Neurology最新文献

{"title":"Clinical and Radiographic Improvement Following Steroid Therapy in Subacute Post-Traumatic Ascending Myelopathy.","authors":"Olumide Emmanuel Adegunna, Anuj Rastogi, Nathan Chan Smyth, Daniel M Mandell, Alfonso Fasano","doi":"10.1212/WNL.0000000000210050","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210050","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210050"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576701","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 Conscious Sedation With Dexmedetomidine and Outcome in Stroke Patients Undergoing Thrombectomy in the DEVT and RESCUE-BT Trials.","authors":"Chen Gong, Jiacheng Huang, Zhongming Qiu, Meng Guo, Liyuan Chen, Hongfei Sang, Weilin Kong, Liping Huang, Pan Hu, Yangmei Chen, Fengli Li, Thanh N Nguyen, Chang Liu","doi":"10.1212/WNL.0000000000209953","DOIUrl":"10.1212/WNL.0000000000209953","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although dexmedetomidine (DEX) is widely administered during endovascular treatment (EVT) to enhance procedural adherence of patients with acute ischemic stroke (AIS) with large vessel occlusion, there is limited research on the association of DEX and outcomes among these patients. Hence, this study aimed to explore the safety and outcomes of DEX during conscious sedation (CS) in a real-world setting among patients undergoing EVT.</p><p><strong>Methods: </strong>This study was an individual patient-level pooled analysis of 2 multicenter randomized clinical trials RESCUE-BT and DEVT. This study included patients who underwent EVT because of occlusion of the internal carotid artery or middle cerebral artery. The DEX group included those receiving intraprocedural DEX for CS, whereas the patients without intraprocedural DEX sedation were categorized into the non-DEX group. The primary outcome was functional independence (modified Rankin Scale score of 0-2 at 90 days). Adjusted odds ratio (aOR) and 95% CI were obtained by logistic regression models.</p><p><strong>Results: </strong>A total of 728 patients were included in this study, of whom 308 (42.3%) were female. The median (interquartile range) age was 69 (59-76) years; the median baseline NIH Stroke Scale score was 16 (12-19). Compared with the non-DEX group, the DEX group had a significantly lower rate of functional independence (40.3% vs 51.3%; aOR 0.66; 95% CI 0.46-0.93; <i>p</i> = 0.019). There was a significantly higher rate of unstable procedural hemodynamics in the DEX group (9.7% vs 2.3%; aOR 4.60, 95% CI 2.12-9.99, <i>p</i> < 0.001). In subgroup analysis, similar results were found in intraprocedural DEX-treated patients when compared with local anesthesia or intraprocedural midazolam-treated patients, respectively.</p><p><strong>Discussion: </strong>There was a negative association between procedural DEX administration during CS and functional outcomes in patients with AIS receiving EVT in a real-world setting. A larger cohort is warranted to validate our findings.</p><p><strong>Classification of evidence: </strong>This study provides Class II evidence that the use of DEX during EVT of AIS is associated with a worse outcome compared with other agents.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e209953"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668630","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: Medullary Edema Due to Dural Arteriovenous Fistula: A Potentially Characteristic Imaging Finding.","authors":"Maeve Bradley, Gerard Mullane, Daniel Borg, Patrick Nicholson, Fiona Carty, Shane Smyth, Killian O'Rourke, Conor Fearon","doi":"10.1212/WNL.0000000000210069","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210069","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210069"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624337","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":"Clinical Reasoning: A 50-Year-Old Man With Ataxia, Dystonia, and Abnormal Ocular Movements.","authors":"Baikuntha Panigrahi, Divya Madathiparambil Radhakrishnan, Arti Saini, Venugopalan Y Vishnu, Anu Gupta, Awadh Kishor Pandit, Ayush Agarwal, Divyani Garg, Mamta Bhushan Singh, Rohit Bhatia, Padma Srivastava, Achal Kumar Srivastava, Roopa Rajan","doi":"10.1212/WNL.0000000000210046","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210046","url":null,"abstract":"<p><p>A 50-year-old male patient presented with a 10-year history of progressive cerebellar ataxia, multifocal dystonia with dystonic tremors, and oculomotor abnormalities including bilateral ptosis, slow saccades, and reduced range of ocular movements. There were no signs of cognitive impairment, parkinsonism, autonomic dysfunction, or muscle weakness, and the family history was unremarkable. This case presents the diagnostic approach to adult-onset cerebellar ataxia with dystonia and abnormal eye movements. In this era of genomic testing, our case highlights the role of clinical phenotyping and the utility of whole-exome sequencing in ataxias.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210046"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624072","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: Noogenic Epilepsy With Orofacial Reflex Myoclonus: A Rare Distinct Electroclinical Syndrome.","authors":"Jayakumari Nandana, Karamala Yalapalli Manisha, Prasannakumar Surabhi, Surendran Veena, Kiren George Koshy, Ramshekhar N Menon, Ashalatha Radhakrishnan","doi":"10.1212/WNL.0000000000210045","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210045","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210045"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576704","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":"Modified Delphi Study to Establish Consensus About Child Neurology Residency Education: Next-Gen Training.","authors":"Rachel Gottlieb-Smith, Danny Rogers, Donald L Gilbert","doi":"10.1212/WNL.0000000000210002","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210002","url":null,"abstract":"<p><strong>Background and objectives: </strong>Rapid advances in diagnostics and treatments are shifting child neurology practice, but child neurology training requirements have been much slower to change. Previous literature confirms strong support for modernization, but no formal consensus exists regarding maintaining or changing training. We aimed to develop a holistic consensus regarding the optimal training pathway and requirements using a modified Delphi process.</p><p><strong>Methods: </strong>The authors invited 48 child neurologists as panelists, intentionally selecting to represent the diverse geography, practice type, subspecialties, and other demographics of child neurologists practicing in the United States. Panelists participated in an anonymized modified Delphi study with 4 rounds evaluating statements regarding current training requirements, core rotation durations, and mandatory subspecialty rotations with the option to agree or disagree. Statements were derived from current Accreditation Council of Graduate Medical Education, American Board of Psychiatry and Neurology, and American Board of Pediatrics requirements for child neurology training and recent literature. Statements that did not reach a predefined level of consensus (≥75% agreement or disagreement on a 7-point Likert scale) were re-queried or modified for subsequent rounds. Panelists had access to all previous anonymized results and comments. The final modifications were presented in round 4 as a comprehensive training proposal.</p><p><strong>Results: </strong>Twenty-seven panelists agreed to participate, with most completing all 4 rounds. In round 1, consensus was reached on 45 of 118 (38%) items; round 2, 28 of 87 (32%); round 3, 16 of 25 (64%); and round 4, 1 of 1 (100%). There was consensus regarding the age scope of practice and certain subspecialties that should be required, but no initial consensus regarding time-based requirements. By round 4, consensus emerged for the following rotations-months: neonatal and pediatric intensive care-4, adolescent medicine-0.5, emergency medicine-1.5, inpatient pediatrics-3, outpatient pediatrics-3.5, inpatient child neurology-9.5, outpatient child neurology-6, inpatient adult neurology-3, outpatient adult neurology-2, genetics-2, EEG/neurophysiology-2, neuroimaging-1, child psychiatry-1, and electives-7.5. The consensus schedule consists of 46.5 total months of requirements.</p><p><strong>Discussion: </strong>This study suggests that, despite diverging views prevalent among child neurologists, a diverse panel can, through a multiround Delphi process, arrive at consensus regarding many core features of the child neurology training structure and certification requirements.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210002"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605825","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":"Is Dexmedetomidine Safe for Procedural Sedation During Mechanical Thrombectomy for Acute Stroke Secondary to Large Vessel Occlusion?","authors":"Zurab Nadareishvili, Dileep R Yavagal","doi":"10.1212/WNL.0000000000210090","DOIUrl":"10.1212/WNL.0000000000210090","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210090"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668632","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":"Neuropsychological Outcomes After Stereo-EEG Radiofrequency Thermocoagulation.","authors":"Emily Cockle, Charles B Malpas, Honor Coleman, Alissandra McIlroy, Joshua Laing, Patrick Kwan, Martin Hunn, Matthew Gutman, Cecilia Harb, Cathermine Meade, Wendyl J D'Souza, Amy J Halliday, Kristian Bulluss, Simon J Vogrin, Rubina Alpitsis, Terence J O'Brien, Genevieve Rayner, Andrew Neal","doi":"10.1212/WNL.0000000000209815","DOIUrl":"10.1212/WNL.0000000000209815","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereo-EEG-guided radiofrequency thermocoagulation (RFTHC) has been proposed as relatively safe from a cognitive perspective; however, there is a lack of evidence based on neuropsychological assessments supporting this. This study is the first prospective evaluation of neuropsychological outcomes associated with stereo-EEG-guided RFTHC in patients with focal drug-resistant epilepsy.</p><p><strong>Methods: </strong>This cohort study involved prospective recruitment of consecutive patients undergoing stereo-EEG from 2 Australian centers. A comprehensive neuropsychological assessment was administered before implantation and 3 months after RFTHC (M = 104.51 days, SD = 29.25). Outcomes across cognitive domains were assessed at a group level with repeated measures <i>t</i> tests. Factorial repeated measures analyses of variance compared memory and language outcomes according to whether dominant mesial temporal lobe (mTL) structures were coagulated. Reliable change indices (RCIs) were computed to explore psychometrically reliable changes at an individual level.</p><p><strong>Results: </strong>The sample comprised 39 patients who underwent stereo-EEG (M = 37.08 ± 9.67 years, range = 17-56 years, 54% female). Nineteen (49%) had a language dominant epileptogenic zone (EZ), 16 (41%) a nondominant EZ, and 4 (10%) a bilateral EZ. All patients underwent RFTHC with a mean of 11.87 (SD = 6.82, range = 2-29) coagulation sites. Ten patients (26%) had RFTHC within the dominant mTL. At a group level, RFTHC was not associated with a significant decline on any neuropsychological measures (all comparisons <i>p</i> > 0.05). Subgroup analyses revealed a decline in delayed verbal recall after RFTHC of dominant mTL structures (<i>F</i>(1,37) = 4.46, <i>p</i> = 0.04, η_p² = 0.11, 95% CI [0-0.30]; medium to large effect), although it did not remain statistically significant after correction for false discovery rate. No statistically significant group differences were observed on visual memory or language measures post-RFTHC (all comparisons <i>p</i> > 0.05). RCI revealed that after RFTHC within the dominant mTL, 20% of patients experienced a decline in verbal memory and 10% in visual memory. By contrast, 7% declined in verbal memory and 10% in visual memory post-RFTHC outside the dominant mTL.</p><p><strong>Discussion: </strong>While these findings support the current view that RFTHC is cognitively benign for most cases, the results raise the question of a verbal memory decline after coagulation of the dominant mTL. Individualized neuropsychological counseling before stereo-EEG is essential to avoid unanticipated deficits.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e209815"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668636","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":"Lumipulse-Measured Cerebrospinal Fluid Biomarkers for the Early Detection of Alzheimer Disease.","authors":"Michelle Safransky, Jenna R Groh, Kaj Blennow, Henrik Zetterberg, Yorghos Tripodis, Brett Martin, Jason Weller, Breton M Asken, Gil D Rabinovici, Wendy Wei Qiao Qiu, Ann C McKee, Thor D Stein, Jesse Mez, Rachel L Henson, Justin Long, John C Morris, Richard J Perrin, Suzanne E Schindler, Michael L Alosco","doi":"10.1212/WNL.0000000000209866","DOIUrl":"10.1212/WNL.0000000000209866","url":null,"abstract":"<p><strong>Background and objectives: </strong>CSF biomarkers of Aβ42 and phosphorylated tau (p-tau181) are used clinically for the detection of Alzheimer disease (AD) pathology during life. CSF biomarker validation studies have largely used clinical diagnoses and/or amyloid PET imaging as the reference standard. The few existing CSF-to-autopsy studies have been restricted to late-stage AD. This CSF-to-autopsy study investigated associations between CSF biomarkers of AD and AD neuropathologic changes among brain donors who had normal cognition at the time of lumbar puncture (LP).</p><p><strong>Methods: </strong>This was a retrospective study of brain donors from the National Alzheimer's Coordinating Center who had normal cognition at the time of LP and who had measurements of CSF Aβ42 and p-tau181 performed with Lumipulse assays. All brain donors were from Washington University Knight ADRC. Staging of AD neuropathologic change (ADNC) was made based on National Institute on Aging-Alzheimer's Association criteria. For this study, participants were divided into 2 categories: \"AD-\" (no AD/low ADNC) and \"AD+\" (intermediate/high ADNC). Accuracy of each biomarker for discriminating AD status was evaluated using area under the curve (AUC) statistics generated using predicted probabilities from binary logistic regressions that controlled for age, sex, <i>APOE ε4</i>, and interval between LP and death.</p><p><strong>Results: </strong>The average age at LP was 79.3 years (SD = 5.6), and the average age at death was 87.1 years (SD = 6.5). Of the 49 brain donors, 24 (49%) were male and 47 (95.9%) were White. 20 (40.8%) had autopsy-confirmed AD. The average interval from LP until death was 7.76 years (SD = 4.31). CSF p-tau181/Aβ42 was the optimal predictor of AD, having excellent discrimination accuracy (AUC = 0.97, 95% CI 0.94-1.00, <i>p</i> = 0.003). CSF p-tau181 alone had the second-best discrimination accuracy (AUC = 0.92, 95% CI 0.84-1.00, <i>p</i> = 0.001), followed by CSF Aβ42 alone (AUC = 0.92, 95% CI 0.85-1.00, <i>p</i> = 0.007), while CSF t-tau had the numerically lowest discrimination accuracy (AUC = 0.87, 95% CI 0.76-0.97, <i>p</i> = 0.005). Effects remained after controlling for prevalent comorbid neuropathologies. CSF p-tau181/Aβ42 was strongly associated with CERAD ratings of neuritic amyloid plaque scores and Braak staging of NFTs.</p><p><strong>Discussion: </strong>This study supports Lumipulse-measured CSF Aβ42 and p-tau181 and, particularly, the ratio of p-tau181 to Aβ42, for the early detection of AD pathophysiologic processes.</p><p><strong>Classification of evidence: </strong>This study provides Class II evidence that Lumipulse measures of p-tau181/Aβ42 in the CSF accurately discriminated cognitively normal participants with and without Alzheimer disease neuropathologic change.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e209866"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A <i>Pons Prospera</i> for Child Neurology.","authors":"Miya R Asato","doi":"10.1212/WNL.0000000000210146","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210146","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210146"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605819","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}