Canadian Journal of Neurological Sciences最新文献

{"title":"Central retinal artery occlusion at a Canadian academic centre.","authors":"Matthew P Quinn, Victoria Liu, Danah Albreiki, Daniel A Lelli","doi":"10.1017/cjn.2025.25","DOIUrl":"https://doi.org/10.1017/cjn.2025.25","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-23"},"PeriodicalIF":2.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442998","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":"Distribution, Demography and Migration Pattern of Neurologists in Canada, 1971-2022.","authors":"Seyed-Mohammad Fereshtehnejad","doi":"10.1017/cjn.2025.23","DOIUrl":"10.1017/cjn.2025.23","url":null,"abstract":"<p><p>Neurology faces prolonged wait times in Canada, with delays worsened by the COVID-19 pandemic. As neurological disease prevalence rises, ensuring adequate access to care is essential. This study analyzes the distribution and migration patterns of neurologists in Canada from 1971 to 2022, using data from the Canadian Institute for Health Information. Neurology remains male-dominated (female-to-male ratio of 0.6), and only Ontario and British Columbia have per capita neurologist levels comparable to high-income countries. Despite stabilized migration to the USA since 2003, regional disparities persist, underscoring the need for strategies to improve retention, integrate foreign-trained professionals and enhance access across Canada.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-5"},"PeriodicalIF":2.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400932","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":"Choroid Plexus Enlargement in Patients with Chronic Migraine: Implications for Glymphatic System Dysfunction.","authors":"Ho-Joon Lee, Dong Ah Lee, Kang Min Park","doi":"10.1017/cjn.2025.21","DOIUrl":"10.1017/cjn.2025.21","url":null,"abstract":"<p><strong>Objectives: </strong>The choroid plexus produces cerebrospinal fluid, which is crucial for glymphatic system function. Evidence suggests that changes in the volume of the choroid plexus may be associated with glymphatic system function. Therefore, this study aimed to investigate alterations in choroid plexus volume in patients with migraines compared with healthy controls.</p><p><strong>Methods: </strong>We enrolled 59 patients with migraines (39 and 20 with episodic and chronic migraines, respectively) and 61 healthy controls. All participants underwent brain magnetic resonance imaging, including three-dimensional T1-weighted imaging. We analyzed and compared choroid plexus volumes between patients with episodic migraines, those with chronic migraines and healthy controls. Additionally, we evaluated the association between choroid plexus volume and the clinical characteristics of patients with migraine.</p><p><strong>Results: </strong>The choroid plexus volume in patients with chronic migraines was higher than that in healthy controls (2.018 vs. 1.698%, <i>p</i> = 0.002) and patients with episodic migraines (2.018 vs. 1.680%, <i>p</i> = 0.010). However, no differences were observed in choroid plexus volumes between patients with episodic migraine and healthy controls. Choroid plexus volume was positively correlated with age in patients with migraines (<i>r</i> = 0.301, <i>p</i> = 0.020) and in healthy controls (<i>r</i> = 0.382, <i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>We demonstrated significant enlargement of the choroid plexus in patients with chronic migraine compared with healthy controls and those with episodic migraine. This finding suggests that chronic migraine may be associated with glymphatic system dysfunction.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384187","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":"Brainstem and Central Variant PRES in Hypertensive Encephalopathy.","authors":"Kevin Perera, Fazeela Mulji, Rakhbeer Boparai, Ryan Koo, Carlos R Camara-Lemarroy","doi":"10.1017/cjn.2025.17","DOIUrl":"10.1017/cjn.2025.17","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257409","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":"Syndrome of the Trephined: A Rare Presentation of Dorsal Midbrain Dysfunction.","authors":"Eugénie Girouard, Elisabeth Meloche, Julien Rousseau, Alby Richard","doi":"10.1017/cjn.2025.18","DOIUrl":"10.1017/cjn.2025.18","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-4"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257411","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":"Real-World Healthcare Utilization and Costs in Migraine Patients in Ontario, Canada.","authors":"Christine Lay, Ana Marissa Lagman-Bartolome, Amnah Awan, Bijal Shah-Manek, Jackie Fleischer, Ana Rusu, Purva Barot, Cristian Iconaru, Shane Golden, Ali Tehrani, Goran Davidovic, Brad Millson","doi":"10.1017/cjn.2024.367","DOIUrl":"https://doi.org/10.1017/cjn.2024.367","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-45"},"PeriodicalIF":2.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081929","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":"Creation and Evolution of the Ontario Stroke Registry: Protocol and Two Decades of Data from a Population-Based Clinical Stroke Registry.","authors":"Amy Y X Yu, Frank L Silver, Jiming Fang, Michael D Hill, Patrice Lindsay, Moira K Kapral","doi":"10.1017/cjn.2025.13","DOIUrl":"10.1017/cjn.2025.13","url":null,"abstract":"<p><strong>Background: </strong>Stroke clinical registries are critical for systems planning, quality improvement, advocacy and informing policy. We describe the methodology and evolution of the Registry of the Canadian Stroke Network/Ontario Stroke Registry in Canada.</p><p><strong>Methods: </strong>At the launch of the registry in 2001, trained coordinators prospectively identified patients with acute stroke or transient ischemic attack (TIA) at comprehensive stroke centers across Canada and obtained consent for registry participation and follow-up interviews. From 2003 onward, patients were identified from administrative databases, and consent was waived for data collection on a sample of eligible patients across all hospitals in Ontario and in one site in Nova Scotia. In the most recent data collection cycle, consecutive eligible patients were included across Ontario, but patients with TIA and those seen in the emergency department without admission were excluded.</p><p><strong>Results: </strong>Between 2001 and 2013, the registry included 110,088 patients. Only 1,237 patients had follow-up interviews, but administrative data linkages allowed for indefinite follow-up of deaths and other measures of health services utilization. After a hiatus, the registry resumed data collection in 2019, with 13,828 charts abstracted to date with a focus on intracranial vascular imaging, identification of intracranial occlusions and treatment with thrombectomy.</p><p><strong>Conclusion: </strong>The Registry of the Canadian Stroke Network/Ontario Stroke Registry is a large population-based clinical database that has evolved throughout the last two decades to meet contemporary stroke needs. Registry data have been used to monitor stroke quality of care and conduct outcomes research to inform policy.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069083","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":"Access to Endovascular Thrombectomy: Does Driving Time to Comprehensive Stroke Center Matter More Than Rurality?","authors":"Foad Taghdiri, Manav V Vyas, Moira K Kapral, Lauren Lapointe-Shaw, Peter C Austin, Peter Gozdyra, Christine Hawkes, Yue Chen, Jiming Fang, Amy Y X Yu","doi":"10.1017/cjn.2025.15","DOIUrl":"10.1017/cjn.2025.15","url":null,"abstract":"<p><strong>Background: </strong>Acute stroke treatments are highly time-sensitive, with geographical disparities affecting access to care. This study examined the impact of driving distance to the nearest comprehensive stroke center (CSC) and rurality on the use of thrombectomy or thrombolysis in Ontario, Canada.</p><p><strong>Methods: </strong>This retrospective cohort study used administrative data to identify adults hospitalized with acute ischemic stroke between 2017 and 2022. Driving time from patients' residences to the nearest CSC was calculated using the Ontario Road Network File and postal codes. Rurality was categorized using postal codes. Multivariable logistic regression, adjusted for baseline differences, estimated the association between driving distance and treatment with thrombectomy (primary outcome) or thrombolysis (secondary outcome). Driving time was modeled as a continuous variable using restricted cubic splines.</p><p><strong>Results: </strong>Data from 57,678 patients (median age 74 years, IQR 64-83) were analyzed. Increased driving time was negatively associated with thrombectomy in a nonlinear fashion. Patients living 120 minutes from a CSC were 20% less likely to receive thrombectomy (adjusted odds ratio [aOR] 0.80, 95% CI 0.62-1.04), and those 240 minutes away were 60% less likely (aOR 0.41, 95% CI 0.28-0.60). Driving time did not affect thrombolysis rates, even at 240 minutes (aOR 1.0, 95% CI 0.70-1.42). Thrombectomy use was similar in medium urban areas (aOR 0.80, 95% CI 0.56-1.16) and small towns (aOR 0.78, 95% CI 0.57-1.06) compared to large urban areas.</p><p><strong>Conclusion: </strong>Thrombolysis access is equitable across Ontario, but thrombectomy access decreases with increased driving distance to CSCs. A multifaceted approach, combining healthcare policy innovation and infrastructure development, is necessary for equitable thrombectomy delivery.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069077","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":"Improving Epilepsy Care in Ontario, Canada: The Impact of a Provincial Strategy for Epilepsy Care.","authors":"Tresah C Antaya, Brooke Carter, Salimah Z Shariff, Lysa Boissé Lomax, Elizabeth Donner, Kirk Nylen, O Carter Snead, Jorge G Burneo","doi":"10.1017/cjn.2025.14","DOIUrl":"10.1017/cjn.2025.14","url":null,"abstract":"<p><strong>Objective: </strong>In 2016, the Ontario Ministry of Health and Long-Term Care implemented the Provincial Strategy for Epilepsy Care to increase epilepsy surgery use in Ontario, Canada. The objectives of this study were to assess whether the use of (1) epilepsy surgery, including (a) its receipt and (b) assessments for candidacy, and (2) other healthcare for epilepsy, including (a) neurological consultations, (b) emergency department (ED) visits and (c) hospital admissions, changed since its implementation.</p><p><strong>Methods: </strong>We used linked health administrative data and an interrupted time series design. Annual cohorts were created for July 1^st to June 30^th of each year from 2007 to 2019, comprising patients with drug-resistant epilepsy eligible for publicly funded prescription drug coverage with no cancer history. We used segmented Poisson regression models to assess whether the annual rates of each outcome changed between the period before the Provincial Strategy was implemented (July 2007-June 2016) and the period after.</p><p><strong>Results: </strong>There was a level increase in the rate of epilepsy surgery of 48% (95% CI: 0%, 118%) and slope decreases in the rates of neurological consultations, ED visits and hospital admissions for epilepsy of 10% (95% CI: -15%, -5%), 10% (95% CI: -20%, 1%) and 7% (95% CI: -12%, -1%) per year, respectively, associated with the Provincial Strategy.</p><p><strong>Conclusion: </strong>The Provincial Strategy may be associated with an increased rate of epilepsy surgery and reduced rates of other healthcare use for epilepsy. Other regions experiencing low epilepsy surgery rates may benefit from similar interventions.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069561","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":"Safety of Dabigatran in Acute Ischemic Stroke Patients with Microbleeds: Post Hoc Analysis of DATAS-II Randomized Trial.","authors":"Pargol Balali, Ken Butcher, Kelvin K H Ng, Raed A Joundi, Scott E Kasner, Aristeidis H Katsanos, Mukul Sharma, Ashkan Shoamanesh","doi":"10.1017/cjn.2024.371","DOIUrl":"10.1017/cjn.2024.371","url":null,"abstract":"<p><strong>Background: </strong>Cerebral microbleeds are associated with an increased risk of hemorrhagic transformation (HT) following acute ischemic stroke. We investigated whether the effect of dabigatran (vs. aspirin) in patients with acute minor non-cardioembolic ischemic stroke/transient ischemic attack (TIA) is modified by baseline microbleeds on MRI.</p><p><strong>Methods: </strong>The Dabigatran Treatment of Acute Stroke II trial randomized 305 patients with acute minor non-cardioembolic ischemic stroke/TIA to dabigatran (150/110 mg twice daily) or aspirin (81 mg daily) for 30 days. Microbleeds were centrally adjudicated in patients with an interpretable blood-sensitive sequence on baseline MRI. In this post hoc analysis, we used multivariable regression models to determine the association between microbleeds and any incident HT on day-30 MRI and excellent functional outcome (modified Rankin scale = 0-1) at 90 days.</p><p><strong>Results: </strong>A total of 251 (82.3%) participants (mean age = 66 ± 13 years, 36% women, median [IQR] onset-to-randomization time = 40[27-55] hours; median [IQR] NIHSS = 1 [0-2]) were included, of whom 82 (33%) had microbleeds. On day-30 MRI, 6% (<i>n</i> = 14) developed HT, and 80% (<i>n</i> = 191) achieved 90-day mRS of 0-1. We found no association between microbleed presence and HT (adjusted OR = 0.84; 95%CI:0.21-3.25) or excellent functional outcome (adjusted RR = 1.09; 95%CI:0.94-1.26). The rate of HT in patients with microbleeds was 3% with dabigatran and 4% with aspirin (OR = 0.85; 95%CI:0.11-6.75). Excellent functional outcome occurred in 74% and 84% of dabigatran and aspirin-treated patients, respectively (RR = 0.88; 95%CI:0.69-1.12). The presence, severity or location of microbleeds did not modify the effect of dabigatran on these outcomes (<i>p</i>-interaction > 0.05).</p><p><strong>Conclusions: </strong>Early dabigatran treatment appears safe in patients with acute minor non-cardioembolic ischemic stroke/TIA and hemorrhage-prone cerebral small vessel disease marked by microbleeds on MRI.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069670","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}