Neurology Asia

Geriatric nutritional risk index predicts in-hospital mortality in elderly patients with cerebral infarction

2025-06-25T07:44:27+00:00

Objective: This study aimed to evaluate the predictive value of the Geriatric Nutritional Risk Index (GNRI) for in-hospital mortality among elderly patients with cerebral infarction.

Methods: Patients aged ≥60 years with a diagnosis of cerebral infarction were extracted from the MIMIC-IV database. GNRI was calculated using height, weight, and serum albumin. The primary outcome was in-hospital mortality. Restricted cubic spline regression, univariate and multivariate logistic regression, and forest plot visualization were performed to assess the prognostic significance of GNRI.

Results: A total of 746 patients were included, with an in-hospital mortality rate of 30.2%. GNRI was significantly lower in non-survivors (86.43) than survivors (88.00), p<0.001. Multivariable logistic regression demonstrated GNRI as an independent predictor of mortality (OR per 1-unit increase, 0.91; 95% CI: 0.87–0.96). The restricted cubic spline showed a near-linear inverse relationship (p overall <0.001, p nonlinear = 0.654).

Conclusion: GNRI is a significant and independent predictor of in-hospital mortality in elderly cerebral infarction patients and may aid clinical risk stratification.

Procalcitonin as a prognostic biomarker for stroke: A systematic review and meta-analysis

2025-07-22T08:47:44+00:00

Background & Objective: Stroke remains as an important cause of morbidity and mortality worldwide. Despite outcome prediction models available, determining functional outcomes remains a challenge hence there have been an increasing interest in novel prognostic biomarkers for stroke. Several studies have explored the prognostic significance of procalcitonin levels in determining functional outcomes and mortality in stroke patients. This study aims to systematically review articles and to determine if elevated procalcitonin is associated with poor functional outcomes and mortality.

Methods: Specific search terms were applied in Medline, Cochrane Library, ClinicalTrial.Gov, Global Index Medicus, and Herdin and studies were screened based on the inclusion and exclusion criteria.

Results: A total of 5 articles were deemed eligible for inclusion and there was no significant heterogeneity among them. Risk of bias was low based on the Quality in Prognostic Studies Tool and no significant bias was detected based on Egger’s test (p = 0.3560). Elevated procalcitonin levels were associated with an unfavorable functional outcome (OR 3.76; 95% CI 2.78-5.09) and mortality (OR 3.91; 95% CI 2.80-5.45) at 3 months to 1 year.

Conclusion: The findings of the study demonstrates procalcitonin’s potential role as a prognostic biomarker in stroke. Larger studies with broader geographic scope may further strengthen the evidence for procalcitonin’s role in stroke prognosis.

Relationship between COVID-19 and stroke: Analysis of biochemical markers and mortality

2023-10-21T13:06:22+00:00

Background & Objective: We aimed to investigate the relationship between COVID-19 and stroke and analyze the biochemical markers that may affect or predict the mortality.

Methods: This study was conducted at Adana City Training and Research Hospital between March 1, 2020, and December 31, 2020. A total of 220 patients diagnosed with stroke and tested with Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for COVID-19 were included. The patients were divided into two main groups: cerebrovascular disease with negative RT-PCR (CVD) and cerebrovascular disease with positive RT-PCR (CVD+COVID-19).

Results: COVID-19 patients had a stroke on average at 8.49±6.8 (min:0- max:32) days. Admission to Intensive Care Unit (ICU) rate and mortality rate were significantly higher in CVD+COVID group (92.6% and 57.4% respectively). CVD+COVID-19 group had significantly higher levels of CRP, LDH, PT, INR, aPTT, fibrinogen, procalcitonin, D-Dimer, ferritin, and N/L ratio compared to the CVD group. In CVD-COVID-19 group the risk of admission to ICU increased 4.68 times. Also in this group NIHSS was found to be 20.57±6.19, albumin 33.12±5.23 g/L, and lymphocyte 1.10±0.76 10^3/µl. Higher lymphocyte and albumin and lower NIHSS values are protective effect on mortality and the optimum cut-off value of NIHSS for predicting mortality and admission to ICU are 18.5 (AUC=0.923) and 12.5 (AUC=0.954), respectively. Each 1 unit increase in the NIHSS value increases the risk of admission to ICU and mortality 1.86 times and 1.43 times, respectively.

Conclusion: This study revealed that stroke patients with COVID-19 had a higher risk for mortality and admission to ICU than non-COVID-19. The NIHSS value was a strong predictor for mortality.

Prognostic value of the TyG-AIP-BMI Composite Index (TabCI) for long-term survival in Ischemic stroke patients: A comprehensive analysis based on MIMIC-IV ICU Data

2025-09-15T01:22:32+00:00

Background & Objective: Insulin resistance-induced metabolic disorders play a crucial role in exacerbating ischemic stroke. This study aims to explore the association between TyG-AIP-BMI Composite Index (TabCI) and long-term mortality risk in severe ischemic stroke patients.

Methods: Data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database were accessed to retrieve data of ischemic stroke patients. Patients were stratified into four groups based on TabCI quartiles. The study assessed the primary outcome of 180-day all-cause mortality and secondary outcomes including 90-day and 1-year ACM. Kaplan-Meier curves were used to compare outcomes across groups, and lasso regression analysis was employed to select covariates. Multivariable Cox proportional hazards regression models and restricted cubic splines (RCS) were used to explore the association between TabCI and these outcomes. Interaction and subgroup analyses were conducted to validate the stability of results.

Results: A total of 1,141 severe ischemic stroke patients were included, with a mean age of 69 years (interquartile range [IQR]: 59-79), and 565 participants (49.5%) were male. Kaplan-Meier analysis indicated significantly lower long-term survival rates in patients in Q1 and Q3 compared to those in Q2 and Q4. Cox proportional hazards regression analysis adjusted for covariates showed a statistically significant increase in 180-day mortality risk in TabCI quartiles, with Q2 and Q4 groups also exhibiting increased risks at 90 days and 1 year. Additionally, RCS analysis revealed a gradual L-shaped correlation between TabCI and 90-day and 180-day all-cause mortality, with a smooth U-shaped trend observed for 1-year mortality, demonstrating significant non-linearity. Subgroup analysis further indicated an inverse correlation between TabCI and long-term mortality risk in non-Caucasian patients and those using aspirin, as well as negative correlations in TabCI among patients not receiving CRRT for 90-day and 180-day mortality.

Conclusion: TabCI may serve as an exploratory marker for stratifying long-term risk among severe ischemic stroke patients; however, its clinical predictive efficacy remains limited and requires further validation in larger, prospective studies.

Retrospective analysis of Routine T2 weighted brain MRI for detecting cervical internal carotid artery steno-occlusive disease

2025-03-18T15:12:04+00:00

Objective: To determine accuracy of signal alteration replacing normal flow voids in routine T2WI MRI brain for identifying cervical carotid steno-occlusive disease.

Methods: Neuroimaging data on patients with ischemic stroke was collected, only patients with both MRI brain T2WI and CT angiography of neck vessels (CTA) were included and the information was analyzed retrospectively. Flow void signals on routine axial T2 WI were analyzed by a neuroradiologist blinded to CTA of neck vessels and compared with CTA of neck vessels as gold standard to determine accuracy of altered flow void signals in identifying carotid steno-occlusive disease.

Results: Total of 278 patients, 34 patients with both T2WI and CTA were included. 15/34(44.1%) showed altered flow voids in cavernous ICA on axial T2WI while 19/34(55.8%) with normal flow voids were considered intra cohort controls.18/19(94.7%) showed normal patency of ICA on both T2WI and CTA of neck vessels. All 15 patients with altered flow void on T2WI showed changes on cervical CTA conferring high specificity of 100%. Homogenously altered signal corresponded to occlusion in 100% (4/4) while heterogenous signals indicated significant stenosis in 88.8 % (8/9). Further, 100 % specificity of normal flow voids on T2WI to exclude significant steno-occlusive disease in cervical ICA was noted.

Conclusions: Loss of normal flow void signal on T2WI is highly specific indicator of significant steno-occlusive carotid disease and its absence vice versa of normal vessels.

Rate of hematoma expansion as a predictor of outcome in intracerebral hemorrhage

2025-09-08T01:59:17+00:00

Objective: We examined the association between intracerebral hemorrhage hematoma expansion rate and 90-day outcomes using the Qatar Stroke Registry.

Methods: We conducted a retrospective analysis of patients admitted with supratentorial intracerebral hemorrhage from January 2014 to December 2024. The modified Rankin Scale was dichotomized into favourable (0–3) and unfavourable outcomes (4–6).

Results: A total of 1,351 patients were included in the final analysis. Fast volume-expanders (>10 mL/hr) had the highest mRS (p=0.002) and highest proportion of mortality at 90 days, compared to the slow volume expander (<5 mL/hr) and intermediate volume expander (5–10 mL/hr), p=0.01. Multivariate analysis revealed that severe NIHSS admission score (>10) was an independent predictor of mortality at 90 days (aOR 11.4, 95% CI: 4.58–28.5). Fast hematoma expansion rate was marginally associated with mortality at 90 days (aOR: 1.79, 95% CI: 0.99–3.20). In contrast, age (aOR 1.03, 95% CI: 1.02–1.04, p<.001), moderate stroke (aOR 3.21, 95% CI: 1.79–5.75, p<.001), severe stroke (aOR 27.0, 95% CI: 15.9–45.9, p<.001), and fast hematoma expansion rate (aOR 1.77, 95% CI: 1.10–2.85, p=0.02) were identified as predictors of a poor outcome (mRS of 4-6) at 90 days.

Conclusion: Fast hematoma expansion is independently associated with worse 90-day outcomes in the Arab population. In resource-limited settings where access to computed tomography angiography might be limited, using a CT head to calculate the volume expansion rate could be a useful predictor of outcomes in patients with supratentorial ICH.

Efficacy of paired associative stimulation combined with low-temperature thermoplastic orthosis in the treatment of post-stroke wrist flexor spasticity

2025-04-06T04:40:28+00:00

Objective: This study aims to investigate the efficacy of Paired Associative Stimulation (PAS) integrated with Low-Temperature Thermoplastic Orthosis (LTTPO) on post-stroke wrist flexor spasticity.

Methods: This prospective randomized controlled study recruited 63 patients with post-stroke wrist flexor spasticity treated in the Neurology Department of our hospital from January 2022 to June 2023. The patients were randomly assigned in a ratio of 1:1 to receive either sham stimulation combined with LTTPO (control group) or PAS combined with low-temperature thermoplastic orthosis (study group) via a random number table, with 31 patients in the control group and 32 in the study group. The primary endpoints used to evaluate treatment efficacy were functional recovery—assessed by the Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), Barthel Index (BI), and Visual Analog Scale (VAS)—and brain functional remodeling.

Results: At treatment completion, 4 weeks post-treatment, and 8 weeks post-treatment, PAS combined with LTTPO provided a significantly higher treatment effectiveness rate than LTTPO with sham stimulation. Patients receiving PAS exhibited significantly better functional recovery of wrist joint and pain mitigation than those with sham stimulation at the aforementioned time points, as evidenced by the lower MAS scores, higher Simplified FMA scores, and lower VAS pain scores. Both groups demonstrated improvements in BI scores over time, indicating enhanced functional independence. However, they also exhibited progressively worsening joint swelling. Despite these opposing trends, the differences between the two groups in both BI improvement and joint swelling were not statistically significant.

Conclusion: The integration of PAS combined with LTTPO offers a viable alternative managing post- stroke wrist flexor spasticity by significantly reducing wrist flexor spasticity, improving functional recovery, alleviating pain, and promoting neural remodeling.

Clinical and etiological spectrum of nontraumatic convexal subarachnoid hemorrhage in a South Indian tertiary care centre

2025-08-18T15:22:38+00:00

Background: Nontraumatic convexal subarachnoid hemorrhage (cSAH) is a distinct subtype of intracranial hemorrhage confined to the cortical sulci. Given its diverse etiologies, accurate diagnosis requires careful clinical and radiological evaluation. The present study aims to characterize the clinical profile, risk factors, neuroimaging features, and etiological spectrum of cSAH in a cohort of South Indian patients.

Methods: We prospectively studied 17 consecutive patients with cSAH presenting to our tertiary care centre in Chennai, India, from 2023 to 2024. Data on demographics, clinical features, risk factors, neuroimaging, and etiologies were collected. Findings were compared with international cohorts.

Results: The mean patient age was 46 years, and 47% were female. Headache occurred in 88%, seizures in 41%, and focal deficits in 35%. Parietal (71%) and frontal (65%) lobes were the most frequent hemorrhage sites; 35% had bilateral involvement. Cerebral venous thrombosis (CVT) was the leading cause (71%), followed by posterior reversible encephalopathy syndrome (12%), reversible cerebral vasoconstriction syndrome (6%), and arteriovenous malformation (6%). Compared with other published cohorts, our patients were younger, had a higher seizure incidence, and a predominance of CVT.

Conclusion: In South Indian patients, cSAH most often results from CVT, especially in younger individuals. Prompt MRI with MR venography is critical for early diagnosis and management.

How should we manage adult patients who present with an absence status? A study of case series

2025-07-09T22:28:30+00:00

Backgrond & Objective: Absence status epilepticus (ASE) is a generalized, prolonged absence seizure that can persist for hours or even days. In adults, it is often misdiagnosed or overlooked, frequently mistaken for focal impaired consciousness non-convulsive status epilepticus or, particularly in the elderly, for confusional episodes related to cerebrovascular disorders. In this study, we retrospectively analyzed adult patients with absence status, considering their clinical and electrophysiological characteristics, as well as their prognosis.

Methods: We reviewed hospital records from 2002 to 2023 to analyze clinical symptoms, ictal and interictal electroencephalography (EEG) findings, blood test results, cranial imaging, and treatment approaches in adult patients with absence status at our clinic.

Results: Five cases were identified as exhibiting ASE. The mean age at the first ASE episode was 48 years. The primary clinical symptom during ASE episodes was varying degrees of confusion. Ictal EEG findings were consistent with typical absence status. Three patients had a prior diagnosis of genetic generalized epilepsy before developing ASE, while two patients were diagnosed with ASE following recurrent ASE episodes. The main triggering factors included noncompliance with anti- seizure medications (ASMs), inappropriate ASMs, and lithium therapy. Valproate and levetiracetam were effective in terminating ASE episodes.

Conclusion: This study presents the clinical and electrophysiological findings of ASE in adults and evaluates prognosis with feasible treatment approaches.

A prospective observational study of tuberculous meningitis with hydrocephalus in Sarawak, Borneo

2025-08-26T05:31:03+00:00

Background: The incidence of hydrocephalus is high in patients with tuberculous meningitis (TBM). Over the past 20 years, studies have shown a tendency to use ventriculoperitoneal shunt (VPS) to treat all patients with TBM and hydrocephalus.

Methods: A prospective observational study was conducted in Sarawak, Borneo (Sibu Hospital and Sarawak General Hospital) from 2019 to 2022. This study aimed to identify patients who would benefit from VPS by assessing Modified Rankin Scale (MRS) post-treatment, survival rate, and various prognostic factors.

Results: 30 cases were recruited and classified using Modified Vellore Grading (MVG). There was no significant difference between the first month and final post-treatment outcomes. However, mortality rates among poor-grade patients increased significantly after the first month. This study followed up on all surviving patients until 31/5/2024, with a follow-up period of 26 to 63 months. We only performed VPS if there was at least a one-grade improvement in MVG or GCS. Despite VPS, mortality rates remained high, particularly among patients with poor grades, specifically MVG 3 and 4. The study also found that baseline MVG or GCS, cerebrospinal (CSF) protein levels, and the presence of infarcts had a statistically significant effect on patient outcomes.

Conclusion: Poor-grade patients often have cerebral infarcts in addition to hydrocephalus. We recommend an extended external ventricular drainage trial of 5 to 7 days as a preliminary procedure for VPS selection in poor-grade patients. This approach allows for a more objective identification of patients who are most likely to benefit from permanent CSF diversion.

Diagnostic and prognostic significance of chest radiographs in adult tuberculous meningitis: A retrospective study

2025-02-28T14:37:22+00:00

Background: Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary TB, carrying significant morbidity and mortality. Our study examined the diagnostic utility and prognostic value of abnormal chest X-rays (CXRs), alongside other clinical, laboratory and neuroimaging features in adult TBM. Methodology: This retrospective study used the Lancet consensus criteria to include all patients diagnosed with TBM at a tertiary referral centre from 2010-2020. Clinical, laboratory and radiological findings on admission were identified. The presence of tuberculomas, enhancement pattern, hydrocephalus, and infarction was assessed using brain imaging. Findings were compared to the functional outcome on the modified Rankin scale (mRS) at 90 days (good: mRS 0-2, poor: mRS 3-6). Correlation with functional outcomes was determined using logistic regression. Cases without imaging were excluded.

Results: This study included 31 adults diagnosed with TBM (median age: 37 years, range: 18-67 years). Abnormal CXRs were seen in 51.61% of patients. Poor functional outcomes were observed in 51.61% of patients and were independently associated with abnormal CXRs (aOR 20.07, 95% CI 1.63-247.60), the absence of Bacillus Calmette-Guérin (BCG) inoculation (adjusted odds ratio (aOR) 7.89, 95% CI 1.01-61.55) and lethargy (aOR 15.89, 95% CI 1.28-196.86). We found significant differences between good and poor outcomes in patients with cerebrospinal fluid (CSF) polymorphs (median: 6% vs median: 43%), CSF lymphocytes (median: 88% vs median: 12%) and cerebral infarction (0% vs 100%).

Conclusion: Abnormal chest radiographs help guide the diagnosis of TBM while awaiting definitive CSF results. They also are independently associated with poor functional outcomes.

The relationship between hand volume/body length and hand volume/hand length ratios and severity of carpal tunnel syndrome

2025-07-09T03:04:08+00:00

Background & Objective: The aim of this study was to investigate whether carpal tunnel syndrome (CTS) would be more severe in individuals with shorter body length and short but more voluminous hands.

Methods: This study was conducted between December 2024 and February 2025, and a total of 126 patients with CTS and 59 non-CTS individuals were enrolled. CTS patients were further categorized into mild, moderate, and severe subgroups. Demographic characteristics, hand volumes, various hand anthropometric measurements, and derived measurement ratios were recorded for statistical analysis.

Results: Compared to the control group, the patient group exhibited significantly higher mean hand volume/hand length ratio, and hand volume/body length ratio (P <0.001), whereas the median hand length was lower (P =0.028). Significant differences among the four groups were also observed in the mean hand volume/hand length ratio, and hand volume/body length ratio (P <0.001 and P =0.002). The severity of CTS was negatively correlated with body length (rho =-0.153, P =0.037) but showed positive correlations with hand volume/body length ratio (rho =0.287, P <0.001), and hand volume/ hand length ratio (rho =0.278, P <0.001). The areas under the ROC curves were 0.679 (95% CI, 0.595-0.763) for the hand volume/hand length ratio and 0.654 (95% CI, 0.568-0.739) for the hand volume/body length ratio.

Conclusions: CTS manifests more severely in patients with shorter body lengths and hands that are short yet relatively voluminous. Hand volume/body length and hand volume/hand length ratios may be predictive of CTS.

Possible founder variant and spectrum of phenotypic manifestations of Fukuyama congenital muscular dystrophy in five unrelated families in Pakistan: A case series

2025-08-22T04:40:32+00:00

Fukuyama congenital muscular dystrophy (FCMD) is a rare autosomal recessive dystroglycanopathy caused by pathogenic/likely pathogenic (P/LP) variants also known as mutations in the FKTN gene, typically presenting in early childhood with hypotonia, progressive muscle weakness, and variable central nervous system and cardiac involvement. This case series describes five male patients from consanguineous families in different regions of Pakistan, all presenting with features of a progressive muscular dystrophy. Genetic analysis revealed a homozygous pathogenic missense variant, FKTN, NM_001079802.1 c.920G>A (p.R307Q), in all five patients, suggesting the presence of a possible founder variant. Despite sharing the same genetic mutation, the patients exhibited significant clinical heterogeneity. This report adds to the limited literature on FCMD in South Asia and emphasizes the phenotypic variability of the disorder, particularly its cardiac manifestations. The development of cardiomyopathy is not uncommon, hence regular cardiac monitoring is crucial. Early genetic diagnosis is vital for appropriate clinical management and genetic counseling in populations with high rates of consanguinity.

Comparison of the efficacy of kinesiotaping and myofascial release techniques in the treatment of superior cluneal nerve entrapment syndrome: A randomised single blind controlled trial

2025-08-23T04:17:14+00:00

Background & Objectives: Conservative treatment options are limited in superior cluneal nerve entrapment syndrome, which is one of the causes of low back pain. The aim of this study was to investigate the effect of kinesiotaping and myofascial release technique in superior cluneal nerve entrapment syndrome.

Methods: Participants were evaluated with Visual Analogue Scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ) and SF-36 before treatment, at the end of treatment and one month after treatment. The first group received kinesiotaping + exercise, the second group received myofascial release technique + exercise, and the control group received only exercise therapy. All groups were given the same exercise program.

Results: All three groups showed improvements in quality of life and a reduction in pain and disability. Compared to the exercise group, the kinesiotaping and myofascial release groups experienced greater reductions in pain and improvements in quality of life, while the myofascial release group experienced a greater reduction in disability.

Conclusion: Kinesiotaping, myofascial release and exercise are effective treatments for superior cluneal nerve entrapment syndrome.

The prevalence and impacts of psychological disorders in Chinese Amyotrophic Lateral Sclerosis (ALS) patients

2025-05-30T04:38:49+00:00

Objective: To investigate the prevalence and influential factors of depression, anxiety, suicidal tendency and sleep disorders in a group of Chinese amyotrophic lateral sclerosis (ALS) patients.

Methods: A total of 103 ALS patients were investigated using the Patient Health Questionnaire-9 (PHQ-9), Self- Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), the Nurses’ Global Assessment of Suicide Risk scale (NGASR) and Pittsburgh sleep quality index (PSQI). The risk factors related to psychological disorders in the patients were analyzed.

Results: The medians (range) of PHQ-9, SDS, SAS, PSQI of patients were 8 (1-27), 45 (24-95), 51.30% (25.43%-83.41%), 7 (1-27), respectively. There were 17 (16.50%), 27 (26.21%) and 12 (11.65%) of ALS patients were classified as moderate, high and extremely high suicide risk as showed by NGASR, respectively. Financial supports were negatively associated with PHQ-9 (p<0.001), SAS (p<0.001), SDS (p<0.001) and NGASR (p<0.001) of ALS patients. Less food intake was strongly associated to high levels of PHQ-9 (p=0.009), SAS (p=0.012), SDS (p<0.001) and NGASR (p=0.028) in ALS patients. Regular reading was significantly related to higher QOL (p=0.019) and lower NGASR (p=0.007) in ALS population.

Conclusion: Depression, anxiety and poor sleep quality were commonly reported by ALS patients, which may result in high risk of suicide. Decrease in food intake, low financial support, poor functional status and rapid progression were risk factors of psychological distress in ALS population. Psychological treatments were crucial for ALS population, which deserved more attention of clinicians.

Amyotrophic lateral sclerosis patients with optineurin gene variants: A case series

2025-07-07T02:37:21+00:00

Background & Objective: Amyotrophic lateral sclerosis (ALS) is an incurable and fatal disease that affects motor neurons, and can be sporadic or familial. Pathogenic variants in the optineurin gene (OPTN) have been implicated in the pathogenesis of ALS, type 12 (ALS12). Knowledge of the causative/disease-modifying genes may provide a novel target for gene therapy.

Methods: We present three patients with ALS who were followed up at our neuromuscular outpatient clinic, and underwent clinical, neurophysiological, neuropsychological, radiological, laboratory, and genetic investigations. We identified variants by analyzing the entire exome and adjacent intronic regions of the causative genes.

Results: The patients had c.1078_1079del, p.Lys360Valfs*18 and c.1242+1G>A homozygous variants and c.403G>T, p.Glu135* heterozygous variant in OPTN, and presented with different clinical features.

Conclusions: Clinicians should be aware of the phenotypes and genetic profiles of patients to gain a better understanding of ALS12 and contribute to the development of new therapies.

NRF2/HO-1 axis and oxidative stress in pediatric migraine with and without aura

2025-08-26T07:29:22+00:00

Objective: Migraine is a frequent neurological disorder in childhood. Oxidative stress plays an important role in its pathophysiology. Nuclear factor erythroid 2–related factor 2 and heme oxygenase-1 regulate the antioxidant defense system. This study evaluated their serum levels and oxidative stress markers in pediatric migraine with and without aura.

Methods: Sixty pediatric migraine patients (34 with aura, 26 without aura) and 27 healthy controls were included. Serum nuclear factor erythroid 2–related factor 2 and heme oxygenase-1 were measured by ELISA, and total antioxidant status, total oxidant status, and oxidative stress index were determined.

Results: In both migraine subgroups, nuclear factor erythroid 2–related factor 2, heme oxygenase-1, and total antioxidant levels were lower, while the total oxidant status and oxidative stress indexes were higher compared to controls (p < 0.01). Subgroup analysis showed no differences between migraine with and without aura. In all patients, nuclear factor erythroid 2–related factor 2 correlated negatively with total oxidant status and oxidative stress index, and positively with total antioxidant status (p < 0.01).

Conclusions: Pediatric migraine patients show reduced nuclear factor erythroid 2–related factor 2 and heme oxygenase-1 as well as altered oxidative stress markers, indicating antioxidant dysregulation. The nuclear factor erythroid 2–related factor 2/heme oxygenase-1 axis may represent a biomarker for early identification of high-risk pediatric patients, and therapies targeting this pathway could provide a novel treatment approach.

The effectiveness of supplemental oxygen therapy in patients receiving acute migraine treatment in the emergency department: A randomized clinical trial

2025-08-26T05:33:58+00:00

Background & Objective: Migraine headaches are a frequent reason for emergency department (ED) visits. While oxygen therapy has demonstrated effectiveness for cluster headaches, its role in other primary headaches remains a topic of research. This study aimed to investigate the effectiveness of supplemental oxygen therapy, when added to standard treatments, for pain management in patients presenting to the ED with acute migraine without aura.

Methods: This study was a randomized, controlled trial. Patients were randomized using the ‘Random Allocation’ program and divided into two groups. All patients presenting to the ED with migraine without aura received 50 mg dexketoprofen + 10 mg metoclopramide HCl in 100 mL normal saline intravenously as standard treatment. The study group also received humidified oxygen at 10 L/min via a simple face mask for 60 minutes. Data collected included patients’ demographic information, pain characteristics, comorbid diseases, medications used, presence of aura, visual analog scale (VAS) scores at 0, 15, 30, and 60 minutes post-treatment, and the need for rescue treatment.

Results: A total of 160 participants were included: 79 in the oxygen group and 81 in the non-oxygen group. No significant differences were found in demographic data or baseline VAS scores between the groups. VAS scores at 15, 30, and 60 minutes did not show a significant difference between the two groups (p > 0.05 for each measurement using either per-protocol [PP] or intention-to-treat [ITT] analysis). One patient in the oxygen group and two patients in the non-oxygen group required rescue treatment, but this difference was not statistically significant (p = 0.57).

Conclusion: This study suggests that supplemental oxygen therapy does not augment the effectiveness of conventional migraine treatment. Current evidence is insufficient to support the routine use of oxygen in emergency departments for the management of migraine headaches.

Evaluation of quality of life, anxiety, depression, and sleep quality in female fibromyalgia patients with and without migraine

2025-06-21T06:37:03+00:00

Objective: This study aims to assess the prevalence and severity of migraine among fibromyalgia patients as well as to assess its impact on quality of life, anxiety, depression, and sleep disturbances.

Methods: A prospective cross-sectional study was conducted among 115 women (mean age 42.1 ± 5.44 years). Fibromyalgia was diagnosed in 48 participants using the 2016 revised American College of Rheumatology (ACR) criteria; 67 participants without fibromyalgia served as the control group. Participants were classified into four subgroups based on fibromyalgia and migraine status. The Headache Impact Test-6 (HIT-6), Visual Analog Scale (VAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and a quality of life (QoL) scale were used for assessment.

Results: The fibromyalgia group exhibited a significantly greater prevalence of migraine compared to the control group (43.75% vs. 13.43%, p < 0.001). Fibromyalgia patients reported greater severe headache intensity (p < 0.001), higher anxiety and depression scores (p < 0.001), poorer sleep quality (p < 0.001), and reduced QoL (p < 0.001). Subgroup analysis showed that the presence of migraine did not significantly affect disease activity, fatigue, or psychological symptoms in fibromyalgia patients, but was associated with worse sleep quality.

Conclusion: Patients with fibromyalgia exhibited increased migraine frequency, greater psychological distress, and more impairment of sleep and quality of life compared to controls. While comorbid migraine does not demonstrably worsen the overall symptomatic burden, it may increase sleep disturbances, underscoring the value of a multidisciplinary care model.

Age-sex interaction on the development of postherpetic neuralgia among shingles patients with moderate and severe pain levels

2025-08-24T02:24:34+00:00

Background: Herpes zoster (HZ), commonly known as shingles, can lead to postherpetic neuralgia (PHN), a chronic neuropathic pain condition that significantly impacts patients’ quality of life. Age is a well-established risk factor for PHN, with incidence increasing among older individuals. However, the role of sex in PHN development remains unclear, with conflicting evidence regarding its influence. This study investigates the interaction between age, sex, and PHN risk among shingles patients with moderate to severe pain levels.

Methods: A retrospective cohort study was conducted using electronic medical records from hospitalized HZ patients between 2018 and 2021. PHN was defined as persistent pain lasting ≥3 months post-HZ onset. Statistical analyses, including logistic regression and generalized additive models, were employed to assess risk factors.

Results: Results showed that age was a significant predictor of PHN, particularly among patients with moderate to severe pain. In male patients, PHN risk increased linearly with age, whereas in female patients, a nonlinear relationship was observed, with a peak in risk between 60 and 70 years. Pain severity and comorbidities were also associated with PHN development. The observed sex differences may be influenced by variations in pain perception and healthcare-seeking behaviors, with older women receiving antiviral treatment earlier.

Conclusion: These findings highlight the importance of considering age-sex interactions when assessing PHN risk. Early intervention, particularly in patients experiencing severe acute pain, may help mitigate PHN development. Further research is needed to refine targeted prevention strategies.

Cognitive dysfunction in patients over 60 with non- specific chronic low back pain: A cross-sectional study

2025-04-06T04:53:48+00:00

Background: Although few studies in recent years have indicated a relationship between chronic low back pain (CLBP) and cognitive impairment, clear evidence is lacking, emphasizing the need for further research in this area. This study aimed to investigate the frequency of cognitive dysfunction and associated factors in patients over 60 with non-specific CLBP.

Methods: A total of 107 consecutive participants, including 57 patients with nonspecific CLBP and 50 healthy controls matched for age, sex, and education, were enrolled in this prospective, cross-sectional, controlled study. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Standard Mini- Mental Test (SMMT). Pain and fatigue severity was measured using the Visual Analog Scale (VAS), while depression, pain catastrophizing, functional disability, and quality of life were evaluated using the Beck Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), Roland Morris Disability Questionnaire (RMDQ), and the Short Form-36 (SF-36) respectively.

Results: The CLBP group showed significantly lower cognitive performance than the control group (p < 0.001). Significant impairments were observed in visuospatial abilities, attention, and executive functions. Beck Depression Inventory, PCS, and RMDQ scores were significantly higher in the CLBP group (p < 0.001), while SF-36 scores and sleep quality were notably lower (p < 0.001 for all).

Conclusions: Chronic low back pain patients exhibit significant cognitive impairments, higher levels of depression, pain catastrophizing, and functional disability, along with a lower quality of life. These findings emphasize the importance of incorporating cognitive and psychological evaluations into the multidisciplinary management of CLBP. Clinicaltrials.gov identifier: NCT06278467

Vaccination strategies in multiple sclerosis patients with Delphi methodology: A Turkish consensus

2025-01-14T21:50:41+00:00

Background: Both the presence of multiple sclerosis (MS) and the use of immunomodulatory therapy for this disease can change the vaccine response in individuals with MS. In this study, due to the lack of guidelines for vaccination of MS patients in our country, the aim was to create a Delphi consensus on vaccination practices and vaccine types in MS patients.

Methods: The Real-time Delphi technique, a more structured and predefined version of the traditional Delphi study was used to ensure a comprehensive research process. The stages of the structured online Delphi application process, which includes repeated rounds, (three rounds) are applied. Fifteen participants are sufficient to achieve homogeneous outcomes according to expertise criteria and in this study, the group comprised 31 experts who met these criteria and participated in all stages.

Results: The assessment of the level of consensus among panelists revealed that there was “almost perfect consensus” on 16 items and “significant consensus” on 12 items. When examining the items in which the panelists did not reach a consensus, it was found that there was “minor consensus (slight-1)” on 1 item, and there was “no consensus (indicate poor-0)” on 2 items.

Conclusion: We wanted to share a “country” practice and our current recommendations on vaccination strategies, by making use of articles containing country-based recommendations and working-group recommendations, as well as our national experiences.

Effect of health fatalism on health perception and health-seeking behavior with multiple sclerosis patients

2025-09-09T12:26:12+00:00

Objectives: The objective of this study was to ascertain the effect of health fatalism on health perception and health-seeking behavior with multiple sclerosis in Türkiye.

Methods: This cross-sectional and descriptive study was conducted between September 2023 and August 2024. The study sample consisted of 382 patients with MS, obtained through the snowball sampling method. The data collection tools included the descriptive information form, Health Fatalism Scale, Health Perception Scale, and Health Seeking Behavior Scale. The data were evaluated using means, percentage calculations, t test, variance analysis, Mann Whitney U test, Kruskal Wallis test and MANOVA.The level of significance was set at p < 0.05.

Result: Among the participants, 86.6% were female, 63.7% had obtained a university degree, 65.8% were married, 46.2% were not employed, 70.2% had a moderate income, 88.3% took their medications as prescribed, and 89.9% underwent regular health examinations. The Health Fatalism Scale was found to be 40.40 ± 15.19. The total score for the Health Perception Scale was 50.73 ± 7.18. The mean total score for the Health Seeking Behavior Scale was 38.60 ± 8.44. The effect of health fatalism on the total score of the health perception scale was found to be significant (p=0.005), with health perception explained by health fatalism to the extent of 10.9%. However, no effect of health fatalism on health-seeking behavior was observed (p=0.987).

Conclusion: It was observed that as health fatalism increased, health perception was negatively affected. However, health perception and health fatalism did not affect health-seeking behavior.

Cross-cultural adaptation and psychometric validation of the Turkish version of Paper and Pencil Test in patients with multiple sclerosis

2025-06-08T10:57:13+00:00

Background & Objective: Multiple Sclerosis (MS) is a chronic neurological disease that impairs patients’ cognitive abilities and motor functions, making it difficult to maintain independent living. This condition leads to significant challenges in complex self-care tasks such as clean intermittent catheterization (CIC). The aim of this study was to adapt the Paper and Pencil Test (PP-Test) into Turkish and evaluate its psychometric properties, thereby providing a reliable tool for assessing CIC skills in patients with MS.

Methods: This methodological study was conducted between June and December 2023 at a university hospital with 61 MS patients who perform CIC. Data were collected using the PP-Test, Clean Intermittent Catheterization Learning Scale, Expanded Disability Status Scale (EDSS), and Functional Independence Measure (FIM). Reliability was assessed using Cronbach’s alpha and interrater agreement (Cohen’s kappa), and validity was analyzed through content validity index (CVI) and predictive validity based on the relationships between PP-Test, EDSS, and FIM scores.

Results: Cronbach’s alpha was 0.97 for female and 0.74 for male participants. Interrater reliability was excellent (κ = 0.87). The CVI was 0.85. PP-Test scores were negatively correlated with EDSS (r = -0.50) and positively correlated with both FIM and CIC ability scores (r = 0.60).

Conclusion: The Turkish version of the PP-Test is a valid and reliable instrument for assessing CIC proficiency in patients with MS. It can be effectively used in clinical and educational settings to evaluate and monitor catheterization learning.

Gene therapy for Batten disease: A systemic review of preclinical and clinical studies

2025-04-02T11:58:56+00:00

Background: Batten disease (BD), or neuronal ceroid lipofuscinosis (NCL), is a group of rare, fatal neurodegenerative disorders caused by mutations in CLN genes, leading to lysosomal dysfunction and progressive neuronal loss. Gene therapy, particularly using adeno-associated virus (AAV) vectors, has emerged as a promising strategy to address the genetic basis of BD across various subtypes, including CLN2, CLN5, and CLN6. This systematic review evaluates the efficacy and challenges of gene therapy in preclinical and clinical settings.

Methods: Following PRISMA guidelines, we reviewed studies from January 2000 to January 2025, sourced from PubMed, Embase, Scopus, and other databases. Included studies assessed viral and non-viral vector-mediated gene therapies for BD in preclinical (animal, in vitro) and clinical contexts. Primary outcomes were restoration of enzymatic function, reduction in neurodegeneration, improvements in motor and cognitive function, safety, and survival.

Results: Preclinical studies demonstrated that AAV-based gene therapy effectively restored enzyme activity, reduced neuronal degeneration, and extended survival in models of CLN5, CLN6, and other subtypes. Clinical trials, particularly for CLN2, showed slower disease progression with intracerebroventricular AAV-TPP1 delivery. However, challenges include genetic heterogeneity, immune responses to vectors, limited central nervous system (CNS) transduction due to the blood-brain barrier, and uncertainties about long-term safety and optimal treatment timing.

Conclusion: Gene therapy holds significant potential for treating BD by targeting its genetic roots, with AAV-mediated approaches showing promise in both preclinical and early clinical studies. Nonetheless, optimizing vector design, delivery methods, and immune management, alongside improving early diagnosis, remains critical to realising its therapeutic potential.

Prognostic marker PTPN6 in glioma and its relationship with immune infiltration

2025-05-06T13:12:31+00:00

Background & Objective: Glioma is a type of malignant tumor that develops in the neurological system, and identification of glioma biomarkers is critical. PTPN6 is a protein tyrosine phosphatase. The role of PTPN6 in glioma is unclear. This is the first study to investigate the expression of PTPN6 in glioma patients and its prognostic value, potential biological functions, and impact on the immune system.

Methods: Gene expression and clinicopathological analysis, enrichment analysis, and immune infiltration analysis were based on The Cancer Genome Atlas (TCGA) data with additional bioinformatics analysis. Statistical analysis was performed using TIMER and ssGSEA to analyze the immune response to PTPN6 expression in glioma. In addition, CGGA, K-M survival analysis, and data from HPA were used to validate the results.

Results: PTPN6 played a vital role as an independent prognostic factor in glioma patients. PTPN6 expression correlated with age, WHO grade, IDH status and 1p/19q codeletion. GSEA found that PTPN6 is closely related to cell adhesion, immunological. PTPN6 expression was positively correlated with infiltration of B cells, CD8+ T cells, CD4+ T cells, macrophages, dendritic cells, and neutrophils and was co-expressed with immune-related genes and immune checkpoints.

Conclusion: The expression of PTPN6 is increased in gl666ioma, and the high expression of PTPN6 is associated with poor prognosis. PTPN6 may affect tumor development by regulating tumor-infiltrating cells in the tumor microenvironment (TME). PTPN6 may be a potential target for immunotherapy.

Serum chemokine profiling in spinal ependymoma: Correlation with tumor characteristics and prognostic implications

2025-04-22T14:16:44+00:00

Background: Spinal ependymomas are rare neoplasms that originate from the ependymal cells lining the central canal of the spinal cord. Since serum levels of cytokines and chemokines are imbalanced in tumorigenesis, this study investigated the serum levels of IL-8, CCL2, and CXCL12 chemokines in patients with spinal cord ependymoma and their correlation with multiple tumor parameters.

Methods: In the current investigation, blood samples were obtained from 50 patients with spinal ependymomas and 25 healthy individuals, who acted as controls, to assess the levels of specific chemokines. The serum levels of interleukin (IL)-8, chemokine (C-C motif) ligand 2 (CCL2), and C-X-C motif chemokine ligand 12 (CXCL12) chemokines were measured using the enzyme-linked immunosorbent assay (ELISA). In contrast, their gene expression levels were assessed using real-time polymerase chain reaction (RT-PCR). Then, the correlation of these factors with tumor size, grade, recurrence, and Karnofsky Performance Status (KPS) score was investigated.

Results: The current study demonstrated that serum expression levels of IL-8, CCL2, and CXCL12 were significantly elevated in patients with spinal ependymoma compared to the control group. The cytokine IL-8 showed a significant relationship with tumor size, grade, and KPS score. CXCL12 and CCL2 also had a significant relationship with tumor size and grade.

Conclusion: Based on the current study, IL-8, CXCL12, and CCL2 are significantly elevated in spinal ependymoma patients and linked to tumor progression. These findings underscore the need for future studies to broaden the characterization of spinal ependymoma and develop blood-based markers for these tumors to guide clinical management.

The relationship between disease severity, treatment adherence, inflammation, and neurocognitive functions in patients with obstructive sleep apnea syndrome

2025-01-13T12:51:03+00:00

Obstructive: Sleep Apnea Syndrome (OSAS) is a condition marked by recurrent interruptions in airflow during sleep, causing intermittent hypoxia and inflammation. These changes adversely affect neurocognitive functions. OSAS is linked to impairments in executive functions, memory, attention, and intellectual capacity. This study aims to evaluate the effects of OSAS on cognitive functions and inflammatory markers and the impact of Continuous Positive Airway Pressure (CPAP) treatment.

Methods: This retrospective study included 106 OSAS patients and 49 healthy controls, classified based on their Apnea-Hypopnea Index (AHI) and CPAP treatment adherence. Patients in the treatment group used CPAP for at least 4 hours daily over 3 months. Cognitive performance was measured using the Montreal Cognitive Assessment, and inflammatory markers such as Platelet Distribution Width (PDW), Platelet-Lymphocyte Ratio (PLR), and Neutrophil-Lymphocyte Ratio (NLR) were analyzed.

Results: MoCA scores showed significant declines in cognitive functions across all OSAS groups (p < 0.001), with notable reductions in executive functions, language, and abstraction. Treated patients showed higher cognitive scores, though differences were not statistically significant. PDW, PLR, and NLR levels were significantly lower in the CPAP-treated group compared to untreated patients.

Conclusion: Untreated OSAS significantly affects cognitive functions, particularly executive functions, language, and abstraction. CPAP treatment provides partial cognitive improvement and reduces inflammatory markers like PLR, PDW, and NLR. These markers may be valuable in assessing treatment effects and detecting suspected OSAS. Further research with larger cohorts is needed to validate these findings and enhance clinical management.

Blood-brain barrier in stroke: Pathophysiological mechanisms and treatment approach

2025-06-29T09:28:29+00:00

The blood-brain barrier (BBB) is a selective semi-permeable structure in the central nervous system (CNS) and has many structural and functional characteristics. It regulates the transfer of molecules, ions, and cells between blood and CNS. Its components include interneurons, astrocytes, microglia, oligodendrocytes, basal lamina, pericytes, endothelial cells, extracellular matrix, and blood. The BBB plays a critical role protecting the brain parenchyma during the ischemic and hemorrhagic stroke. However, this barrier’s integrity is disrupted during ischemic stroke. Pathophysiological mechanisms in stroke induce cerebral edema associated with BBB injury. Many immune reactivations occur in patients with stroke. Especially, neutrophils play a critical role in the BBB disruption. Monocytes have proinflammatory or anti-inflammatory activity related with the type and duration of stroke. In addition, lymphocytes, microglia, astrocytes, pericytes, natural killer (NK) are the other main immune cells in this period. Previous studies reported that some strategies for stabilization of BBB yield positive functional outcome in stroke. Inhibition of neutrophil infiltration with reparixin and junctional adhesion molecule A antagonist peptide (JAM-Ap) is effective treatment approach to reduce infarct volume and neurological deficits. Regulation of neutrophil polarization (all-trans retinoic acid, rosiglitazone, etc.) is another neutrophil-related treatment option. Fingolimod, a S1P receptor agonist, modulates immune homeostasis and reduces hemorrhagic transformation. Microglial regulation, cytokine, and astrocyte inhibition are another BBB-related treatment approach. In conclusion, the severity of BBB’ injury is associated with poor functional outcome in ischemic and hemorrhagic stroke. In particular, studies on functional and structural stabilization of BBB may provide significant positive contributions in stroke treatment.

PAI-1 4G/5G mutation leads to acute mountain sickness with reversible splenial lesion syndrome and intracranial arteriovenous thrombosis: A case report and literature review

2025-07-02T04:54:06+00:00

Acute mountain sickness (AMS) rarely manifests with concurrent reversible splenial lesion syndrome (RESLES), cerebral venous sinus thrombosis (CVST), and bilateral watershed infarctions. We present the first reported case linking these neurological complications to a plasminogen activator inhibitor-1 (PAI-1) 4G/5G promoter mutation under hypoxic stress. A 23-year-old male developed AMS with encephalopathy and lower limbs weakness following rapid ascent to 3,000m. Critical findings included: 1) Corpus callosum splenium lesions showing RESLES-specific magnetic resonance imaging (MRI) evolution; 2) CVST involving straight and transverse sinuses on magnetic resonance venography (MRV); 3) Watershed infarcts at arterial borderzones. Thrombophilia screening revealed a heterozygous PAI-1 4G/5G mutation, with elevated hematocrit (50.3%) and D-dimer (4.14 μg/mL). Combined anticoagulation (low-molecular-weight heparin transitioning to dabigatran) and hyperbaric oxygen achieved partial venous recanalization at 1-month follow-up, with complete RESLES resolution. In conclusion, this case highlights the complex interplay between genetic factors (PAI-1 mutation), high-altitude hypoxia, and the development of rare cerebrovascular complications, providing valuable insights for clinical diagnosis and treatment.

Reversible cerebral vasoconstriction syndrome associated with paroxysmal nocturnal hemoglobinuria: A case study

2024-09-18T05:39:48+00:00

Reversible cerebral vasoconstriction syndrome (RCVS), characterized by thunderclap headaches (TCH) and other clinical and radiological manifestations, typically occurs under some triggering conditions. This is the report of a 43 years old woman with known paroxysmal nocturnal hemoglobinuria (PNH) who received regular blood transfusion and glucocorticoid treatment, and developed RCVS. The association between PNH and RCVS has not been previously reported.

Pancytopenia and Stevens-Johnson syndrome induced by oxcarbazepine: A case report

2025-06-30T22:44:16+00:00

Oxcarbazepine (OXC), a commonly prescribed medication for focal and secondarily generalized seizure, has been associated with the development of pancytopenia in approximately 1% of patients. The incidence of Stevens-Johnson syndrome (SJS) in Han Chinese patients receiving OXC has been reported as 8 cases per 100,000 individuals annually. However, the simultaneous occurrence of both conditions is relatively rare. We report a case of pancytopenia and SJS induced by OXC. An 8-year-old Chinese female developed SJS after 9 days of initiating OXC therapy. On the 13th day of treatment, a complete blood count revealed pancytopenia. Prompt withdrawal of OXC, along with the administration of immunoglobulin, methylprednisolone, and supportive care, resulted in a favorable outcome with full recovery and restoration of normal hematological parameters. This case highlights the rare coexistence of pancytopenia and SJS induced by OXC in a single patient. Early diagnosis through heightened vigilance is crucial for achieving favorable outcomes. Prompt drug withdrawal and initiation of immunosuppressive treatments during the early phase can contribute to a good prognosis. Additionally, pre-exposure genetic testing and regular evaluation of the hematologic profile should be considered for patients undergoing OXC therapy.

Neurosyphilis presenting with behaviour change and temporal and frontal lobe MRI abnormalities

2025-09-09T13:01:58+00:00

General paresis is the result of a chronic, slowly progressive meningoencephalitis secondary to central nervous system infection by Treponema pallidum and its onset is insidious with predominant cognitive deficits and neuropsychiatric manifestations. We report a case of a patient who presented with behavioural change and was found to have MRI signal abnormalities in the medial temporal lobe. A viral or autoimmune aetiology was initially pursued prior to the diagnosis of neurosyphilis. The patient’s clinical status and MRI findings improved following a 14-day course of intravenous benzylpenicillin therapy. Neurosyphilis is an easy-to-screen and treatable disease that should be considered in the differential diagnosis in patients presenting with MRI signal abnormalities in the temporal lobes or limbic structures. Early recognition and initiation of treatment may limit cognitive complications and morbidity.

Neurolisteriosis mimicking Weber’s syndrome: A rare clinical presentation

2025-08-22T08:45:55+00:00

Neurolisteriosis, an infection of the central nervous system caused by Listeria monocytogenes, can present with a wide variety of clinical signs and symptoms thereby rendering the diagnosis and treatment challenging. This report pertains to a 67-year-old woman with a history of autoimmune haemolytic anaemia on long-term steroid therapy who developed generalized weakness, lethargy, double vision, right third cranial nerve palsy and left hemiparesis. MRI brain revealed multiple brain abscesses in the cerebrum and the brainstem. The cerebrospinal fluid (CSF) culture confirmed the presence of Listeria monocytogenes bacteriae. The patient was treated with high-dose ampicillin and gentamicin leading to significant improvement and near complete neurological recovery at the end of six weeks. While neurolisteriosis presents quite often as a case of meningitis, it can rarely masquerade as stroke, encephalitis and/or cranial nerve palsies. This extremely rare clinical presentation as seen in our patient with multiple brain abscesses, including one in the ventromedial midbrain leading to Weber’s syndrome (crossed hemiplegia), prompted us to report this case.

Amiodarone-induced parkinsonism

2025-04-19T01:39:15+00:00

Drug-induced parkinsonism (DIP) is the second most common cause of parkinsonism, primarily resulting from medications that block dopamine D2 receptors or reduce dopamine in the basal ganglia. While antipsychotics are most frequently linked to DIP, cases related to other agents like amiodarone are rare. We describe a 79-year-old Filipino woman with sick sinus syndrome who developed parkinsonian symptoms after two months of amiodarone therapy. A high Nanjaro score, lack of response to levodopa, and dramatic improvement following discontinuation of amiodarone all aided the diagnosis of DIP. Supporting features include acute-subacute onset, timing of symptom development and absence of non-motor signs typical of PD. In conclusion, although rare, amiodarone can be associated with parkinsonism, highlighting the importance of clinical suspicion and vigilance, as the motor features of DIP can closely mimic those of PD.

The skin knew first: A diagnostic chase for primary diffuse leptomeningeal melanocytosis

2025-08-07T17:32:34+00:00

Primary diffuse leptomeningeal melanocytosis (PDLM) is a rare and clinically aggressive primary tumor of the central nervous system that arises from leptomeningeal melanocytes. We report the case of a 38-year-old male presenting with subacute-onset headache, nausea, and vomiting, without focal neurological deficits. Magnetic Resonance Imaging (MRI) of the brain revealed diffuse leptomeningeal enhancement with cystic changes and mild ventriculomegaly. Despite an extensive infectious and inflammatory workup, no etiology was identified. Surgical biopsy during temporal craniotomy revealed a melanocytic neoplasm with atypical pigmented cells invading the cortex. Immunohistochemistry was positive for S100 and HMB-45, with a Ki-67 index of 7–8%, confirming the diagnosis of primary diffuse leptomeningeal melanocytosis. Whole-body 18F-fluorodeoxyglucose emission tomography (FDG-PET/ CT) excluded systemic melanoma, establishing the primary CNS origin. The patient underwent whole- brain radiotherapy and temozolomide-based chemotherapy but succumbed during treatment. This case underscores the diagnostic challenges of primary diffuse leptomeningeal melanocytosis, which mimics more common infectious or inflammatory meningitides. A high index of suspicion, especially in the presence of congenital melanocytic nevi and characteristic radiological findings, should prompt early tissue diagnosis. Given its rapid progression and dismal prognosis, prompt recognition is crucial for initiating timely intervention.

Silent seizures in glioma: The role of preoperative EEG in detecting electrographic seizures

2025-06-21T16:51:24+00:00

Seizures are a common presentation in glioma patients, yet electrographic seizures — subclinical seizure activity detected only on electroencephalography (EEG) are often overlooked due to the lack of routine EEG screening. This case report describes a glioma patient who presented with worsening occipital headaches and cognitive decline but no overt seizures. Preoperative EEG revealed an electrographic seizure originating from the left temporal region, despite the absence of clinical manifestations. The patient underwent surgical resection, and histology confirmed a WHO grade 4 IDH-mutant astrocytoma. This case highlights the importance of proactive EEG screening, even in the absence of clinical seizures, as it facilitated early seizure detection and treatment. Further studies are needed to evaluate the impact of treating electrographic seizures on long-term outcomes in glioma.