Neurological research and practice最新文献

{"title":"Stroke-associated pneumonia: from immunodepression to bedside management and future research directions.","authors":"Alexander Benkendorff, Andreas Meisel","doi":"10.1186/s42466-026-00546-9","DOIUrl":"https://doi.org/10.1186/s42466-026-00546-9","url":null,"abstract":"<p><p>Stroke-associated pneumonia (SAP) is one of the most frequent complications after acute stroke, affecting approximately one in eight stroke patients. Besides prolonged hospitalisation and increased healthcare costs, it is also a major risk factor for mortality and poor functional recovery. The pathophysiology of SAP is driven by two converging processes: impaired local airway defence due to dysphagia as well as reduced airway clearance reflexes, and systemic stroke-induced immunodepression driven by dysfunction of the autonomic nervous system. While post-stroke immunodepression is a major risk factor for SAP, it might limit unwanted autoimmune responses within the brain. Conversely, SAP itself may drive neuroinflammation and contribute to post-stroke cognitive impairment. Despite its clinical importance, high-quality evidence to guide practice on prevention, diagnosis, and treatment of SAP remains scarce and guideline recommendations are mostly based on expert consensus. Diagnosis of SAP is suggested to be based on standardised clinical criteria supported by chest radiography and C-reactive protein as an adjunct where uncertainty persists. After diagnosis, guidelines suggest prompt empirical antibiotic therapy according to local protocols. In contrast, preventive antibiotics, even for high-risk patients, neither improve clinical outcome nor reduce SAP frequency. Currently recommended preventive strategies for SAP therefore mostly focus on dysphagia management and early mobilisation. This review integrates the pathophysiology, long-term consequences of SAP and further research directions based on the current knowledge on post-stroke immunology with prevention, diagnosis and treatment of SAP as set out in the recent European Stroke Organisation guideline and related guidelines.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation in stroke patients: facts, numbers and current challenges.","authors":"Katrin Wasser, Deborah Bochert, Johanna Rosemarie Leyhe, Marianne Hahn, Sonja Gröschel, Klaus Gröschel, Rolf Wachter","doi":"10.1186/s42466-026-00538-9","DOIUrl":"https://doi.org/10.1186/s42466-026-00538-9","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is a leading, modifiable risk factor for ischaemic stroke, with 20-30% of stroke patients harbouring underlying AF. Management of AF, however, differs substantially depending on clinical context. In ischaemic stroke patients with pre-known AF, direct oral anticoagulants (DOACs) are the cornerstone of secondary prevention, with initiation timing guided by infarct severity following a risk-adapted approach. In patients with no history of AF, prolonged cardiac rhythm monitoring after stroke or transient ischaemic attack improves AF detection rates. However, it remains uncertain whether this translates into a reduced risk of recurrent stroke, with randomised trials such as Find-AF 2 ongoing. Subclinical AF, detected via implantable devices, is associated with an increased stroke risk correlating with arrhythmia burden; recent trials (ARTESiA, NOAH-AFNET 6) suggest that anticoagulation may reduce ischaemic stroke risk in this population, but at the cost of increased bleeding, necessitating individualised decision-making. Particularly challenging are anticoagulation decisions with concomitant cerebral amyloid angiopathy or prior intracerebral haemorrhage (ICH) due to competing risks of thromboembolism and haemorrhage. Recent meta-analyses indicate that resuming DOACs after ICH reduces ischaemic events but significantly raises the risk of recurrent haemorrhage, without clear improvement in net clinical benefit. New treatment options, such as left atrial appendage closure, carotid artery filter systems, factor XIa inhibitors or rhythm control, must demonstrate in adequately powered randomised controlled trials that they can optimise treatment outcomes in this complex and growing patient group. This article summarises some common interdisciplinary neurological and cardiological questions and discusses the most recent evidence on AF-related stroke prevention across various patient groups, highlighting the importance of individualised, multidisciplinary, and imaging-informed decision-making.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FXI and FXII in experimental stroke and FXI in clinical stroke trials.","authors":"Stine Mencl, Friederike Langhauser, Jordi Kühne Escolà, Benedikt Frank, Martin Köhrmann, Christoph Kleinschnitz","doi":"10.1186/s42466-026-00540-1","DOIUrl":"10.1186/s42466-026-00540-1","url":null,"abstract":"<p><p>Targeting the contact activation system through Factor XI (FXI) or Factor XII (FXII) inhibition represents a major paradigm shift in antithrombotic therapy for ischemic stroke. Unlike traditional anticoagulants, contact pathway factors drive pathological thrombus propagation and thromboinflammation; crucially, while FXII plays a negligible role in physiological hemostasis, FXI contributes only secondarily, thereby substantially uncoupling antithrombotic efficacy from major bleeding risk. However, a notable disconnect exists between experimental models and clinical development. Preclinical stroke literature, primarily rodent middle cerebral artery occlusion (MCAO) models, is overwhelmingly concentrated on FXII targeting, where FXII deficiency or blockade consistently reduces cerebral infarct volumes, preserves microvascular perfusion, and attenuates thromboinflammation, whereas experimental studies of direct FXI treatment remain sparse. Conversely, human clinical translation has focused largely on oral FXIa inhibitors, maintaining a favorable bleeding profile across indications but yielding mixed efficacy, ranging from neutral Phase II studies and the early termination of OCEANIC-AF to positive secondary stroke prevention data. Following positive OCEANIC-STROKE findings, asundexian (under FDA priority review as of September 2026) emerges as a prospective add-on to antiplatelet therapy for the secondary prevention of noncardioembolic stroke or high-risk TIA, particularly in nonlacunar or atherosclerotic populations. Reconciling preclinical FXII data with clinical FXIa trial outcomes provides a timely rationale to systematically review evidence across MCAO models and human stroke trials to delineate the distinct therapeutic potentials of FXI and FXII inhibition.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208281","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":"Post-transfer reassessment for endovascular treatment: factors associated with changes in EVT eligibility.","authors":"Daniel P O Kaiser, Julia Holzer, Daniela Schoene, Volker Puetz, Matthias Gawlitza","doi":"10.1186/s42466-026-00539-8","DOIUrl":"10.1186/s42466-026-00539-8","url":null,"abstract":"<p><strong>Background: </strong>Repeat imaging after interhospital transfer for endovascular treatment (EVT) remains controversial because EVT eligibility may change during transfer, whereas routine repeat imaging may delay reperfusion. We investigated factors associated with complete recanalization and extensive infarct progression, and their implications for post-transfer reassessment.</p><p><strong>Methods: </strong>We retrospectively analyzed 200 consecutive patients with anterior circulation large vessel occlusion transferred for EVT between 2016 and 2020 who underwent repeat non-contrast CT, CT angiography, and serial neurological assessment. Primary outcomes were complete recanalization on repeat CT angiography and extensive infarct progression (ASPECTS 0-3) precluding EVT. Factors associated with both outcomes were evaluated using multivariable Firth penalized logistic regression.</p><p><strong>Results: </strong>Changes affecting EVT eligibility occurred in 19 patients (9.5%), including complete recanalization in 10 (5.0%) and extensive infarct progression in 9 (4.5%). Intravenous thrombolysis was associated with complete recanalization (OR 4.87, 95% CI 1.08-46.25; P = 0.039), while greater neurological improvement showed a consistent direction of association (OR 1.09, 95% CI 1.00-1.18; P = 0.059). Greater neurological deterioration (OR 0.83, 95% CI 0.70-0.97; P = 0.018) and lower baseline CTA source-image ASPECTS (OR 0.55, 95% CI 0.34-0.79; P = 0.001) were associated with extensive infarct progression.</p><p><strong>Conclusions: </strong>Approximately one in ten transferred patients experienced clinically meaningful changes affecting EVT eligibility. Neurological reassessment combined with baseline CTA source-image ASPECTS may help identify patients most likely to benefit from repeat imaging and supports a selective rather than routine repeat imaging strategy after interhospital transfer.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148808","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":"Deep brain stimulation for arm tremor: one-year blinded follow-up of a randomized trial.","authors":"Nadja Kvernmo, Martin M Reich, Jonas Roothans, Ane E Konglund, Are H Pripp, Espen Dietrichs, Jens Volkmann, Inger Marie Skogseid","doi":"10.1186/s42466-026-00537-w","DOIUrl":"10.1186/s42466-026-00537-w","url":null,"abstract":"<p><strong>Objective: </strong>To present the secondary endpoints at one-year blinded follow-up from our randomized controlled study, that compared the efficacy of DBS in the ventral-intermediate thalamic nucleus (VIM) with the posterior subthalamic area (PSA) three months each in crossover design, and showed significantly greater reduction of the Sum dominant arm tremor score (Fahn-Tolosa-Marin) during the PSA-DBS period. The outcomes at one year are now reported to verify target choice and sustained benefit with clinically optimized free programming.</p><p><strong>Methods: </strong>Forty-five patients with isolated or combined arm action tremor received four-level DBS leads to reach both VIM (upper two levels) and PSA (lower two), and were randomized post-operatively to VIM-DBS month 1-3 followed by PSA-DBS month 4-6, or vice versa. Thereafter electrode choice was free as judged by best clinical outcome. Predefined secondary endpoints were the tremor score improvements from preoperative to the one-year follow-up for dominant and non-dominant arm, other body regions, total score, two patient-rated measures and adverse events.</p><p><strong>Results: </strong>At the one-year follow-up, Sum dominant arm tremor scores had improved from median 24 at baseline to 4 (p<.001, n = 43), corresponding to median 79% improvement. All other secondary endpoints also improved significantly (p<.001). Median action tremor improvement was for Essential tremor(ET) 83%, for Parkinson´s disease(PD) and Dystonic tremor 100% and for Cerebellar tremor 55%. Over 90% of stimulated contacts were in PSA.</p><p><strong>Interpretation: </strong>At one year, good and sustained tremor suppression from PSA-DBS was confirmed in ET, PD and Dystonic tremor. Suppression of Cerebellar tremor was more variable.</p><p><strong>Trial registration: </strong>NCT03156517, May 29, 2017.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149714","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":"Place and cause of death among people with chronic neurological diseases in Munich: a population-based study using death certificates.","authors":"Sarah Kristina Bublitz, Claudia Bausewein, Veronika Detter, Berend Feddersen, Matthias Graw, André Klima, Patricia Klotz, Stefan Lorenzl, Sabine Gleich","doi":"10.1186/s42466-026-00536-x","DOIUrl":"10.1186/s42466-026-00536-x","url":null,"abstract":"<p><strong>Introduction: </strong>Access to palliative care is often delayed and fragmented for patients with chronic neurological diseases. This study aimed to characterize the place and cause of death among individuals with chronic neurological diseases to help identify potential gaps in palliative care provision.</p><p><strong>Method: </strong>In this cross-sectional study, all death certificates from the city of Munich, Germany (2020-2023) were reviewed. Cases were included if malignant brain tumours, amyotrophic lateral sclerosis (ALS) or other motor neuron diseases, Parkinson's disease (PD), multiple sclerosis (MS) or other neurodegenerative or neuromuscular diseases were recorded as the cause of death or as a comorbidity.</p><p><strong>Results: </strong>Of 60,357 deaths, 2,536 individuals (4.2%) had at least one chronic neurological disease. The most common place of death was the hospital (43.8%), followed by nursing homes (25.9%) and the private home (25.0%), with variations among disease subgroups. Overall, the neurological disease was recorded as the immediate or underlying cause of death in 57.3% of cases, while in the remaining cases it was documented as a comorbidity, reflecting its presence without formal causal attribution to death.</p><p><strong>Discussion: </strong>This population-level analysis provides insight into the place and circumstances of death for a large cohort of patients with chronic neurological diseases in a major German metropolitan area and highlights substantial heterogeneity in end-of-life trajectories. The findings indicate that mortality statistics based on death certificates reflect structural limitations in cause-of-death attribution. Nevertheless, place of death remains a robust indicator, showing high hospital utilization and limited hospice use across most diagnostic groups, underscoring potential gaps in goal-concordant care.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121323","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":"Telemedical communication patterns in myasthenia gravis in a remote monitoring study.","authors":"Meret Herdick, Sophie Lehnerer, Maximilian Mönch, Lea Gerischer, Haoqi Sun, Pushpa Narayanaswami, Andreas Meisel, Maike Stein","doi":"10.1186/s42466-026-00535-y","DOIUrl":"10.1186/s42466-026-00535-y","url":null,"abstract":"<p><strong>Purpose: </strong>Myasthenia gravis (MG) is a rare neuromuscular disease. In-person appointments in specialized centers are not readily available, especially on short notice. The purpose of this study was to analyze patient-specialist communication through a telemedical platform.</p><p><strong>Methods: </strong>In a randomized controlled study 45 MG patients were observed over three months. The intervention group (N = 30) was monitored via a mobile application ('app') that enabled chat function and assessed MG -specific outcome measures and data from external devices. We quantitatively evaluated communication patterns for patients and specialists from the chat. Controls (N = 15) received standard of care. Perceived MG specialist accessibility and contact with physicians outside the study team regarding MG-related issues was assessed in both groups.</p><p><strong>Findings: </strong>In total, MG specialists were contacted a median of six times per patient via the chat, most commonly regarding medical issues (151, 54.5%), followed by technical (70, 25.3%), organizational (53, 19.1%), and other (3, 1.1%) topics. Specialists initiated contact a median of eight times per patient, most frequently addressing medical concerns (190, 49.4%), 38.4% of which were recommendations for medication changes. Specialists also addressed technical (154, 40.0%), organizational (36, 9.4%) and other (5, 1.3%) issues. Contacts with physicians outside the study team did not differ between groups. Perceived specialist accessibility was rated higher with telemedical support by the intervention group.</p><p><strong>Conclusion: </strong>MG patients have a notable demand for timely advice especially concerning treatment recommendations. Future studies should evaluate the potential of telemedical solutions to prevent worsening of symptoms.</p><p><strong>Trial registration: </strong>The study was registered under DRKS00029907 on August 19, 2022.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077364","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 of stroke unit certification with process quality in acute ischemic stroke: a registry-based study.","authors":"Malin Boehl, Max Geraedts, Limei Ji, Björn Misselwitz, Tobias Neumann-Haefelin","doi":"10.1186/s42466-026-00532-1","DOIUrl":"10.1186/s42466-026-00532-1","url":null,"abstract":"<p><strong>Background: </strong>Certification of primary and comprehensive Stroke Units (pSU, cSU) was established in Germany to ensure standardized, guideline-adherent and quality-assured care for patients with acute ischemic stroke. However, real-world evidence remains limited that treatment quality is different in certified institutions. In this analysis we focused on potential differences between certified and non-certified institutions concerning various aspects of intravenous thrombolysis.</p><p><strong>Methods: </strong>We conducted a retrospective registry-based observational analysis of patients with acute ischemic stroke in Hesse, Germany, between 2021 and 2024. Associations between stroke unit certification, intravenous thrombolysis (IVT), and process quality indicators were assessed using multivariable generalized linear mixed-effects models accounting for hospital-level clustering.</p><p><strong>Results: </strong>A total of 59,514 patients with acute ischemic stroke were included. IVT within 4.5 h after symptom onset was performed significantly more often in certified stroke units than in non-certified hospitals (pSUs: OR 2.32, 95% CI 1.65-3.27; cSUs: OR 2.19, 95% CI 1.57-3.07). In the extended treatment window (> 4.5-24 h), higher odds of IVT were also observed in pSUs (OR 2.41, 95% CI 1.16-5.00) and cSUs (OR 4.20, 95% CI 2.07-8.50). Certified stroke units achieved guideline-recommended targets more often, including a door-to-needle time ≤ 60 min (pSUs: OR 3.13, 95% CI 2.13-4.61; cSUs: OR 2.60, 95% CI 1.80-3.75) and ≤ 30 min (pSUs: OR 1.85, 95% CI 1.04-3.28; cSUs: OR 2.84, 95% CI 1.62-4.99). No significant differences were observed between pSUs and cSUs.</p><p><strong>Conclusions: </strong>Stroke unit certification was associated with a more frequent use of IVT and shorter door-to-needle times.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067115","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 of oral anticoagulation persistence and health-related quality of life in stroke survivors with atrial fibrillation: long-term results of the Berlin atrial fibrillation registry.","authors":"Lena Steindorf-Sabath, Manuel C Olma, Serdar Tütüncü, Claudia Kunze, Ulrike Grittner, Jil Heege, Joanna Dietzel, Johannes Schurig, Peter U Heuschmann, Matthias Endres, Karl Georg Haeusler","doi":"10.1186/s42466-026-00534-z","DOIUrl":"10.1186/s42466-026-00534-z","url":null,"abstract":"<p><strong>Background: </strong>Persistence to oral anticoagulation (OAC) is crucial to prevent recurrent stroke in patients with atrial fibrillation (AF). Little is known about the association of OAC intake, persistence to OAC, and type of OAC with health-related quality of life (HRQoL) in stroke survivors with AF.</p><p><strong>Methods: </strong>This retrospective analysis of the multicenter Berlin Atrial Fibrillation Registry included 1,042 patients with acute ischemic stroke or transient ischemic attack (TIA) and AF. HRQoL data were measured at 3,12,24 and 36 months after stroke/TIA using the EQ-5D-3 L questionnaire (including EQ-Index and EQ-VAS). Associations between OAC status, persistence to and type of OAC (direct oral anticoagulants (DOACs) against vitamin K antagonists (VKAs)) at 12 and up to 36 months with HRQoL were examined using multivariable linear models.</p><p><strong>Results: </strong>Overall, 842 patients completed the 12-months follow-up and 437 patients the 36-months follow-up. After 12 months, OAC intake was associated with higher EQ-VAS scores (β = 6.70, p = 0.017), although this effect was not observed up to 36 months (ß= -3.67, p = 0.075). Non-persistence to OAC was associated with lower EQ-VAS scores at 12 (ß= -6.25, p = 0.004) and 36 months (ß= -5.39, p < 0.001). No evidenve of a statistically significant difference in HRQoL was found between patients persistent to DOACs and those persistent to VKAs. EQ-Index values were not statistically significantly affected.</p><p><strong>Conclusion: </strong>Non-persistence to OAC was associated with reduced EQ-VAS up to 36 months after stroke. Notably, no evidence of a statistically significant difference regarding HRQOL was found between patients persistent on DOAC or VKA. Ensuring long-term persistence to OAC may support HRQoL in stroke survivors with AF.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984457","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":"Neurological and neuroimaging sequelae of lightning injury: a retrospective study and literature review.","authors":"Tim Steinberg, Carsten Lukas, Berthold Schalke, Christina Wendl, Ralf Linker, Bernhard Neumann, Ingo Kleiter","doi":"10.1186/s42466-026-00523-2","DOIUrl":"10.1186/s42466-026-00523-2","url":null,"abstract":"<p><strong>Background: </strong>Lightning injuries (LI) can affect multiple organs, including the peripheral and central nervous system (CNS). Neuroimaging studies in LI are scarce, and it is unknown whether off-target changes in the CNS occur.</p><p><strong>Methods: </strong>Retrospective review of patients who were treated in two neurology tertiary referral centers for sequelae of LI between 2004-2024 and had magnetic resonance imaging (MRI) or computed tomography (CT) of the CNS. A narrative literature search was performed to identify other studies on neuroimaging after LI.</p><p><strong>Results: </strong>Of 31 patients (39% female, median age 38 years), 30 had cranial neuroimaging (28 had cranial MRI, five cranial CT), and 14 spinal MRI. The median delay between LI and first neuroimaging was 67 days. Cranial MRI or CT showed two cases of brain edema, one accompanied by subarachnoid bleeding, one case of laminar cortical necrosis after resuscitation, and one case with hyperintensities in the hippocampi. 14 patients with cranial MRI had unspecific white matter lesions. In six of 14 patients who received a spinal MRI, intramedullary spinal cord lesions were found. A review of 54 published patients revealed pathological neuroimaging in 24 (44%) cases. Main findings were hypoxic encephalopathy after cardiac arrest, intracerebral bleeding, cerebral ischemia, brain edema and subarachnoid bleeding.</p><p><strong>Interpretation: </strong>Typical neuroimaging findings after LI include brain edema, intracerebral or subarachnoid bleeding, ischemia, hypoxic encephalopathy, and intramedullary spinal cord lesions. Moreover, brain white matter lesions are common, which are of unknown significance, since clinical correlates are rare and pre-existing pathologies often cannot be ruled out.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"8 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972836","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}