Neurology最新文献

{"title":"Author Response: Right Brain: The Unraveling.","authors":"Nara Miriam Michaelson","doi":"10.1212/WNL.0000000000209852","DOIUrl":"https://doi.org/10.1212/WNL.0000000000209852","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e209852"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573550","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 Between Changes in White Matter Volume Detected With Diffusion Tensor-Based Morphometry and Motor Recovery After Stroke.","authors":"Matthew A Edwardson, Amritha Nayak, M Okan Irfanoglu, Marie L Luby, Lawrence L Latour, Carlo Pierpaoli","doi":"10.1212/WNL.0000000000213408","DOIUrl":"10.1212/WNL.0000000000213408","url":null,"abstract":"<p><strong>Background and objectives: </strong>Diffusion tensor-based morphometry (DTBM) provides a more accurate assessment of volumetric changes in white matter structures than conventional T1-based TBM techniques. We sought to determine whether DTBM could detect volume loss in the corticospinal tract (CST) and whether this marker was associated with impaired stroke recovery.</p><p><strong>Methods: </strong>Retrospective clinical MRI scans were obtained from a cohort of participants enrolled in a natural history study with acute anterior circulation ischemic stroke and unilateral arm impairment (NIH Stroke Scale [NIHSS] arm motor item score ≥2). Maps of the change in fractional anisotropy (delta FA) and the DTBM log of the Jacobian (LnJ, representing volumetric change) between scans, acquired <36 hours and 30 days after stroke, were computed. Voxel-wise Spearman rank-based analysis identified clustered regions of interest (ROIs) where the delta FA and LnJ from baseline to 30 days correlated with individual arm motor recovery scores on the NIHSS from baseline to 30 days. Qualitative comparisons were made between delta FA and LnJ maps for good and poor recovery groups (delta NIHSS arm item score ≥2 or <2, respectively) in reference to controls.</p><p><strong>Results: </strong>Twenty-one participants with anterior circulation stroke were evaluated (mean age 63.6 years, median NIHSS arm motor item score 4, 48% female). Voxel-wise statistical maps identified 2 ROIs for delta FA and 4 ROIs for LnJ showing strong correlations with arm motor recovery (range of Spearman ρ = 0.77-0.81, all <i>p</i> < 0.01). The delta FA ROIs included the corona radiata and adjacent white matter, whereas LnJ ROIs included the centrum semiovale, corona radiata, internal capsule, and pons. Visual inspection of the average delta FA map from participants with poor arm motor recovery showed diffuse changes in the CST and adjacent subcortical regions while LnJ maps demonstrated more focal CST changes, particularly in the brainstem and internal capsule.</p><p><strong>Discussion: </strong>DTBM detects focal volume loss in the CST over the first 30 days after stroke likely related to Wallerian degeneration. These volumetric changes may provide complementary information to FA in characterizing white matter loss after stroke. Like FA, DTBM shows strong correlations with arm motor recovery that could be useful for predicting recovery after stroke.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213408"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557256","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":"In the Same Vein as My Father.","authors":"Leo Sison Acosta, Lealani Mae Y Acosta","doi":"10.1212/WNL.0000000000213474","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213474","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213474"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557392","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":"Neuroimaging Features of Sneddon Syndrome.","authors":"Sarbesh Tiwari, Pradeep Kumar Gunasekaran, Revathi Bainaboina, Anil Budania, Vikrant Verma, Lokesh Saini","doi":"10.1212/WNL.0000000000213510","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213510","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213510"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557420","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":"Reader Response: Right Brain: The Unraveling.","authors":"Rachel M Horne, Andrea Hollomotz, Helen L Ford, Shruthi Venkatachalam, Kharis Hutchison, Nikos Evangelou, Charley Baker, Suzanne Britt","doi":"10.1212/WNL.0000000000209834","DOIUrl":"https://doi.org/10.1212/WNL.0000000000209834","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e209834"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573577","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":"Sex-Specific Patterns of Reproduction in People With Epilepsy: A Nationwide Cohort Study From Denmark.","authors":"Josefine Klakk, Betina B Trabjerg, Samuel F Berkovic, Chris Cotsapas, Churl-Su Kwon, Ruth Ottman, Julie Werenberg Dreier, Jakob Christensen","doi":"10.1212/WNL.0000000000213468","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213468","url":null,"abstract":"<p><strong>Background and objectives: </strong>Reproduction is lower in male individuals compared with female individuals with epilepsy. The reason is unknown. We studied sex-specific reproduction in individuals with epilepsy and the role of epilepsy subtype and psychiatric comorbidity.</p><p><strong>Methods: </strong>We conducted a population-based register study in Denmark, using data from January 1, 1982, to December 31, 2021. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) with 95% CIs for the chance of having ≥1 child. We followed all persons from 15 years of age until birth of live-born offspring, 45 years of age, emigration, death, or end of follow-up (December 31, 2021), whichever occurred first. Epilepsy status was identified from the Danish National Patient Register. The primary outcome was the occurrence of live-born children identified from the Danish Medical Birth Register among persons with and without epilepsy.</p><p><strong>Results: </strong>We included 2,593,097 individuals (49% of female individuals), including 46,243 (1.8%) with epilepsy (mean age at diagnosis of 13.1 years [SD 9.2]). Compared with individuals without epilepsy, the aHR of having ≥1 child was reduced in both sexes with epilepsy, but lower in male individuals (0.59, 95% CI 0.57-0.60) compared with female individuals with epilepsy (0.72, 95% CI 0.71-0.74). By age 45 years, the probability of being childless was 45.9% in male individuals and 30.7% in female individuals with epilepsy, compared with 22.8% in male individuals and 14.1% in female individuals without epilepsy. Compared with persons without epilepsy, the chance of having a first child was lower in female individuals with focal epilepsy (aHR 0.61, 95% CI 0.58-0.64) than in female individuals with generalized epilepsy (aHR 0.72, 95% CI 0.69-0.75), and lower in male individuals with focal epilepsy (aHR 0.51, 95% CI 0.48-0.53) than in male individuals with generalized epilepsy (aHR 0.57, 95% CI 0.54-0.60). Reproduction was particularly low in persons with epilepsy and psychiatric comorbidity (male individuals: aHR 0.30, 95% CI 0.28-0.32; female individuals: aHR 0.51, 95% CI 0.48-0.53).</p><p><strong>Discussion: </strong>Individuals with epilepsy were less likely to become parents than individuals without epilepsy, and the association was stronger in male individuals and those with psychiatric comorbidity and varied with epilepsy subtype.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213468"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649728","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":"Post-Concussion Brain Changes Relative to Pre-Injury White Matter and Cerebral Blood Flow: A Prospective Observational Study.","authors":"Nathan W Churchill, Michael G Hutchison, Simon J Graham, Tom A Schweizer","doi":"10.1212/WNL.0000000000213374","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213374","url":null,"abstract":"<p><strong>Background and objectives: </strong>Medical clearance for return to play (RTP) after sports-related concussion is based on clinical assessment. It is unknown whether brain physiology has entirely returned to preinjury baseline at the time of clearance. In this longitudinal study, we assessed whether concussed individuals show functional and structural MRI brain changes relative to preinjury levels that persist beyond medical clearance. Secondary objectives were to test whether postconcussion changes exceed uninjured brain variability and to correlate MRI findings with clinical recovery time.</p><p><strong>Methods: </strong>For this prospective observational study, healthy athletes without a history of psychiatric, neurologic, or sensory-motor conditions were recruited from a single university sport medicine clinic. Clinical and MRI data were collected at preseason baseline, and those who were later concussed were reassessed at 1-7 days after injury, RTP, 1-3 months after RTP, and 1 year after RTP. A demographically matched control cohort of uninjured athletes was also reassessed at their subsequent preseason baseline. Primary outcomes were postconcussion changes in MRI measures of cerebral blood flow (CBF), white matter mean diffusivity (MD), and fractional anisotropy (FA), evaluated using mixed models. Secondary outcomes were group differences in MRI change scores and correlations of change scores with days to RTP.</p><p><strong>Results: </strong>Of the 187 athletes enrolled in the study, 25 had concussion with follow-up imaging (20.3 ± 1.5 years, 56% male, 44% female) and were compared with 27 controls (19.7 ± 1.8 years, 44% male, 56% female). Concussed athletes showed statistically significant changes from baseline, including decreased frontoinsular CBF (mean and 95% CI -8.97 [-12.80, -5.01] mL/100 g/minute, z = -4.53), along with increased MD (1.94 × 10^-5 [1.26, 2.69] × 10^-5, z = 5.48) and reduced FA (-7.30 × 10^-3 [-9.80, -5.05] × 10^-3, z = -6.07) in the corona radiata and internal capsule. Effects persisted beyond RTP, although only CBF changes exceeded longitudinal variability in controls. For participants with longer recovery periods, significantly greater changes in medial temporal CBF were also seen (ρ = 0.64 [0.44, 0.81], z = 6.80).</p><p><strong>Discussion: </strong>This study provides direct evidence of persistent postconcussion changes in CBF and white matter at RTP and up to 1 year later. These results support incomplete recovery of brain physiology at medical clearance, with secondary analyses emphasizing the sensitivity of CBF to clinical recovery.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213374"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616527","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":"Effect of Incident Stroke on Dementia Risk Over 10 Years in a Cohort of Asian American and Non-Latino White Older Adults in California.","authors":"L Paloma Rojas-Saunero, Yixuan Zhou, Eleanor Hayes-Larson, Yingyan Wu, Taylor Mobley, Roch A Nianogo, Holly Elser, Gilbert C Gee, Ron Brookmeyer, Rachel Whitmer, Paola Gilsanz, Elizabeth Rose Mayeda","doi":"10.1212/WNL.0000000000213488","DOIUrl":"10.1212/WNL.0000000000213488","url":null,"abstract":"<p><strong>Background and objectives: </strong>Limited evidence exists on stroke incidence and its impact on dementia risk in Asian American older adults, a population with lower dementia risk than other racial and ethnic groups. We aimed to estimate the cumulative incidence of stroke and assess its effect on dementia risk over 10 years among Chinese, Filipino, Japanese, South Asian, and non-Latino White older adults in Northern California.</p><p><strong>Methods: </strong>This cohort study included Kaiser Permanente Northern California members who participated in surveys between 2002 and 2009 with linked electronic health record data through 2020. We included Chinese, Filipino, Japanese, South Asian, and non-Latino White participants aged 60-89 years without history of stroke or dementia at the time of survey (baseline). Incident stroke and incident dementia were identified using International Classification of Diseases codes. We estimated the cause-specific cumulative incidence of stroke at 10 years of follow-up using the Aalen-Johansen estimator. We estimated the effect of incident stroke on dementia risk with risk ratios and risk differences from a weighted Kaplan-Meier survival estimator. We used time-varying inverse probability weights to adjust for confounding and censoring due to loss to follow-up and death. In secondary analyses, we restricted the exposure to ischemic stroke.</p><p><strong>Results: </strong>We included 147,986 participants (Chinese [n = 6,034], Filipino [n = 4,649], Japanese [n = 3,099], South Asian [n = 996], non-Latino White [n = 133,208]); the mean baseline age ranged from 69 to 72 years, and the percentage of female participants ranged from 40% to 63% across groups. The 10-year cumulative incidence of stroke (95% CIs) ranged from 10.7% (9.9%-11.6%) for Chinese participants to 13.7% (12.4%-15.2%) for Japanese participants. Risk ratios relating incident stroke and dementia risk at 10 years of follow-up were 4.3 (3.0-6.4) for Chinese participants, 3.3 (2.2-4.6) for Filipino participants, 4.6 (2.5-6.6) for Japanese participants, 5.4 (1.5-12.4) for South Asian participants, and 2.9 (2.7-3.2) for non-Latino White participants. Restricting analyses to ischemic stroke yielded similar results.</p><p><strong>Discussion: </strong>Stroke incidence is high among Asian American and non-Latino White older adults and is associated with increased dementia risk in all groups. Future research needs to disentangle the pathophysiologic mechanisms involved in the acute event of stroke that trigger and accelerate dementia onset.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213488"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573571","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":"Use of Portable 24-Hour Polysomnography as Alternative Diagnostic Tool for Narcolepsy Type 1 in Adults and Children.","authors":"Francesco Biscarini, Stefano Vandi, Corrado Zenesini, Luca Vignatelli, Francesca Citeroni, Elena Antelmi, Christian Franceschini, Lucie Barateau, Yves Dauvilliers, Emmanuel Mignot, Giuseppe Plazzi, Fabio Pizza","doi":"10.1212/WNL.0000000000213473","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213473","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;The diagnosis of narcolepsy type 1 (NT1) currently requires the multiple sleep latency test (MSLT), or a nocturnal sleep-onset REM period (SOREMP) combined with typical cataplexy, or alternatively the determination of CSF hypocretin-1 (CSF-hcrt-1) deficiency. We evaluated the 24-hour polysomnography (PSG) recordings in adult and pediatric patients as an alternative diagnostic tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients of any age, referred to the narcolepsy center of a university hospital for suspected central disorder of hypersomnolence (CDH), were consecutively recruited between 2013 and 2022. Participants underwent 2 days (day1-night1-day2-night2) of continuous dynamic PSG followed by MSLT. When consent was given, CSF-hcrt-1 was measured. The accuracy of 24-hour PSG variables from night1 and day2 (index test) was assessed with receiver operating characteristic (ROC) curve analysis in identifying NT1 based on current criteria (applied to night2-PSG, MSLT, and CSF-hcrt1). The markers with area under the curve (AUC) ≥0.75 were then tested in adults and children, separately, and to diagnose NT1 and narcolepsy type 2 (NT2) in different scenarios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight hundred seven patients (30.1% pediatric, 52.4% male) were included, and 709 had CSF-hcrt-1 measured. According to the standard criteria, 322 were diagnosed with NT1 (mean age 26.7 ± 17.1 years, 40.4% pediatric, 54.0% male) and 484 with non-NT1 (mean age 32.7 ± 16.5 years, 23.3% pediatric, 51.3% male), encompassing 31 with NT2, 163 with idiopathic hypersomnia, and 281 with other diagnoses. Detecting SOREMP ≥1 during daytime resulted in AUC = 0.84 (95% CI 0.82-0.87), with 84.4% sensitivity and 84.5% specificity for NT1. Performance was superior to all nighttime-PSG measures (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) including nighttime-SOREMP (AUC = 0.77, 95% CI 0.74-0.80; sensitivity = 62.1%, specificity = 91.7%) and did not differ from 24-hour SOREMP ≥1 (AUC = 0.85, 95% CI 0.82-0.87; sensitivity = 89.7%, specificity = 80.2%). The combination of daytime-SOREMP ≥1 with cataplexy showed AUC = 0.89 (95% CI 0.86-0.91) for NT1, superior to the combination of nighttime-SOREMP with cataplexy (AUC = 0.78, 95% CI 0.76-0.81, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and similar to MSLT criteria for narcolepsy (AUC = 0.90, 95% CI 0.88-0.92, &lt;i&gt;p&lt;/i&gt; = 0.36). Performances were similar in adults and children. Daytime-SOREMP ≥1 identified NT1 and NT2 combined within all CDH with a sensitivity of 80.8% and specificity of 88.0%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The detection of daytime-SOREMP during dynamic 24-hour PSG is more accurate than nighttime-SOREMP for diagnosing narcolepsy and, combined with cataplexy, is comparable with MSLT criteria for the identification of NT1. These results offer the prospect of 24-hour PSG diagnostics for NT1 in the home setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Classification of evidence: &lt;/strong&gt;This study provides Class II evidence that daytime SOREMP during a 24","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213473"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625402","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 19-Year-Old Woman With Progressive Weakness and Numbness in Her Arms and Legs.","authors":"Al-Alya Alsabah, Merve Kaleli, Negar Khanlou, Yigit Karasozen","doi":"10.1212/WNL.0000000000213495","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213495","url":null,"abstract":"<p><p>Acute worsening of chronic weakness and numbness can have diagnostic challenges when trying to distinguish between acquired and hereditary conditions. We present the case of a 19-year-old patient who had acute worsening of chronic symmetric sensory and motor neuropathy with no response to intravenous immunoglobulin. Her story highlights the diagnostic approach for patients with atypical features of acquired vs genetic neuropathies and the importance of interpreting a \"pathogenic\" gene variant in this clinical context. Readers will explore the diagnostic steps our group has considered to reach our final diagnosis and the management of patients with complex neuropathy.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 7","pages":"e213495"},"PeriodicalIF":7.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557386","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}