BMC Neurology最新文献

{"title":"Clinical value of structural cranial magnetic resonance imaging analysis in assessing brain aging in ischemic stroke patients.","authors":"Tao Wang, Xiaoguang You, Junjing Yin, Huang Pan, Ziling Liu, Qian Dai, Jingang Yu","doi":"10.1186/s12883-026-04941-2","DOIUrl":"https://doi.org/10.1186/s12883-026-04941-2","url":null,"abstract":"<p><strong>Objective: </strong>Using structural cranial magnetic resonance imaging (MRI), we constructed a structural Brain Aging Index (sBAI) and evaluated the brain aging status, expressed as Brain Predicted Age Difference (Brain-PAD), in acute ischemic stroke patients. We aim to investigate its associations with baseline clinical and imaging characteristics, small vessel disease (SVD) burden, and 12-month functional and cognitive outcomes, and explored its potential contribution to prognostic models.</p><p><strong>Methods: </strong>A retrospective cohort of 150 patients with acute ischemic stroke admitted between November 2021 and November 2023 was analyzed. Diffusion-weighted imaging (DWI) infarct volume, white matter hyperintensity (WMH) volume, lacunes, cerebral microbleeds (CMBs), enlarged perivascular spaces (EPVS), hippocampal volume, and cortical thickness were collected. Clinical and imaging differences were compared between the \"age-matched group\" (Brain-PAD < + 5 years) and the \"accelerated brain aging group\" (Brain-PAD ≥ + 5 years).</p><p><strong>Results: </strong>Patients in the accelerated brain aging group had significantly higher admission National Institutes of Health Stroke Scale (NIHSS) scores, larger DWI infarct volumes, greater WMH burden, and higher total SVD scores. During follow-up, the accelerated brain aging group had a lower rate of favorable functional outcome at discharge and a higher incidence of poor 12-month functional outcome, together with significantly lower MoCA scores. Admission NIHSS and WMH volume (aOR = 1.10) were independent predictors of 12-month functional outcome. sBAI was significantly associated with 12-month MoCA scores.</p><p><strong>Conclusion: </strong>Brain aging status derived from structural MRI is closely associated with acute lesion burden, cumulative small vessel disease, and poststroke cognitive and functional outcomes.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of low-dose trazodone hydrochloride for insomnia in patients with myasthenia gravis.","authors":"Jing-Ting Peng, Xiu-Yun Kong, Ran Li, Yang-Yue Cao, Han-Qiu Jiang, Jia-Wei Wang, Shi-Lei Cui","doi":"10.1186/s12883-026-04962-x","DOIUrl":"https://doi.org/10.1186/s12883-026-04962-x","url":null,"abstract":"<p><strong>Background: </strong>The management of insomnia in patients with myasthenia gravis (MG) poses a clinical challenge, as MG is a well-recognized contraindication to sedative-hypnotic agents. This retrospective study aimed to assess the efficacy and safety of low-dose trazodone hydrochloride for the management of insomnia in MG patients.</p><p><strong>Methods: </strong>Clinical data were collected from MG patients with comorbid insomnia who received low-dose trazodone hydrochloride (25-100 mg, once nightly, for ≥ 4 weeks). Enrolled patients were stratified into three groups based on Self-Rating Depression Scale (SDS) scores: pure insomnia group (SDS: 0-52), mild depression group (SDS: 53-62), and moderate-to-severe depression group (SDS ≥ 63). Changes in Pittsburgh Sleep Quality Index (PSQI) scores, SDS scores, and Myasthenia Gravis Activities of Daily Living (MG-ADL) scores before and after trazodone hydrochloride administration were analyzed.</p><p><strong>Results: </strong>Total 68 MG patients were enrolled, including 17 cases of ocular MG and 51 cases of mild generalized MG. Of these patients, 18 (26.5%) were assigned to the pure insomnia group, 30 (44.1%) to the mild depression group, and 20 (29.4%) to the moderate-to-severe depression group. Post-treatment PSQI scores were significantly reduced compared to baseline across all groups (all p < 0.01). The mild depression group exhibited a significant decrease in SDS scores after treatment (p < 0.01), whereas no significant reduction in SDS scores was observed in the moderate-to-severe depression group. No patients experienced an increase in MG-ADL scores. Mild adverse events were reported in 4 patients (5.9%), including hypotension (n = 2), dizziness (n = 1), and nausea (n = 1).</p><p><strong>Conclusions: </strong>Low-dose trazodone hydrochloride demonstrates favorable efficacy and safety in improving insomnia in patients with stable and mild MG.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of virtual reality/motion-sensing games incorporating swing-based elements on upper limb function after stroke: a systematic review and meta-analysis.","authors":"Wenzhi Cai, Yikun Zheng, Jingyi Wu, Guopeng Hu, Daisuke Takeshita, Ping Yeap Loh, Yuqi He","doi":"10.1186/s12883-026-04948-9","DOIUrl":"https://doi.org/10.1186/s12883-026-04948-9","url":null,"abstract":"<p><strong>Background: </strong>Upper limb impairment is a common consequence of stroke and can markedly limit independence in daily life. Virtual reality (VR) and motion-sensing games incorporating swing-based elements have increasingly been used in rehabilitation, but their effectiveness for post-stroke upper limb recovery remains unclear. This article aims to systematically evaluate the effectiveness of VR/motion-sensing games incorporating swing-based elements on upper limb function after stroke.</p><p><strong>Method: </strong>This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251141175). PubMed, Web of Science, Scopus, and the Cochrane Library were searched from January 1999 to September 2025 for randomized controlled trials. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic and Cochran's Q test. Sensitivity and subgroup analyses were performed, and publication bias was explored using funnel plots and Egger's test.</p><p><strong>Results: </strong>Ten randomized controlled trials involving 426 participants were included. Compared with conventional therapy, virtual reality/motion-based games incorporating swing-like elements demonstrated significant improvement in upper limb functional recovery. The overall meta-analysis showed a merge standardized mean difference of 0.64 (95% CI: 0.44, 0.84) in favour of the intervention group. Substantial between-study heterogeneity was observed (I² = 82.2%, p < 0.001). Exploratory subgroup analyses suggested relatively larger effects in older participants and in those with longer stroke duration, although these findings should be interpreted cautiously. Sensitivity analysis showed that the pooled effect was stable, and Egger's test did not indicate significant publication bias (p = 0.454).</p><p><strong>Conclusion: </strong>VR/motion-sensing games incorporating swing-based elements may improve upper limb function after stroke and could serve as a useful adjunct to conventional rehabilitation. Further rigorously designed trials with standardized protocols are required to strengthen the evidence base and determine optimal intervention strategies.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and verification of multimodal model for prognosis in elderly patients with aneurysmal subarachnoid hemorrhage.","authors":"Wengao Zhang, Gang Li, Yue Gao, Zhiguo Liu, Baoxu Zhang, Jinfeng Wang","doi":"10.1186/s12883-026-04940-3","DOIUrl":"https://doi.org/10.1186/s12883-026-04940-3","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to construct and validate an individualized prediction model for poor prognosis in elderly patients with Aneurysmal subarachnoid hemorrhage (aSAH) based on multimodal indicators such as clinical, imaging, and laboratory data.</p><p><strong>Methods: </strong>We retrospectively enrolled 241 consecutive patients with aSAH from January 2017 to December 2020 as the training set. An independent temporal validation set included 104 consecutive patients from January to September 2024, with assignment strictly by chronological order. In the training set, univariate analysis identified candidate predictors of poor prognosis, which were refined via LASSO regression. Significant variables were then entered into multivariate logistic regression to define independent predictors. Using these predictors, we constructed random forest (RF), support vector machine (SVM), and k-nearest neighbor models (KNN). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Model interpretability and variable contributions were analyzed with SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>There were no statistically significant differences in the baseline clinical data between the training set and the validation set (all P > 0.05). The results of multivariate Logistic regression analysis showed that World Federation of Neurosurgical Societies (WFNS) score, modified Fisher grade, intracerebral hematoma volume, maximum thickness of subarachnoid blood clots, C-reactive protein, and duration of symptomatic cerebral vasospasm were identified as independent risk factors for poor prognosis (all P < 0.05). The performance evaluation of the machine-learning models showed that the SVM model had the best discrimination, with AUCs of 0.838 (95% CI: 0.764-0.912) and 0.791 (95% CI: 0.688-0.895) in the training set and the validation set, respectively. The calibration curve showed a high consistency between the predicted probability and the actual risk. DCA indicated that the model had clinical net benefits within a wide range of thresholds. SHAP analysis confirmed that C-reactive protein, maximum thickness of subarachnoid clot, and intracerebral hematoma volume were the most important contributing factors to the increased risk of poor prognosis.</p><p><strong>Conclusion: </strong>This study successfully constructed and validated a prediction model for poor prognosis in elderly patients with aSAH based on multimodal indicators. The model has robust performance, clinically accessible indicators, and good interpretability, providing a valuable quantitative tool for dynamic risk stratification and implementation of stratified management.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the phenotypic and genotypic spectrum of spinal muscular atrophy in Bangladeshi children.","authors":"Jobaida Parvin, Husnea Ara Khan, Narayan Chandra Saha, Seikh Azimul Hoque, Mohammad Monir Hossain, Dipa Saha, Nusrat Shams","doi":"10.1186/s12883-026-04946-x","DOIUrl":"https://doi.org/10.1186/s12883-026-04946-x","url":null,"abstract":"<p><p>Spinal muscular atrophy (SMA) is a monogenic neuromuscular disorder caused by SMN1 gene deletion and classified by clinical severity. The objective of this study was to evaluate the genotypic and phenotypic spectrum in SMA in Bangladeshi children.This cross-sectional prospective study was conducted in Pediatric Neurology Department, National Institute of Neurosciences and Hospital of Bangladesh from January 2019 and December 2022. A total of sixty four cases with clinically suspected SMA were enrolled. Genetic confirmation was done using MLPA.Genetic confirmation was achieved in 48 (75%) patients. Homozygous deletion of SMN1 exons 7 and 8 was detected in 44 (68.75%) cases, while isolated exon 7 deletion was found in 4 (6.25%) cases. No deletion was identified in 16 (25%) cases. Among genetically confirmed patients, SMA type I was most common (54%), followed by type II (40%) and type III (6%). The mean age of onset was significantly earlier in SMA type I compared with types II and III (p < 0.05). A significant inverse correlation was observed between SMN2 copy number and disease severity (Spearman's rho = 0.825, p < 0.001). Most type I patients had two SMN2 copies, whereas type II and III patients predominantly had three or more copies. Respiratory complications and mortality were predominantly in type I patients. Two patients received risdiplam and two underwent gene replacement therapy (onasemnogene abeparvovec).In conclusion, A significant genotype-phenotype correlation exists between SMN2 copy number and clinical severity among Bangladeshi children with SMA. Limited access to disease-modifying therapy highlights the need for early diagnosis and improved treatment accessibility in resource-limited settings.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between homocysteine and post-stroke depression in patients with spontaneous intracerebral hemorrhage.","authors":"Chao Zhang, Guojuan Chen, Peng Ding, Lei Xiang, Wei Yue","doi":"10.1186/s12883-026-04951-0","DOIUrl":"https://doi.org/10.1186/s12883-026-04951-0","url":null,"abstract":"<p><strong>Introduction: </strong>Depression after a stroke is the most frequent and burdensome neuropsychiatric post-stroke complication. This study aimed to determine the relationship between post-stroke depression (PSD) and the levels of homocysteine (HCY) in patients with spontaneous intracerebral hemorrhage (SICH).</p><p><strong>Method: </strong>We collected data from patients with hemorrhagic stroke (HS) admitted to the hospital and recorded their demographic and clinical characteristics. We also searched for information regarding HAM-D₁₇ (Hamilton Depression) scores and HCY levels at 3 m, the use of antidepressant medications and folic acid during the follow-up period in the group of patients diagnosed with PSD and hyperhomocysteinemia (HHcy) in the acute phase.</p><p><strong>Result: </strong>A total of 1,852 patients were included. 642 (34.7%) patients with PSD and 598 (32.3%) patients with HHcy, 364 (19.7%) patients with both conditions. A link between depression and low HCY level has similarly been found in patients with HS (OR, 1.549; 95% CI, 1.358-1.768). Additionally, left-sided stroke, anterior circulatory stroke, intraventricular hemorrhage, symptoms of paralysis or dysarthria, and higher NIHSS scores occurred more often in the PSD group. Compared to the antidepressant medications (ADM) group, HAM-D₁₇ scores decreased significantly in the ADM plus folic acid group at the end of 3 m (P = 0.036).</p><p><strong>Conclusion: </strong>On the basis of our data, PSD was significantly more frequent in patients with HHcy in patients with SICH at the acute phase. The location of hemorrhage and the severity of the disease are significantly correlated with the incidence of PSD. Oral doses of folic acid and ADM showed significant improvements in the HAM-D₁₇ scores for the patients with comorbid PSD and HHcy.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Berlin Score for predicting sleep apnea in patients with acute ischemic stroke.","authors":"Augustus Ck Wong, Yi-Sin Wong, Sheng-Feng Sung, Chi-Shun Wu, Yu-Hsiang Su, Mao-Hsun Lin, Chien-Yu Su, Cheung-Ter Ong","doi":"10.1186/s12883-026-04873-x","DOIUrl":"https://doi.org/10.1186/s12883-026-04873-x","url":null,"abstract":"<p><strong>Background: </strong>Sleep-disorder breathing is common among ischemic stroke patients. It associated with increasing risk of stroke and poor functional outcome after stroke. Polysomnography (PSG) is the diagnostic standard but the application for acute stroke patients is limited. The Berlin Questionnaire (BQ) is a tool used for screen obstructive sleep apnea in general population, however, the diagnostic accuracy in acute ischemic stroke patients is inconsistent.</p><p><strong>Objects: </strong>The study aims to explore the accuracy of Berlin Questionnaire (BQ) for detecting the sleep apnea for acute ischemic stroke patients, using home-based sleep apnea testing as a reference. We compare the accuracy between BQ and a modified BQ.</p><p><strong>Methods: </strong>We conducted a prospective observational study between March 2023 and February 2025 at a teaching hospital in central Taiwan. Patients aged 20-85 years with MRI-confirmed acute ischemic stroke admitted within 48 h of onset were included. Each participant completed the Berlin Questionnaire and underwent home-based sleep apnea testing (Alice NightOne, Philips Respironics). Sleep apnea severity was defined by the respiratory event index (REI). The accuracy of BQ and mBQ in predicting moderate-to-severe sleep apnea (REI ≥ 15) was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).</p><p><strong>Results: </strong>Forty-six patients completed both assessments. Twenty-one patients (45.7%) had no or mild sleep apnea (REI < 15), and 25 (54.3%) had moderate-to-severe sleep apnea (REI ≥ 15). Alcohol use and higher body mass index (BMI) were significantly associated with moderate-to-severe apnea (p = 0.01 for both). The BQ demonstrated a sensitivity of 45.8%, specificity of 72.7%, PPV of 64.7%, and NPV of 55.2% for predicting moderate-to-severe sleep apnea. The mBQ improved performance to a sensitivity of 54.1%, specificity of 72.7%, PPV of 68.4%, and NPV of 59.3%. Patients with moderate-to-severe apnea exhibited significantly lower minimum oxygen saturation compared with those with no or mild apnea (p = 0.03).</p><p><strong>Conclusions: </strong>The accuracy of the Berlin Questionnaire for detecting sleep apnea in acute ischemic stroke is moderate but improves with modification of BMI weighting. Moderate-to-severe apnea is associated with lower oxygen saturation, highlighting the importance of early screening and targeted management in stroke units. Larger, multicenter studies are warranted to validate these findings and explore the prognostic implications of nocturnal hypoxemia in stroke recovery.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Varicella-zoster virus infection triggering GD3 antibody-positive variant Guillain-Barré syndrome: a case report and literature review.","authors":"Yujun Wu, Liyan Gu, Jieyi Liu, Weihua Yan, Jie Wei","doi":"10.1186/s12883-026-04938-x","DOIUrl":"https://doi.org/10.1186/s12883-026-04938-x","url":null,"abstract":"<p><strong>Background: </strong>Bilateral facial palsy variant Guillain-Barré syndrome (GBS) is a distinct clinical subtype. As an acute immune-mediated polyradiculoneuropathy often triggered by infections, varicella-zoster virus (VZV) is a rare yet significant precipitating factor for this variant. Anti-ganglioside antibodies, particularly anti-GD3, are involved in the pathogenesis of GBS, but their significance in VZV-associated bilateral facial palsy subtype remains incompletely elucidated.</p><p><strong>Case presentation: </strong>We report a 46-year-old female who developed acute bilateral facial palsy and limb sensory deficits following VZV infection. Serum anti-ganglioside testing confirmed GD3 IgG positivity, and cerebrospinal fluid analysis revealed albuminocytological dissociation. Nerve conduction studies supported a demyelinating polyneuropathy, and the patient showed significant improvement after intravenous immunoglobulin therapy.</p><p><strong>Conclusions: </strong>This case suggests that VZV may act as a potential trigger for GD3 antibody-positive variant GBS. Early immunotherapy may improve outcomes, emphasizing the need for systematic antibody testing in atypical presentations of this variant GBS. Further studies are required to clarify the pathophysiological role of GD3 antibodies in VZV-associated variant GBS.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term cerebral atrophy and cognitive function in patients recovering from progressive multifocal leukoencephalopathy: two case reports.","authors":"Sunao Takahashi, Daisuke Ono, Takanori Yokota, Nobuo Sanjo","doi":"10.1186/s12883-026-04949-8","DOIUrl":"https://doi.org/10.1186/s12883-026-04949-8","url":null,"abstract":"<p><strong>Background: </strong>Long-term brain atrophy and cognitive function have rarely been reported in patients without pre-existing brain disorders who survived progressive multifocal leukoencephalopathy (PML).</p><p><strong>Case presentation: </strong>Patient 1 was a 38-year-old woman with late-onset combined immunodeficiency, who presented with progressive cognitive decline and right hemiparesis. Brain MRI revealed a hyperintense lesion in the left frontal lobe. Patient 2 was a 53-year-old man in remission from follicular lymphoma, who experienced cognitive deterioration and displayed hyperintense signals in the left frontal and bilateral posterior lobes on MRI. Brain biopsy confirmed PML in both patients. After recovering from acute neurological decline, the cognitive and physical function of the patients was followed and we retrospectively analyzed sequential alterations in the MRI over eight years. Hyperintense lesion areas, cerebral hemisphere size, and intracranial volume were measured to calculate the monthly change ratios of the brain (MCRB), along with assessment of the third ventricle width. Both patients experienced no relapse. Wechsler Memory Scale-Revised scores improved in Patient 1 but slightly declined in Patient 2 despite stable Mini-Mental State Examination scores in both patients. MRI results were classified as lesion expansion, lesion reduction, and chronic atrophy. During the chronic atrophic stage, MCRB decreased by 0.06% and 0.09% in Patients 1 and 2, respectively. The third ventricle widened by 3 and 25 μm/month in Patients 1 and 2, respectively.</p><p><strong>Conclusion: </strong>Progressive cerebral atrophy occurs during PML's chronic stage, even without relapse. In these two cases, the patient with extensive bilateral lesions in the acute phase showed greater third ventricle enlargement and cognitive decline.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of early ACTH levels on neurological recovery in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort study.","authors":"Ghaith Saleh R Aljboor, Aoun Tulemat, Grace H E Tan, Nina Carlos- De Clercq, Mugurel Petrinel Rădoi, Toader Corneliu, Toma Marius Papacocea","doi":"10.1186/s12883-026-04952-z","DOIUrl":"https://doi.org/10.1186/s12883-026-04952-z","url":null,"abstract":"<p><strong>Background/objectives: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) triggers a marked systemic stress response and may be accompanied by hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Adrenocorticotropic hormone (ACTH) may reflect the acute neuroendocrine response to injury and could be associated with early functional status. This study aimed to describe the frequency of acute-phase ACTH abnormalities and evaluate the association between early ACTH levels and functional outcomes at hospital discharge in patients with aSAH.</p><p><strong>Methods: </strong>In this prospective cohort study, 20 consecutive aSAH patients admitted within 48 hours of symptom onset were enrolled. Plasma ACTH levels were obtained at random time points within the first 48 hours of admission (predefined cutoff ≤7 days; no patient exceeded 48 hours), prior to definitive aneurysm treatment. Blood samples were obtained within 24 hours of admission and prior to surgical intervention. Sampling was targeted between 08:00 and 10:00 to minimize circadian variation; however, minor deviations were unavoidable in the acute neurocritical care setting. Functional outcomes were assessed at discharge using the Glasgow Outcome Score (GOS) and Modified Rankin Scale (MRS). Associations were evaluated using Spearman correlation, non-parametric group comparisons, and exploratory multivariable regression analyses adjusting for key severity variables.</p><p><strong>Results: </strong>Using institutional laboratory reference ranges, 12/20 patients (60%) had ACTH values below the reference range, 7/20 (35%) were within range, and 1/20 (5%) had elevated ACTH. ACTH levels were significantly associated with discharge outcomes (mRS: ρ = +0.67, p = 0.0014; GOS: ρ = -0.59, p = 0.0063). ACTH distributions differed between favourable (mRS ≤ 2) and unfavourable (mRS > 2) outcome groups (p = 0.014). In exploratory multivariable analysis, ACTH showed a consistent association with outcome but did not remain statistically significant after adjustment.</p><p><strong>Conclusions: </strong>Early ACTH levels obtained during the acute hospitalization were associated with short-term functional outcomes at discharge after aSAH. Given the random sampling design, the stress-sensitive nature of ACTH, and the absence of paired cortisol measurements, these findings should be interpreted as reflecting ACTH dysregulation rather than definitive endocrine deficiency. Larger studies with standardized sampling and longer-term follow-up are warranted.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}