BMC Neurology[JOURNAL]
Sun
200 papers
Switching from complement inhibitors in AQP4-IgG-positive NMOSD: clinical characteristics, an operational "cluster phase" and potential strategies to prevent therapeutic gaps.
Sakurai K, Kaburagi K, Isahaya K … +2 more , Akiyama H, Yamano Y
BMC Neurol · 2026 Jun · PMID 42374283 · Full text
BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) can cause severe neurological disability after a single relapse. Although relapse rates have markedly decreased with the emergence of targeted biologics, treatme...
BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) can cause severe neurological disability after a single relapse. Although relapse rates have markedly decreased with the emergence of targeted biologics, treatment switches are increasingly encountered due to long-term treatment considerations and adverse events. However, safe switching strategies, especially within 12 months after a relapse, which we defined operationally as the "cluster phase", have not been established. We investigated relapse risk and potential preventive strategies when switching from complement inhibitors in AQP4-IgG-positive NMOSD. METHODS: We retrospectively reviewed patients with AQP4-IgG-positive NMOSD treated at St. Marianna University School of Medicine who underwent at least one biologic switch. Clinical records were assessed for patient characteristics, treatment history, timing of switching, and relapse occurrence. Particular attention was given to switching from complement inhibitors during the cluster phase. RESULTS: Among 14 patients who switched biologics, 5 switched from complement inhibitors, 4 switched between complement inhibitors, 2 between B-cell-depleting therapies, and 3 from IL-6 receptor inhibitors. Six of the 14 switches occurred during the cluster phase, including 3 from complement inhibitors (all to B-cell-depleting agents). One of the two patients switched without bridging therapy during the cluster phase experienced optic neuritis relapse, while no relapses occurred in the other 13 switching cases. This observation suggests a possible vulnerability during the cluster phase, although definitive conclusions cannot be drawn due to the small sample size. CONCLUSIONS: Switching from complement inhibitors during the cluster phase may be associated with an increased susceptibility to relapse. Bridging strategies, such as plasma exchange or temporary biologic overlap, may help reduce the likelihood of therapeutic gaps, but these findings remain hypothesis-generating. Clinicians should proactively discuss future switching scenarios and develop long-term treatment plans with patients.
Cervical compressive myelopathy in Africa: a systematic review of clinical presentation, diagnostic pathways, surgical management, and outcomes.
Uzoechina G, Muili AO, Bajracharya P … +5 more , Ajayi W, Joshi V, Ibrahim T, AbdulGafar Adesola K, Abdulsalam A
BMC Neurol · 2026 Jun · PMID 42374277 · Full text
BACKGROUND: Degenerative cervical myelopathy (DCM) is the leading cause of non-traumatic cervical spinal cord dysfunction globally; however, broader cervical compressive myelopathies remain poorly characterised across Af...
BACKGROUND: Degenerative cervical myelopathy (DCM) is the leading cause of non-traumatic cervical spinal cord dysfunction globally; however, broader cervical compressive myelopathies remain poorly characterised across African settings. This systematic review evaluated the clinical presentation, diagnostic pathways, surgical management, and outcomes of cervical myelopathy across African settings. METHODS: This review was conducted according to PRISMA 2020 guidelines. PubMed, African Journals Online (AJOL), Google Scholar, and African neurosurgical registries were searched from inception to 25 December 2025. Both degenerative and non-degenerative compressive cervical myelopathies were eligible where cervical cord compression was clearly described. Data were synthesised narratively because of substantial methodological and clinical heterogeneity. Risk of bias was assessed using Joanna Briggs Institute (JBI) appraisal tools. RESULTS: Fifteen studies involving 315 patients from four African sub-regions met inclusion criteria. Degenerative cervical spondylotic myelopathy constituted the predominant aetiology across major surgical cohorts, although several studies included mixed myelopathy populations or rarer compressive causes such as fluorosis-associated OPLL and CPPD-related ligamentum flavum calcification. Patients consistently presented late, with prolonged symptom duration (12-48 months) and advanced neurological impairment, commonly Nurick grade ≥ 3. Motor deficits and gait disturbance were the dominant presenting features, while sphincter dysfunction reflected advanced disease. Diagnostic pathways evolved from plain radiography and myelography to increasing MRI utilisation; however, MRI scarcity remained a major barrier contributing to delayed diagnosis. Surgical decompression, via anterior cervical discectomy and fusion or posterior laminectomy, produced neurological improvement in 50-97.6% of patients. Earlier presentation and lower preoperative severity were the strongest predictors of favourable recovery. No included study demonstrated low overall risk of bias. CONCLUSION: Cervical myelopathy in Africa is characterised by delayed presentation and limited diagnostic resources, yet surgical decompression appears feasible and is associated with neurological improvement in reported cohorts. Expansion of MRI access, earlier referral systems, and prospective multicentre registries are required to improve outcomes and strengthen the evidence base.
Impact of migraine on work productivity of healthcare providers at Kasr Al-Ainy Hospital.
Osama W, Magdy R, Al-Azayem SA … +12 more , Elsebaie EH, Amer AA, Elshenawey AMA, Abdelghany FHA, Elsayed RM, Farouk D, Moawad SM, Samir S, Ibrahim ARN, Orayj KM, Abdelaty LN, Mounir N
BMC Neurol · 2026 Jun · PMID 42374274 · Full text
BACKGROUND & OBJECTIVES: Migraine is more prevalent among healthcare providers (HCPs), which adversely affects the quality of life and work productivity. This study aimed to screen for migraine in HCPs working at Kasr Al...
BACKGROUND & OBJECTIVES: Migraine is more prevalent among healthcare providers (HCPs), which adversely affects the quality of life and work productivity. This study aimed to screen for migraine in HCPs working at Kasr Al-Ainy Hospital and its drawbacks on work productivity. METHODS: This door-to-door survey was held at the workplace, targeting HCPs at Kasr Al-Ainy Hospital. Migraine screening was conducted based on the migraine diagnostic criteria of the International Classification of Headache Disorders- 3rd edition. Healthcare providers with migraines were requested to answer the Migraine Disability Assessment Test (MIDAS) and the Work Productivity and Activity Impairment Questionnaire-General Health Version (WPAI-GH). Absenteeism, presenteeism, and economic loss due to migraine were calculated. RESULTS: One thousand one hundred seventy-nine HCPs working at Kasr Al-Ainy Hospital agreed to participate in our survey. Only 387 (32.8%) participants met the diagnostic criteria of migraine, 31.8% of them had MIDAS grade-IV. The mean score of the WPAI-GH was 60.47 ± 40. The mean percent of absenteeism and presenteeism was 12.29% and 46%, respectively. The mean economic loss caused by absenteeism and presenteeism was $29.4 and $38.2, respectively. Participants with MIDAS grade-IV had significantly higher absenteeism, presenteeism, and economic loss than those in lower grades. Although 159 HCPs with migraine had indications for prophylactic treatment, only 73.6% received it. CONCLUSION: About one-third of HCPs at Kasr Al-Ainy Hospital suffered from migraines, which negatively affected their work productivity, with higher presenteeism than absenteeism. Strenuous efforts should be directed toward reducing the cost burden associated with migraine.
Association of serum uric acid levels with cognitive function in the hypertensive population: a cross-sectional study.
Peng Q, Yu C, Zhou W … +8 more , Zhao P, Song X, Wang X, Yan C, Wang T, Zhu L, Cheng X, Bao H
BMC Neurol · 2026 Jun · PMID 42374273 · Full text
BACKGROUND: The association between serum uric acid (SUA) and cognitive function is controversial in previous studies. Hypertension group are prone to cognitive decline. We aimed to investigate the correlation between se...
BACKGROUND: The association between serum uric acid (SUA) and cognitive function is controversial in previous studies. Hypertension group are prone to cognitive decline. We aimed to investigate the correlation between serum uric acid levels and cognitive function among Chinese hypertensive patients using the Chinese adapted version of Mini-Mental State Examination (CAMSE). METHODS: We included 9,471 subjects from the China Hypertension Registry study. Serum uric acid was measured using biochemical analysis instruments. The CAMSE assessment was performed to evaluate the cognitive function. Participants with different educational backgrounds used different CAMSE score cutoffs to define cognitive impairment (CI): < 24 for participants with junior high school education or above (≥ 7 years of schooling), < 20 for those with primary school education (1-6 years), and < 17 for illiterate participants. RESULTS: We enrolled 9,471 hypertensive participants (mean age 63.6 ± 9.8 years; 47.9% males, n = 4540), with mean CAMSE score22.1 ± 6.4 and SUA 428.6 ± 121.1 µmol/L. Baseline characteristics differed across SUA quartiles (all P < 0.05). Multivariable and RCS analyses showed SUA was associated with CAMSE score and CI. Fully adjusted, each one-unit lnSUA increase correlated with 0.47 higher CAMSE score (95% CI: 0.02, 0.92) and 28% lower CI (OR: 0.72; 95% CI: 0.58, 0.90). Q1 vs. Q2: 0.35 lower CAMSE score (95% CI: -0.65, -0.05) and 24% higher CI (OR: 1.24; 95% CI: 1.08, 1.43); Q3/Q4 vs. Q2 had no differences. A SUA threshold of 445.9 µmol/L was identified: below it, each lgSUA increase reduced CI by 57% (OR: 0.43; 95% CI: 0.27, 0.69). Subgroup analyses showed no interactions (all P> corrected α). CONCLUSION: There is a threshold effect of SUA level on CAMSE score and cognitive impairment in Chinese hypertensive patients. In participants with SUA < 445.9 µmol /L, decreased serum uric acid level was independently associated with cognitive decline.
Personalizing post-stroke symptom management: integrating network analysis and in silico intervention to identify subgroup-specific targets.
Zhang Y, Wang A, Fang Q … +1 more , Ma J
BMC Neurol · 2026 Jun · PMID 42374260 · Full text
BACKGROUND: Stroke is a leading cause of death and disability worldwide. Survivors often experience multiple co-occurring symptoms that interact in complex ways. These interactions create significant symptom burden and r...
BACKGROUND: Stroke is a leading cause of death and disability worldwide. Survivors often experience multiple co-occurring symptoms that interact in complex ways. These interactions create significant symptom burden and reduce quality of life. However, substantial heterogeneity exists in how patients experience post-stroke symptoms. Traditional approaches often treat patients as a homogeneous profile. They also focus on individual symptoms in isolation. This limits the development of tailored symptom management strategies. OBJECTIVE: This study aimed to identify distinct symptom burden based on patients' reported symptom experiences, compare their symptom network structures, and simulate potential intervention targets using computational modeling. METHODS: A total of 451 stroke survivors were recruited from three hospitals in Zhejiang Province, China. Symptoms were assessed using the Stroke Symptom Experience Scale. Exploratory factor analysis was used to identify symptom domains. Latent profile analysis was applied to categorize patients based on these domains. Network analysis with EBICglasso regularization was employed to estimate symptom networks for the full sample and each identified profile. The stability of centrality indices was assessed via the case-dropping bootstrap, and network structures were compared using a Network Comparison Test. Finally, the NodeIdentifyR algorithm was used to simulate the potential impact of aggravating and alleviating interventions on each symptom. The goal was to generate hypotheses about potential high-risk and high-benefit targets for future study. RESULTS: Four symptom domains were identified: Motor Dysfunction, Emotional Disorders, Cognitive and Language Disorders, and Pain and Foot Morphological Abnormalities. Latent profile analysis revealed two distinct patient profiles based on symptom experience: a low symptom burden profile (Profile 1, 65.4%) and a high symptom burden profile (Profile 2, 34.6%). In the overall network, limited limb mobility (S1), impaired memory (S9), and impaired attention (S10) showed the highest centrality. The two profiles exhibited significantly different network structures (M = 0.285, p = 0.026). Core symptoms shifted from motor and self-care deficits (S1, S19) in Profile 1 to cognitive symptoms (S9, S10) in Profile 2. In simulated interventions, targeting central symptoms such as S1 was associated with the greatest predicted alleviating impact. This intervention corresponded to a reduction in overall burden by 11.8% in the model. However, the simulations also suggested a dissociation between centrality and risk. In Profile 1, worsening a non-central symptom (foot varus, S6) was predicted to be associated with an elevation in total burden by 26.2%. This effect size was larger than that of most central symptoms. CONCLUSION: In this cohort of 451 stroke survivors, symptom experience was not homogeneous. Patients could be grouped into low and high symptom burden profiles with different network structures. Simulation analyses showed that targeting high-centrality symptoms was associated with the largest predicted burden reductions, while worsening a non-central symptom (foot varus, S6) in the low-burden subgroup was predicted to increase burden by 26.2%. A sensitivity analysis confirmed that motor, cognitive, and emotional symptom domains play important roles, though the precise ranking of individual symptoms should be interpreted with caution. We introduce a benefit-risk framework as a hypothesis-generating tool for symptom management. Future longitudinal studies are needed to validate these predictions.
Differences in gut microbiota composition between ischemic stroke patients and healthy individuals.
Movahedi M, Ahmadi S, Rahnemayan S … +1 more , Mehrvar K
BMC Neurol · 2026 Jun · PMID 42374255 · Full text
OBJECTIVES: Ischemic stroke is a leading cause of mortality and disability worldwide. Emerging evidence suggests that the gut microbiota, acting through the gut-brain axis, may play a critical role in stroke pathophysiol...
OBJECTIVES: Ischemic stroke is a leading cause of mortality and disability worldwide. Emerging evidence suggests that the gut microbiota, acting through the gut-brain axis, may play a critical role in stroke pathophysiology. Dysbiosis, an imbalance of gut microbiota, has been associated with neuroinflammation and poor stroke outcomes. This study aimed to compare gut microbiota composition in ischemic stroke patients versus healthy controls to explore potential microbial changes linked to stroke. METHODS: A case-control study was conducted on 30 ischemic stroke patients and 30 healthy age- and gender-matched controls. Fecal samples were analyzed using real-time PCR to assess the relative abundance of four key gut bacterial phyla (Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria). Statistical analysis was performed with SPSS, and results were considered significant at p < 0.05. RESULTS: Ischemic stroke patients exhibited significant alterations in gut microbiota composition compared to controls. Firmicutes levels were significantly decreased (p = 0.04), while Proteobacteria levels were significantly elevated (p = 0.003). Although reductions in Bacteroidetes and Actinobacteria were observed, these differences were not statistically significant. The Firmicutes-to-Bacteroidetes (F/B) ratio was increased in ischemic stroke patients, indicating dysbiosis associated with stroke. CONCLUSIONS: The study identified gut microbiota dysbiosis in ischemic stroke patients, suggesting its potential role in stroke pathophysiology. Reduced Firmicutes and increased Proteobacteria may contribute to inflammation and oxidative stress, potentially worsening stroke outcomes. These findings highlight the potential for gut microbiota modulation as a therapeutic strategy to improve stroke management and recovery.
Mismatch-time ratio combined with ASPECTS: a novel indicator of favorable prognosis in multimodal ct prediction of anterior circulation large vessel occlusion.
Huang Y, Zhou C, Liu R … +11 more , Li W, Yuan Q, Ma H, Wang Y, Zhang R, Zhong C, Qin R, Gao F, Cheng Y, Zhu S, Geng D
BMC Neurol · 2026 Jun · PMID 42374239 · Full text
BACKGROUND: Patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) require computed tomography(CT) at stroke centers to determine eligibility for endovascular therapy (EVT).However, the performance of...
BACKGROUND: Patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) require computed tomography(CT) at stroke centers to determine eligibility for endovascular therapy (EVT).However, the performance of prognostic prediction methods using multimodal CT remains unclear. This study aimed to investigate the significance of the mismatch-time ratio (MTR) of CT perfusion imaging (CTP) parameters of conjunction with Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in non-contrast CT (NCCT) for predicting short-term prognosis following EVT in patients with anterior circulation AIS-LVO. METHODS: Patients with anterior circulation AIS-LVO who underwent EVT at the stroke specialty alliance of the Affiliated Hospital of Xuzhou Medical University from February 2023 to October 2024 were retrospectively were retrospectively included. The mismatch ratio defined by CTP parameters and the ratio of time from onset to CTP (T) were designated as the MTR. Based on the modified Rankin Scale (mRS) at 90 days after EVT, patients were categorized into a favorable prognosis group (mRS ≤ 3) and an adverse prognosis group (mRS > 3). Independent prognostic factors for favorable prognosis at 90 days post-EVT in patients with AIS-LVO were determined by univariate logistic regression and stepwise regression analyses. The predictive performance of MTR alone and the combined predictive efficacy of MTR with ASPECTS was compared via receiver operating characteristic (ROC) curve analysis for prognosis at 90 days post-EVT. RESULTS: 105 patients were enrolled, comprising 44 in the favorable prognosis group and 61 in the adverse prognosis group. Stepwise regression analysis revealed that MTR (OR = 2.072, P = 0.015, 95% CI: 1.155-3.719) and ASPECTS (OR = 2.363, P = 0.001, 95% CI: 1.445-3.866) were independent predictors of favorable prognosis. ROC curve analysis showed that MTR alone predicted a positive prognosis at 90 days post-EVT for AIS-LVO, with an AUC of 0.778 (P < 0.001). The combination of MTR and ASPECTS predicted a favorable prognosis at 90 days post-EVT for AIS-LVO, yielding an AUC of 0.828 (P < 0.001). CONCLUSION: MTR serves as a novel imaging biomarker indicating positive short-term prognosis for EVT in patients with anterior circulation AIS-LVO. The integration of MTR with ASPECTS enhances the prognostic accuracy of EVT in patients with anterior circulation AIS-LVO.
Plasma choline and betaine and neurological function trajectory after acute ischemic stroke.
Zong Z, Zhou C, Guo H … +6 more , Cao M, Wu S, Xu T, Zhang Y, Zhong C, Liu H
BMC Neurol · 2026 Jun · PMID 42374230 · Full text
BACKGROUND: Choline metabolism, which participates in various biological processes, has been implicated in the development of atherosclerosis and neurological disorders. However, it remains uncertain whether disruptions...
BACKGROUND: Choline metabolism, which participates in various biological processes, has been implicated in the development of atherosclerosis and neurological disorders. However, it remains uncertain whether disruptions in the choline metabolism contribute to longitudinal changes in neurological function. OBJECTIVES: We aimed to prospectively investigate the associations between circulating levels of choline and betaine and neurological function trajectory among patients with ischemic stroke. METHODS: Data came from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). Baseline plasma levels of choline and betaine were measured in 933 participants by ultra-high-performance LC-MS/MS. Group-based trajectory model was employed to identify distinct neurological function trajectories, as measured by NIHSS at admission, 14 days or discharge, and at 3-, 12-, and 24-month follow-up. RESULTS: A total of 933 stroke patients were included. Higher choline and betaine levels were generally associated with lower odds of more severe neurological deficit trajectories. Compared with the lowest tertile, the highest choline tertile had adjusted odds ratios (aORs) of 0.68 (95% confidence interval [CI]: 0.44-1.04) for moderate neurological deficits and 0.24 (95% CI: 0.09-0.66) for persistent-severe deficits. Corresponding aORs for betaine were 0.57 (95% CI: 0.37-0.90) and 0.20 (95% CI: 0.08-0.51), respectively. Furthermore, in fully adjusted models, each 1-SD higher log-choline and -betaine was associated with 26% and 28% lower odds of moderate-to-severe neurological deficit. In addition, both choline and betaine improved risk discrimination and reclassification for moderate-to-severe neurological deficit beyond conventional risk factors. CONCLUSIONS: Our study found that lower plasma levels of choline and betaine were generally associated with moderate and persistent-severe neurological function trajectories. TRIAL REGISTRATION: NCT01840072; registration date: 2013-04-13.
Rising trends in dementia and psychoactive drug-related mortality in the United States, 2000-2023. A retrospective analysis using CDC WONDER.
Arif U, Awais AM, Nadeem E … +8 more , Das V, Wassam M, Sohail F, Shafiq SB, Naz F, Maheshwari S, Touseef M, Yattassaye M
BMC Neurol · 2026 Jun · PMID 42366379 · Full text
BACKGROUND: Dementia, termed major neurocognitive disorder in the DSM-5-TR, and substance use disorders (SUD) are major and increasingly overlapping public health concerns in the United States. However, population-level...
BACKGROUND: Dementia, termed major neurocognitive disorder in the DSM-5-TR, and substance use disorders (SUD) are major and increasingly overlapping public health concerns in the United States. However, population-level trends examining their combined contribution to mortality remain limited. This study evaluates national mortality trends involving both conditions. METHODS: We conducted a retrospective analysis of the CDC WONDER Multiple Cause of Death database (2000-2023). Deaths listing both dementia and SUD as underlying or contributing causes were identified using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Trends were analyzed using Joinpoint regression, reporting annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). RESULTS: A total of 283,206 deaths were identified. The overall AAMR increased significantly from 0.58 in 2000 to 7.63 in 2023 (AAPC: 13.29%; 95% CI: 10.42-16.23; p<0.001). Sex-stratified analysis showed higher mortality in males (AAMR: 0.87→9.61) than females (0.41→6.23), although females demonstrated a greater relative increase (AAPC: 14.07% vs 12.55%; both p<0.001). By race, non-Hispanic (NH) White individuals had the highest absolute rates (AAMR: 0.60→8.57), while NH Black individuals exhibited the highest long-term burden (AAPC: 12.69%; p<0.001). Hispanic individuals showed lower rates but consistent increases (AAMR: 0.22→3.33; p<0.001). Age-stratified analysis demonstrated increasing age-adjusted mortality rates among individuals aged 45-64 years (0.14→0.61; p<0.001). Among older adults (≥65 years), mortality rates initially increased substantially (2.79→41.94) through 2020 (p<0.001), then declined sharply, reaching 0.61 in 2023 (p<0.001). Regionally, the Midwest had the highest mortality (AAMR: 0.58→10.8; AAPC: 14.38%; p<0.001), while the Northeast had the lowest rates (0.29→4.95; p<0.001). All regions showed significant upward trends (p<0.001). Urbanization analysis revealed increasing mortality in metropolitan (0.56→3.5) and non-metropolitan areas (0.71→3.8), with stronger growth in non-metropolitan regions (AAPC: 16.72% vs 15.82%; p<0.001). CONCLUSION: Mortality involving both dementia and substance use disorders has increased substantially in the United States over the past two decades, with significant disparities across sex, race, geography, and urbanization. These findings highlight the growing burdens of neurodegenerative disease and substance use, emphasizing the need for integrated public health strategies targeting both conditions.
Neutrophil to high-density lipoprotein cholesterol ratio and prognosis in acute ischemic stroke: a systematic review and meta-analysis.
Lin H, Liu Q, Liu Y … +2 more , Huang H, Liang Z
BMC Neurol · 2026 Jun · PMID 42365245 · Full text
BACKGROUND: The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is emerging as a potential composite biomarker integrating aspects of inflammation and lipid metabolism in the context of acute ischemic stro...
BACKGROUND: The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is emerging as a potential composite biomarker integrating aspects of inflammation and lipid metabolism in the context of acute ischemic stroke (AIS). However, its clinical utility remains uncertain due to limited and inconsistent evidence across studies. METHODS: A comprehensive systematic search was conducted in PubMed, Embase, and the Cochrane Library up to September 2025 to identify studies examining the association between NHR and adverse outcomes or mortality in AIS patients. Heterogeneity among studies was evaluated through sensitivity and subgroup analyses, and potential publication bias was explored using Egger's test, recognizing the limited power due to the small number of included studies. RESULTS: A meta-analysis including 4,138 patients from five studies suggested a possible association between higher NHR and adverse outcomes in AIS (OR 1.89, 95% CI: 1.18-3.02; I² = 82%), although substantial heterogeneity limits confidence in the pooled estimate. Sensitivity analyses yielded similar trends, but findings should be interpreted cautiously. Subgroup analyses indicated stronger associations for patients undergoing reperfusion therapy (OR 2.80, 95% CI: 1.79-4.38) and at 3-month follow-ups (OR 2.24, 95% CI: 1.51-3.32), while no significant associations were observed with conventional treatment or 1-month follow-ups. The pooled area under the curve (AUC) was 0.63, reflecting limited predictive performance. Only a single study examined mortality, reporting no significant association with NHR (OR 1.5; 95% CI: 0.47-4.74). CONCLUSIONS: Elevated NHR is associated with adverse outcomes in AIS, supporting its potential as a prognostic biomarker. However, evidence for mortality prediction is limited, and further prospective studies are needed.
Risk prediction models for early neurological deterioration after intravenous thrombolysis in acute ischemic stroke patients: a systematic review and meta-analysis.
Chen Y, Li C, Fan L … +3 more , Zhang W, Ding Y, Zhao H
BMC Neurol · 2026 Jun · PMID 42363152 · Full text
BACKGROUND: An increasing number of risk prediction models have been developed to predict early neurological deterioration (END) in patients with acute ischemic stroke after intravenous thrombolysis. However, the methodo...
BACKGROUND: An increasing number of risk prediction models have been developed to predict early neurological deterioration (END) in patients with acute ischemic stroke after intravenous thrombolysis. However, the methodological quality and clinical applicability of these models remain unclear. OBJECTIVE: To systematically review studies on risk prediction models for END in patients with acute ischemic stroke treated with intravenous thrombolysis (IVT). DESIGN: Systematic review and meta-analysis of observational studies. METHODS: Seven databases (CNKI, Wanfang Database, VIP database, PubMed, Web of Science, the Cochrane Library, and Embase) were systematically searched from inception to December 20, 2025. Information extracted from the included studies comprised study design, data sources, outcome definitions, sample size, predictors, model development methods, and model performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess evaluate the risk of bias and applicability of the included studies. RESULTS: Eighteen studies were ultimately included, comprising 18 prediction models. All studies utilized logistic regression to predict END. The incidence of END after IVT among patients with acute ischemic stroke patients ranged from 7.7% to 31.3%. The baseline National Institutes of Health Stroke Scale (NIHSS) score was the most frequently identified predictor. All studies were rated as having a high risk of bias based on the PROBAST assessment, primarily due to inconsistent outcome definitions, inappropriate data sources, and inadequate reporting within the analysis domain. The pooled area under the curve (AUC) for the five validated models was 0.87 (95% CI: 0.84-0.91), suggesting moderate predictive performance. CONCLUSION: Although the included prediction models showed moderate discriminative performance for END in patients with acute ischemic stroke following intravenous thrombolysis, all studies were assessed as having a high risk of bias based on the PROBAST checklist. These findings emphasize the need for nurse-led risk monitoring, standardized neurological assessments, and early preventive nursing interventions for high-risk patients. CLINICAL TRIAL REGISTRATION: The protocol for this study is registered with PROSPERO (registration number: CRD42025628890).
Serum serotonin and its association with glycaemic indices and haemoglobin in adults with migraine: a comparative cross-sectional study.
Jaganathan A, Radhakrishnan K, Musthak Ali MA … +2 more , Sundaram RW, Subbiah A
BMC Neurol · 2026 Jun · PMID 42363072 · Full text
BACKGROUND: Migraine is a neurovascular disorder involving serotonergic, vascular, metabolic and haematological pathways. Peripheral serotonin has been implicated in migraine biology, but its relationship with glycaemic...
BACKGROUND: Migraine is a neurovascular disorder involving serotonergic, vascular, metabolic and haematological pathways. Peripheral serotonin has been implicated in migraine biology, but its relationship with glycaemic and haematological markers remains unclear. This study evaluated serum serotonin in migraine and examined associations with clinical, glycaemic and haematological variables. METHODS: This comparative cross-sectional study included 74 adults with migraine diagnosed using International Classification of Headache Disorders, 3rd edition criteria and 82 non-migraine controls from a tertiary-care teaching hospital. Demographic data, anthropometry, blood pressure, pulse rate, fasting glucose, HbA1c, estimated average glucose, haemoglobin, thyroid-stimulating hormone and serotonin were recorded. Group comparisons used t-tests and age-adjusted analysis of covariance. Pearson and partial correlations assessed serotonin associations. Multiple regression used estimated average glucose in the primary model and HbA1c in a sensitivity model, as estimated average glucose is derived from HbA1c. RESULTS: Among 156 participants, the migraine group was older and had higher blood pressure, pulse rate, fasting glucose and HbA1c/estimated average glucose, with lower haemoglobin. Serum serotonin was lower in migraine than control participants (10.72 ± 5.42 vs. 88.43 ± 6.26 ng/mL; p < 0.001), remaining significant after age adjustment. Serotonin correlated inversely with HbA1c/estimated average glucose, fasting glucose, blood pressure and pulse rate, and positively with haemoglobin. In multivariable analysis, estimated average glucose, haemoglobin and age were independently associated with serotonin. CONCLUSIONS: Adults with migraine showed lower peripheral serotonin and altered glycaemic, haemodynamic and haematological profiles. These exploratory findings require validation in longitudinal studies with detailed migraine phenotyping.
Idiopathic Posterior Reversible Encephalopathy Syndrome (PRES) in a 4-month-old infant: a case report.
Oudrhiri Safiani M, Zarouali H, El Harrak S … +5 more , Ed Dafali L, Ziani H, Ennafiri M, Bentalha A, Ech Cherif El Kettani S
BMC Neurol · 2026 Jun · PMID 42351070 · Full text
BACKGROUND: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological condition characterized by acute neurological symptoms associated with vasogenic cerebral edema. Although increasingly recognized...
BACKGROUND: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological condition characterized by acute neurological symptoms associated with vasogenic cerebral edema. Although increasingly recognized in pediatric populations, PRES remains exceptionally rare in infants younger than six months, making diagnosis particularly challenging in this age group. CASE PRESENTATION: We report the case of a 4-month-old previously healthy infant admitted for recurrent afebrile generalized tonic-clonic seizures. Initial clinical examination, laboratory investigations, cerebrospinal fluid analysis, and cranial computed tomography were unremarkable. Brain magnetic resonance imaging revealed bilateral, symmetrical cortico-subcortical occipital hyperintensities on T2-weighted and FLAIR sequences, with diffusion-weighted hyperintensity and mildly reduced ADC signal, overall suggestive of PRES with a possible superimposed cytotoxic component. No sustained arterial hypertension or underlying metabolic, infectious, autoimmune, or toxic cause was identified despite extensive evaluation, supporting the diagnosis of idiopathic PRES. Seizures were controlled with antiepileptic therapy, and the clinical course was favorable without early recurrence. CONCLUSION: This case highlights an exceptionally early presentation of idiopathic PRES in infancy and underscores the need to consider this diagnosis in unexplained seizures, even in the absence of classical risk factors. Early MRI is essential for diagnosis, and long-term neurodevelopmental follow-up remains crucial given the uncertain prognosis in this age group.
Association of prognostic nutritional index with mortality in patients with sepsis-associated delirium: a retrospective MIMIC-IV study.
Kong S, Yang C, Li X … +4 more , Lai Q, Zhang J, Wang Y, Lyu J
BMC Neurol · 2026 Jun · PMID 42351046 · Full text
BACKGROUND: A concerning sign of severe brain dysfunction, sepsis-associated delirium (SAD) is associated with poor clinical outcomes. The prognostic value of the Prognostic Nutritional Index (PNI) for patients with SAD...
BACKGROUND: A concerning sign of severe brain dysfunction, sepsis-associated delirium (SAD) is associated with poor clinical outcomes. The prognostic value of the Prognostic Nutritional Index (PNI) for patients with SAD is unclear. OBJECTIVE: To determine the association between PNI and all-cause mortality at 90, 180, and 360 days in SAD patients. METHODS: We classified SAD patients into low-PNI and high-PNI groups based on PNI. We then used Kaplan-Meier (KM) survival analysis, multivariate Cox regression, restricted cubic spline (RCS) models, inverse probability of treatment weighting (IPTW), and subgroup analysis to evaluate the association between these groups and all-cause mortality at 90, 180, and 360 days. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of PNI. RESULTS: Among 2,160 patients, the low PNI group had significantly higher mortality than the high PNI group at 90 days (51.9% vs. 33.5%), 180 days (56.4% vs. 37.1%), and 360 days (60.6% vs. 41.5%). After adjustment, Cox regression showed low PNI was associated with a 1.55-fold higher 90-day mortality (95% CI: 1.34-1.79, p < 0.001). A restricted cubic spline model revealed a nonlinear PNI-outcome relationship. These results were robust in IPTW and subgroup analyses, and ROC analysis demonstrated predictive performance comparable to that of SOFA and albumin. CONCLUSION: The PNI is a simple, useful, and easily accessible tool that can help identify patients with SAD who are at increased risk of adverse outcomes at an early stage.
Factors associated with improvement in gait disturbance of polyneuropathy in POEMS syndrome.
Nara T, Shibuya K, Kuroiwa R … +6 more , Misawa S, Suichi T, Otani R, Ogushi M, Murata A, Kuwabara S
BMC Neurol · 2026 Jun · PMID 42351042 · Full text
BACKGROUND: Distal dominant muscle weakness is one of the characteristic symptoms of polyneuropathies, largely affecting patients' quality of life. The aim of this study was to identify factors influencing gait disturban...
BACKGROUND: Distal dominant muscle weakness is one of the characteristic symptoms of polyneuropathies, largely affecting patients' quality of life. The aim of this study was to identify factors influencing gait disturbances in POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome. METHODS: This study consists of 2 study designs: Study 1 was a cross-sectional study and Study 2 was retrospective cohort study. Study 1: a total of 60 patients with POEMS syndrome was included. Gait disturbance was assessed using the Functional Ambulation Categories (FAC), and relationships among FAC, physical functional assessments, and tibial nerve conduction studies (NCS) parameters were analyzed. Study 2: after treatment, 27 of the 60 patients were divided into the 2 groups based on FAC results: the gait improvement group (n = 14) and non-improvement group (n = 13). Factors contributing to gait improvement were assessed. RESULTS: Study 1: The median age of patients was 56 years; 26 patients walked independently, whereas the remaining 34 required assistance with walking. The median scores for manual muscle testing were 4/5 for the iliopsoas, 5/5 for the quadriceps, and 2/5 for the tibialis anterior. The median score for great toe position sense was 5/5. Gait disturbances were significantly correlated with muscle strength of the iliopsoas (rho = 0.57), quadriceps (rho = 0.64), and tibialis anterior (strongest correlation; rho = 0.82), and with great toe position sense (rho = 0.59) (all, p < 0.0001). In contrast, NCS parameters were not correlated with gait disturbances. Study 2: strength of the 3 muscles was improved after treatments in the gait improvement group, and Δ muscle strength of the iliopsoas muscles was significantly associated with gait improvement (rho = 0.54, p < 0.05). CONCLUSIONS: Whereas weakness of the distal lower limb muscles largely affects gait ability in POEMS polyneuropathy, recovery in proximal lower limb muscle strength is more important for gait improvement.
Adenylate kinase 5 autoimmune encephalitis following craniopharyngioma radiotherapy.
Quan M, Ren F, Sun T … +3 more , Chang X, Chen L, Wang L
BMC Neurol · 2026 Jun · PMID 42351024 · Full text
BACKGROUND: Anti-AK5 encephalitis is a rare, non-paraneoplastic autoimmune disorder, typically characterized by anterograde amnesia as a core clinical manifestation. Although seizures are infrequent in the early disease...
BACKGROUND: Anti-AK5 encephalitis is a rare, non-paraneoplastic autoimmune disorder, typically characterized by anterograde amnesia as a core clinical manifestation. Although seizures are infrequent in the early disease phase, some patients may develop seizures as the condition progresses. CASE PRESENTATION: We report a rare case of anti-adenylate kinase 5 (AK5) autoimmune encephalitis following surgical resection and radiotherapy for craniopharyngioma. After cranial radiotherapy, the patient exhibited clinical manifestations such as personality changes and a decline in recent memory. However, the diagnosis was not made until several years later when the patient presented with the onset of epilepsy. By that time, imaging already showed abnormal signals and atrophy in the hippocampus. CONCLUSION: This case highlights the distinct clinical features of AK5 encephalitis and raises the potential association between brain radiotherapy and the development of autoimmune inflammation within the central nervous system.
Systematic review of prevalence of pain among people with dementia living in the community.
Helvik AS, Temür BN, Bergh S … +1 more , Tevik K
BMC Neurol · 2026 Jun · PMID 42351020 · Full text
BACKGROUND: Pain is common among people living with dementia (PLWD) in the community and is associated with substantial negative consequences for both individuals and caregivers; however, knowledge regarding its prevalen...
BACKGROUND: Pain is common among people living with dementia (PLWD) in the community and is associated with substantial negative consequences for both individuals and caregivers; however, knowledge regarding its prevalence and assessment in a community living population with dementia remains limited. The aim of this systematic review was to examine the prevalence of pain and the pain assessment inventories used among PLWD at home. METHOD: This systematic review was registered in PROSPERO (CRD420251136436) and was conducted in accordance with the PRISMA 2020 statement. The searched databases include PubMed, MEDLINE, CINAHL, APA PsycInfo, AgeLine, the Cochrane Library, and Idunn, covering articles published from January 2000 to February 2026. Quantitative observational studies that reported pain through self-report questionnaires, staff- and/or caregiver- assessments were included to define the prevalence of pain in samples or subsamples of PLWD at home. The database search identified 1,296 records, of which 25 articles from 22 studies were included in the final review. RESULTS: Sample sizes ranged from 36 to 1,379 PLWD at home. Pain was reported as any pain occurring within a defined timeframe, pain present on the day of assessment, pain meeting predefined severity criteria, or pain interfering with daily activities. The prevalence of pain among PLWD at home was consistently high, with higher prevalence estimates reported in studies assessing any pain compared with those applying severity or consequence-based criteria. The prevalence of any pain during the past month was found to vary between 36 and 76%. Considerable methodological heterogeneity was observed in terms of pain definitions, assessment methods, and inclusion criteria, which makes comparisons across studies difficult. CONCLUSION: The overall high prevalence of pain identified in this review underscores the need for systematic and standardized pain assessment for PLWD at home.
Effectiveness of prophylactic administration of new-generation antiepileptic drugs for prevention of seizures following surgical clipping in patients with aneurysmal subarachnoid hemorrhage.
Kayahara T, Sakurada K, Mochizuki Y … +4 more , Maeda T, Take Y, Teranishi A, Kurita H
BMC Neurol · 2026 Jun · PMID 42351009 · Full text
BACKGROUND: The efficacy of prophylactic administration of antiepileptic drugs (AEDs) for patients with aneurysmal subarachnoid hemorrhage (SAH) remains controversial, and further research is required to ascertain the ef...
BACKGROUND: The efficacy of prophylactic administration of antiepileptic drugs (AEDs) for patients with aneurysmal subarachnoid hemorrhage (SAH) remains controversial, and further research is required to ascertain the efficacy of new-generation AEDs in preventing the seizures that may occur after aneurysmal SAH. This study aimed to clarify the efficacy of prophylactic administration of new-generation AEDs in preventing the development of seizures following surgical clipping for aneurysmal SAH. METHODS: A retrospective study was conducted on 89 patients diagnosed with SAH between 2021 and 2024 who underwent surgical clipping for ruptured intracranial aneurysms. In the present study, seizures were not defined based on findings of electroencephalogram, but defined as apparent convulsion. The administration of AEDs was started immediately after the surgery, and how to use the AEDs was determined by each physician, including the selection of the type of AEDs, dose escalation, and treatment duration. We investigated patient characteristics, including the development of seizures, prophylactic administration of AEDs, and clinical outcomes. RESULTS: Of the 89 patients, seizures were observed in 8 (9.0%) patients. Patients diagnosed with seizures were significantly older and had worse prognoses. Perampanel was administered prophylactically to a significantly larger number of patients without seizures. However, there were no significant differences in the administration of lacosamide or levetiracetam between patients with and without seizures, respectively. In contrast, no substantial differences were observed in patient characteristics, except for seizure occurrence and lacosamide utilization between those who were and were not administered perampanel. CONCLUSIONS: Prophylactic administration of perampanel or adequate escalation of the dose could contribute to a decrease in the incidence of seizures developing after surgical clipping for aneurysmal SAH.
Efficacy and safety of treatment strategies for early neurological deterioration after acute ischemic stroke: a network meta-analysis of randomized controlled trials.
Liu J, Fu B, Zhang Z … +1 more , He Q
BMC Neurol · 2026 Jun · PMID 42350977 · Full text
BACKGROUND: Early neurological deterioration (END) is a serious complication of acute ischemic stroke and may occur spontaneously or after reperfusion therapy. OBJECTIVE: To compare the efficacy and safety of different i...
BACKGROUND: Early neurological deterioration (END) is a serious complication of acute ischemic stroke and may occur spontaneously or after reperfusion therapy. OBJECTIVE: To compare the efficacy and safety of different interventions for acute ischemic stroke patients with END using network meta-analysis. METHODS: Randomized controlled trials were identified through systematic searches of major databases up to February 2026. The primary outcome was the 90-day modified Rankin Scale score. Secondary outcomes included neurological improvement (assessed by NIHSS), intracranial hemorrhage, and mortality. RESULTS: Five randomized controlled trials including 1,164 patients were analyzed. Compared with standard antiplatelet therapy (ST; which included aspirin monotherapy, placebo plus aspirin, or dual antiplatelet therapy depending on the study protocol), indobufen combined with ST, and tirofiban combined with ST, significantly improved 90-day functional outcome, whereas argatroban combined with standard treatment reduced mean mRS scores but did not significantly increase the proportion of patients achieving favorable functional outcomes (mRS 0-2) or excellent functional outcomes (mRS 0-1). Indobufen demonstrated the highest probability of being the optimal treatment for reducing the mean 90-day mRS score and improving 90-day NIHSS scores based on SUCRA rankings. Indobufen and tirofiban (each added to ST) also significantly improved neurological recovery at short- and long-term follow-up. However, argatroban and tirofiban did not significantly increase the proportion of patients achieving favorable functional outcomes. None of the interventions increased the risk of intracranial or symptomatic hemorrhage. CONCLUSIONS: Indobufen was associated with lower mean 90-day mRS and NIHSS scores, whereas tirofiban added to standard antiplatelet therapy increased the proportion of patients achieving a favorable functional outcome defined as mRS 0-2. Neither tirofiban nor argatroban significantly increased the proportion achieving an excellent functional outcome defined as mRS 0-1. These findings should be interpreted cautiously because of the limited number and size of the included trials.
Association of the triglyceride-glucose index with one-year all-cause mortality in patients with spontaneous basal ganglia hemorrhage: a retrospective study.
Zhang L, Wang Z, Wang J … +4 more , Nie D, Xu P, Ding Y, Sun G
BMC Neurol · 2026 Jun · PMID 42343317 · Full text
BACKGROUND: The triglyceride-glucose (TyG) index is a marker of insulin resistance, and its relationship with the prognosis of patients with spontaneous basal ganglia hemorrhage (SBGH) has not been clearly established. T...
BACKGROUND: The triglyceride-glucose (TyG) index is a marker of insulin resistance, and its relationship with the prognosis of patients with spontaneous basal ganglia hemorrhage (SBGH) has not been clearly established. This study aimed to evaluate the relationship between the TyG index and one-year all-cause mortality. METHOD: This single-center, hospital-based retrospective study included 282 patients with SBGH. Missing values were imputed using a random forest algorithm. The primary outcome was one-year all-cause mortality, which was confirmed by standardized telephone follow-ups. Variables considered for multivariable modeling were prespecified based on established clinical relevance and prior literature, after which bidirectional stepwise selection was used to select the final model covariates. Association between the TyG index and mortality was assessed using Cox proportional hazards models. Additional analyses included Kaplan-Meier survival curves and restricted cubic spline (RCS) analyses. Incremental predictive performance of adding TyG to the baseline model was assessed using the AUC, IDI, and NRI. Robustness was examined using E-values and sensitivity analyses, including complete-case analyses, exclusion of extreme values, further adjustment for AST and INR, and subgroup analyses. RESULTS: Among the 282 participants, 49 (17.4%) died during the one-year follow-up. The results revealed significant associations between the TyG index and mortality. Specifically, for each 1-SD increase in the TyG index, the risk of all-cause mortality increased by 61.1% (HR = 1.611, 95% CI = 1.184-2.191). RCS analyses suggested an approximately linear relationship (P for nonlinearity > 0.05) and identified a cutoff value of 8.499. Patients with TyG ≥ 8.499 had worse one-year survival (log-rank P = 0.002). Adding the TyG index to the basic model increased the AUC from 0.691 to 0.723 (optimism-corrected 0.661 vs. 0.703; ΔAUC was not significant), improved IDI (0.044, P = 0.047), but not continuous NRI (0.090, P = 0.299). Sensitivity analyses supported the robustness of these associations. Subgroup analyses suggested that the association was generally consistent, with limited evidence of interaction. CONCLUSION: The TyG index may aid early risk stratification in SBGH. However, further research is required to determine if improved TyG index control would lead to better clinical results in the future.
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