IF 1.1 4区医学

Neurologist Pub Date : 2025-05-19 DOI: 10.1097/NRL.0000000000000623

Yue Zhang, Xintong Luo, Xiujuan Song, Jiamin Li, Yonggang Liu, Lina Wang, Guojun Tan

{"title":"Efficacy of Human Urinary Kallidinogenase in Real-world Patients With Acute Ischemic Stroke: A Matched Comparison.","authors":"Yue Zhang, Xintong Luo, Xiujuan Song, Jiamin Li, Yonggang Liu, Lina Wang, Guojun Tan","doi":"10.1097/NRL.0000000000000623","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000623","url":null,"abstract":"Objectives: We aimed to investigate the efficacy and safety of human urinary kallidinogenase (HUK) in real-world patients with acute ischemic stroke (AIS).Methods: AIS patients with prospective follow-up between April 2019 and June 2022 were enrolled in this study. Based on their treatment, the eligible patients were separated into 2 groups: the HUK group and the non-HUK group. Propensity score matching (PSM) analysis was used to reduce the biases from the unequal distribution of initial characteristics. The validated clinical composite scoring system was used to evaluate the neurological recovery. The safety outcomes include stroke recurrence, all-cause mortality, and major complications.Results: A total of 312 patients were enrolled in each of the 2 groups, and there were no significant differences in baseline characteristics between them. After treatment, both groups of AIS patients achieved favorable neurological outcomes. The National Institute of Health Stroke Scale (NIHSS) scores at discharge (3.47±3.41 vs. 4.37±2.85) demonstrated better neurological recovery in the HUK group. At the 90-day assessment, patients in the HUK group exhibited a higher incidence of favorable functional outcome (modified Rankin Scale score of 0 to 2, 74.68% vs. 60.58%), and lower risk of stroke recurrence (2.88% vs. 6.73%). The all-cause mortality (1.60% vs. 2.24%) was not significantly different between both groups.Conclusions: HUK improved neurological and functional outcomes in patients with AIS in a large real-world population and had an acceptable safety profile.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Embolic Hippocampal Infarct From Ipsilateral Tandem Carotid Stenosis: A Case Report and Lesson on Hippocampal Dual Vascular Supply. 同侧串联颈动脉狭窄致栓塞性海马梗死1例及对海马双血管供应的启示。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-14 DOI: 10.1097/NRL.0000000000000610

Samantha J Brown, Jennifer Nikolova, Monica Nitu, Justin Cramer, Oana Dumitrascu

{"title":"Embolic Hippocampal Infarct From Ipsilateral Tandem Carotid Stenosis: A Case Report and Lesson on Hippocampal Dual Vascular Supply.","authors":"Samantha J Brown, Jennifer Nikolova, Monica Nitu, Justin Cramer, Oana Dumitrascu","doi":"10.1097/NRL.0000000000000610","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000610","url":null,"abstract":"Introduction: Although primarily supplied by the vertebrobasilar system, the hippocampus is partially supplied by ipsilateral carotid artery branches through the anterior choroidal artery or a prominent posterior communicating artery. We report a patient with acute hippocampus infarction likely due to symptomatic ipsilateral tandem carotid stenosis and discuss acute vascular-mediated hippocampal injury.Case report: An 80-year-old female with obesity, dyslipidemia, hypertension, alcohol use disorder, history of breast cancer on letrozole, and traumatic brain injury was brought into our emergency department for 24 hours of confusion. On examination, she exhibited limited registration, recall, and executive dysfunction with otherwise normal language, visuo-spatial orientation, and praxis. Brain MRI showed a small area of diffusion restriction in the anterior right hippocampus with matched FLAIR hyperintensity, consistent with acute infarction. Computed tomography angiogram head and neck showed 90% stenosis of the proximal right internal carotid artery (ICA), <50% narrowing of the proximal left ICA, and moderate bilateral narrowing of the paraclinoid ICAs, all due to calcific atheromatous plaques. The etiology of the hippocampal infarction was suspected embolism from the ipsilateral severe carotid stenosis. Planning for right cervical carotid revascularization ensued.Conclusion: This case highlights the dual hippocampal vascular supply and that hippocampal embolic infarcts could be a sign of a symptomatic severe carotid artery stenosis that may require urgent revascularization for stroke secondary prevention.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Atypical Frontal Release Signs in Acute Anterior Cerebral Artery Infarction and Striatal Dopaminergic Dysfunction: A Case Report. 急性脑前动脉梗死和纹状体多巴胺能功能障碍的非典型额叶释放征象1例报告。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-12 DOI: 10.1097/NRL.0000000000000628

Gohei Yamada, Takanari Toyoda, Tomoyuki Kuno, Eiichi Katada, Noriyuki Matsukawa

{"title":"Atypical Frontal Release Signs in Acute Anterior Cerebral Artery Infarction and Striatal Dopaminergic Dysfunction: A Case Report.","authors":"Gohei Yamada, Takanari Toyoda, Tomoyuki Kuno, Eiichi Katada, Noriyuki Matsukawa","doi":"10.1097/NRL.0000000000000628","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000628","url":null,"abstract":"Introduction: Dystonic hand postures are uncommon in patients with frontal lobe infarction. Here, we report the first case of a patient with frontal lobe infarction presenting with unique dystonic hand postures-specifically, a pointing gun posture and full-finger extension posture-in combination with frontal release signs.Case report: A 68-year-old man with a prior diagnosis of probable Parkinson disease acutely developed speech and communication impairment, along with reduced voluntary motor function in the right lower extremity. Neurological examination revealed apathy, motor and sensory aphasia, and flaccid paralysis of the right lower limb. Brain magnetic resonance imaging showed an ischemic stroke involving the left superior frontal gyrus, cingulate gyrus, and corpus callosum. Dopamine transporter single-photon emission computed tomography revealed reduced tracer accumulation in the left striatum. Ten days after stroke onset, the patient exhibited a pointing gun posture in the right hand. A repeat neurological examination revealed a grasp reflex. Removing grasped objects led to a transient index finger extension with flexion of the other fingers or a transient full extension of all fingers. The former resembled a pointing gun posture, while the latter, a newly described phenomenon, was termed the full-finger extension posture. In addition, groping movements with the pointing gun posture were observed.Conclusion: Atypical frontal release signs, including the pointing gun posture and full-finger extension posture, may reflect specific thalamocortical excitation resulting from a combination of contralateral striatal dopaminergic denervation and frontal lobe infarction involving the supplementary motor area.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Involvement of Posterior Circulation Accounts for Higher Disability in Ischemic Strokes With NIHSS ≤3 But Not With NIHSS 4-5. NIHSS≤3而NIHSS≤4-5的缺血性卒中中，后循环受累可导致更高的残疾。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-08 DOI: 10.1097/NRL.0000000000000615

Maurizio Giorelli, Ruggiero Leone, Sergio Altomare, Anna Digiovanni

{"title":"Involvement of Posterior Circulation Accounts for Higher Disability in Ischemic Strokes With NIHSS ≤3 But Not With NIHSS 4-5.","authors":"Maurizio Giorelli, Ruggiero Leone, Sergio Altomare, Anna Digiovanni","doi":"10.1097/NRL.0000000000000615","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000615","url":null,"abstract":"Objectives: Minor strokes are defined as ischemic cerebrovascular accidents that present with mild symptoms scoring ≤5 on the National Institute of Health Stroke Scale (NIHSS). We aimed to investigate whether features related to stroke characteristics, location, severity, or symptoms could predict the risk of disability after minor strokes.Methods: Minor strokes (105) were divided into 2 subgroups: those with baseline NIHSS ≤3 and those with baseline NIHSS 4-5. Comorbidities, occurrence of disability, stroke location, etiology, and outcomes were examined in the 2 subgroups and in those who developed a modified Rankin scale (mRs) of 0 to 1 or mRs >1.Results: No-IVT minor strokes in the NIHSS 4-5 subgroup were associated with more disability compared with the NIHSS ≤3 subgroup (P>0.05). Residual disability (mRS >1) was associated with a higher incidence of posterior circulation strokes (PCS) (P=0.0015), large vessel stenosis (P=0.01), and PCS-related symptoms (imbalance, gait ataxia, and eye movement disorders) not accounted for by NIHSS, in strokes with baseline NIHSS ≤3. Disability (mRS >1) was associated with baseline disabling symptoms, which NIHSS effectively and reliably captured in patients with stroke with NIHSS 4-5.Conclusions: Symptoms that might predict unfavorable outcomes are not well captured by the available clinical instruments that are usually used to evaluate and score acute ischemic stroke at onset. When deciding on the management of minor stroke, clinicians must consider and judge all potentially disabling deficits, in addition to the pure scores of the adopted evaluation scales.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review. 卒中相关性肺炎与脑-肠-肺轴：系统文献综述。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-07 DOI: 10.1097/NRL.0000000000000626

Jing Bai, Yusheng Zhao, Zihe Wang, Peng Qin, Jingjie Huang, Yupei Cheng, Chaoran Wang, Yuyan Chen, Longxiao Liu, Yuxing Zhang, Bangqi Wu

{"title":"Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review.","authors":"Jing Bai, Yusheng Zhao, Zihe Wang, Peng Qin, Jingjie Huang, Yupei Cheng, Chaoran Wang, Yuyan Chen, Longxiao Liu, Yuxing Zhang, Bangqi Wu","doi":"10.1097/NRL.0000000000000626","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000626","url":null,"abstract":"Background: Stroke-associated pneumonia (SAP), a highly lethal complication following stroke, is closely linked to dysregulation of the \"brain-gut-lung axis.\" Accumulating evidence indicates that stroke triggers intestinal alterations through the brain-gut axis, while multiple studies confirm that gut-derived changes can mediate pneumonia through the gut-lung axis. However, the mechanisms connecting stroke-induced intestinal dyshomeostasis to SAP remain incompletely elucidated, and the multiorgan interaction mechanisms of the \"brain-gut-lung axis\" in SAP pathogenesis require further exploration.Review summary: This systematic literature review systematically searched databases, including PubMed, using the keywords \"stroke,\" \"gastrointestinal microbiome,\" and \"bacterial pneumonia,\" incorporating 80 mechanistic studies. Key findings reveal that stroke initiates a cascade of \"neuro-microbial-immune\" pathway interactions along the brain-gut-lung axis, leading to intestinal dyshomeostasis characterized by microbiota and metabolite alterations, barrier disruption, immune dysregulation, inflammatory responses, and impaired gut motility. These intestinal perturbations ultimately disrupt pulmonary immune homeostasis, promoting SAP development. In addition, stroke directly induces vagus nerve injury through the brain-gut axis, resulting in impaired swallowing and cough reflexes that exacerbate aspiration-related pulmonary infection risks.Conclusions: Elucidating the role of the brain-gut-lung axis in SAP pathogenesis provides critical insights into its underlying mechanisms. This paradigm highlights intestinal homeostasis modulation and vagus nerve stimulation as promising therapeutic strategies for SAP prevention and management, advancing a multitargeted approach to mitigate poststroke complications.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Expansive Arterial Remodeling and Its Risk Factors in Cerebral Infarction: A Retrospective Study. 脑梗死扩张性动脉重构及其危险因素的回顾性研究。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-01 DOI: 10.1097/NRL.0000000000000600

Bingzheng Gong, Ying Pian, Qichao Yang, Jingjun Zhang

{"title":"Expansive Arterial Remodeling and Its Risk Factors in Cerebral Infarction: A Retrospective Study.","authors":"Bingzheng Gong, Ying Pian, Qichao Yang, Jingjun Zhang","doi":"10.1097/NRL.0000000000000600","DOIUrl":"10.1097/NRL.0000000000000600","url":null,"abstract":"Objective: Cerebral infarction (CI) is a prevalent and frequently occurring condition. However, the association between expansive remodeling in the carotid artery system and CI is still uncertain. This study aims to investigate the significance of the carotid artery system and aortic arch (AA) remodeling for the prevention and treatment of CI.Methods: We collected data from 821 patients who underwent computed tomography angiography at our hospital, performed statistical analysis, and compared it with various clinical data.Results: We found that the diameters and detection rates of the common carotid artery (CCA), internal carotid artery (ICA), carotid bifurcation, and AA were significantly greater in the CI group than in the without CI group ( P <0.05). The number of carotid sinus plaque (CSP) and the length of aortic arch plaque (AAP) were considered to be 2 important factors in predicting CCA remodeling. Moreover, the thickness of AAP was considered to be an important factor in predicting AA remodeling.Conclusions: Patients with CI exhibited a significant increase in the diameter of the carotid system and AA, which correlated with certain features of arterial plaque. Hence, early detection of arterial plaques, along with interventions to delay or potentially reverse expansive arterial remodeling, may be effective in preventing and treating CI.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"132-139"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Short-Term Frequently Relapsing Ischemic Strokes Followed by Rapidly Progressive Dementia in CADASIL: A Case Report and Literature Review. CADASIL患者短期频繁复发的缺血性脑卒中后迅速进展的痴呆：病例报告与文献综述

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-01 DOI: 10.1097/NRL.0000000000000601

Yumei Geng, Chang Cai, Huimin Li, Qing Zhou, Mengying Wang, Huicong Kang

{"title":"Short-Term Frequently Relapsing Ischemic Strokes Followed by Rapidly Progressive Dementia in CADASIL: A Case Report and Literature Review.","authors":"Yumei Geng, Chang Cai, Huimin Li, Qing Zhou, Mengying Wang, Huicong Kang","doi":"10.1097/NRL.0000000000000601","DOIUrl":"10.1097/NRL.0000000000000601","url":null,"abstract":"Introduction: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease with slow natural progression. Ischemic stroke and cognitive impairment are its most common clinical symptoms. Here, we report a rare 50-year-old woman who had rapid disease progression with c.457C>T, p.Argl53Cys heterozygous mutation in exon 4 of NOTCH3 and discuss the possible reasons. Furthermore, we summarized the clinical and neuroimaging characteristics of 14 CADASIL patients with Arg153Cys mutation in exon 4.Case report: The proband suffered acute ischemic stroke 5 times in 5 months, followed by rapidly progressive dementia (RPD) and inability to live independently, though she didn't have vascular risk factors and had been under standardized secondary prevention therapy since the first stroke. Magnetic resonance imaging showed extensive white matter hyperintensities, numerous ischemic infarcts and microbleeds, and severe brain atrophy. Her elder brother and other patients with Arg153Cys mutation in exon 4 all did not progress so quickly. Her multiple strokes may be associated with the poor self-regulation of vessels, which may promote the occurrence of RPD. Antiplatelet and anticoagulant drugs were difficult to prevent ischemic strokes. Severe imaging findings may indicate rapid progression of CADASIL. In addition, we found that headache was a very frequent symptom in CADASIL patients with Arg153Cys mutation in exon 4, accounting for 76.9%.Conclusions: CADASIL can also appear to have rapid progression, as illustrated by our proband, which is worthy of clinicians' attention and intervention timely. Headache may present in a relatively higher proportion of CADASIL patients with Arg153Cys mutation in exon 4.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"182-189"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke. 替罗非班联合血栓抽吸及支架取栓治疗缺血性大血管闭塞性脑卒中的疗效观察。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-01 DOI: 10.1097/NRL.0000000000000603

Yang Jiao, Xiaoli Wang, Yaxin Guan, Xinxin Wang, Zhaosheng Li, Xiuzhi Xiang, Zhongmin Zhang

{"title":"Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke.","authors":"Yang Jiao, Xiaoli Wang, Yaxin Guan, Xinxin Wang, Zhaosheng Li, Xiuzhi Xiang, Zhongmin Zhang","doi":"10.1097/NRL.0000000000000603","DOIUrl":"10.1097/NRL.0000000000000603","url":null,"abstract":"Objective: This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS).Methods: Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment.Results: A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference ( P >0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group.Conclusions: Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"140-144"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction. 急性孤立性脑桥梗死的基底动脉粥样硬化和早期临床恶化。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-01 DOI: 10.1097/NRL.0000000000000606

Dogan D Oge, Ethem M Arsava, Mehmet A Topcuoglu

{"title":"Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction.","authors":"Dogan D Oge, Ethem M Arsava, Mehmet A Topcuoglu","doi":"10.1097/NRL.0000000000000606","DOIUrl":"10.1097/NRL.0000000000000606","url":null,"abstract":"Objectives: Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic basilar artery (BA) anatomy in ECW in patients with AIPI is herein studied.Methods: In 146 AIPI patients, infarcts were grouped into tegmental, lateral, anterolateral, anteromedial horizontally; and low, mid, mid-up, and upper pontine vertically. BA dolichoectasia was categorized according to Smoker criteria. An additional criteria of BA laterality angle was described. The length between the infarct long-axis and BA cross-sectional center was measured, and named as \"branch length (BL).\" ECW was defined as any increase in NIHSS.Results: ECW was seen in 22 (15%) patients. Univariate analysis documented a higher female ratio (22% vs. 10%, P =0.007), higher atrial fibrillation (18% vs. 7%, P =0.067), more common anteromedial infarct location (77% vs. 49%, P =0.025), and Smoker category-3 BA height (32% vs. 10%, P =0.043) in these patients. In anteromedial infarcts, BL was longer (8.3 vs. 6.1 mm, P =0.052), and reaching to significance in those located at mid-up/upper pontine level (1.22 vs. 0.62 mm, P =0.006). BL >4.4 mm showed an acceptable discriminatory capacity for ECW with an AUC of ROC: 0.615 (95% CI: 0.511-0.712). A regression model indicated female sex (β±SE=1.129±0.551, P =0.040), BL (per 4.4 mm, β±SE=1.236±0.614, P =0.044), and BA height-category-3 (β±SE=1.711±0.645, P =0.008) as independent predictors for ECW.Conclusions: Some features of basilar dolichoarteriopathy, such as the extreme location of the height of the BA tip and the length of the involved perforator in the prepontine cistern, may be predictors of early clinical worsening in acute isolated pontine infarcts.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"145-149"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Validation of an Artificial Intelligence-Powered Virtual Assistant for Emergency Triage in Neurology. 神经病学紧急分诊人工智能虚拟助手的验证。

IF 1.1 4区医学

Neurologist Pub Date : 2025-05-01 DOI: 10.1097/NRL.0000000000000594

Lucas Alessandro, Santiago Crema, Juan I Castiglione, Daiana Dossi, Federico Eberbach, Alejandro Kohler, Alfredo Laffue, Abril Marone, Vanesa Nagel, José M Pastor Rueda, Francisco Varela, Diego Fernandez Slezak, Sofía Rodríguez Murúa, Carlos Debasa, Pensa Claudio, Mauricio F Farez

{"title":"Validation of an Artificial Intelligence-Powered Virtual Assistant for Emergency Triage in Neurology.","authors":"Lucas Alessandro, Santiago Crema, Juan I Castiglione, Daiana Dossi, Federico Eberbach, Alejandro Kohler, Alfredo Laffue, Abril Marone, Vanesa Nagel, José M Pastor Rueda, Francisco Varela, Diego Fernandez Slezak, Sofía Rodríguez Murúa, Carlos Debasa, Pensa Claudio, Mauricio F Farez","doi":"10.1097/NRL.0000000000000594","DOIUrl":"10.1097/NRL.0000000000000594","url":null,"abstract":"Objectives: Neurological emergencies pose significant challenges in medical care in resource-limited countries. Artificial intelligence (AI), particularly health chatbots, offers a promising solution. Rigorous validation is required to ensure safety and accuracy. Our objective is to evaluate the diagnostic safety and effectiveness of an AI-powered virtual assistant (VA) designed for the triage of neurological pathologies.Methods: The performance of an AI-powered VA for emergency neurological triage was tested. Ten patients over 18 years old with urgent neurological pathologies were selected. In the first stage, 9 neurologists assessed the safety of the VA using their clinical records. In the second stage, the assistant's accuracy when used by patients was evaluated. Finally, VA performance was compared with ChatGPT 3.5 and 4.Results: In stage 1, neurologists agreed with the VA in 98.5% of the cases for syndromic diagnosis, and in all cases, the definitive diagnosis was among the top 5 differentials. In stage 2, neurologists agreed with all diagnostic parameters and recommendations suggested by the assistant to patients. The average use time was 5.5 minutes (average of 16.5 questions). VA showed superiority over both versions of ChatGPT in all evaluated diagnostic and safety aspects ( P <0.0001). In 57.8% of the evaluations, neurologists rated the VA as \"excellent\" (suggesting adequate utility).Conclusions: In this study, the VA showcased promising diagnostic accuracy and user satisfaction, bolstering confidence in further development. These outcomes encourage proceeding to a comprehensive phase 1/2 trial with 100 patients to thoroughly assess its \"real-time\" application in emergency neurological triage.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"155-163"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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