NeurologistPub Date : 2026-05-01DOI: 10.1097/NRL.0000000000000665
Yuerong Wu, Xuelian You, Jianmin Qiu
{"title":"Kimura's Disease Complicated by Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy: A Case Report and Review of the Literature.","authors":"Yuerong Wu, Xuelian You, Jianmin Qiu","doi":"10.1097/NRL.0000000000000665","DOIUrl":"10.1097/NRL.0000000000000665","url":null,"abstract":"<p><strong>Introduction: </strong>Kimura's disease is a chronic inflammatory disorder, while cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral small vessel disease.</p><p><strong>Case report: </strong>A 56-year-old Chinese male with a 6-year history of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy was admitted due to recurrent cerebral infarcts. He also had a concurrent diagnosis of Kimura's disease accompanied by hypereosinophilia and elevated serum immunoglobulin E levels. Although the patient had been on oral antiplatelet therapy, no preventive treatment had been previously administered for the hypereosinophilia or high immunoglobulin E levels. We conducted follow-up to track disease progression and to review the management approach, including its strengths and shortcomings.</p><p><strong>Conclusion: </strong>This case represents a rarely reported instance of Kimura's disease coexisting with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. It underscores the importance of differentiating stroke etiologies and illustrates the potential for complications when hypereosinophilic conditions are left untreated.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"124-127"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NeurologistPub Date : 2026-03-01DOI: 10.1097/NRL.0000000000000647
Rawan Hosny
{"title":"\"Inverse\" Foster Kennedy Syndrome: A Case Report.","authors":"Rawan Hosny","doi":"10.1097/NRL.0000000000000647","DOIUrl":"10.1097/NRL.0000000000000647","url":null,"abstract":"<p><strong>Introduction: </strong>Foster Kennedy syndrome classically occurs in frontal space-occupying lesions (SOL). It describes the appearance of optic atrophy in one eye and optic nerve swelling in the other. Optic atrophy occurs due to direct compression from lesion (on the ipsilateral side) and optic nerve head swelling occurs due to increased intracranial tension due to mass effect (on the contralateral side).</p><p><strong>Case report: </strong>We report a case of a 37-year-old female presenting with a right SOL, yet left optic nerve atrophy and right optic nerve head swelling; inverse Foster Kennedy syndrome.</p><p><strong>Conclusion: </strong>Inverse Foster Kennedy syndrome is a rare entity that should be taken into consideration when reviewing a patient with optic atrophy in one eye and swelling in the other.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"56-59"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811730","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}
NeurologistPub Date : 2026-03-01DOI: 10.1097/NRL.0000000000000652
Heather Pump, Anteneh M Feyissa
{"title":"Early Institution of Immunotherapy Alters the Course of Temporal Lobe Epilepsy With GAD65 Antibody: A Clinical Report.","authors":"Heather Pump, Anteneh M Feyissa","doi":"10.1097/NRL.0000000000000652","DOIUrl":"10.1097/NRL.0000000000000652","url":null,"abstract":"<p><strong>Introduction: </strong>Glutamic acid decarboxylase 65 (GAD65) antibody-associated temporal lobe epilepsy (GAD65-TLE) is a rare form of autoimmune-associated epilepsy characterized by medically refractory seizures and cognitive decline. Diagnosis typically requires antibody testing and clinical correlation, and treatment options include immunotherapy and antiseizure medications (ASMs). However, many patients experience persistent or worsening symptoms despite ongoing treatment.</p><p><strong>Case report: </strong>A 20-year-old woman presented with mild cognitive impairment and focal aware seizures that gradually progressed in frequency and severity. A diagnostic workup revealed GAD65-TLE, and the patient began treatment with intravenous methylprednisolone infusions and antiseizure medications within 6 months of her presentation. After 20 months of treatment, the patient was on stable doses of levetiracetam and lamotrigine and finished tapering immunosuppressive therapy with methylprednisolone. The frequency of her focal aware seizures significantly decreased, whereas the focal impaired aware and focal bilateral tonic-clonic seizures resolved. The patient was able to return to all of her previous daily activities.</p><p><strong>Conclusions: </strong>In patients presenting with new-onset seizures characterized by unusual semiology and frequent focal aware seizures, it is crucial to consider GAD65-TLE in the list of potential diagnoses. Delayed diagnosis may lead to resistance to both ASMs and immunotherapy. This case report emphasizes how prompt identification and early initiation of immunotherapy can significantly impact the course of the disease.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"49-52"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041992","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}
NeurologistPub Date : 2026-03-01DOI: 10.1097/NRL.0000000000000648
Yuxia Ma, WenYuan Li, Tingting Yang, Xiang He, Yifang Yang, Ying Tang, Lin Han
{"title":"Cluster Analysis of Different Impaired Cognitive Domains in Patients With Post-Stroke Cognitive Impairment.","authors":"Yuxia Ma, WenYuan Li, Tingting Yang, Xiang He, Yifang Yang, Ying Tang, Lin Han","doi":"10.1097/NRL.0000000000000648","DOIUrl":"10.1097/NRL.0000000000000648","url":null,"abstract":"<p><strong>Objectives: </strong>A cluster analysis was conducted to classify the 7 different cognitive domains affected by PSCI patients, to explore the correlation and similarity between cognitive domains and provide a basis for targeted intervention.</p><p><strong>Methods: </strong>We collected demographic and disease-related data from 724 PSCI patients. We used Python 3.8 software to perform K-means clustering and hierarchical clustering on the 7 cognitive domains assessed by the MoCA scale, and used the silhouette coefficient to determine the optimal number of clusters k.</p><p><strong>Results: </strong>The results of K-means clustering and hierarchical clustering show that the 7 dimensions of MoCA can be grouped into 2 categories. Cluster 1 scored lower in the cognitive areas of visual space and executive function, attention, language, abstraction, and delayed recall, whereas cluster 2 had higher scores in the naming and orientation domains. The scores in all cognitive domains of cluster 1 are lower than those of cluster 2, indicating severe cognitive impairment. Compared with cluster 2, the subjects in cluster 1 have poor physical health, living conditions, economic status, and social support ability.</p><p><strong>Conclusions: </strong>The 7 dimensions of MoCA can be divided into 2 categories. In clinical practice, health care professionals should pay special attention to the severity of the patient's condition, the affected area, and individual differences, and develop precise and personalized treatment plans to improve the patient's cognitive function and quality of life.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"32-42"},"PeriodicalIF":1.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821722","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}
{"title":"Eculizumab as a Fast-Acting Therapy in a Myasthenic Crisis Patient With Poor Response to Efgartigimod: A Case Report.","authors":"Zhouao Zhang, Xinyan Guo, Tiancheng Luo, Mingjin Yang, Tianyu Ma, Xue Du, Zhouyi Wang, Xiaoyu Huang, Yong Zhang","doi":"10.1097/NRL.0000000000000651","DOIUrl":"10.1097/NRL.0000000000000651","url":null,"abstract":"<p><strong>Introduction: </strong>Myasthenic crisis (MC) is the most serious manifestation of myasthenia gravis (MG) and it poses a big challenge in clinical management. Plasma exchange and intravenous immunoglobulin are the first-line therapy for MC, but a subset of patients exhibit poor response. Recently, neonatal Fc receptor (FcRn) inhibitors and complement inhibitors showed great efficacy in MC. However, there is no report on whether eculizumab can serve as a rescue therapy for patients who have not responded to efgartigimod.</p><p><strong>Case report: </strong>This case report describes a Chinese patient with generalized MG who experienced an acute exacerbation and suffered from MC. Despite poor responsiveness to efgartigimod, the patient was successfully rescued with eculizumab. Under regular treatment with eculizumab once every 2 weeks, the patient achieved a status of minimal symptom expression. However, the efficacy of eculizumab in MC has yet to be confirmed through more clinical trials.</p><p><strong>Conclusions: </strong>This case report hints the potential of complement inhibitors as viable treatments alternative for MC patients who poorly respond to antibody-clearing therapy. Besides, further research is necessary to determine the preferred or suitable treatment option for specific patients.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"53-55"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999369","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}
NeurologistPub Date : 2026-03-01DOI: 10.1097/NRL.0000000000000656
Rozaleen Aleyadeh, Marialuisa Zedde, Joao P Marto, Nils Henninger, Jamil Said, Jennifer A Frontera, Richa Sharma, Ronen R Leker, Thais L Secchi, Fransisca Indraswari, Abid Y Quereshi, Lily W Zhou, Alexandre Y Poppe, Hipolito Nzwalo, Victor C Wall, Ana C Fonseca, Piers Klein, David S Liebeskind, Sheila C O Martins, Malik Ghannam, Vishnu Dantu, Jorge G Ortiz Gracia, Giovanna De Marco, Ekaterina Bakradze, Mary Penckofer, Anvesh Balabhadra, Setareh S Omran, Christopher Chang, Christopher R Leon Guerrero, Varsha Muddasani, Regina von Rennenberg, Xiaofan Guo, Cheran Elangovan, Mohammad AlMajali, Faddi S Velez, Reza B Shahripour, Daniel M Mandel, Adeel Zubair, Marwa Elnazeir, Balaji Krishnaiah, Christoph Stretz, Shadi Yaghi, Nancy Maalouf
{"title":"Cervical Artery Dissection Diagnosed Following Chiropractic Cervical Manipulation: A STOP-CAD Subanalysis.","authors":"Rozaleen Aleyadeh, Marialuisa Zedde, Joao P Marto, Nils Henninger, Jamil Said, Jennifer A Frontera, Richa Sharma, Ronen R Leker, Thais L Secchi, Fransisca Indraswari, Abid Y Quereshi, Lily W Zhou, Alexandre Y Poppe, Hipolito Nzwalo, Victor C Wall, Ana C Fonseca, Piers Klein, David S Liebeskind, Sheila C O Martins, Malik Ghannam, Vishnu Dantu, Jorge G Ortiz Gracia, Giovanna De Marco, Ekaterina Bakradze, Mary Penckofer, Anvesh Balabhadra, Setareh S Omran, Christopher Chang, Christopher R Leon Guerrero, Varsha Muddasani, Regina von Rennenberg, Xiaofan Guo, Cheran Elangovan, Mohammad AlMajali, Faddi S Velez, Reza B Shahripour, Daniel M Mandel, Adeel Zubair, Marwa Elnazeir, Balaji Krishnaiah, Christoph Stretz, Shadi Yaghi, Nancy Maalouf","doi":"10.1097/NRL.0000000000000656","DOIUrl":"10.1097/NRL.0000000000000656","url":null,"abstract":"<p><strong>Objectives: </strong>Cervical artery dissection (CeAD) is an important cause of ischemic stroke in young adults. Nearly 100 million annual chiropractic cervical manipulations are performed in the United States. The relationship between manipulation and CeAD remains controversial.</p><p><strong>Methods: </strong>We analyzed patients in the multicenter STOP-CAD registry (n=4023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between manipulation-associated and nonmanipulation-associated cases using χ 2 and t tests. Multivariable logistic regression identified key factors associated with manipulation-related CeAD.</p><p><strong>Results: </strong>About 1 in 20 CeAD cases in this registry reported antecedent cervical manipulation. In multivariable binary logistic regression, compared with patients without prior manipulation, those with prior manipulation were younger (OR per year 0.98, 95% CI: 0.97-0.99, P =0.014), more often female (OR: 1.64, 95% CI: 1.21-2.23, P =0.001), less often diabetic (OR: 0.24, 95% CI: 0.08-0.78, P =0.018), presented with neck pain (OR: 2.80, 95% CI: 2.08-3.77, P <0.001), and had higher odds of isolated vertebral artery dissection (OR: 2.15, 95% CI: 1.57-2.94, P <0.001). Recurrent ischemic stroke rates were similar between groups.</p><p><strong>Conclusions: </strong>Given the very high number of manipulations performed annually, the absolute risk of secondary CeAD is extremely low. Manipulation-associated cases have distinct clinical features, occurring more often in younger women with vertebral dissections. Whether manipulation acts as a precipitating trigger or patients with early CeAD symptoms seek manipulation remains unresolved.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"46-48"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013052","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}
NeurologistPub Date : 2026-03-01DOI: 10.1097/NRL.0000000000000649
Pengchao Ying, Haitao Wu, Hong Ren, Luo Li
{"title":"Application of Artificial Intelligence in the Diagnosis and Treatment of Moyamoya Disease: Current Status, Challenges, and Future Prospects.","authors":"Pengchao Ying, Haitao Wu, Hong Ren, Luo Li","doi":"10.1097/NRL.0000000000000649","DOIUrl":"10.1097/NRL.0000000000000649","url":null,"abstract":"<p><strong>Background: </strong>Various artificial intelligence-based medical technologies have been used for diagnosing and treating diseases. Although moyamoya disease (MMD) poses a significant threat to the lives of patients, artificial intelligence (AI) use in MMD is still limited.</p><p><strong>Review summary: </strong>This study aims to review the literature on predicting, diagnosing, and treating MMD with AI, as well as to discuss its current status, challenges, and future directions. Using AI in treating MMD can enhance diagnostic accuracy and treatment outcomes. AI-driven imaging analysis aids in the early detection of vascular abnormalities linked to MMD, facilitating timely intervention and management. In addition, machine learning (ML) algorithms can analyze large data sets from clinical trials and patient records to identify patterns and predict outcomes, informing personalized treatment plans.</p><p><strong>Conclusions: </strong>AI has shown great potential in the diagnosis and treatment of MMD. The application of AI in treating MMD represents a promising frontier that may revolutionize clinical practices.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"60-64"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999283","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}
NeurologistPub Date : 2026-03-01DOI: 10.1097/NRL.0000000000000654
Andrea Loggini, Camile Bonin Pinto, Jonatan Hornik, Laura Boada Robayo, Amber Schwertnam, Karam Dallow, Laramie Knapp, Alejandro Hornik, Faddi G Saleh Velez
{"title":"Development and Validation of a Grading Scale to Predict Functional Outcome in Acute Stroke Patients Treated With intravenous Thrombolytics in the Rural Setting.","authors":"Andrea Loggini, Camile Bonin Pinto, Jonatan Hornik, Laura Boada Robayo, Amber Schwertnam, Karam Dallow, Laramie Knapp, Alejandro Hornik, Faddi G Saleh Velez","doi":"10.1097/NRL.0000000000000654","DOIUrl":"10.1097/NRL.0000000000000654","url":null,"abstract":"<p><strong>Objectives: </strong>To develop an accurate and easy-to-use predictive tool of short-term functional outcome for ischemic stroke patients treated with thrombolysis in the rural setting.</p><p><strong>Methods: </strong>This multicenter retrospective study involved the Southern Illinois Healthcare rural stroke network registry as derivative cohort, and the University of Oklahoma Health Sciences Center stroke database as validation cohort. Demographics, clinical, laboratory, and radiographic data were collected. Short-term outcome at 30 days was divided in good (mRS ≤2) bad (mRS ≥5). A backward logistic regression analysis was developed by clinical significance of the dependent variables and a 5-point predictive score system was developed based on clinical plausibility and practicality. Calibration curve was designed. The score was tested on the validation cohort. P value was set at 0.05 for all statistical analyses.</p><p><strong>Results: </strong>Of 222 patients included in the derivation cohort, 35 (16%) had poor short-term outcome. In a backward logistic regression model, baseline mRS (OR: 1.511, 95% CI: 1.047-2.182, P =0.02), and NIHSS (OR: 1.136, 95% CI: 1.063-1.214, P <0.01) were independently associated with poor short-term outcome. Age also had a strong trend toward significance (OR: 1.045, 95% CI: 0.995-1.093, P =0.05). Additional variables were re-entered in the final predictive model based on clinical plausibility and practicality. The 5-point predictive score was then created adding one point for each of the following variables: age >75, cardiac disease, baseline mRS >2, NIHSS ≥20, and GFR <40. The c-statistic of the model was 0.79, 95% CI: 0.71-0.87. In the validation cohort of 200 patients, the model performed with a c-statistic of 0.75, 95% CI: 0.64-0.86. Good outcome was predicted with a c-statistic of 0.71, 95% CI: 0.64-0.77 in the derivation cohort, and 0.69, 95% CI: 0.62-0.76 in the validation cohort.</p><p><strong>Conclusions: </strong>This predictive score is an accurate and easy-to-use tool to help providers in the rural settings facilitate early conversations with stroke patients and their families. Providing rural settings with affordable and accurate prognostic tools is a crucial step in bridging the gap in stroke care between urban and rural settings.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"27-31"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041925","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}
NeurologistPub Date : 2026-03-01DOI: 10.1097/NRL.0000000000000653
Miles Richman, Rod Foroozan
{"title":"Variability in Lumbar Puncture Assessment in Patients With Papilledema From Idiopathic Intracranial Hypertension: A Multi-Institutional Review.","authors":"Miles Richman, Rod Foroozan","doi":"10.1097/NRL.0000000000000653","DOIUrl":"10.1097/NRL.0000000000000653","url":null,"abstract":"<p><strong>Objectives: </strong>The evaluation of papilledema often requires lumbar puncture (LP) to measure opening pressure and analyze cerebrospinal fluid (CSF). However, opening pressure can be reported in different units (eg, cm H 2 O, mm Hg), and the ordering practices of CSF constituents can vary. This study aims to evaluate the pattern of opening pressure assessment and CSF laboratory ordering practices in patients with papilledema due to idiopathic intracranial hypertension (IIH).</p><p><strong>Methods: </strong>This was a retrospective review across 3 institutions based in Houston, TX. Information was obtained for patients with optic disc edema suspected of papilledema due to IIH who presented between 2009 and 2024. Patients were included if their records contained an LP procedure note for the evaluation of papilledema. Opening pressure units and CSF constituents were recorded.</p><p><strong>Results: </strong>A total of 227 charts were included, consisting of 317 opening pressure measurements and 245 cases with at least 1 documented CSF laboratory order. We found that units of measurement for opening pressure were reported as cm H 2 O (71%), cm (10%), no units (9%), mm H 2 O (3%), mm Hg (3%), cm CSF (2%), mm (1%), and cm/H 2 O (1%). Among the CSF samples sent for analysis, 99% included cell count, 97% included glucose, 95% included protein, 75% included culture, and 35% included additional laboratory measures.</p><p><strong>Conclusions: </strong>Inconsistencies in LP measurement units and CSF laboratory orders may lead to misinterpretation, potentially impacting patient care for those suspected of having papilledema due to IIH. We recommend greater standardization of the assessment of LP results for those undergoing evaluation for papilledema suspected due to IIH.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"43-45"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041977","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}
NeurologistPub Date : 2026-01-01DOI: 10.1097/NRL.0000000000000646
Liming Shu, Siyu Li, Lin Lin, Yu Yu, Baogong Liao, Tao Lu
{"title":"White Matter Structural Network Dysfunction Mediates the Effect of Hypertension on Cognitive Decline in Parkinson Disease.","authors":"Liming Shu, Siyu Li, Lin Lin, Yu Yu, Baogong Liao, Tao Lu","doi":"10.1097/NRL.0000000000000646","DOIUrl":"10.1097/NRL.0000000000000646","url":null,"abstract":"<p><strong>Objectives: </strong>Hypertension (HBP) is a risk factor for the development of motor and cognitive functions in Parkinson disease (PD) patients, but the specific mechanism is unclear. This study investigated white matter structural network abnormalities and their mediation effect of cognitive decline in patients with PD and HBP.</p><p><strong>Methods: </strong>PD patients with HBP and normal blood pressure (HBP and non-HBP) underwent conventional and multi-shell diffusion magnetic resonance imaging (MRI) at baseline. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at baseline and 12-month follow-up. Enlarged perivascular spaces (EPVS) in the basal ganglia and midbrain were assessed at baseline. White matter structural network based on the diffusion MRI was constructed. The mediation effect and correlations of EPVS and the network metrics with cognitive function were analyzed.</p><p><strong>Results: </strong>At 12-month follow-up, the cognitive decline was found in the HBP group. Global connectivity was impaired in the HBP group. The number and maximum diameter of EPVS were higher in the HBP group. The nodal connectivity was impaired in the HBP group and associated with the cognitive function at baseline and follow-up. Both global and nodal network metrics, as well as the counts of EPVS mediated the effect of HBP on the cognitive decline.</p><p><strong>Conclusions: </strong>The PD patients with HBP had worse cognitive function. Hypertensive impairment of white matter connectivity may be the underlying mechanism of cognitive decline in PD patients.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"6-13"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12757124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}