Neurology最新文献

{"title":"Teaching Video NeuroImage: Rhythmic Ictal Nonclonic Hand Motions: A Valuable Lateralizing Sign in Focal Epilepsy.","authors":"Kaley J Marcinski Nascimento,Alexis King,Sándor Beniczky,Fábio A Nascimento","doi":"10.1212/wnl.0000000000213346","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213346","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"4 1","pages":"e213346"},"PeriodicalIF":9.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988902","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 Differences in Natural History and Health Outcomes Among Individuals With Tic Disorders.","authors":"Marisela E Dy-Hollins,Lori B Chibnik,Natasha A Tracy,Lisa Osiecki,Cathy L Budman,Danielle C Cath,Marco A Grados,Robert A King,Gholson J Lyon,Guy A Rouleau,Paul Sandor,Harvey S Singer,Nutan Sharma,Carol A Mathews,Jeremiah M Scharf","doi":"10.1212/wnl.0000000000210249","DOIUrl":"https://doi.org/10.1212/wnl.0000000000210249","url":null,"abstract":"OBJECTIVESTo analyze sex differences in outcomes in Tourette syndrome (TS) and Persistent Motor or Vocal tic disorders (PMVT) in the Tourette Association of America International Consortium for Genetics (TAAICG) dataset.METHODSThe relationship between sex and clinical measures was explored in 2,403 participants (N = 2,109 with TS; N = 294 with PMVT) from the TAAICG dataset using generalized estimating equation regression models, and adjusted for age and family relationships.RESULTSFemale (vs male) participants with TS (25.5% of the sample) had 0.46 times lower odds of being formally diagnosed clinically with TS before the research study (p < 0.00001), later age at symptom onset (6.5 ± 2.8 vs 6.0 ± 2.7; p = 0.001), later age at diagnosis (13.3 ± 11.2 vs 10.7 ± 8.1; p = 0.0001), a longer time-to-diagnosis (3 [1, 7] vs 2 [1, 5], p = 0.01), and lower tic severity (28.4 ± 9.1 vs 30.7 ± 8.7); p < 0.0001). Female (vs male) participants with PMVT (42.9% of the sample) had an earlier age at symptom onset (7.9 ± 3.3 vs 8.9 ± 3.7; p = 0.05).DISCUSSIONFemale (vs male) participants with TS are less likely to be formally diagnosed, have later age at symptom onset, later age at diagnosis, and longer time-to-diagnosis. Female (vs male) participants with PMVT have an earlier age at symptom onset. Future research is needed to understand differences longitudinally in TS and PMVT.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"45 1","pages":"e210249"},"PeriodicalIF":9.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988907","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":"Risk of Suicide After Aneurysmal Subarachnoid Hemorrhage: A Nationwide Study.","authors":"Aleksanteri Asikainen,Miikka Korja,Jaakko Kaprio,Ilari Matias Rautalin","doi":"10.1212/wnl.0000000000213348","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213348","url":null,"abstract":"BACKGROUND AND OBJECTIVESAlthough around one-third of survivors of aneurysmal subarachnoid hemorrhage (aSAH) suffer from anxiety and depression, studies focusing on suicide risk after aSAH are lacking. Thus, we aimed to investigate whether survivors of aSAH have an elevated risk of suicide death in comparison with the general population.METHODSUsing 2 externally validated nationwide registers (Care Register for Health Care and Cause of Death Register), we identified all ≥15-year-old survivors of aSAH (alive 30 days after hospital admission) in Finland during 1998-2017 and followed these patients until death or the end of 2018. By calculating standardized mortality ratios (SMRs) with 95% CIs using the Mid-P exact test, we compared the observed suicide rates of survivors of aSAH with the expected rates based on the age-matched, sex-matched, and year-matched general Finnish population.RESULTSWe identified 5,708 survivors of aSAH (59% female, median age 55 years) of whom 19 (5 female patients and 14 male patients) died by suicide during a total of 53,060 person-years (median 8.9 years) of follow-up. Of all deaths by suicide, 7 were caused by self-poisoning, 6 by hanging/strangulation, 3 by a firearm, 2 by jumping, and 1 by a sharp object. The observed rate of suicide was 35.8 per 100,000 person-years compared with the expected rate of 20.4 per 100,000 person-years resulting in an overall SMR of 1.75 (95% CI 1.09-2.69). The risk of suicide was especially high among 15-39-year-old female and male patients (72.5 per 100,000 person-years; SMR = 3.57 [1.31-7.92]) and during the first year after aSAH (81.2 per 100,000 person-years; SMR = 3.64 [1.16-8.77]), after which the risk attenuated.DISCUSSIONSurvivors of aSAH are at excessive risk of suicide death in comparison with the general population. Given that this risk seems to be the highest among young individuals and during the first year after aSAH, early assessment and management of psychological distress, especially in young survivors of aSAH may be warranted. Future studies should include detailed individual-level data on psychiatric comorbidities and aSAH-specific factors, as well as record both nonfatal and fatal suicide attempts.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"99 1","pages":"e213348"},"PeriodicalIF":9.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988903","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: \"Broomstick-Like\" Appearance of Intracranial Arteries in ACTA2 Leukovasculopathy.","authors":"Nidhi Ravishankar,Arpita Lakhotia","doi":"10.1212/wnl.0000000000213329","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213329","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"37 1","pages":"e213329"},"PeriodicalIF":9.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988908","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: Hyperventilation-Induced Alternating Hemiplegia With Concomitant Hemispheric EEG Slowing in a 7-Year-Old Girl With Headache.","authors":"","doi":"10.1212/WNL.0000000000210264","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210264","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 1","pages":"e210264"},"PeriodicalIF":7.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846990","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":"Message From the Editors to Our Reviewers.","authors":"José G Merino, Olga Ciccarelli, Frederik Barkhof, Rebecca Burch, Brian C Callaghan, Peter Hedera, Linda A Hershey, Barbara C Jobst, Andrea Lauren Christman Schneider, Bradford B Worrall, Courtney J Wusthoff","doi":"10.1212/WNL.0000000000210282","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210282","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 1","pages":"e210282"},"PeriodicalIF":7.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829470","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 39-Year-Old Returning Traveler With Acute Encephalopathy and Strokes.","authors":"Clayton Travis Buback, Kamesh Krishnamurthy, Natalie Neale, Zainab Zullali, Douglas Pet","doi":"10.1212/WNL.0000000000210177","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210177","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 1","pages":"e210177"},"PeriodicalIF":7.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818624","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":"Early Neuro-Deterioration and Mortality Among Neurology Inpatients in a Zambian Referral Hospital: A Prospective Cohort Study.","authors":"Morgan L Prust, Kasakula Kaunda, Vanessa Salasky, Kondwelani Mateyo, Mulenga Bwalya, Mulenga Chilando, Musisye Luchembe, David Nassoro, Dickson Munkombwe, Coolwe Namangala, Julia Mwamba, Faith Simushi, Leroy Yankae, Michael Kinkata, Gina Perez, Hari Pradhyuman, Meron Awaris, Sarah Braun, Lorraine Chishimba, Mashina Chomba, Alex Peloso, Stanley Zimba, Ngosa Mumba, Deanna R Saylor","doi":"10.1212/WNL.0000000000210132","DOIUrl":"10.1212/WNL.0000000000210132","url":null,"abstract":"<p><strong>Objectives: </strong>Neurocritical illnesses occur disproportionately in countries with limited health care capacity. Identifying risk factors of reversible neurodeterioration may improve care in resource-limited settings. We investigated whether early neurodeterioration (END) predicted inpatient mortality at a resource-limited Zambian hospital.</p><p><strong>Methods: </strong>We conducted a prospective observational cohort study from January to August 2023 of neurology inpatients at Zambia's national referral hospital. All inpatients older than 18 years were eligible for inclusion and monitored from admission to discharge in a clinical registry. END was defined as a drop in the Glasgow Coma Scale (GCS) within 3 days of admission. We used linear regression to compare mortality between participants with and without END.</p><p><strong>Results: </strong>We enrolled 500 participants. Two hundred ninety-five participants had GCS recorded more than once within 3 days of admission. END occurred in 53 participants (18%) and predicted increased mortality (72% vs 11%, odds ratio [OR] 18.98, 95% CI 7.74-46.51, <i>p</i> < 0.001), even after a single-point GCS drop (70%, OR 13.08, 95% CI 3.2-53.47, <i>p</i> < 0.001). Seizures were more frequent in participants with END (27% vs 12.5%, χ² = 9.9, <i>p</i> = 0.002). The leading mortality drivers were aspiration pneumonia (34%) and sepsis (31%).</p><p><strong>Discussion: </strong>END was common, associated with unfavorable outcomes, and frequently driven by preventable and/or treatable factors. Protocolized interventions for reversible complications may improve neurologic outcomes in resource-limited settings.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 1","pages":"e210132"},"PeriodicalIF":7.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818693","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":"Circulating miRNAs Associated With 3-Month Outcome in Patients With Acute Ischemic Stroke.","authors":"Isabel Fernández-Pérez, Marta Vallverdú-Prats, Lucía Rey-Álvarez, Eva Giralt Steinhauer, Angel Ois, Elisa Cuadrado-Godia, Ana Rodriguez-Campello, Antoni Suárez-Pérez, Adrià Macias-Gómez, Carolina Soriano-Tárraga, Francisco F Purroy, Gloria Arque, Silvia Tur, Guillem Cañellas, Cristofol Vives-Bauza, Tomas Segura, Gemma Serrano-Heras, Uxue Lazcano, Joan Jiménez-Balado, Jordi Jimenez-Conde","doi":"10.1212/WNL.0000000000210085","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210085","url":null,"abstract":"<p><strong>Background and objectives: </strong>Post-ischemic stroke (IS) outcomes vary widely among individuals, independently of clinical factors. This variability could be related to epigenetic mechanisms that regulate biological processes involved in recovery after ischemia. While several microRNAs (miRNAs) and their target genes are implicated in the pathophysiology of IS, their role in functional outcomes remains unclear. Our aim is to identify potential miRNAs associated with the 3-month outcome in patients with IS.</p><p><strong>Methods: </strong>A discovery study was performed in patients with acute IS assessed at Hospital del Mar of Barcelona from 2009 to 2018. Main inclusion criteria were initial NIH Stroke Scale (NIHSS) score >2, hospital admission within 24 hours of IS onset, and previous functional independence. Poor 3-month outcome was defined as a modified Rankin Scale score >2. We performed miRNA next-generation sequencing on plasma samples obtained within 24 hours and performed a differential expression analysis for 2,083 miRNAs using the DESeq2 package. A replication stage was performed using real time-PCR in another multicenter cohort, with equivalent inclusion criteria and multivariate regression models. We also performed enrichment pathways analyses in both phases.</p><p><strong>Results: </strong>The discovery cohort included 215 patients with IS (mean age 74.7 ± 10.2 years, 54.9% male). Age, sex, and stroke severity (measured with the 24-hour NIHSS) were associated with the 3-month outcome (<i>p</i> < 0.05). After adjusting for these potential confounders, we found 74 miRNAs significantly associated (<i>Q</i> < 0.05) with the 3-month poor outcome. Pathway analysis revealed significant associations with pathways related to angiogenesis, neuronal morphogenesis, transforming growth factor β (TGF-β), endothelial development, and cognition. The replication included 191 patients (mean age 78.0 ± 6.0 years, 49.7% male). We analyzed 26 miRNAs selected from the discovery stage, and 5 miRNAs replicated their association with poor outcomes (<i>p</i> < 0.05, fold change >1.7): miR-376c-3p, miR-4463, miR-199a-3p, miR-584-5p, and miR-134-5p.</p><p><strong>Discussion: </strong>We identified 5 miRNAs overexpressed in patients with poor 3-month outcomes after IS, which could be involved in biological processes such as cognition, neuronal morphogenesis, and TGF-β response, suggesting a potential role in brain recovery. These findings were not evaluated in infratentorial and lacunar strokes, which limits generalizability in these particular subtypes. Further investigation is needed to explore potential applicability of these findings.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 1","pages":"e210085"},"PeriodicalIF":7.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801763","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":"Circulating MicroRNA Relationship to Outcome in Ischemic Stroke.","authors":"Maria Guadalupe C Real, Glen C Jickling","doi":"10.1212/WNL.0000000000210237","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210237","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 1","pages":"e210237"},"PeriodicalIF":7.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801761","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}