smoking, and complete occlusion at presentation were independently associated with incomplete recanalization. Further study is required to determine whether these findings may help guide tailored imaging surveillance and secondary prevention strategies.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218566"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228329","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: Symmetrical Corticospinal Tract Involvement in Meningoencephalitis Associated With Vimentin Immunoglobulin G.","authors":"Yike Wang, Zengyi Zhang, Haitao Ren, Siyuan Fan, Hongzhi Guan","doi":"10.1212/WNL.0000000000218600","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218600","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218600"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112749","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":"Emergency Department Visits for Falls and First-Time Seizure.","authors":"Andy Y Wang, Andrew J Wood, Cenai Zhang, Hooman Kamel, Ava L Liberman, Elan L Guterman","doi":"10.1212/WNL.0000000000218597","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218597","url":null,"abstract":"<p><strong>Background and objectives: </strong>Unrecognized seizures occur in up to 77% of individuals with epilepsy, leading to delays in diagnosis with significant consequences including injury, mortality, impaired psychosocial functioning, and negative socioeconomic impacts. Falls are a common reason to present to the emergency department (ED) and may be a sentinel sign of an unrecognized seizure. Whether falls represent missed opportunities for earlier seizure recognition remains unknown. We therefore evaluated the temporal association between ED visits for falls and first-time seizure.</p><p><strong>Methods: </strong>We conducted a retrospective case-crossover study using the State Inpatient Databases and State Emergency Department Databases from 11 states (Arkansas, Florida, Georgia, Iowa, Massachusetts, Maryland, Nebraska, New York, Utah, Vermont, and Wisconsin) between 2016 and 2021. Adults aged 18 years and older with an acute care visit for a first-time seizure were identified using ICD-10 codes. Using patients as their own controls, we applied conditional logistic regression to compare the odds of an ED visit for a fall during prespecified case periods preceding the seizure (1-7, 8-30, 31-90, and 91-180 days prior) vs corresponding control periods 1 year earlier. Prespecified intervals were selected to assess graded temporal proximity.</p><p><strong>Results: </strong>There were 57,547 patients with a first-time seizure and 7,307 patients (mean age 49.3 years and 55.2% female) with at least one prior ED visit for a fall during the case or control periods. ED visits for a fall were more common in case compared with control periods, with the highest odds in the 7 days immediately before the acute care visit for first-time seizure (OR = 2.6, 95% CI 2.2-3.2). In a week-by-week analysis, the association persisted up to 22 weeks before seizure, demonstrating temporal attenuation as time from the event increased. These findings were consistent across age and sex strata and after excluding those who had traumatic brain injury. In analyses restricted to first-time status epilepticus, the association in the 7 days preceding seizure was most pronounced (OR = 4.5, 95% CI 2.5-9.0).</p><p><strong>Discussion: </strong>ED visits for falls are more common immediately preceding first-time seizure, potentially representing missed opportunities for earlier diagnosis, evaluation, and intervention. Prospective studies are needed to clarify the underlying mechanisms and clinical implications.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218597"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137669","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":"Bibliometrics and Thematic Content of the Papers Published in <i>Neurology</i> Over the Past 75 Years.","authors":"Brenna H Kent, José G Merino, Emily L Johnson, Andrew M Southerland","doi":"10.1212/WNL.0000000000218757","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218757","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218757"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207629","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":"Infection as a Contributor to Dementia: The Plot Thickens.","authors":"Claire Sexton, Mitchell S V Elkind","doi":"10.1212/WNL.0000000000218650","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218650","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218650"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207632","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":"Icarus in the ICU.","authors":"Shiv Ayappa","doi":"10.1212/WNL.0000000000218636","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218636","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218636"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112763","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: A Deep Gray Signature: Bilateral Striatal Injury in Powassan Encephalitis.","authors":"Elena M Kleinhenz, Adithya Sivaraju","doi":"10.1212/WNL.0000000000218648","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218648","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218648"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137824","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: Cervical Lymph Node Metastasis From an IDH1-Mutant Astrocytoma.","authors":"Sebastian Jeising, Amir Khriesh, Lucas Hoffmann, Sebastian Lettmaier, Roland Coras, Oliver Schnell, Philipp Karschnia","doi":"10.1212/WNL.0000000000218602","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218602","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218602"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128303","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":"Recommendations for the Management of Spontaneous Intracranial Hypotension With Spinal Longitudinal Epidural CSF Collection: A Delphi Study.","authors":"Soyoun Choi, Ian Carroll, Deborah I Friedman, Peter G Kranz, Eugene Lee, Manjit Matharu, Simy Parikh, Henrik W Schytz, Marcio Nattan Portes Souza, Yen-Feng Wang, Hsiangkuo Yuan, Mi Ji Lee","doi":"10.1212/WNL.0000000000218638","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218638","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spontaneous intracranial hypotension (SIH) results from spinal CSF leakage. Epidural blood patch (EBP) is an important first-line treatment. However, pre-EBP, intra-EBP, and post-EBP practice varies widely owing to limited consensus guidance. We aimed to develop expert consensus statements to support clinical decision-making in SIH management, including peri-EBP practices, focusing on patients with spinal longitudinal epidural CSF collection (SLEC) before definitive leak type classification.</p><p><strong>Methods: </strong>An international multidisciplinary Delphi process was conducted between January 2024 and July 2025, involving experts in neurology, neurosurgery, radiology, and anesthesiology. Consensus was defined a priori as ≥70% agreement for strong agreement, 60%-69% for partial agreement, and <60% for no consensus, based on a 5-point Likert scale in round 3. Responses were collected anonymously using an online survey platform, with summarized feedback from the previous round provided between rounds.</p><p><strong>Results: </strong>Fourteen experts were invited, with 10, 9, and 9 participants in rounds 1, 2, and 3, respectively. Before EBP, bed rest was recommended for recent-onset SIH with severe orthostatic headache (88.9%); other conservative methods such as abdominal binder and hydration were considered not mandatory (90%). Semitargeted EBP was recommended as initial management for patients with extradural CSF collections (70%). Dynamic CT myelography was preferred for localization (70%). Post-EBP care was variable, particularly in bed rest duration, with most recommendations (70%) exceeding 12 hours. Definitions of clinical remission (80%) and radiologic remission (90%) were established. Radiologic follow-up after clinical remission was recommended (78%). No consensus was reached on follow-up strategies for persistent symptoms, although \"doing nothing\" was not recommended. No consensus was reached for persistent extradural CSF despite clinical remission, requiring an individualized approach. Light activity after EBP was recommended within a few days (70%). No consensus was reached on the optimal number of EBPs before invasive leak localization or surgical intervention.</p><p><strong>Discussion: </strong>This Delphi study outlines expert recommendations and uncertainties for SIH management, including peri-EBP practices. This study incorporated the initial management strategy for patients in whom leak-type classification was incomplete. However, the treatment section primarily focused on the SLEC-positive setting and presumed ventral dural tears; lateral dural tears and CSF-venous fistulas warrant future consensus development.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218638"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207181","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}