BMC Neurology最新文献

{"title":"Seizure prophylaxis versus epilepsy prevention after acquired brain injury: a cross-sectional clinicaltrials.gov registry analysis, 2000-2026.","authors":"Anil Chimakurthy, Viswabhaskar Susarla, Jeet Hemantkumar Chaudhary, Om Desai","doi":"10.1186/s12883-026-05327-0","DOIUrl":"10.1186/s12883-026-05327-0","url":null,"abstract":"<p><strong>Background: </strong>Seizures after acquired brain injury pose distinct therapeutic questions: early seizure prophylaxis, treatment of acute symptomatic seizures, and late epilepsy prevention. These endpoints are often conflated, although early seizure suppression does not establish disease-modifying antiepileptogenesis, these end points are often confused.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of ClinicalTrials.gov records that were first posted from January 1, 2000, to June 18, 2026. Records retrieved through four disease-specific seizure-related searches were exported from the ClinicalTrials.gov web interface, deduplicated by NCT number, and adjudicated into a primary seizure-management or sensitivity/monitoring cohort. A purposively selected validation set of 269 potentially eligible or difficult-to-classify records underwent independent post-review classification by 2 reviewers who were blinded to each other's responses. A prespecified secondary subset comprised completed primary-cohort trials evaluating pharmacologic interventions.</p><p><strong>Results: </strong>The searches yielded 1,054 exported records and 878 unique records after deduplication. Final adjudication retained 85 primary cohort studies and 39 sensitivity/monitoring records. Brain tumor/neurosurgery (27/85, 31.8%) and traumatic brain injury (TBI) (23/85, 27.1%) predominated, whereas intracerebral hemorrhage and subarachnoid hemorrhage each had only 3 trials. Among the 44 completed or discontinued trials, 17 (38.6%) were discontinued. Among 26 completed trials eligible for results-reporting assessment, 11 (42.3%) had posted results, of which 10 (90.9%) were interventional drug trials. Only 3 of 15 completed pharmacologic trials had a late-prevention aim. Reviewer agreement ranged from 85.1% to 90.3%, with unweighted Cohen kappa values of 0.776-0.825.</p><p><strong>Conclusions: </strong>The seizure management pipeline after acquired brain injury registered on ClinicalTrials.gov is concentrated in brain tumor/neurosurgery and TBI, with sparse representation of hemorrhagic stroke and few completed pharmacologic trials targeting late epilepsy prevention. The registry findings support a clearer separation of the objectives of acute seizure prophylaxis, treatment of acute symptomatic seizures, and late epilepsy prevention. The etiology-specific design recommendations are presented as an author-proposed framework rather than empirical effectiveness conclusions.</p><p><strong>Clinical trial registration: </strong>Not applicable.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world short-term effectiveness of erenumab after single versus multiple prior preventive treatment failures.","authors":"Chantal Schmidt, Lukas Becker, Diana Lindner, Christoph Kleinschnitz, Alexander Wolfgang Becker, Dagny Holle, Armin Scheffler","doi":"10.1186/s12883-026-05311-8","DOIUrl":"10.1186/s12883-026-05311-8","url":null,"abstract":"<p><strong>Background: </strong>Erenumab, a monoclonal antibody targeting calcitonin gene-related peptide receptor, has been approved in Germany since 2018 for migraine prophylaxis. Initially, reimbursement regulations restricted its use to drug-resistant patients who had failed or were unsuitable for conventional preventive treatments. Over time, initiation after failure of only one prior preventive treatment became possible. As earlier initiation of effective preventive therapy may improve clinical outcomes, we compared the effectiveness of erenumab in patients with single versus multiple prior preventive treatment failures.</p><p><strong>Methods: </strong>In this retrospective single-center study, data from 196 patients with episodic or chronic migraine who received erenumab for at least three months were analysed. Patients were categorised into a multiple prior preventive therapy (MPT) group (n = 140), comprising individuals with two to six previous preventive treatment failures, and single preventive therapy (SPT) group (n = 56), including patients who had received no more than one prior treatment failure before initiating erenumab. To evaluate the association between prior treatment exposure and treatment response, a multivariate logistic regression analysis was performed with achievement of a ≥ 50% reduction in monthly headache days (MHD) as the primary outcome. Subgroup analyses, LASSO-based variable selection, and propensity score weighting were conducted as sensitivity analyses.</p><p><strong>Results: </strong>A clinically meaningful treatment response (50% MHD response) was achieved by 35.7% (n = 20/56) of patients in the SPT group and 30.7% (n = 43/140) in the MPT group. No significant difference in treatment effectiveness was observed between groups. In the adjusted logistic regression model, SPT was not significantly associated with treatment response (SPT vs. MPT: adjusted OR 1.39, 95% CI 0.53-3.69; p = 0.5).</p><p><strong>Conclusion: </strong>Short-term effectiveness of erenumab was comparable in patients with no more than one versus multiple prior preventive treatment failures, suggesting that treatment response is not solely dependent on the number of previous preventive treatment failures. These findings should be interpreted in light of the retrospective single-center design and the limited sample size, which resulted in relatively wide confidence intervals.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term survival in amyotrophic lateral sclerosis - data from a population-based registry in Rhineland-Palatinate, Germany.","authors":"Joachim Wolf, Anton Safer, Ulrich Stefenelli, Johannes C Woehrle, Matthias Maschke, Wilfred A Nix, Armin J Grau","doi":"10.1186/s12883-026-05325-2","DOIUrl":"10.1186/s12883-026-05325-2","url":null,"abstract":"<p><strong>Background: </strong>Data on long-term survival in amyotrophic lateral sclerosis (ALS) is scarce. In a population-based ALS cohort in Germany we evaluated long-term survival and assessed key factors influencing long-term survival, including demographic and clinical variables that are available at an early stage of the disease.</p><p><strong>Methods: </strong>Data from patients in the prospective, population-based ALS-registry Rhineland-Palatinate were analyzed. Survival was evaluated separately for time from symptom onset and time from diagnosis. Patient demographic and disease-related variables were analyzed in relation to survival probability using the Kaplan-Meier method and Cox proportional hazards regression.</p><p><strong>Results: </strong>Data from 200 incident ALS patients (106 men and 94 women) were included in the study. The median age of the patients was 68 years (range 23-85 years; mean age 65.8 years; standard deviation 10.5 years). The median survival time was 2.5 years from symptom onset and 1.5 years from diagnosis. 12% of the patients survived for at least ten years from first manifestation of symptoms. Multivariate statistics revealed that younger age, a low progression rate, the absence of frontotemporal dementia and a long interval between symptom onset and diagnosis were predictors of long survival.</p><p><strong>Conclusions: </strong>12% of ALS patients are still alive ten years after the onset of symptoms, which is important for advance planning of patient care. In our analysis demographic and clinical variables available at an early stage of the disease have emerged as valuable predictive factors.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT01955369; registered retrospectively 28/09/2013).</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the role of serum IL-6 in predicting outcomes of b-cell depleting therapy in multiple sclerosis: a retrospective cohort study.","authors":"Tristan Kölsche, Ramona Hagler, Niklas Huntemann, Lars Masanneck, Marc Müller, Bela Jesaja Kutsojannis, Joshua M Boeckers, Patricia Kirschner, Karin Schulze-Bosse, Orhan Aktas, Sven G Meuth, Tobias Ruck, Marc Pawlitzki","doi":"10.1186/s12883-026-05252-2","DOIUrl":"10.1186/s12883-026-05252-2","url":null,"abstract":"<p><strong>Background: </strong>Interleukin-6 (IL-6) plays a pivotal role in autoimmune inflammation through its effects on B-cell differentiation, Th17 expansion, and regulatory T-cell suppression. Given ocrelizumab's (OCR) mechanism of selective CD20⁺ B-cell depletion, baseline IL-6 levels have been hypothesized to predict disease activity and long-term outcomes in multiple sclerosis (MS). However, the prognostic value of serum IL-6 in OCR-treated patients remains unclear. Therefore, the objective of this study was to evaluate whether baseline and longitudinal serum IL-6 levels can predict clinical and radiological outcomes in OCR-treated MS patients.</p><p><strong>Methods: </strong>This exploratory, single-center retrospective cohort study included 73 patients with Relapsing-Remitting MS (RRMS, n = 30) or primary progressive MS (PPMS, n = 43) who initiated OCR at University Hospital Düsseldorf between 2018 and 2025. Baseline serum IL-6 was compared with 86 healthy controls (HC) and correlated with clinical, radiological, and biomarker outcomes over 24 months. Clinical endpoints included confirmed progression independent of relapse activity (PIRA), and relapse-associated worsening (RAW), alongside MRI activity and Serum Neurofilament Light Chain (sNfL) and Serum Glial Fibrillary Acidic Protein (sGFAP) levels. Between-group comparisons used Welch's t-test or Wilcoxon rank-sum test, paired longitudinal comparisons used paired t-tests or Wilcoxon signed-rank tests, and associations between baseline biomarkers and outcomes were evaluated using Cox regression, multivariable linear or logistic regression, and rank-based linear models for IL-6.</p><p><strong>Results: </strong>Baseline serum IL-6 levels showed no significant differences between the overall MS cohort and HC (p = 0.178), nor between RRMS and PPMS subgroups (p = 0.024; adjusted post-hoc p > 0.05). No baseline biomarker, including IL-6 (HR 1.83; 95% CI 0.73-4.61; p = 0.989), sNfL, and sGFAP predicted disease activity. Longitudinal analysis under OCR revealed largely stable IL-6 concentrations but patients maintaining No Evidence of Disease Activity-3 (NEDA-3) showed 50% reduction in IL-6 at 12 months (mean change - 1.30 pg/mL, p = 0.0318), whereas those with loss of NEDA-3 remained stable (mean change 0.09 pg/mL).</p><p><strong>Conclusion: </strong>Baseline serum IL-6 alone is insufficient to predict clinical or radiological outcomes in OCR-treated MS patients. However, the significant longitudinal decline specifically in stable patients suggests that IL-6 dynamics, rather than static baseline measures, may better reflect sustained therapeutic response. These findings underscore the limited utility of serum IL-6 alone as a biomarker and support further exploration of longitudinal, multiparametric approaches.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent brief positional vertigo as the initial presentation of medial branch of the posterior inferior cerebellar artery territory cerebellar infarction: a case report.","authors":"Shaoqing Zhang, Yujing Xie, Zhehao Hu, Yuanyuan Chen, Yongxing Su, Zhengfei Ma","doi":"10.1186/s12883-026-05299-1","DOIUrl":"https://doi.org/10.1186/s12883-026-05299-1","url":null,"abstract":"<p><strong>Background: </strong>Isolated episodic vertigo is usually attributed to peripheral vestibular disorders, but may uncommonly represent posterior circulation ischemia. Brief recurrent positional vertigo caused by medial branch of the posterior inferior cerebellar artery (mPICA) territory infarction is uncommon.</p><p><strong>Case presentation: </strong>A 63-year-old man with poorly controlled hypertension presented with recurrent brief vertigo triggered mainly by lying down, getting up, or turning over in bed. Initial neurological examination, positional tests, and cranial CT were unremarkable, and BPPV was considered but not confirmed. Persistent attacks followed by spontaneous horizontal nystagmus and mild left-sided dysmetria prompted MRI-DWI, which revealed acute infarction in the medial left cerebellar hemisphere and vermis. After antiplatelet and statin therapy, he remained symptom-free at 1-, 3-, and 6-month follow-up, with an mRS score of 0.</p><p><strong>Conclusions: </strong>mPICA territory infarction may mimic BPPV as brief recurrent positional vertigo. In older patients with vascular risk factors, persistent or atypical positional vertigo warrants repeated neurological examination and early MRI-DWI.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living in the United States Stroke Belt and cognitive change in the Women's Health Study: a cohort study.","authors":"Alice C von Alvensleben, Julie E Buring, Ricarda S Schulz, Paula J Filser, Jae H Kang, Pamela M Rist, Tobias Kurth","doi":"10.1186/s12883-026-05224-6","DOIUrl":"10.1186/s12883-026-05224-6","url":null,"abstract":"<p><strong>Background and objectives: </strong>Residence in the United States Stroke Belt has been linked to a higher stroke mortality rate, raising the question of whether this increased risk is also associated with other brain health outcomes, such as cognitive change, defined as within-person changes in cognitive performance over time. This study aimed to investigate if residing in the Stroke Belt is associated with cognitive decline compared to residing outside this region in a large cohort of women.</p><p><strong>Methods: </strong>We used data from the cognitive cohort of the Women's Health Study, a U.S.-based cohort of predominantly White women currently or formerly employed in health professions. Our analyses included 6,362 women aged ≥65 years at baseline who underwent cognitive assessments. The exposure was residency in the Stroke Belt. Cognitive change was assessed as the primary outcome using repeated measures of a global cognitive composite score. Linear mixed-effects models were applied, adjusted for age, education, and lifestyle factors, measured by Life's Simple 7 score with random effects for each of the participating women (fully adjusted model). Secondary analyses used logistic regression to examine the association between Stroke Belt residency and the odds of belonging to the first quintile or first decile of the cognitive change distribution (secondary outcome), representing women with the greatest cognitive decline.</p><p><strong>Results: </strong>Of the participating women, 1,131 (17.8%) resided within the Stroke Belt. Compared to women residing outside the Stroke Belt, women residing in the Stroke Belt did not have significantly different rates of cognitive decline. The fully adjusted difference in change in the global cognitive composite score from the first to the last assessment between women living inside and outside the Stroke Belt was β = -0.03, SE = 0.02, p = 0.233. Women residing in the Stroke Belt had higher odds of being in the first quintile (adjusted odds ratio (OR) 1.20, 95% confidence interval (CI) 1.00-1.42) and in the first decile (adjusted OR 1.43, 95% CI 1.14-1.78) of the cognitive change distribution.</p><p><strong>Discussion: </strong>Residence in the U.S. Stroke Belt was not associated with overall differences in cognitive decline trajectories, although secondary analyses suggested a possible increase in more pronounced decline among women living in the region.</p><p><strong>Trial registration information: </strong>ClinicalTrials.gov Identifier: NCT00000479; retrospectively submitted: October 27, 1999.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequent use of zinc-containing denture adhesive can cause neurological trouble: a case of severe copper deficiency myeloneuropathy visible in T2w-STIR sequences of spinal MRI.","authors":"Isabel-Cathleen Helmsen, Martin Klietz, Julius Renne, Florian Wegner","doi":"10.1186/s12883-026-05280-y","DOIUrl":"https://doi.org/10.1186/s12883-026-05280-y","url":null,"abstract":"<p><strong>Background: </strong>We report a case of severe copper deficiency myeloneuropathy due to frequent application of zinc-containing denture adhesive. Our case report is supposed to enhance the clinical awareness for this preventable neurological disease.</p><p><strong>Case presentation: </strong>A 51-year-old patient presented with signs and symptoms of ataxia as well as spastic paraparesis and hyperreflexia. The patient reported hypesthesia with a sensory threshold at the level of T5 and a pallanesthesia of the lower extremities was determined. He could stand up with help but was unable to walk since May 2025. Laboratory tests revealed markedly reduced serum levels of ceruloplasmin and copper whereas zinc was elevated. He had been using zinc-containing denture adhesive up to five times per day for his dental protheses since a trauma with multiple tooth extractions 25 years ago. Standard MRI of the spine with T1- and T2-weighted MRI sequences was rated negative for any spinal cord abnormality. Only repeated MRI including T2w-STIR (short tau inversion recovery) sequences revealed a triangular signal enhancement in the cervical and upper thoracic spinal cord located in the posterior columns suggesting myelopathy. Copper gluconate supplementation (2 mg/d) and omission of zinc-containing denture adhesive led to a normalization of serum copper levels and slow recovery of neurological deficits during the following weeks of rehabilitation. In 2026, the patient reported improved symptoms and was able to walk again with help for short distances.</p><p><strong>Conclusions: </strong>In cases of suspected hypocupremic myeloneuropathy and a negative standard MRI of the spine, additional T2w-STIR sequences should be used to provide morphological evidence for this diagnosis. Zinc-free denture adhesive should be recommended to prevent severe neurological conditions resulting from prolonged copper deficiency.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mendelian randomization reveals the causal relationship between cholecystectomy and ischemic stroke.","authors":"Yue Xiao, Zejin Zhao, Jinlong Liu","doi":"10.1186/s12883-026-05246-0","DOIUrl":"https://doi.org/10.1186/s12883-026-05246-0","url":null,"abstract":"<p><strong>Background: </strong>The association between cholecystectomy and ischemic stroke remains unclear. Therefore, this study aimed to investigate the potential association of genetically predicted liability to cholecystectomy with ischemic stroke and its subtypes using Mendelian randomization (MR).</p><p><strong>Methods: </strong>The inverse variance weighted (IVW) method was used as the primary analytical method, with weighted median and MR-Egger regression as complementary methods. Overall ischemic stroke was defined as the primary outcome, whereas ischemic stroke subtypes were considered secondary outcomes. A Bonferroni-corrected significance threshold was applied to the three secondary outcomes. Heterogeneity, horizontal pleiotropy, and the influence of individual variants were assessed using sensitivity analyses.</p><p><strong>Results: </strong>Genetically predicted liability to cholecystectomy was not associated with overall ischemic stroke in the primary IVW analysis (OR = 0.57, 95% CI 0.23-1.37, P = 0.208). In the secondary analyses, the inverse association with small-vessel ischemic stroke remained significant after Bonferroni correction (OR = 0.10, 95% CI 0.02-0.57, P = 0.009). The inverse association with large-artery atherosclerotic ischemic stroke was nominally significant but did not meet the corrected threshold (OR = 0.09, 95% CI 0.01-0.71, P = 0.023), whereas no association was observed for cardioembolic ischemic stroke.</p><p><strong>Conclusion: </strong>Genetically predicted liability to cholecystectomy was not significantly associated with overall ischemic stroke. The secondary analyses supported an inverse association with small-vessel ischemic stroke and suggested a possible inverse association with large-artery atherosclerotic ischemic stroke. No significant association was observed for cardioembolic ischemic stroke.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The early fogging effect in cerebral infarction - a case report and review of the literature.","authors":"Luisa M Müller, Daniel Dubinski, Justus Groß, Peter Donndorf, Matthias Wittstock, Daniel Cantré, Thomas M Freiman, Jens-Christian Schewe, Florian Geßler, Gerd Klinkmann, Sae-Yeon Won","doi":"10.1186/s12883-026-05131-w","DOIUrl":"10.1186/s12883-026-05131-w","url":null,"abstract":"<p><strong>Background: </strong>The fogging effect is a well-known phenomenon usually seen two to three weeks post stroke, characterized by a pseudonormalization of the infarcted tissue.</p><p><strong>Case presentation: </strong>A 62-year-old patient underwent emergent thoracic endovascular aortic repair (TEVAR) due to a Stanford Type B aortic dissection. Post-intervention dual antiplatelet therapy and systemic anticoagulation were administered. The following day, the patient developed acute neurological deficits. Cranial CT and perfusion imaging demonstrated an infarction in the left posterior inferior cerebellar artery territory, and conservative management was pursued. A follow-up CT scan 27 h later revealed an isodense area within the infarcted region consistent with the fogging effect.</p><p><strong>Conclusion: </strong>Our case demonstrated this fogging effect at an unusually early timepoint. We hypothesize that systemic therapeutic anticoagulation together with dual antiplatelet therapy may have contributed to the early onset of fogging. This case highlights the limitations of non-contrast CT in stroke assessment and underscores the importance of multimodal imaging and awareness of this phenomenon.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of MI-BCI combined with tDCS in early rehabilitation after anterior cruciate ligament reconstruction monitored by resting-state fMRI: the first case report.","authors":"Chongwen Zuo, Yi Yin, Chong Zhang, Xiaoyan Ma, Zhiyang Zheng, Shan Wang, Chaoqun Ye","doi":"10.1186/s12883-025-04605-7","DOIUrl":"10.1186/s12883-025-04605-7","url":null,"abstract":"<p><strong>Background: </strong>To recover lower-limb motor function is a primary goal for rehabilitation after anterior cruciate ligament (ACL) reconstruction. Although quantitative testing and questionnaire evaluation provide a lot of valuable information, functional magnetic resonance imaging (fMRI) provides a powerful method to preliminarily explore the neural recovery process of novel rehabilitation interventions. In this case, we aimed to investigate changes in functional connectivity (FC) of motor imagery-based brain-computer interface (MI-BCI) combined with tDCS intervention in early post-ACL reconstruction rehabilitation, monitored via resting-state fMRI.</p><p><strong>Case presentation: </strong>A 38-year-old man patient who underwent left ACL reconstruction received MI-BCI combined with tDCS intervention 5sessions/peek for 4 weeks. before and after the intervention, the resting-state fMRI was assessed. Seed-based analysis was performed using the primary motor cortex (M1) and supplementary motor area (SMA) as the seeds, representing the sensorimotor network (SMN). The results showed increased connectivity between the SMN and specific motor-related (e.g., precentral gyrus, postcentral gyrus, pallidum and paracentral lobule) and sensory information processing areas (e.g., calcarine, lingual gyrus, calcarine, thalamus, posterior cingulum). In addition, decreased FC between both M1 and the bilateral precentral gyrus was observed, and the FC between the left M1, SMA, and the right frontal midline regions was also reduced.</p><p><strong>Conclusions: </strong>Our preliminary results showed that MI-BCI combined with tDCS could be an effective method to recovery the lower-limb motor function and promote neural remodeling of an ACL reconstruction patient in early stage. Alterations of the SMN functional connectivity after intervention seems to partially explain the neural remodeling process, if applied on a large sample sizes, could provide more information about specific motor area.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}