Neurology最新文献

{"title":"Association Between Cerebral Amyloid Angiopathy and Nontraumatic Subdural Hemorrhage.","authors":"Wells Andres,Samuel Bruce,Alexander Eliot Merkler,Costantino Iadecola,Mony J De Leon,Gloria C Chiang,Hooman Kamel,Cenai Zhang,Santosh B Murthy","doi":"10.1212/wnl.0000000000213614","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213614","url":null,"abstract":"BACKGROUND AND OBJECTIVESCerebral amyloid angiopathy (CAA) is a common cause of intracerebral hemorrhage (ICH) in older patients. Whether CAA is associated with isolated subdural hemorrhage (SDH), without an accompanying ICH, remains unclear. We, therefore, tested this relationship in a large, heterogeneous sample of patients across the United States.METHODSWe performed a retrospective cohort study using administrative claims data from all admissions to nonfederal acute care hospitals in 11 states in the United States between 2016 and 2021. Among hospitalized patients, we included only those aged 50 years or older, a threshold necessary to meet Boston criteria v2.0 for CAA. We divided this population into 3 groups: those with a diagnosis of CAA, those with other cerebrovascular diseases (CVDs) but without CAA, and those with neither CAA nor other CVDs. The main outcome was a first-documented, isolated, nontraumatic SDH; we did not count SDH cases with a concurrent traumatic brain injury. The exposures and outcome were identified using previously validated ICD-10-CM diagnosis codes. Using Cox regression analyses, we compared the risk of incident SDH among the 3 groups after adjustment for demographics and comorbidities. In prespecified sensitivity analyses, patients with a baseline diagnosis of dementia were excluded.RESULTSAmong 8.5 million hospitalized patients aged 50 years or older, 2,335 had CAA and 600,646 had other CVDs. During a median follow-up of 2.0 years (interquartile range 1.0-3.9), incident SDH occurred in 34 patients with CAA (1.5%), 3,552 patients with other CVDs (0.6%), and 35,425 patients without CAA or other CVDs (0.4%). In adjusted Cox regression analysis, there was an increased risk of incident SDH seen with CAA (hazard ratio [HR] 3.1; 95% CI 2.2-4.4) and with prevalent CVD (HR 1.4; 95% CI 1.3-1.5). Findings were similar in sensitivity analyses excluding patients with dementia.DISCUSSIONIn a large, heterogeneous cohort, we found that CAA was associated with a 3-fold heightened risk of SDH, higher than the increased risk seen in patients with other CVDs. These findings support the emerging hypothesis that CAA is a risk factor of isolated nontraumatic SDH.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"9 1","pages":"e213614"},"PeriodicalIF":9.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926453","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 Outpatient Follow-Up With 30-Day Readmission After Epilepsy or Seizure Discharge in Medicare Beneficiaries Aged 65 and Older.","authors":"Leah J Blank,Grace Van Hyfte,Parul Agarwal,Madhu Mazumdar,Nathalie Jette","doi":"10.1212/wnl.0000000000213638","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213638","url":null,"abstract":"BACKGROUND AND OBJECTIVESOlder adults are expected to have higher readmission rates after seizure-related hospitalization. We sought to define the 30-day readmission rate for older adults after seizure hospitalization and to examine whether occurrence, timing, or specialization of follow-up with primary or neuro-related care is associated with lower readmission risk.METHODSThis is a retrospective cohort study using 2016-2019 Medicare claims data, including adults aged older than 65 years hospitalized with a primary diagnosis of seizure/epilepsy. The primary outcome was readmission within 30 days. Exposure of interest was presence or absence of follow-up and specialty of the follow-up provider. Beneficiaries were followed from 90 days before admission to 30 days after discharge. We defined variables a priori based on literature/clinical judgment and used a least absolute shrinkage and selection operator (LASSO) method to determine factors that were contributing to the data's variance for inclusion in the final model.RESULTSOf 80,620 beneficiaries with admissions for seizure/epilepsy, 17.72% were readmitted within 30 days. Overall, 20.6% saw only primary care, 2.5% neurology only, 0.3% neurosurgery only, and 0.1% epilepsy only, and 5.4% had a combination of visits. Readmission rates differed by follow-up visit status: 22% readmission rate for those with no follow-up and only 6% with any health care visit. Among those with a visit, the readmission rates by specialty were as follows: 8% for primary care alone, 5% for neurology alone, 16% for neurosurgery alone, 1% for epileptology alone, and 2% for those who had seen a combination of these specialties. In our LASSO-selected multivariable model, outpatient follow-up was associated with lower odds of readmission: early (days 1-15) primary care visit (adjusted odds ratio [aOR] 0.49; 95% CI 0.45-0.52, p < 0.001); early neurology visit (aOR 0.39; 95% CI 0.33-0.46, p < 0.001); and later (days 16-30) neurosurgery visit (aOR 0.42; 95% CI 0.27-0.67, p < 0.001), later neurology visit (aOR 0.16; 95% CI 0.13-0.21, p < 0.001), or later primary care visit (aOR 0.16; 95% CI 0.14-0.17, <0.001), all associated with reduced odds of readmission.DISCUSSIONWe found high rates of readmission in older adults. Outpatient follow-up was associated with reduced odds of readmission. These findings reinforce the importance of discharge planning and suggest that ensuring outpatient follow-up with either primary care or neurology may be an easy intervention to reduce readmissions.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"44 1","pages":"e213638"},"PeriodicalIF":9.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926454","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":"Medical Big Data for Studying Cerebral Amyloid Angiopathy: New Opportunities, Familiar Challenges.","authors":"Craig S Anderson","doi":"10.1212/wnl.0000000000213741","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213741","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"24 1","pages":"e213741"},"PeriodicalIF":9.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926455","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 Hypoxemia Due to Obstructive Sleep Apnea With White Matter Hyperintensities and Temporal Lobe Changes in Older Adults.","authors":"Destiny E Berisha,Batool Rizvi,Miranda G Chappel-Farley,Nicholas Tustison,Lisa Taylor,Abhishek Dave,Negin S Sattari,Ivy Y Chen,Kitty K Lui,John C Janecek,David B Keator,Ariel B Neikrug,Ruth M Benca,Michael A Yassa,Bryce A Mander","doi":"10.1212/wnl.0000000000213639","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213639","url":null,"abstract":"BACKGROUND AND OBJECTIVESCerebral small vessel disease (CSVD) is a leading cause of cognitive decline and functional loss in older adults. Obstructive sleep apnea (OSA) is common in older adults, can increase cerebrovascular disease risk, and is linked to medial temporal lobe (MTL) degeneration and cognitive impairment. However, the interaction between OSA features and CSVD burden and their combined effect on MTL structure and function are not well understood. This study tested the hypothesis that CSVD burden is a candidate mechanism linking OSA to MTL degeneration and impaired memory in older adults.METHODSCognitively unimpaired older adults from the Biomarker Exploration in Aging, Cognition, and Neurodegeneration cohort were recruited for an observational, in-lab overnight polysomnography (PSG) study with emotional mnemonic discrimination ability assessed before and after sleep. Participants had no neurologic or psychiatric disorders and were not on sleep-affecting medications. PSG-derived OSA variables included apnea-hypopnea index (AHI), total arousal index, and minimum SpO2. MRI was used to assess global and lobar white matter hyperintensity (WMH) volumes and MTL structure (hippocampal volume; entorhinal cortex [ERC] thickness) at an earlier time point. Regressions were implemented while adjusting for age, sex, and concurrent use of antihyperlipidemic and/or antihypertensive medication. Minimum SpO2 was transformed into a Hypoxemia Severity Index for normality, in which lower SpO2 values indicated more severe hypoxemia.RESULTSThirty-seven older adults were included in the study (age 72.5 ± 5.6 years, 23 women, AHI = 13.8 ± 18.0 [range 0-80]). Hypoxemia measures significantly predicted global WMH volume (bminSpO2 = 0.141 [0.001-0.282], bduration <90% = 0.008 [0.000-0.016]). This relationship was driven by hypoxemia severity during REM sleep (bREMminSpO2 = 0.143 [0.003-0.284]), which also predicted frontal (bREMminSpO2 = 0.101 [0.004-0.198]) and parietal (bREMminSpO2 = 0.121 [0.024-0.219]) WMH burden. Greater frontal WMH burden indirectly mediated the relationship between REM sleep hypoxemia and ERC thickness (indirect effect = -0.043, 95% CI -0.1174 to -0.00015). Reduced ERC thickness was, in turn, associated with worse overnight mnemonic discrimination ability (bleftERCthickness = 0.112 [0.014-0.211]).DISCUSSIONThese findings identify CSVD as a candidate mechanism linking OSA-related hypoxemia to MTL degeneration and impaired sleep-dependent memory in older adults, specifically implicating hypoxic events during REM sleep.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"48 1","pages":"e213639"},"PeriodicalIF":9.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920986","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":"Fast Food, Slow Damage: The Role of Ultraprocessed Foods in Parkinson Disease.","authors":"Maria I Maraki,Nikolaos Scarmeas","doi":"10.1212/wnl.0000000000213684","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213684","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"1 1","pages":"e213684"},"PeriodicalIF":9.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920966","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":"Long-Term Consumption of Ultraprocessed Foods and Prodromal Features of Parkinson Disease.","authors":"Peilu Wang,Xiao Chen,Muzi Na,Mario H Flores-Torres,Kjetil Bjornevik,Xuehong Zhang,Xiqun Chen,Neha Khandpur,Sinara Laurini Rossato,Fang Fang Zhang,Alberto Ascherio,Xiang Gao","doi":"10.1212/wnl.0000000000213562","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213562","url":null,"abstract":"BACKGROUND AND OBJECTIVESConsumption of ultraprocessed foods (UPFs) has been associated with a higher risk of various chronic diseases, but its relation to prodromal Parkinson disease (PD) remains unclear. We aimed to assess the association between long-term UPF consumption and nonmotor features suggestive of prodromal PD.METHODSThis longitudinal analysis included participants without a history of PD from the Nurses' Health Study and Health Professionals Follow-Up Study. UPF consumption was assessed using repeated food frequency questionnaires (1984-2006) and grouped based on Nova classification. Participants provided data on probable REM sleep behavior disorder (pRBD) and constipation in 2012. Between 2014 and 2015, a subset of participants provided data on 5 additional nonmotor features, including hyposmia, impaired color vision, excessive daytime sleepiness, body pain, and depressive symptoms. The primary outcome was the combination of all 7 prodromal features and further categorized as 0 (reference), 1, 2, and ≥3 features. The secondary outcomes were all features except constipation, a combination of 3 commonly recognized features (constipation, pRBD, and hyposmia), and individual features. Multinomial logistic regression was used to estimate the association of UPF consumption with the combination of prodromal features. The association between UPF consumption and each individual feature was further examined using logistic regression.RESULTSThe study analyzed 42,853 participants (25,095 women [58.6%]; mean [SD] age, 47.8 [5.2] years). Comparing extreme quintiles of UPF consumption, the multivariable-adjusted odds ratio (OR) for having ≥3 vs 0 prodromal features was 2.47 (95% CI 1.89-3.23, ptrend < 0.0001) for cumulative average intake and 1.50 (95% CI 1.18-1.89, ptrend = 0.0009) for baseline intake. Similar results were observed for combinations of all features except constipation (OR 2.00, 95% CI 1.29-3.11, ptrend < 0.0001) and combinations of 3 features (OR 2.47, 95% CI 1.41-4.34, ptrend = 0.008). In addition, higher UPF consumption was associated with increased odds of individual prodromal features, including pRBD, constipation, body pain, and depressive symptoms.DISCUSSIONLong-term UPF consumption was positively associated with nonmotor prodromal PD features. More studies are warranted to confirm whether lowering UPF consumption may prevent the occurrence of nonmotor symptoms that often precede PD diagnosis.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"117 1","pages":"e213562"},"PeriodicalIF":9.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920968","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":"Greater Accumulation of Brain White Matter Hyperintensities in People Diagnosed and Treated During Acute HIV Compared With People Without HIV.","authors":"Kathryn B Holroyd,Phillip Chan,Carlo Sacdalan,Netsiri Dumrongpisutikul,Somchai Sriplienchan,Pathariya Promensa,Pom Sailasuta,Mantana Pothisri,Suwanna Puttamaswin,Sandhya Vasan,Victor Valcour,Lydie Trautmann,Serena Spudich,Robert Paul,Jacob Bolenzius,","doi":"10.1212/wnl.0000000000213591","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213591","url":null,"abstract":"BACKGROUND AND OBJECTIVESPeople living with HIV (PWH) have increased rates of ischemic stroke even after antiretroviral therapy (ART) and viral suppression. Cerebral white matter hyperintensities (WMHs) on brain MRI are associated with an increased risk of stroke and cognitive impairment. This study sought to characterize and quantify brain WMHs during acute HIV infection and after early ART initiation compared with people without HIV.METHODSParticipants diagnosed with acute HIV infection (AHI) from the RV254/SEARCH010 cohort in Thailand and demographically matched people without HIV (PWoH) were identified. The inclusion criterion was age 18 years or older; exclusion criteria were history of psychiatric disorder, neurologic disorder, or pregnancy. Participants who had paired 3T MRI brain scans completed at enrollment and at two-year follow-up were included in the analysis. WMH data were extracted from T2 fluid-attenuated inversion recovery sequences and standardized to total intracranial volume to generate an index of WMH volume change. A repeated-measures ANOVA was used to test for WMH change over time per group, and WMH change was compared with HIV disease measures and vascular comorbidities using parametric and nonparametric testing.RESULTSSeventy-two RV254 participants (PWH, 99% male) and 37 PWoH (100% male), with a mean age of 31 years, were included. PWH had a mean estimated duration of exposure to HIV of 21 days (SD = 9). Both groups had very low rates of vascular comorbidities. At baseline, the volume of WMHs did not differ between groups. However, there was a greater increase in WMH volume over 2 years in PWH (mean 21.6%) compared with PWoH (mean 5.8%, p = 0.004, partial η2 = 0.075, Cohen d = 0.597) despite undetectable plasma viral load. Within PWH, hypertension and higher BMI were associated with a greater increase in WMHs (p = 0.038 and p = 0.016, respectively). Greater WMH accumulation also correlated with higher baseline CD4+ T-cell count in PWH (r = 0.272, p = 0.021).DISCUSSIONYoung Thai men with AHI demonstrated greater WMH progression than PWoH over 2 years despite ART initiation and viral suppression. These data suggest that brain white matter is vulnerable to HIV during early infection, independent from vascular comorbidities or lifestyle factors. Limitations include homogeneity in sex and ethnicity and follow-up period limited to 24 months.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"24 1","pages":"e213591"},"PeriodicalIF":9.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915210","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":"What Are Current Concepts on the Functional Organization of the Globus Pallidus Externus and Its Potential Role in Parkinson Disease?","authors":"Eduardo Benarroch","doi":"10.1212/wnl.0000000000213623","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213623","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"12 1","pages":"e213623"},"PeriodicalIF":9.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915212","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":"Trigeminal Tract Abnormality Leading to Leukodystrophy With Brainstem and Spinal Cord Involvement and High Lactate Diagnosis.","authors":"Irène Pei,Thomas Bogdan,Christine Tranchant,Nadège Calmels,Mathieu Anheim,Thomas Wirth","doi":"10.1212/wnl.0000000000213569","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213569","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"63 1","pages":"e213569"},"PeriodicalIF":9.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915211","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":"Three-Dimensional Maps of the Lenticulostriate Artery Territory.","authors":"Daniel Antoniello,Sally S Ladsaria,Runjhun Bhatia","doi":"10.1212/wnl.0000000000213649","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213649","url":null,"abstract":"BACKGROUND AND OBJECTIVESAccurate knowledge of the cerebral vascular territories is foundational to stroke care. Yet, precise digital reference maps are not widely accessible, especially for subcortical structures. To address this shortcoming, we constructed 3-dimensional vascular territory maps of the MCA perforators-the lenticulostriate arteries (LSAs).METHODSNineteen LSA infarcts were demarcated on DWI scans and then normalized onto a standard 3-dimensional template brain. Normalized infarct volumes were then superimposed to create infarct density maps (heatmaps).RESULTSLSA territory heatmaps display the spatial distribution of infarct frequency of the entire territory and highlight its spatially consistent subterritories: medial group, lateral group-rostral, and lateral group-caudal. The maps show each territory's most commonly affected core, as well as their typical shape, boundary, and variability.DISCUSSIONThe LSA territory maps can be used for education, clinical reference, or research. They can be explored 3-dimensionally on any web browser or downloaded for use. In addition, we present a framework for understanding infarcts within the LSA system based on microvascular architecture.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"15 1","pages":"e213649"},"PeriodicalIF":9.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915213","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}