BMJ Neurology Open最新文献

{"title":"Gait and balance worsening after bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) for Parkinson's disease: a systematic review.","authors":"Jules M Janssen Daalen, Ashok Selvaraj, Hisse Arnts, Bastiaan R Bloem, Ronald Hma Bartels, Dejan Georgiev, Rianne A J Esselink, R Saman Vinke","doi":"10.1136/bmjno-2024-000898","DOIUrl":"https://doi.org/10.1136/bmjno-2024-000898","url":null,"abstract":"<p><strong>Background: </strong>Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a widely applied therapy in Parkinson's disease (PD). Occasionally, postoperative worsening of gait or balance occurs, even in the face of a persistently gratifying appendicular symptom improvement. The characteristics vary considerably, and the risk factors for this postoperative gait or balance worsening are largely unknown. We systematically investigated the literature for all cases of gait or balance worsening after STN-DBS in PD and explored its characteristics and determinants. In consecutive populations with best medical treatment as the control group, we also explored its incidence.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Cochrane. We considered all cases occurring between 1 month after surgery (to exclude immediate postoperative complications as most likely cause) and 12 months after surgery (to exclude disease progression).</p><p><strong>Results: </strong>From 2719 entries, we included 20 studies (n=1010 operated patients). Freezing of gait and falls were the most commonly reported symptoms. The first worsening of symptoms occurred between 3 and 6 months after surgery. Modulation of pedunculopontine afferents was more likely associated with worsening of gait and balance. In controlled trials with consecutive patients, 24 cases (15.9%) were reported, compared with 5.8% with best medical treatment (p=0.0013).</p><p><strong>Conclusions: </strong>Gait or balance worsening after STN-DBS is a complex phenomenon that cannot readily be explained by mere disease progression. The multifactorial nature warrants further study in gait labs and through advanced imaging techniques. Future studies should also estimate the actual incidence, which we could not establish as we excluded cohorts without any reported cases.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000898"},"PeriodicalIF":2.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of dual antiplatelet therapy on patients with minor stroke after thrombolysis: a systematic review and meta-analysis.","authors":"Muhammad Hamayal, Warda Shahid, Iqra Iftikhar, Erum Siddiqui, Najia Sadiq, Muhammad Awwab, Momina Hafeez, Muhammad Bilal Nadeem, Muhammad Danyal Tahir","doi":"10.1136/bmjno-2024-000957","DOIUrl":"10.1136/bmjno-2024-000957","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis for acute minor ischaemic strokes did not provide any benefit in the recent TEMPO-2 trial. In general, single antiplatelet agents are used to improve the outcomes after thrombolysis. This systematic review was done to assess the impact of dual antiplatelet therapy (DAPT) after thrombolysis in patients with minor stroke.</p><p><strong>Materials and methods: </strong>A literature search was performed on PubMed, The Cochrane Library and Science Direct for articles between 2016 and 2024. All studies included patients with minor stroke, aged ≥18 years, National Institutes of Health Stroke Scale score of ≤5 (or 3) and those who received thrombolysis prior to DAPT. The primary endpoint was modified Rankin Scale (mRS) score of 0-1 at 90 days. The quality of the studies was assessed using the Newcastle Ottawa Scale. Risk ratios (RRs) were calculated, and subgroup analysis was done.</p><p><strong>Results: </strong>Only 4 out of 4364 studies originally retrieved met the inclusion criteria and were included. The analysis showed that the mRS score improvement at 90 days was almost similar in both DAPT and single antiplatelet therapy (SAPT) groups (RR 1.09; 95% CI (0.98, 1.21), p=0.11). Risk of symptomatic intracranial haemorrhage (SICH) (RR 0.65; 95% CI (0.11, 3.97), p=0.64) and stroke recurrence (RR 0.88; 95% CI (0.44, 1.78), p=0.64) was reduced with DAPT compared with SAPT without any major significance.</p><p><strong>Conclusion: </strong>While these findings could not establish the superiority of DAPT over SAPT, DAPT showed slightly better results in functional outcomes, reducing the risk of stroke recurrence and SICH after thrombolysis in patients with minor stroke.</p><p><strong>Prospero registration number: </strong>CRD42024593717.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000957"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher-level gait disorders: a population-based study on prevalence, quality of life, depression and confidence in gait and balance.","authors":"Jenny Larsson, William Hansson, Hanna Israelsson Larsen, Lars-Owe D Koskinen, Anders Eklund, Jan Malm","doi":"10.1136/bmjno-2024-000992","DOIUrl":"https://doi.org/10.1136/bmjno-2024-000992","url":null,"abstract":"<p><strong>Background: </strong>Higher-level gait disorders (HLGDs) are slow, unsteady neurological GDs in older people. GDs can reduce quality of life (QoL) and cause depression. This has not been investigated in HLGD even though some HLGD causes are treatable, potentially affecting associated problems. We aimed to investigate gait and balance confidence, depressive symptoms and QoL in HLGD.</p><p><strong>Methods: </strong>In a population (n=3769, 65-84y), 798 reported gait impairment (questionnaire) and were clinically examined together with 249 age- and sex-matched controls. Gait property groups were formed: 'HLGD', 'other neurological GD', 'non-neurological GD' or 'no GD'. Swedish Falls Efficacy Scale (FES(S)), Modified Gait Efficacy Scale (mGES), Euro Quality of Life 5-Dimension 5-Level index, Euro Quality of Life Visual Analogue Scale (EQ VAS) and Geriatric Depression Scale-15 (GDS-15) were compared.</p><p><strong>Results: </strong>In the general population, 38% had GDs, of which 16% (n=87/561) were HLGDs, giving an HLGD prevalence of 5.8%; 26% (n=145/561) were other neurological GDs; and 59% (n=329/561) non-neurological GDs. HLGD had more depressive symptoms than non-neurological GD and no GD (GDS-15 HLGD, 3.9±3.4; non-neurological GD, 2.5±2.8; no GD, 1.4±2.0; p<0.05), lower EQ VAS (HLGD, 63±17; non-neurological GD, 71±18; no GD, 82±14; p<0.001), lower gait confidence (mGES HLGD, 60±22; non-neurological GD, 74±21; no GD, 90±13; p<0.001) and lower balance confidence (FES(S) HLGD, 93±32; non-neurological GD, 111±25; no GD, 124±13; p<0.001).</p><p><strong>Conclusions: </strong>HLGDs are common and associated with reduced QoL, reduced confidence in gait and balance, and depressive symptoms, emphasising awareness of mental health among older people with slow unsteady gait.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000992"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic process, misdiagnosis and bias in suspected idiopathic intracranial hypertension: a retrospective observational cohort study.","authors":"Nadja Skadkær Hansen, Johanne Juhl Korsbæk, Steffen Hamann, Rigmor Højland Jensen","doi":"10.1136/bmjno-2024-000863","DOIUrl":"10.1136/bmjno-2024-000863","url":null,"abstract":"<p><strong>Background: </strong>Misdiagnosis of idiopathic intracranial hypertension (IIH) is prevalent and potentially harmful. We evaluated the diagnostic process of IIH and the impact of implementing a National Guideline (NG) on IIH management to improve patient care.</p><p><strong>Method: </strong>In this observational retrospective study, we retrieved data on diagnostic investigations, duration, errors and causes for suspecting IIH from patients referred to the Danish Headache Center by suspected new-onset IIH from January 2020 to September 2022. We compared outcomes by final diagnosis (true vs disproven IIH) and the period before and after implementation of the NG. Level of significance was Bonferroni adjusted to p<0.002.</p><p><strong>Results: </strong>96 patients were referred. We confirmed IIH in 27 (28%) and disproved IIH in 69 (72%) whose final diagnoses were predominantly headache disorders (70%) and pseudo-papilloedema (12%). True IIH was discovered by optic disc oedema (n=25, none detected by neurologists); neuroimaging indicating elevated intracranial pressure (n=1) or a typical clinical phenotype (n=1) aided little but often elicited IIH suspicion suggesting anchoring bias with premature closure. Misdiagnosis affected 11% (n=11). Diagnostic workup was more comprehensive and faster in true IIH (p<0.001). Mismanagement dropped by implementation of the NG (from 44% to 20%, p=0.02).</p><p><strong>Conclusion: </strong>Optic disc oedema is the most predictive determinant of true IIH; neuroimaging and phenotype alone have poor diagnostic value and introduce bias. Fundus exam is urgent and decisive in suspected IIH and should guide diagnostic strategy to mitigate unnecessary investigations and preserve vision. An NG reduced diagnostic errors and optimised the diagnostic process.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000863"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical data and reporting quality in NMDAR-antibody encephalitis and pregnancy: a systematic review.","authors":"Scarlett L Harris, Sophie N M Binks, Donal Skelly, Hanine Fourie, Phoebe Cherrington-Walker, Tomasz Bajorek, Sarosh R Irani, M Isabel Leite, Adam E Handel, Adam Al-Diwani","doi":"10.1136/bmjno-2024-001005","DOIUrl":"10.1136/bmjno-2024-001005","url":null,"abstract":"<p><strong>Background: </strong>N-methyl-D-aspartate receptor antibody encephalitis (NMDAR-Ab-E) can have an onset during, after or prior to a pregnancy. In animal models, transplacental NMDAR immunoglobulin G transfer can affect neurodevelopment. In contrast, clinical reports of mothers affected by NMDAR-Ab-E typically are reassuring. We systematically reviewed maternal, infant and childhood clinical data pertaining to NMDAR-Ab-E with an onset before, during or after pregnancy and compared this to our single autoimmune neurology centre experience.</p><p><strong>Methods: </strong>After pre-registration on PROSPERO (CRD42023408447), we searched PubMed and Scopus for NMDAR-Ab-E case reports/series with an onset before, during or after pregnancy (last search 19/10/2023). We extracted maternal, neonatal and childhood outcomes using an idealised checklist to derive summary statistics.</p><p><strong>Results: </strong>After quality control, we identified 66 pregnancies in 61 women from 48 reports or series. 72% of women recovered with minimal or no neurological deficits, comparable to non-pregnancy-associated NMDAR-Ab-E. Likewise, 80% of pregnancies resulted in live births with a single neonatal death reported. Data on neonatal outcome measures were frequently unreported, and childhood follow-up was provided in only 60%. Our centre's experience is consistent: 3/4 mothers recovered with no functional deficits and 7/8 children without evidence of compromise at a median follow-up of 2 years.</p><p><strong>Conclusions: </strong>Current evidence does not overall suggest unfavourable maternal, fetal or childhood outcomes after NMDAR-Ab-E. However, the available sample is small, predominantly single case reports with modest follow-up, lacks standardisation, and data are often incomplete. Future approaches should address these caveats: developing multi-centre collaboration towards an international registry.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e001005"},"PeriodicalIF":2.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between stroke and systemic inflammation response index (SIRI): a National Health and Nutrition Examination Survey (NHANES) Study 2015-2020.","authors":"Adib Valibeygi, Mohammadreza Fardaei, Sepideh Niknejad","doi":"10.1136/bmjno-2024-000718","DOIUrl":"10.1136/bmjno-2024-000718","url":null,"abstract":"<p><strong>Objectives: </strong>The present study aimed to compare the relationship between history of stroke and four different inflammatory indices, including high-sensitivity C reactive protein (hsCRP), inflammatory burden index (IBI), neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI).</p><p><strong>Methods: </strong>In this cross-sectional study, data from the National Health and Nutrition Examination Survey from 2015 to 2020 were used, yielding a sample of 25 531 participants. Individuals younger than 20, pregnant women, patients with cancer and missing cases were excluded. Baseline characteristics and inflammatory markers mentioned above were analysed. Logistic regression models assessed the association between inflammatory indices and the history of stroke.</p><p><strong>Results: </strong>Of the 7828 eligible cases, 271 (3.4%) had a history of stroke. Stroke was more prevalent among older subjects, smokers, patients with diabetes, hypertension and dyslipidaemia, and those less physically active. All inflammatory indices were elevated considerably in stroke survivors, according to crude analysis. After adjusting for covariates, hsCRP (p=0.519, 95% CI: 0.961 to 1.083), NLR (p=0.125, 95% CI: 0.947 to 1.565) and IBI (p=0.157, 95% CI: 0.991 to 1.060) did not reveal any significant difference between the stroke survivors and control subjects. SIRI was the only inflammatory index significantly associated with a history of stroke (p=0.005, 95% CI: 1.154 to 2.274).</p><p><strong>Conclusion: </strong>This study revealed that among the hsCRP, IBI, NLR and SIRI, SIRI is the only one independently associated with a history of stroke. Our findings, in conjunction with the pre-existing evidence from observational and experimental studies, highlight the role of monocytes as a component of SIRI in chronic inflammation, which may induce vascular thrombotic events, including stroke.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000718"},"PeriodicalIF":2.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: ICAM-1 and CRP as biomarkers of 3-month outcome in acute ischaemic stroke.","authors":"","doi":"10.1136/bmjno-2023-000516corr1","DOIUrl":"10.1136/bmjno-2023-000516corr1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1136/bmjno-2023-000516.].</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000516corr1"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures.","authors":"Michael Valente, Mark Parsons, Bernard Yan, Chushuang Chen, Milanka Visser, Henry Ma, Andrew Bivard","doi":"10.1136/bmjno-2024-000939","DOIUrl":"10.1136/bmjno-2024-000939","url":null,"abstract":"<p><p>Vascular territory mapping (VTM) software estimates which intracerebral vessel provides peak arterial flow to a brain voxel. This observational study was performed to assess the hypothesis that the VTM algorithm may correlate to visual measurements of leptomeningeal grading and stroke outcome measures in acute middle cerebral artery (MCA) occlusion. VTM software assigned regions of the brain to an estimated feeding intracerebral vessel. Whole brain dynamic CT angiography was used to visually grade the extent of flow in either anterior or posterior cerebral leptomeningeal arteries. The final dataset included 115 patients with MCA occlusion. The median age was 74 years (IQR 62-82). The time from onset of symptoms to scan was a median of 129 min (IQR 85-241) and the median National Institutes of Health Stroke Scale (NIHSS) was 15 (IQR 12-19). Baseline imaging revealed a median ischaemic core of 19 mL (IQR 6-39) and perfusion lesion of 92 mL (IQR 68-122). Ischaemic core and posterior cerebral artery VTM volume were significantly associated with less robust posterior collateral flow on visual grading. VTM variables were not predictive of anterior collateral grade or stroke outcome measures. There did not appear to be a significant relationship between VTM volumes and visualised leptomeningeal collateral flow direction. The clinical utility and diagnostic value of VTM software in predicting collateral flow patterns remain to be elucidated, and further validation studies are warranted to determine the potential applications in acute stroke assessment.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000939"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a diagnostic checklist to identify functional cognitive disorder versus other neurocognitive disorders.","authors":"Verónica Cabreira, Jane Alty, Sonja Antic, Rui Araujo, Selma Aybek, Harriet A Ball, Gaston Baslet, Rohan Bhome, Jan Coebergh, Bruno Dubois, Mark Edwards, Sasa R Filipovic, Kristian Steen Frederiksen, Thomas Harbo, Bradleigh Hayhow, Robert Howard, Jonathan Huntley, Jeremy Darryl Isaacs, Curt LaFrance, Andrew Larner, Francesco Di Lorenzo, James Main, Elizabeth Mallam, Camillo Marra, João Massano, Emer R McGrath, Isabel Portela Moreira, Flavio Nobili, Suvankar Pal, Catherine M Pennington, Miguel Tábuas-Pereira, David Perez, Stoyan Popkirov, Dane Rayment, Martin Rossor, Mirella Russo, Isabel Santana, Jonathan Schott, Emmi P Scott, Ricardo Taipa, Tiago Teodoro, Michele Tinazzi, Svetlana Tomic, Sofia Toniolo, Caroline Winther Tørring, Tim Wilkinson, Martin Zeidler, Lisbeth Frostholm, Laura McWhirter, Jon Stone, Alan Carson","doi":"10.1136/bmjno-2024-000918","DOIUrl":"10.1136/bmjno-2024-000918","url":null,"abstract":"<p><strong>Background: </strong>Functional cognitive disorder (FCD) poses a diagnostic challenge due to its resemblance to other neurocognitive disorders and limited biomarker accuracy. We aimed to develop a new diagnostic checklist to identify FCD versus other neurocognitive disorders.</p><p><strong>Methods: </strong>The clinical checklist was developed through mixed methods: (1) a literature review, (2) a three-round Delphi study with 45 clinicians from 12 countries and (3) a pilot discriminative accuracy study in consecutive patients attending seven memory services across the UK. Items gathering consensus were incorporated into a pilot checklist. Item redundancy was evaluated with phi coefficients. A briefer checklist was produced by removing items with >10% missing data. Internal validity was tested using Cronbach's alpha. Optimal cut-off scores were determined using receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>A full 11-item checklist and a 7-item briefer checklist were produced. Overall, 239 patients (143 FCD, 96 non-FCD diagnoses) were included. The checklist scores were significantly different across subgroups (FCD and other neurocognitive disorders) (F(2, 236)=313.3, p<0.001). The area under the curve was excellent for both the full checklist (0.97, 95% CI 0.95 to 0.99) and its brief version (0.96, 95% CI 0.93 to 0.98). Optimal cut-off scores corresponded to a specificity of 97% and positive predictive value of 91% for identifying FCD. Both versions showed good internal validity (>0.80).</p><p><strong>Conclusions: </strong>This pilot study shows that a brief clinical checklist may serve as a quick complementary tool to differentiate patients with neurodegeneration from those with FCD. Prospective blind large-scale validation in diverse populations is warranted.Cite Now.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000918"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perfusion patterns as a tool for emergency stroke diagnosis: differentiating proximal and distal MCA occlusions.","authors":"Aglae Velasco Gonzalez, Liu Jingyu, Boris Buerke, Dennis Görlich, Joaquin Ortega-Quintanilla, Cristina Sauerland, Norbert Meier, Walter Heindel","doi":"10.1136/bmjno-2024-001001","DOIUrl":"10.1136/bmjno-2024-001001","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the effectiveness of a novel Perfusion Pattern (PP) scale in differentiating between proximal and distal middle cerebral artery (MCA) occlusions in patients with acute ischaemic stroke.</p><p><strong>Methods: </strong>This retrospective study included 201 patients with acute ischaemic stroke, categorised into two groups: those with M1 segment occlusions (n=114) and those with distal medium vessel occlusions (n=87). We analysed multimodal stroke CT imaging and clinical data, focusing on the occlusion site, hypoperfusion extent and basal ganglia involvement. Patients with tandem stenosis or multiple acute occlusions were excluded. Perfusion patterns were categorised into three types (PP-1, PP-2 and PP-3) based on the extent of hypoperfusion. Statistical analysis explored associations between the occlusion site, perfusion pattern and collateral status.</p><p><strong>Results: </strong>Among the 201 patients (mean age 75±14 years, 86 men), PP-1 was observed in 36.8% of patients (74/201), PP-2 in 27.4% (55/201) and PP-3 in 35.8% (72/201). The distribution of PP varied significantly by occlusion site (p<0.0001). Distal medium vessel occlusions were associated with PP-1 in 78.4% of cases (58/74), while PP-3 was most prevalent in M1 occlusions (90.3%, 65/72). The contingency coefficient revealed that occlusion location had a stronger association with the perfusion pattern (c=0.556) than collateral type (c=0.245). However, 21.6% of M1 occlusions (16/74) showed a PP-1 pattern and 9.7% of distal medium vessel occlusions (7/72) exhibited PP-3. Basal ganglia infarction presence was a reliable indicator of M1 occlusion with a 94% likelihood.</p><p><strong>Conclusions: </strong>Perfusion patterns can effectively differentiate between proximal and distal medium vessel MCA occlusions, aiding targeted assessment of CT angiography.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e001001"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}