Neurology Asia

Characteristics of stroke inpatients in a single- center in Kunming: A multi-ethnic settlement with a northern sub-tropical low-latitude plateau mountain monsoon climate

Hongyan Zhu — 2024-10-05

Objective: This study aimed to evaluate the characteristics of stroke inpatients in Kunming in southwest China.

Methods: Basic demographic information and risk factors of stroke inpatients admitted to a first-rate tertiary referral hospital in Kunming from January 1, 2015, to September 15, 2022, were retrospectively analysed. In total, 7,108 stroke inpatients with ischemic stroke (IS), primary intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) were included.

Results: IS was the most common type of stroke (75.97%), followed by ICH (13.45%) and SAH (10.58%). There were significant differences among the three groups in sex, age, ethnic, residence, occupation, and medical expenses (P<0.05). There was also a statistically significant difference in the proportion of inpatients between the four seasons (P<0.05). Hypertension, dyslipidemia, and diabetes were common risk factors for stroke. There were significant differences in the incidence of smoking, alcohol use, hypertension, dyslipidemia, diabetes, atrial fibrillation, and pulmonary infection among the three stroke subtypes (P<0.05).

Conclusion: Demographic information and risk factors were different among the three stroke subtypes. The number of hospitalized patients from all three groups varied slightly in different seasons in Kunming. Different types of cerebrovascular disease patients in the region have different characteristics from demographic information to risk factors.

Triglyceride-HDL index as a predictor of post-stroke outcomes: A retrospective analysis of 6,235 ischemic stroke patients from the Qatar Stroke Database

aizaz ali — 2024-10-05

Objectives: In this study, we explored the Qatar stroke database to study the independent effect of sex- specific TG-HDL index on neurologic and cardiovascular outcomes following stroke in a predominantly Arab and Southeast Asian population.

Methods: All patients admitted with acute ischemic stroke between 2014-2022 were included. TG-HDL index on admission was calculated and patients were stratified into sex-specific quartiles. We studied the 90-day modified Rankin Score (mRS), and 1-year major cardiac adverse events (MACE). Multivariate linear and binary logistic regression analyses were performed to identify the independent effect of TG-HDL index on short- and long-term outcomes.

Results: A total of 6,235 stroke patients were identified. Overall, mean age was 55±13 years; 5,122 patients (82%) male; 1,989(32%) Arab; 1,628(26%) BMI ≥30; 3,526 (57%) diabetes mellitus; 4,598 (74%) hypertension, 3,158 (51%) dyslipidemia, and 1,876 (30%) smokers. The median TG levels were 1.5 (1.0-2.3), HDL levels 1.0 (0.8-1.2), and TG-HDL index was 1.5 (1.0-2.3). On long term follow-up, 120 (2%) had a recurrent stroke, 314 (5.1%) had MACE, 38 (0.6%) had post-stroke MI, and 37 (0.6%) had post-stroke cardiac revascularization procedures. On multivariate analyses, higher sex-specific TG-HDL index was independently associated with lower adjusted odds of severe stroke and lower inpatient mortality, and higher 1-year adjusted odds of post-stroke MI (p<0.05).

Conclusion: TG-HDL was strongly associated with in-patient mortality and long-term post-stroke cardiovascular outcomes but not long-term stroke recurrence. Our finding of an independently increased 1-year risk of post-stroke MI with higher TG-HDL index may warrant consideration of this index as a cardiac risk stratification tool for stroke patients.

Risk factors of acute stroke associated pneumonia and predictive value of serum amyloid A combined with neutrophil-to-lymphocyte ratio

Liuhai Zhang — 2024-10-05

Objectives: This study aimed to explore the risk factors for stroke-associated pneumonia (SAP) and assess the predictive value of Serum Amyloid A (SAA) combined with neutrophil-to-lymphocyte ratio (NLR) on SAP.

Methods: The study included acute ischemic stroke (AIS) patients from January 2021 to June 2022 in our hospital. The patients’ history of chronic diseases, the clinical characteristics, and the laboratory testing data were recorded. SPSS 22 was used for statistical analysis. Receiver operating characteristics (ROC) curves and logistic regression analysis were used to identify independent predictors.

Results: We studied 356 patients with AIS, of which 19.4% (n = 69) developed SAP. In the SAP group, the patients with higher the proportion of hypertension, coronary heart disease and higher the NIHSS score were older, the blood glucose, neutrophil count, NLR and SAA of the SAP group were significantly higher than the Non-SAP group. Multiple logistic regression analysis for SAP showed that age , NIHSS,SAA and NLR were independent risk factors for SAP. For SAA alone, the area under the curve (AUC) in the ROC curve was 0.765, For NLR alone, the AUC was 0.840. When SAA combined with NLR, the AUC increased to 0.853. we created a 4-item prediction model, the AUC increased to 0.881.

Conclusion: Age, NIHSS, SAA and NLR were independent risk factors for SAP. When SAA combined with NLR, its predictive value for SAP was higher than its alone, the value of prediction for SAP appeared to be much stronger when SAA and NLR incorporated in a prediction model including age, and NIHSS.

Prognosis of the post COVID-19 stroke based on D-dimer and inflammatory markers: A mixed model meta-regression analysis

Mohammad Javad Nourmohammadi — 2024-10-05

Background & Objective: With regard to the importance of inflammatory biomarker and stroke in COVID-19 prognosis, this study aims to compare the mortality of stroke in COVID-19 patients based on the level of inflammatory biomarkers, considering the temporality of stroke occurrence after COVID-19 infection.

Methods: As a secondary study, aggregate data were collected by a systematic review. Mixed model meta-regression analyses were conducted to study the effects of stroke, inflammatory biomarkers and D-dimer on mortality of patient with COVID-19 as main effects and interactions. The effect measure was death rate. The protocol was registered in PROSPERO with registration number CRD42023383065.

Results: A total of 2,725 COVID-19 patients, consisting of 96 patients with stroke with a temporal precedence of COVID-19 were investigated from three studies. Among the inflammatory biomarkers, only CRP found eligible for pooled analysis. In the interaction model of CRP, significant positive interactions with CRP were found for both groups of stroke and non-stroke (P <0.001), in which the interaction with stroke group was more severe. In the interaction model of D-dimer, a significant positive interaction with D-dimer was found for the stroke group (P <0.001), while the interaction with the non-stroke group was not statistically significant (P =0.158).

Conclusion: The present study found the role CRP and D-dimer in prognosis of stroke in patients with COVID-19 as both main effect and interaction modeling. The evidence obtained from these mixed model meta-regression analyses was of moderate quality.

Risk of stroke in Alzheimer’s disease: A meta-analysis

Juan Liu — 2024-10-05

Background: Stroke occurs when a blood vessel of the brain narrowed or completely blocked. Stroke and Alzheimer’s disease (AD) are the commonest diseases in elderly. Some studies confirm the association between AD and the increased risk of stroke.

Methods: In present meta-analysis we conducted a systematic analysis on risk of stroke in AD patients. A thorough literature search was conducted using different databases, including Google Scholar and MEDLINE. The present metanalysis includes all the studies published from 2010 to 2023. We found more than 57,260 matching results and five were relevant to our area of interest and met all the selection criteria.

Results: All the selected studies confirm the association of stroke with AD. The AD patients were al higher risk of stroke (ischemic and haemorrhagic) than the normal individuals.

Conclusion: Present meta-analysis confirms the significant association of AD with stroke. There were only five studies available. To validate the results further evidences are required.

Factors associated with unfavorable outcome of anterior circulation ischemic stroke following emergency endovascular therapy after complete recanalization

Chunchao Yang — 2024-10-05

Objective: Endovascular thrombectomy (EVT) improves long-term patients outcomes and decreases mortality among ischemic stroke patients. However, not all patients can benefit from EVT recanalization. The present study aims to evaluate the predictors of unfavorable outcomes associated with emergency endovascular therapy despite complete recanalization.

Methods: We investigated 74 eligible patients receiving EVT from January 2019 to January 2022 at a comprehensive stroke center. Demographics, clinical, radiological and treatment characteristics, safety, and functional outcomes were collected. Modified Rankin scale (mRS) score ≤ 2 at 90 days was defined as a good functional outcome.

Results: A total of 111 patients were initially eligible for the study, of which 37 were excluded, resulting in 74 patients in the final study. The mean age was 69.08±12.12 years old, 67.57% patients were male, 44.59% patients with atrial fibrillation, 64.86% with hypertension, 21.62% patients with diabetes mellitus, 16.22% patients with coronary artery diseases, 6.76% with parenchymal hematoma. Median pre-EVT NIHSS (IQR) was 15.5 (12.0, 19.25). Median door-to-recanalization time (DRT) (IQR) was 208.0 (160.0,278.5) minutes and median last known norma to puncture time (LKNPT) (IQR), was 362.0 (280, 452.5) minutes. Individuals with a poorer outcome were older [73.56±9.29 vs. 65.28±13.02 years old, P=0.002], had a higher prevalence of atrial fibrillation (AF) [58.82 vs. 13%, P=0.023] and a higher National Institute of Health Stroke Scale (NIHSS) [median 16 (IQR 12.0-22.3) vs median 15 (IQR 10.0-18.0), P=0.143]. Female sex, hypertension, diabetes mellitus, coronary artery disease, and a slightly longer door-to-recanalization time were more prevalent in the unfavorable prognosis group; however, statistical analysis did not show any significant differences. Logistics binary regression model showed that older age [OR: 0.1.160 (1.011 to 1.112, P=0.031)] and AF [OR: 3.190 (1.111 to 9.164, P=0.031)] were associated with an unfavorable outcome.

Conclusion: Older age, and atrial fibrillation were factors associated with the unfavorable outcome despite complete recanalization after emergency EVT of ischemic stroke.

Effects of thrombus characteristics on clinical outcome and success of recanalization in acute ischemic stroke

AHMET YABALAK — 2024-10-05

Background: Despite current developments in mechanical thrombectomy (MT), successful recanalization cannot be achieved in all patients. One of the factors related to this is the characteristics of the thrombus. In this study, we aimed to evaluate the effects of thrombus length and permeability on procedural success and clinical outcome.

Methods: Patients with intracranial ICA, middle cerebral artery M1, or M2 occlusions, who underwent MT between November 2019 and January 2022 were included in the study. Thrombus length, density and permeability were calculated and the relationship between recanalization success and modified Rankin Scores (mRS) at the 3rd month was evaluated. Good clinical outcome was defined as an mRS score of 2 or less.

Results: Forty-six of the 79 patients included in the study had a good clinical outcome. Although thrombus length was shorter and permeability was higher in patients with good clinical outcome, statistical significance was not achieved. There was a positive correlation between thrombus density, thrombus length and the number of passes, and a negative correlation between permeability. There was no significant difference in thrombus length, density and permeability between patients with and without successful recanalisation. Thrombus length was found to be a predictor of clinical outcome at 3 months in univariate analysis, whereas only age was found to be an independent predictor in multivariate analysis.

Conclusions: In conclusion, despite certain findings not achieving statistical significance, the observed trends offer valuable insights for future research. A comprehensive understanding of thrombus nature could guide personalized stroke treatment strategies in the future.

The effect of different surgical methods and timing of surgery on the clinical efficacy in patients with hypertensive intracerebral hemorrhage in basal ganglia

Boxiang Han — 2024-10-05

Objective: To explore the effect of different surgical methods and timing on the clinical efficacy of patients with hypertensive intracerebral hemorrhage (HICH) in basal ganglia.

Methods: A total of 200 patients with HICH in basal ganglia were divided into traditional craniotomy (TC) group, small bone window craniotomy (SBWC) group and neuroendoscopic minimally invasive surgery (NMIS) group. And they were also divided into ultra-early group, early group and delayed group, depending on the timing of surgery. The operation time, intraoperative blood loss, hematoma clearance rate and incidence of complications among different groups were recorded and analyzed. The National Institutes of Health Stroke Scale (NIHSS) and Glasgow outcome scale (GOS) were used to evaluate the neurological function and prognosis.

Results: The NMIS group was superior to the TC group and SBWC group in terms of operation time, and intraoperative blood loss, hematoma clearance rate, complication 6-months NIHSS scores and the GOS scores (P<0.05). There was no significant differences in operation time, intraoperative blood loss, hematoma clearance rate and complication among the ultra-early group, the early group and the delayed group (P>0.05). While the ultra-early group was superior to the early group and the delayed group in terms of 6-month NIHSS scores and the GOS scores.

Conclusion: NMIS could reduce the operation time, intraoperative blood loss, and complications, and improve the hematoma clearance rate and prognosis of patients with HICH in basal ganglia. And the ultra-early surgical treatment improved the prognosis of patients with IHCH in basal ganglia.

Clinical features and predictors of early neurological deterioration in patients with Trousseau syndrome-related cerebral infarction

Weiwei Gao — 2024-10-05

Objective: This study aimed to explore the clinical features of Trousseau syndrome (TS)-related cerebral infarction and determine predictors of early neurological deterioration (END).

Methods: A retrospective study was conducted on patients with TS-related cerebral infarction admitted to the Zhongshan Hospital Affiliated with Xiamen University, from December 2015 to December 2023. Patients were categorized into groups with and without END. The laboratory findings and imaging data were compared, and receiver operating characteristic (ROC) curves were constructed to determine the best predictors of END.

Results: The study included 30 patients with TS-related cerebral infarction, comprising 17 males and 13 females with an average age of 70.93 ± 8.7 years. Five patients experienced END. Lung cancer was the most common primary malignancy (n=13, 43.33%), with most patients (n=22, 73.33%) having stage IV disease with extensive metastasis. The primary neurological symptom was hemiplegia (n=17, 56.67%). The mean NIHSS score at admission was 9.33 ± 5.83. Imaging revealed varying stages of cerebral infarction in 10 patients (38.46%). Within three months, 25 patients (83.33%) died, 8 of whom (32%) succumbed to tumor-related complications. The incidence of END in TS-related cerebral infarction patients was 16.67% (5/30). Patients in the END group had significantly greater D-dimer levels and lower fibrinogen (Fib) levels upon admission (P < 0.001, P = 0.042). Comparisons of ROC curves revealed that D-dimer (AUC 0.916, optimal cutoff 17.86, sensitivity 1.000, specificity 0.840) and Fib (AUC 0.788, optimal cutoff 2.54, sensitivity 1.000, specificity 0.740) significantly predicted END (P = 0.004, P = 0.045). The combined use of these markers improved the AUC to 0.952, with a sensitivity of 1.00 and specificity of 0.920, surpassing those of the individual markers (P = 0.002).

Conclusion: TS-related cerebral infarction most commonly occurs in patients with advanced-stage lung cancer with widespread metastasis and is associated with poor long-term prognosis. Elevated D-dimer and decreased fibrinogen levels are significant predictors of END in patients with TS-related cerebral infarction.

Risk factors and prognosis of acute ischemic stroke complicated with cerebral microbleeds

Yangbo Hou — 2024-10-05

Objective: To observe the risk factors and prognosis of patients with acute ischemic stroke complicated with cerebral microbleeds (CMBs) to provide a theoretical basis for better prevention and treatment of acute ischemic stroke and reduction of bleeding risk.

Methods: The clinical data of 200 patients with acute ischemic stroke who completed susceptibility weighted imaging (SWI) were retrospectively analyzed. They were divided into a CMB group and a non CMB group. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors and prognosis of acute ischemic stroke.

Results: Univariate analysis showed that systolic blood pressure, fasting plasma glucose, free triiodothyronine (FT3), infarct site in the cerebral lobe and total anterior circulation infarct (TACI) (using the Oxfordshire Community Stroke Project (OCSP) classification) were correlated with acute ischemic stroke complicated with CMBs (P < 0.05). Multivariate logistic regression analysis showed that systolic blood pressure (OR: 1.02, 95% CI: 1.009–1.032), fasting blood glucose (OR: 1.174, 95% CI: 1.082–1.274) and infarct site in the cerebral lobe (OR: 12.925, 95% CI: 7.412–22.540) were independent risk factors for acute ischemic stroke complicated with CMBs (P < 0.05). TACI (OR: 0.004, 95% CI: 0.002–0.007) may not be an independent risk factor (P < 0.05).

Conclusion: Systolic blood pressure, fasting blood glucose and infarct site in the cerebral lobe, but likely not TACI, were independent risk factors for acute ischemic stroke complicated with CMBs. The presence or absence of CMBs did not affect the prognosis of acute ischemic stroke.

Medication prescribing trends and its associated adverse drug reactions among hospitalized stroke patients from a main stroke center in Penang, Malaysia: A retrospective 5-year study

Monica Danial — 2024-10-05

Adverse drug reactions (ADRs) are one of the major threats in our healthcare system, which profusely affects health, transience, and quality of life, especially among hospitalized patients. This 5-year study was conducted to determine the incidence and analyze the pattern of ADRs among stroke patients at Hospital Seberang Jaya (HSJ), Malaysia which is the main stroke center for all tertiary healthcare institutions in Penang, Malaysia. A total of 1,993 patients were hospitalized for stroke during the study period of 5 years out of which only 30 of them were reported to experience ADRs during hospitalization. The study patients had a mean (SD) of 61 (±11.8) years, Modified Rankin Score (mRS) score of 1.8 (±1.6), NIH Stroke Scale (NIHSS) score of 3.0 (4.0) with median (IQR) duration of adverse drug reaction of 3.0 (7.0) days. The majority of the patients were Malay (66.7%); female (50.0%); experienced ischemic stroke (90.0%); with first episode of stroke (93.3%); with comorbidity dyslipidemia (60.0%); and mostly recovered post ADRs (80.0%). The major drug classes that contributed to ADRs were vaccines, anti-infective, anti-epileptic, anti-platelets, and others. Evaluation of the causality of ADRs indicated majority were possible (50.0%) ADRs based on the Naranjo scale. The evaluated incidence of ADRs among stroke patients is low in this study. This low incidence rate could be possibly due to active clinical interventions by healthcare professionals during hospitalization. ADR monitoring is highly warranted among the sub-population of stroke patients due to the existence of multiple risk factors and their state of vulnerability.

Stroke knowledge level among patients with ischemic stroke at Universiti Malaya Medical Centre

parimalaganthi Varadan — 2024-10-05

Background and Objectives: Stroke is a significant public health concern. The rising trend among stroke survivors, middle-aged, and multi-comorbid patients highlights the need for preventive intervention. In Malaysia, stroke survivors had insufficient understanding of stroke, despite being a common illness in the country.

Methods: A single-centre prospective study was conducted to determine the level of knowledge of stroke, its warning signs and symptoms, risk factors, and its association among stroke survivors who received treatment at the Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. A validated Stroke Knowledge Test (SKT) questionnaire was used to analyse stroke knowledge.

Results: The participant’s mean age was 57.79 (± 11.13) years old, with the majority being first-time stroke patients (87.2%), below 60 years of age (55.3%), had multiple comorbidities (93.4%), and male gender (68.1%). Most (71.4%) were non-adherent to their current medications. The study participants scored poorly on identifying warning signs compared to their knowledge of strokes in general and understanding of stroke risk factors. The majority have poor knowledge of smoking (1.8%) and atrial fibrillation (AF) (1.5%) as risk factors. However, there was good knowledge of the purpose of rehabilitation (98.9%).

Conclusions: Participants’ knowledge about stroke, warning signs, symptoms, and risk factors were insufficient. Stroke knowledge was significantly associated with education, medication adherence, habitation, and income.

Frequency and outcome of cerebral venous thrombosis attributed to oral contraceptive pills

Maryam Vasaghi-Gharamaleki — 2024-10-05

Background: Oral contraceptive (OCP) use is a significant risk factor for cerebral venous thrombosis (CVT). There is limited research on its association with CVT development in Islamic countries. Therefore, our study aimed to assess the risk of different OCPs in developing CVT and their prognosis.

Methods: This is an observational retrospective single-center cohort study that included CVT patients between March 2018 and March 2021. All CVT participants were registered in the organized registry system (CVT registry code: 9001013381) at the Neurology Research Center of Shiraz University of Medical Science. Univariate analysis and multivariable binary logistic regression modeling were applied to determine the associated factors leading to poor outcome.

Results: A total of 204 patients (139 women, 65 men) were enrolled in the study. Seventy-four females (53.25% of total female patients) used OCPs, with second-generation OCPs being the most commonly used type (70%). OCP consumption was associated with a lower mortality rate (P=0.004, aOR=11.732) and a better 3-month follow-up outcome (p=0.001, aOR=9.882) than their female counterparts who did not use OCPs. The duration and generation of OCPs did not affect the follow-up outcome (P=0.148, P=0.428, respectively) or mortality (P=0.555, P=0.569, respectively). In multivariable analysis, the use of OCPs was a predictor of a favorable 3-month follow-up outcome in females (aOR =4.423, 95% CI: 0.423-46.248).

Conclusion: These results suggest that OCPs may have a positive impact on the prognosis of CVT in women. However, further research is required to understand the underlying mechanisms and validate these findings.

The effectiveness and safety of bevacizumab in improving the efficacy of antiseizure medication in treating refractory epilepsy induced by stereotactic radiosurgery in meningiomas

Wenwen Hou — 2024-10-05

Background: Refractory epilepsy (RE) increases rapidly after stereotactic radiosurgery (SRS), but the reports on RE treatment are rare, with various methods and efficacy. In recent years, bevacizumab (BEV) has been widely used as it is effective in eliminating intracranial oedema and reducing radioactive damage. The aim of this study was to evaluate the application of additional BEV to RE after SRS in the real world.

Methods: Seizure freedom and seizure response were defined as 100% and > 50% reduction in seizure frequency at baseline and 6-, 9- and 12-month follow-ups. The sustained seizure-free (SSF), sustained seizure response (SSR) was used to assess the effectiveness of BEV. The number of anti-seizure medications (ASM), seizure severity (NH3), and epilepsy quality of life rating scale (QOLIE-31) scores were compared before and 12 months after treatment.

Results: Forty-one patients were included from January 2020 to December 2022. During the 1-year follow-up, 5 patients (12.2%) achieved SSF lasting 12 months, and 4.9% and 7.3% enjoyed SSF more than 6 months and 9 months, respectively. Twelve patients (29.3%) achieved SSR lasting for 12 months, and 19.5% and 24.4% of the study cohort achieved SSR more than 6 months and 9 months, respectively. Patients’ ASM, NH3, and QOLIE-31 scores significantly improved 12 months after treatment, and the adverse reactions were controllable.

Conclusion: This study is the first to explore and report the additional use of BEV in the treatment of RE after SRS in meningiomas. BEV was effective and safe in the treatment of SRS-induced RE.

The impact of visual field defects following anterior temporal lobectomy

Jayakumari Nandana — 2024-10-05

Objective: This prospective study aimed to quantify visual field defects (VFDs) along with other defects in ophthalmic functions after anterior temporal lobectomy (ATL) in patients with mesial temporal lobe epilepsy (MTLE) and their impact on quality of life using a VFQ-25 questionnaire.

Methods: Ophthalmic evaluation was done during pre-operative evaluation as well as 3 months after surgery. It included the Best Corrected Visual Acuity (BCVA), visual field evaluation, colour vision examination, fundoscopy, extraocular movements and diplopia charting. Visual field evaluation was done using a Humphrey field analyser. The foveal threshold (FT), mean deviation (MD) and pattern standard deviation (PSD) were calculated for each patient. Quality of life assessment was done using the Visual Functioning Questionnaire-25 (VFQ-25). Two-tailed independent T-tests and Chi-square tests were performed for comparison of results.

Results: Thirty-four patients were included in this study (23 men and 11 women). The mean age was 26.6 years (range 9-44 years). Post-operatively, none complained of a visual field disturbance. Thirty-one (91.17%) of 34 patients had a new quantifiable superior quadrantanopia. FT, MD and PSD of patients ranged between 29db to 40db, -1.23 to -14.28 and 1.75 to 15.34, respectively. There was no detectable abnormality in visual acuity, colour vision, fundoscopy, diplopia charting or extraocular movements. VFQ-25 scores ranged from 84 to 100. The difference between VFQ scores of patients with and without quadrantanopia was not significant.

Conclusion: Standard ATL produces asymptomatic VFDs that do not affect quality of life. A combined effort of the neurologist and ophthalmologist is recommended to counsel the patient before surgery.

Individualized surgical management of acute intracranial infection-associated hydrocephalus

Dajiang Xie — 2024-10-05

Objective: This study aims to discuss and summarize surgical treatments for acute intracranial infections with hydrocephalus as a supplement to antibiotic treatment.

Methods: A total of 29 patients diagnosed with acute intracranial infection associated with hydrocephalus were divided into three groups for comparison and analysis of surgical interventions and outcomes.

Results: In this study, 29 patients in one group underwent surgical treatment, while 28 received various forms of external cerebrospinal fluid (CSF) drainage, with a maximum of 5 drainage procedures. Additionally, 6 patients had Ommaya reservoir implantation, 6 had debridement, and 11 had a hydrocephalus shunt. Among the five patients in Group 1, all underwent shunt device extubation. The statistical analysis revealed no significant difference in surgical modes between the groups, but the outcomes did show a statistically significant difference (χ2 = 6.433, P = 0.040).

Conclusion: Individualized and multiple surgeries are needed for acute intracranial infection associated with hydrocephalus. In cases where the infection is secondary to a shunt, the primary surgical approach involves removing the shunt device. In situations where the infection is linked to hydrocephalus following different craniotomies, addressing scalp infection, cerebrospinal fluid leakage, and skull defects is essential. In instances of community-acquired intracranial infection associated with hydrocephalus, continuing drainage of cerebrospinal fluid is imperative.

Which kinesiotaping technique is effective? Comparision of two different techniques in patients with carpal tunnel syndrome

Zeynep Kirac Unal — 2024-10-05

Background & Objective: Although different kinesiotaping (KT) techniques can be applied in the treatment of carpal tunnel syndrome (CTS), to our knowledge, there is no study in the literature showing the superiority of these techniques over each other. The aim of this study is to compare the effectiveness of KT techniques applied to the dorsal surface and palmar surface of the forearm in patients with CTS.

Methods: Forty six patients (70 wrists) diagnosed with CTS were randomized into 3 groups. Fabricated night splint was applied to the first group, KT was applied to the palmar surface of the wrist to the second group, and KT was applied to the dorsal surface of the wrist to the third group. Clinical, electrophysiological and ultrasonographic evaluations before treatment and at the end of 3-week treatment were compared.

Results: In the comparison pre- and post-treatment, the changes in pain evaluated with Visual Analog Scale, and median motor nerve distal latency were significant in all groups, the change in median nerve sensory conduction velocity was significant in Groups 1 and 2, the change in median motor nerve conduction velocity was significant in only Group 2, the change in The Boston Carpal Tunnel Questionnaire (BCTQ)-Symptom Severity Status was significant in Group 1 and Group 3, the change in BCTQ-Functional Severity Scale and median nerve cross-sectional area was significant in only group 1. When the changes in treatment between the groups were compared, no statistically significant difference was found in any of the parameters.

Conclusion: While splinting and different KT methods provided various benefits in CTS patients, they were not statistically superior to each other.

The importance of medial plantar nerve conduction study in detectıon of polyneuropathy in inflammatory bowel disease

Reyhan SURMELI — 2024-10-05

Background & Objective: Peripheral neuropathy is the most frequent neurologic complication of inflammatory bowel disease (IBD). We aimed to evaluate the clinical utility of medial plantar nerve conduction study (NCS) in the detection of distal sensory polyneuropathy in IBD patients.

Methods: The study was performed with 21 Crohn’s disease (Group 1) patients, 24 Ulcerative Colitis (Group 2) patients without clinical peripheral neuropathy and 28 healthy participants (Group 3). Each patient group underwent electrophysiological conduction studies. The findings were analyzed statistically.

Results: Abnormal medial plantar nerve conduction was present on both sides in 11 (24.4 %) patients with IBD; 5 (11.1 %) patients had low sural nerve amplitude, and 5 (11.1 %) had low superficial peroneal nerve amplitude bilaterally. There were significant differences between the IBD groups (Group 1 and 2) and Group 3 in the mean sensory nerve action potential amplitude of the right medial plantar nerve (p<0.024), and in the mean sensory nerve action potential amplitude of the left medial plantar nerve (p<0.025). The polyneuropathy pattern was mostly of the sensory axonal type in patients with IBD.

Conclusions: These electrophysiologic findings indicate that peripheral neuropathy is more prevalent in IBD. In IBD patients the amplitudes of the medial plantar nerve were abnormal more than in the sural and superficial peroneal nerves.

Ultrasound-guided pulsed radiofrequency of the greater occipital nerve in chronic migraine; proximal approach versus distal approach, a single-blind, randomized controlled trial

Gevher Rabia Genç Perdecioğlu — 2024-10-05

Background & Objective: Ultrasound-guided pulsed radiofrequency treatment of the greater occipital nerve can be used at distal and proximal levels of the greater occipital nerve in patients with chronic migraine. We aimed to evaluate the treatment efficacy, procedure duration, and pain experienced during the procedure for both methods.

Methods: In the study, 60 chronic migraine patients randomly divided into two groups using a computer programme were evaluated. In the proximal group, the greater occipital nerve was accessed at the level of the 2nd cervical vertebra, while in the distal group it was accessed at the level of the protuberencia occipitalis. Patients completed the Migraine Disability Rating Scale, Visual Analogue Scale and a headache diary before treatment as well as at 1 month and 3 months afterwards. The time from the beginning of the intervention to the spread of the stimulus to the C2 dermatome during the sensory stimulation test was recorded. Patients were asked to rate their pain during the procedure using a Visual Analogue Scale.

Results: The Visual Analog Scale scores and headache frequencies were significantly decreased in both the proximal group and distal group (p<0.001). The procedure time was shorter (p<0.001) and was less painful in the distal group (p<0.001).

Conclusions: In this study, we observed that pulsed radiofrequency of both distal and proximal levels of the greater occipital nerves effectively treated migraine. A shorter procedure time and superior patient tolerability make the distal stimulation the procedure of choice.

Emergency department CT scan utilization and findings in geriatric patients presenting with non-traumatic headache

Handan Özen Olcay — 2024-10-05

Background & Objective: In geriatric patients, headache is a common reason for emergency department (ED) visits. Because secondary headaches are more common in geriatric patients than in younger patients, the former should be carefully excluded at presentation. In this study, we aimed to investigate the role of brain computed tomography (CT) in geriatric patients presenting to the ED with non-traumatic headache, the indications for imaging, the CT findings, and factors associated with detection of pathology.

Methods: Patients aged 65 years and older who presented to the ED with headache between January 1, 2023 and December 31, 2023, who underwent a brain CT scan, and who had complete data were included in the study. Patients with an intracranial mass, acute-subacute ischemic findings, intraparenchymal and subarachnoid hemorrhage, and cerebral edema on brain CT scan were considered as having significant pathology.

Results: The study included 384 patients. CT scan was normal in 61.2% of the patients and 10.4% had significant pathology. It was observed that 24.5% of the patients underwent CT scan for prolonged headache and 19.3% for severe headache. Logistic regression analysis showed that severe headache, loss of consciousness, anticoagulant use, neurological deficit, and elevated blood pressure at presentation were predictors of the detection of significant pathology on CT scan.

Conclusion: In conclusion, 10.4% of geriatric patients presenting to the emergency department with headache have significant CT findings, and the impact of these findings on the emergency management of patients cannot be ignored. Incorporating these findings into clinical decision-making guidelines could improve the effectiveness of emergency management protocols by facilitating rapid and specific diagnostic interventions for geriatric patients presenting with headache.

Validation and reliability of the Malay version of the painDETECT questionnaire (PDQ-M) among patients with neuropathic and nociceptive pain

Huai Heng Loh — 2024-10-05

Background: Neuropathic pain is chronic and debilitating. Early and accurate diagnosis is important for appropriate management. The painDETECT questionnaire (PDQ) is an effective screening tool for presence of neuropathic pain. We tested the validity and reliability of the translated Malay version of PDQ (PDQ-M).

Methods: This was a multi-center cross-sectional study conducted over 24 months. The original English version of PDQ was translated into Malay version following international guidelines. Subsequently, patients with chronic pain were administered PDQ-M and Malay version of SF36 at baseline and 2-4 weeks later. The reliability, construct and criterion validity of PDQ-M were evaluated. Clinician diagnoses were used as gold standard for comparison of diagnostic accuracy. Multiple regression analysis was performed to determine correlation between PDQ-M and SF-36 scores.

Results: A total of 97 patients were included in the study (53 with neuropathic pain, 44 with nociceptive pain). The EFA of PDQ-M produced three factors which explained 58.3% of the variance. It exhibited fair consistency with Cronbach’s alpha coefficient of 0.719 (for all 9 items) and 0.755 (for 7-item with Likert scale). PDQ-M is reliable with Cronbach’s alpha coefficient of 0.719 and 0.852 for test-retest reliability. A score of ≥17 was the best cut-off value for discriminating between neuropathic and non-neuropathic pain in PDQ-M (79.2% sensitivity, 50.0% specificity). Multiple regression analysis exhibited total PDQ-M score to have significant negative correlation with all components of SF-36 scores except role limitation due to physical health.

Conclusions: PDQ-M is a reliable and valid self-administered screening tool for neuropathic pain.

Incidence and risk factors of cognitive impairment in COVID-19 survivors within the first six months and its association with functional outcome

Darwinus LAJIM — 2024-10-05

Background & Objective: There is growing evidence of cognitive decline post-COVID-19, even in mild infection. We aim to evaluate the incidence of cognitive impairment, domains affected, its risk factors and the effect on function during the subacute period when rehabilitation is crucial.

Methods: In this study, the incidence of impaired cognition was assessed in patients at 3 and 6 months post-COVID-19 infection between August 2021 and July 2022 at University Malaya Medical Center, with Montreal Cognitive Assessment (MoCA). The most common cognitive domains affected were identified with descriptive analysis. Associated sociodemographic and clinical factors were analyzed with simple and multiple logistic regression models. The post-COVID-19 Functional Scale (PCFS) was used to assess functional status. The correlation between cognition (MoCA score) and functional status (PCFS scale) was performed using Spearman correlation test.

Results: We recruited 100 patients and found that 44% had impaired cognition at three months and 43% at six months. Patients with secondary education level (p =0.001, OR 13.541), oxygen therapy (p=0.039, OR 7.811), and obesity (p=0.029, OR 4.764) were associated with a higher risk of impaired cognition. The most affected MoCA domains were language, executive function, attention and memory. Lower MoCA score was correlated with higher PCFS grade (lower functional status) (p <0.001, ρ -0.729).

Conclusion: Post-COVID-19 cognitive impairments were common up to 6 months of illness and affect function. Clinicians are advised to perform cognitive screening especially in higher risk patients and provide necessary interventions.

Correlation of MRI brain findings with executive dysfunction and vascular risk factors in elderly patients with cognitive impairment

Bhawna Sharma — 2024-10-05

Objectives: The primary objective of the present study was to investigate the relationship between gray matter changes, white matter changes and executive function among older Indian adults with vascular risk factors.

Methods: This hospital based observational analytical study was conducted in a tertiary care health facility located in the north-western region of India for a duration of one year between October 2021 and September 2022 among patients between 60 and 90 years of age presenting to the outpatient sections of Department of Neurology with executive dysfunction. We assessed the vascular risk factors, evaluated executive function, and then the patients underwent brain MRI on a 1.5T MRI scanner.

Results: The proportion of patients with dorsolateral atrophy was significantly higher (p<0.001) among patients with executive dysfunction (83.10%). Hypertension significantly contributed to predict the atrophy of temporal lobe and parietal lobe (p<0.05). Hyperintensity of periventricular area was found significantly higher among executive dysfunction patients (85.92%). Elevated HbA1c levels and smoking significantly contributed to predict the white matter hyperintensity of basal ganglia (p<0.05). The present study also found that hypertension and alcohol use significantly predicted white matter hyperintensity in the frontal area (p<0.05).

Conclusion: Specific white matter hyperintensity loci and grey matter volume loss were closely associated with executive dysfunction in elderly. It is understood that modifying and treating vascular risk factors can prevent progression of executive dysfunction and these findings emphasize the complex nature of the relationship between vascular risk factors, cognitive impairment, and brain structure.

Exploration of a comprehensive index for predicting cognitive impairment in patients with cerebral small vessel disease and white matter lesions

Weifu Zhang — 2024-10-05

Background & Objective: The objective of this study was to explore the risk factors for cognitive impairment in patients with cerebral small vessel disease (CSVD), and to construct a predictive model for cognitive impairment in CSVD patients, providing personalized diagnostic and treatment strategies for patients.

Methods: Clinical data and blood indicators of CSVD patients admitted to the Department of Neurology at the Second Affiliated Hospital of Shandong First Medical University from February 2022 to February 2023 were collected. Additionally, these patients underwent cranial MRI examinations and completed neurological and psychological assessments, including the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Based on the MoCA and MMSE results, the patients were divided into the cognitive impairment group and the normal cognitive group. Clinical data, blood indicators, and white matter lesion (WML) grades were compared between the two groups. Univariate logistic regression analysis was performed to identify the risk factors for cognitive impairment in CSVD patients. Using MoCA assessment results as the gold standard and several clinical indicators as independent variables, a logistic regression model was constructed. Predicted values were calculated based on this model, and a receiver operating characteristic (ROC) curve for the comprehensive diagnosis of multiple variables was plotted to evaluate the model’s accuracy.

Results: A total of 134 CSVD patients were included, and cognitive impairment occurred in 98 cases, with an incidence rate of 73.13%, while 36 patients did not have cognitive impairment. Univariate logistic regression analysis of the collected variables identified eight factors: age, education level, hypertension, diabetes, cerebral hemorrhage, low-density lipoprotein cholesterol (LDL-C), hyperhomocysteine (HHCY), and WML grading. Multivariate logistic regression analysis identified age, LDL-C, and WML grading as the final predictive factors, establishing a combined diagnostic model to predict the probability of cognitive impairment in patients. The constructed ROC curve for the comprehensive diagnosis of multiple variables yielded an area under the curve of 0.870, indicating good accuracy. To facilitate clinical diagnosis, the combined diagnostic model was simplified into an L score calculation formula, with the optimal cutoff value of 5.223. When the L score is <5.223, the patient can be considered not having cognitive impairment, while an L score >5.223 indicates cognitive impairment, allowing for the prediction of the risk of cognitive impairment in patients.

Conclusion: Age, education level, hypertension, diabetes, cerebral hemorrhage, LDL-C, HHCY, and WML grading are related risk factors for cognitive impairment in CSVD patients. Age, LDL-C, and WML grading are independent risk factors for cognitive impairment in CSVD patients. The clinical predictive model for cognitive impairment in cerebral small vessel disease, constructed using the final predictive factors, showed good performance and clinical utility. It facilitates individualized risk assessment for cognitive impairment in CSVD patients and allows for targeted follow-up observation for high-risk individuals.

Predictors of caregiver burden in Alzheimer’s disease: Caregiver stress, life satisfaction and quality of life levels

Alime Selçuk Tosun — 2024-10-05

Objective: The purpose of this study was to determine the impact of socio-demographic and health characteristics, caregiving stress, life satisfaction, and quality of life on the caregiving burden in caregivers of Alzheimer’s patient.

Methods: This study is a descriptive-correlational type study. A total of 146 individuals who are caregivers of Alzheimer’s patient constitute the sampling of the study. The Zarit Burden Interview, Caregiver Strain Index, Satisfaction with Life Scale, and SF-36 Quality of Life.

Results: The care burden mean score of caregivers was 61.29±10.3. It was determined that age (β=0.648), caring duration (β=0.429), gender(β=0.672), marital status(β=0.936), educational status(β=0.863), the affinity of the caregiver with the patient(β=0.734), working status(β=0.524), perceived income adequacy(β=0.926), perceived health condition(β=0.682), presence of chronic disease(β=0.529), caregiving stress(β=0.633), life satisfaction score(β=-0.775), physical subscale score (β=-0.824) and mental subscale score(β=-0.489) quality of life had an influence on the caregiving burden (p<0.001). It was determined that the effective determining factors account for 76.4% of the variation in the caregiving burden.

Conclusions: The caregivers of Alzheimer’s disease patients have a high caring burden. In addition to the socio-demographic and health characteristics of caregivers, caregiving stress, life satisfaction, and quality of life are important determinants of the caring burden.

Associations between the Framingham Risk Score and cognitive functions in people with multiple sclerosis

Alevtina ERSOY — 2024-10-05

Background & Objective: Cognitive impairment is common in people with multiple sclerosis (MS). The Framingham Risk Score (FRS) is an algorithm used to estimate the 10-year risk of developing cardiovascular disease (CVDr). This study aimed to evaluate the possible associations between FRS and cognitive impairment in people with MS.

Methods: Demographic characteristics, laboratory parameters, clinical findings, vascular risk factors, and Brief International Cognitive Assessment for MS (BICAMS) test results, FRS and CVDr scores were recorded for 110 MS patients.

Results: FRS and CVDr scores exhibited a significant negative correlation with the number of correct responses in the Symbol Digit Modalities Test (p < 0.001 for all) and California Verbal Learning Test–Second UK Edition (CVLT-II) test (p < 0.001 for all), and significant positive correlation with the number of incorrect responses in the CVLT-II (p < 0.001 for all). The total score of the Brief Visuospatial Memory Test Revised had a negative correlation with FRS and CVDr (p < 0.001 for both). BICAMS scores showed no significant correlation with smoking status, homocysteine, and uric acid levels.

Conclusion: We suppose that vascular risk factors and FRS and CVDr scores may be associated with the deterioration of working memory, information processing speed, verbal learning, and memory in people with MS. Based on the potential impact of vascular risk factors on cognitive functions, our findings suggest that lifestyle changes, appropriate treatment, and using a multidisciplinary approach toward vascular risk factors during MS management may exhibit a positive effect on cognition in people with MS.

Exploring the experience of multiple sclerosis patients in Turkey: Insights from a national survey

Melih Tütüncü — 2024-10-05

Objective: To evaluate sociodemographic profile, clinical characteristics, disability and treatment status of multiple sclerosis (MS) patients in Turkey with respect to patient perspectives and expectations.

Methods: A total of 2,176 MS patients participated in this cross-sectional questionnaire survey including items on sociodemographic, disease and treatment characteristics, daily life and perspectives and expectations.

Results: Mean (SD) patient age was 36.4(9.4) years and 76.3% of patients were females. The numbness/weakness in the extremities (57.3%) was the most common presenting symptom. Overall, 56.8% reported treatment switch (due to attacks in 47.3%), while 22.2% reported physical disability and 39.7% reported work-related problems. Males had higher rate of MS-related physical disability (33.0% vs. 19.0%, p<0.001) than females. Use of an assistive device was a more common in patients with longer disease duration (≥15 years; 39.0%) and in those under IV treatment (64.0%). Nearly half of patients reported significant concerns related to uncertainty of the future and impaired quality of life as well as lack of hope for future improvement. The majority of patients reported that they would prefer less frequent SC injection dosing and 43.3% reported preference for monthly high- efficacy SC injection.

Conclusion: This nationwide questionnaire-based study in Turkish MS patients revealed the altered disability status with respect to sociodemographic profile, and altered treatment expectations specific to the route of administration, in addition to significant concerns regarding the uncertainty of the future, impaired quality of life and lack of hope for future improvement in nearly half of patients.

Investigation of the effects of IL-13 and IL-22 cytokine levels on disease activity, prognosis, and treatment response in multiple sclerosis patients treated with fingolimod and glatiramer acetate

Fidel Demir — 2024-10-05

Background: Multiple Sclerosis (MS) is an inflammatory, demyelinating and neurodegenerative disease. In this study, we investigated serum protein levels of Interleukin-13 (IL-13) and Interleukin-22 (IL-22) cytokines. These cytokines play an important role in the generation and regulation of the inflammatory response, which is the pathogenesis of MS, and are potential biomarkers for monitoring therapeutic response. cytokines may play a role in the development of MS lesions.

Methods: The study included 66 MS patients and 22 healthy individuals. IL-13 and IL-22 cytokine protein levels were measured by ELISA from peripheral blood serum samples collected from the participants. Patient demographics and treatment history data were also collected.

Results: IL-13 and IL-22 parameters were lower in MS patients compared to the control group. There was a significant difference between the patient and control groups in terms of IL-13 (p<0.001). Although the mean IL-22 level of the control group was higher than the patient group, the difference did not reach a significant level (p: 0.257).

Conclusion: The results of the study suggest that IL-13 and IL-22 cytokines play an important role in the pathogenesis of MS and are affected by fingolimod and glatiramer acetate treatment.

The evaluation of neurologists’ awareness on hepatitis B virus reactivation before launching immunosuppressive treatment

Arzu Tarakci — 2024-10-05

Background: Individuals encountering hepatitis B virus (HBV) are at risk of hepatitis B virus reactivation (HBVr) when exposed to immunosuppressive (IS) therapy. Here, we aimed to evaluate neurologists’ knowledge on HBVr in patients receiving IS treatment and draw attention to importance of the issue.

Methods: Eighty-six physicians from neurology departments throughout Turkey between 1st March- 30th April 2020 were enrolled.

Results: Of 86 physicians (average age 37.2±7.6 years), 34 (39.5%) were affiliated with university hospitals, 23 (26.7%) in training and research hospitals, and 29 (33.6%) in secondary healthcare centers. While 28 (32.5%) stated following a guideline, 58 (67.4%) declared following no guidelines. Physicians receiving postgraduate training on HBVr administered prophylaxis before IS treatment at a higher rate (p=0.04), and 69 (80.2%) considered all patients receiving any IS treatment should be screened for HBVr. To all participants, patients selected for screening should be tested for HBsAg; 83 (96.6%) and 29 (33.3%) stated patients should be tested for anti-HBs and anti-HBc IgG, respectively.

Conclusion: Given our study findings, rate of screening performed by neurologists to give IS treatment for HBVr and their awareness level on the situation were not found to be sufficient. In addition, two more important factors required to be raised awareness were detected in our study: First, the rate of using anti-HBc in screening is low, and the awareness should be increased in this direction. Secondly, the risk of HBVr should be categorized in terms of IS treatment and host in our country where HBV infection is seen at a high rate, and determining the prophylactic approach is insufficient.

Efficacy of acetylcholinesterase inhibitors for cognitive impairment in multiple sclerosis: A systematic review and meta-analysis

Melmar C Folloso — 2024-10-05

Background & Objective: Multiple Sclerosis (MS) is a chronic demyelinating condition characterized by a myriad of neurologic deficits. The prevalence rate of Cognitive impairment (CI) ranges from 40 to 60 percent among community-dwelling individuals with MS. Cholinergic dysfunction is one of the different mechanisms proposed to cause CI, supporting the use of acetylcholinesterase inhibitors (AChEIs) in certain conditions. The study aims to determine the safety and efficacy of acetylcholinesterase inhibitors in multiple sclerosis patients with cognitive impairment through a review of randomized clinical trials.

Methods: Using the updated PRISMA guidelines, we searched MEDLINE by PubMed, Cochrane Central Register for Controlled Trials (CENTRAL), ClinicalTrials. gov website, Google Scholar, and HERDIN Database for relevant studies until November 15, 2022.

Results: A total of 73 records were identified and five studies were included in the analysis. Pooled evidence shows that AchEIs (donepezil 10 mg/day or rivastigmine 10 mg/day for 12 to 14 weeks) did not significantly improve Paced Auditory Serial Addition Test (PASAT) score for information processing and sustained attention and the Selective Reminding Test (SRT) score for verbal memory. Another study using the Weschler Memory Scale (WMS) also did not show significant improvement in their scores. However, a recent trial that used the Everyday memory questionnaire (EMQ), prospective and retrospective memory questionnaire (PRMQ), and the Digit span test (DST) showed significant difference between pre- and post-intervention mean scores in the donepezil group (p<0.001). The physical and mental health scores of the Multiple Sclerosis Quality of Life questionnaires (MSQOL) significantly improved in MS patients receiving donepezil. Both donepezil and rivastigmine were associated with non-serious adverse events.

Conclusion: The use of AchEIs among MS patients does not significantly improve objective measures of cognition but has positive impact on subjective scales of cognition (EMQ and PRMQ). AchEIs were shown to improve patients’ quality of life. AchEIs are safe and well tolerated among MS patients.

A comparison of infectious and autoimmune meningoencephalitis: Clinical presentation, biochemical markers and MRI findings

Vinoshini Nair Sukumaran — 2024-10-05

Objective: This study investigates distinguishing patterns in lesion distribution, relevant clinical presentation and biochemical markers in MRI to differentiate infective encephalitis (IE) and autoimmune encephalitis (AE).

Methods: Retrospective study of adult patients with a confirmed diagnosis of IE and AE admitted to the Neurology unit from January 2012 to December 2020 with MRI Brain. Selected cases with confirmed IE (according to the 2013 Infective Encephalitis Consortium diagnostic criteria) or antibody-positive AE (detection of Neuronal auto-antibody from blood or CSF), coupled by clinical presentation. MRI brain lesion distribution, lobar involvement, enhancement, haemorrhage, vasculopathy and atrophy were analysed.

Results: Forty-seven patients (21 IE and 26 AE, respectively) were selected. IE group are older (48.0 ± 16.81) compared to AE (28.4 ± 14.10). Fever and vomiting were significant in IE (p<0.001), whereas psychosis, seizure, movement disorder, and tumour (ovarian teratoma) were significant in the AE cohort. Cerebrospinal fluid (CSF) analysis showed elevated leucocytes with polymorphism and high protein levels in IE (2.081 g/L ± 2.93 vs AE (0.352g/L ± 0.18). MR imaging detected abnormal findings in 61.9% of cases with infectious encephalitis (IE), while 76.9% of cases with autoimmune encephalitis (AE) exhibited normal MRI results. Asymmetrical lesions and inferior frontal lobe distribution (57.1%) were significantly prevalent in IE (p<0.05). Enhancement patterns and haemorrhage were rarely observed in AE patients.

Conclusion: IE presented at an older age, with the majority having MRI findings such as asymmetrical lesions, leptomeningeal enhancement, and involvement of medial temporal, hippocampus and inferior frontal cortex. IE clinically presents with fever, vomiting, and elevated CSF leucocytes and protein levels. AE presents at a younger age with seizure, psychosis, movement disorder, tumour (ovarian teratoma). Fewer AE have MRI findings, and if present, tend to be symmetrical in distribution. Lobar involvement in the inferior frontal was the MRI feature that significantly favoured the diagnosis of IE compared to AE. IE and AE have distinct clinical, biochemical, and MRI abnormalities that can be discriminated between the 2 entities.

Characteristics and prognosis of LGI1 antibody encephalitis

Ruixue Zhang — 2024-10-05

Objectives: To investigate clinical manifestations and outcomes of patients with LGI1 autoimmune encephalitis.

Methods: A total of 12 patients who were diagnosed with LGI1 autoimmune encephalitis were retrospectively analyzed between 2018 and 2022 at the Department of Neurology of the Affiliated Hospital of Xuzhou Medical University. Clinical characteristics, laboratory examinations, electroencephalograms, brain magnetic resonance images and prognosis were assessed. The clinical data were collected by searching through electronic medical records.

Results: Among 12 patients, 8 were male and 4 were female. The average age at disease onset was 61.8 years (24–83). The most common clinical symptoms were seizures (n=10), cognitive dysfunction (n=8), and mental behavioral disorders (n=8). A total of 9 cases had hyponatremia. Brain MRI and electroencephalographic were abnormal in 7 patients each. All patients were treated with first line immunotherapy. Most patients responded well and 3 patients relapsed on follow-up.

Conclusion: Characteristic features of LGI1 antibody encephalitis include subacute onset cognitive impairment, seizures, faciobrachial dystonic seizures (FBDS), and mental and behavioral abnormalities. Especially, FBDS and hyponatremia suggest LGI1-antibody encephalitis. Therefore, early identification and immunotherapy may prevent cognitive impairment and improve prognosis.

Encephalopathy with a reversible lesion in the splenium of the corpus callosum in adults

Gökhan Özdemir — 2024-10-05

Background & Objectives: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical and radiological syndrome with a lesion in splenium of the corpus callosum. This lesion is typically detected in the corpus callosum with magnetic resonance imaging (MRI) and usually disappears within a few weeks. The clinical and radiological features of MERS were evaluated for this study.

Methods: Twelve patients were included in the study. They were treated between 2018 and 2021 years. The patients’ demographic and clinical features, laboratory data, treatment and prognoses were documented.

Results: There were 7 male and 5 female patients in the series. The mean age was 37.92 ± 15.32 (19–62) years. There was history of upper respiratory tract infection in 7 patients, visual loss episodes in 3 patients, epileptic seizure in 2 patients, arthroplasty in 1 patient, cardiac arrhythmia in 1 patient, and COVID-19 (SARS-CoV-2) infection in 2 patients. Focal lesion was detected in the splenium of the corpus callosum with diffusion-weighted MRI which resolved with repeat diffusion MRI and clinical symptoms improved.

Conclusions: Axial diffusion-weighted MRI images show typical splenium ovoid lesion of corpus callosum in patients with MERS. Patients with MERS have a good prognosis. It is important to consider MERS as one of the differential diagnoses in adult patients with fever and cognitive impairment.

Excessive daytime sleepiness in older adults: A bibliometric and visualization analysis

Ziqian Feng — 2024-10-05

Background: To analyse the bibliometric results of a study on the research trends in excessive daytime sleepiness (EDS) among older adults to provide clinicians and researchers with a better understanding of the current status and to identify potential new research directions.

Methods: We searched the Web of Science Core Collection for articles on immunotherapy for EDS in older adults. We used three software packages (VOSviewer, CiteSpace, and Tableau) to analyze the articles in terms of journals, keywords, citations, co-citations, and research areas and identify research hotspots as well as promising future trends in this field.

Results: Our findings showed an annual increase in the number of articles on EDS that were published. Among them, authors from the USA had the highest number of publications globally in this field, while in terms of institutions, the highest number of articles came from Stanford University (n = 26, 2.73%). The articles covered diverse research areas and included clinical neurology, neuroscience, and the respiratory system. As expected, journal-wise, the majority of articles were published in “Sleep” and “Sleep Medicine”. Keywords indicating research areas in recent years were ‘important difference,’ ‘obstructive sleep apnea,’ and ‘shift work.’ These were also reflected in the results of the co-citation analysis.

Conclusions: Overall, EDS is an area of increasing interest and offers excellent research opportunities for the future.

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): A rare cause of ischemic stroke in young

Gautam B Kale — 2024-10-05

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is the second known genetic form of cerebral small vessel disease after cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). It is a very rare single gene disorder affecting cerebral small blood vessels. Diagnosis of CARASIL should strongly be suspected in a young non-hypertensive patient with lacunar stroke in the basal ganglia and brainstem and alopecia limited to scalp.

Iatrogenic botulism after botulinum toxin type A: Five cases

özlem totuk — 2024-10-05

Botulinum toxin A (BTX-A) is frequently used for spasticity, focal dystonia, hemifacial spasm, hyperhidrosis, strabismus, chronic migraine and cosmetic purposes. Therapeutic use is generally safe. It is important to consider the risk of iatrogenic botulism, especially in high dose approved or with unapproved formulations and indications. Five patients with iatrogenic botulism were described. All patient developed systemic symtomps of Botulism following botulinum toxin injection for various reason. Clinical presentatiton, treatment and outcome were explained in this report.

Conclusion: Based on the case series reported, we would like to emphasize the important of adhering to recommended dose of approved formulations approved or unapproved indication of BTX-A.

Exploring diagnostic and therapeutic implications of subacute lower motor neuronopathy in the setting of acute lymphoblastic leukemia: A case report

Xueming Li — 2024-10-05

Subacute lower motor neuronopathies (SLMN) have not been previously documented in association with acute lymphoblastic leukemia (ALL). We present a case with SLMN during the remission phase of ALL. Our patient, a young teenage male with ALL who was in remission following COTP chemotherapy, manifested weakness in the lower extremities. Following a comprehensive investigations, the patient was diagnosed with SLMN. Muscle biopsy corroborated the diagnosis, with neurogenic muscular atrophy, muscle fiber grouping and target fibers. The patient’s symptom improved on two occasions following corticosteroid therapy but the symptom relapsed upon discontinuation of the medication. This case support the association of SLMN in ALL.

Intestinal pseudo-obstruction in a myasthenia gravis patient after thymectomy: A case report and literature review

Yun Qian — 2024-10-05

Intestinal pseudo-obstruction in patients with myasthenia gravis is a rare and poorly understood phenomenon. We report a case coexisting with intestinal pseudo-obstruction and myasthenia gravis. The patient was diagnosed to have myasthenia gravis and underwent thymectomy seven years ago. He was tested positive for anti-acetylcholine receptor antibody and was free of thymoma recurrence during the current illness. Despite being given gastrointestinal decompression and parenteral nutrition, the patient’s gastrointestinal symptoms did not improve. Symptoms were rectified effectively by immunomodulatory therapy. This case adds intestinal pseudo-obstruction to the phenotypic profile of post-thymectomy myasthenia gravis. High titer of AChR antibody might play a role in the pathogenesis of myasthenia gravis with intestinal pseudo-obstruction.

Sural sparing reversible sensorimotor abnormalities in hypokalemia: A close mimic of GBS

Pratik Patel — 2024-10-05

Nerve conduction studies (NCS) in hypokalemic paralysis usually show decreased compound muscle action potential (CMAP) which improves with correction of hypokalemia and normalizes in between the attacks. Inactivity of Na+ K+ ATPase pump due to hypokalemia results in decreased excitability of muscle fibers resulting in reduced CMAP on NCS. Sensory symptoms, as well as abnormalities in sensory NCS is a rare phenomenon. Here we describe a 40-year-old male who presented with acute onset rapidly progressive ascending quadriparesis with type 2 respiratory failure due to hypokalemia following hepatorenal dysfunction. NCS done before hypokalemia correction, suggested sural sparing with generalized reduced CMAPs, nonrecordable median and ulnar nerves sensory nerve action potential (SNAP) and abnormal F waves. After hypokalemia correction there was improvement in CMAPs as well as SNAPs. Thus, hypokalemia can present as an axonal sensorimotor involvement with sural sparing on NCS study similar to Guillain-Barré syndrome subtype.

Effective management of hip adductor spasticity: A case report on diagnostic obturator nerve block and botulinum toxin injection

Richard Soon Kiat Teo — 2024-10-05

It is important to distinguish spasticity from contracture in patients presenting with upper motor neuron (UMN) syndrome and restricted range of movement (ROM) because treatment strategies differ. We demonstrate how we perform ultrasound-guided obturator nerve (ON) block to distinguish spasticity from contracture in a patient with bilateral hip adductor spasticity secondary to a non-traumatic spinal cord injury. We report here a 26-year-old gentleman with a history of Mycobacterium tuberculosis thoracic spondylodiscitis with spinal cord compression. His neurological status was T6 ASIA impairment scale C and his impairments were spastic paraparesis, neurogenic bowel and neurogenic bladder. He had difficulty with wheelchair transfer and positioning, perineal care as well as intermittent self- catheterization due to severe spasticity of bilateral hip adductors with significantly restricted ROM. Bilateral ON block resulted in clinically significant improvement in spasticity and ROM of the right lower limb but not the left. The effects were similar following intramuscular BTX-A injection of bilateral hip adductors. Ultrasound-guided diagnostic ON block via the distal approach is inexpensive, safe and can be readily performed in clinic setting without the need for sedation or prolonged monitoring. Improvement in MAS score of at least 1 point and ROM of at least 15° following ON block should be used to distinguish hip adductor spasticity from contracture in patients with UMN syndrome and reduced ROM. Diagnostic nerve block allows for greater physician certainty when discussing various treatment options including expedited referral for surgical consult. The findings of this report offer insights into the decision-making process in managing complex presentations of UMN syndrome.