BMC Neurology[JOURNAL]
Sun
200 papers
Comparison of 5.0T and 3.0T time-of-flight MR angiography for visualizing the anterior choroidal artery.
Li Z, Shang M, Fu M … +4 more , Wang Z, Yin L, Yu D, Gan J
BMC Neurol · 2026 Jun · PMID 42286529 · Full text
BACKGROUND: This study aimed to compare the image quality of 5.0T and 3.0T time-of-flight (TOF) magnetic resonance angiography (MRA) for visualization of the anterior choroidal artery (AChA). METHODS: This retrospective...
BACKGROUND: This study aimed to compare the image quality of 5.0T and 3.0T time-of-flight (TOF) magnetic resonance angiography (MRA) for visualization of the anterior choroidal artery (AChA). METHODS: This retrospective study included patients who underwent both 3.0T and 5.0T TOF-MRA within a 48-hour interval. Objective image quality was assessed using signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality was independently evaluated by two radiologists using segment-based AChA visibility scores, and quantitative measurements of vessel length and diameter were obtained. RESULTS: A total of 42 patients who underwent both 3.0T and 5.0T TOF-MRA were included in the paired analysis. Compared with 3.0T imaging, 5.0T TOF-MRA demonstrated significantly higher objective image quality, with increased signal-to-noise ratio (93 ± 5 vs. 65 ± 3) and contrast-to-noise ratio (75 ± 6 vs. 52 ± 4) (both P < 0.001). Subjective analysis showed significantly higher visibility scores for distal anterior choroidal artery segments on 5.0T imaging, particularly for the A2 (P = 0.007) and A3 (P < 0.001) segments. Paired morphological measurements further demonstrated greater apparent AChA length (left: 24.4 ± 7.3 mm vs. 18.7 ± 9.2 mm; P < 0.001) and diameter (left: 1.1 mm (1.0-1.2) vs. 0.9 mm (0.7-1.1); P < 0.001) on 5.0T TOF-MRA compared with 3.0T imaging. CONCLUSIONS: 5.0T TOF-MRA improved visualization of the AChA, particularly its distal segments, compared with 3.0T imaging; further studies are needed to clarify its clinical implications. CLINICAL TRIAL NUMBER: Not applicable.
Trends in both Alzheimer's disease and Diabetes mellitus related mortality among middle-aged and older adults in the United States, 1999 to 2023: a CDC WONDER database analysis.
Javed A, Kumar S, Iftekhar M … +6 more , Siddiqui HT, Khan A, Faisal F, Ali M, Sohail F, Khan MH
BMC Neurol · 2026 Jun · PMID 42286514 · Full text
OBJECTIVE: To analyze the temporal trends of both Alzheimer's disease and Diabetes mellitus-related mortality in adults aged > 45years in the United States between 1999 and 2023, and to evaluate the changes in mortality...
OBJECTIVE: To analyze the temporal trends of both Alzheimer's disease and Diabetes mellitus-related mortality in adults aged > 45years in the United States between 1999 and 2023, and to evaluate the changes in mortality patterns over time. BACKGROUND: Alzheimer's Disease and Diabetes Mellitus are two different diseases that have diverse underlying pathophysiology, but they often coexist, having common pathways. There is a high prevalence of concurrence between these two conditions, yet their combined mortality trend is underexplored. METHODS: We utilize mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER). Individuals aged > 45 were included who had both Alzheimer's disease (G30) and Diabetes mellitus(E10-14). Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 were calculated and were standardized to the 2000 U.S population. Joint point regression models were used to identify the temporal variations and to calculate Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) with 95% confidence intervals. RESULTS: Overall, a total of 224,082 deaths occurred in patients of both Alzheimer's disease and Diabetes mellitus, in the age group ≥ 45 years, from 1999 to 2023. There is an upward trajectory noted from 2.82 in 1999 to 4.42 in 2023, with the highest incidence between 2017 and 2020, followed by a decline. Mortality rose in both sexes, with a persistently higher rate in females. The mortality rise from 1999 to 2023 in middle-aged people (45-64 years), and there was a rise in the trend of around 41% among adults ≥ 65 years. White individuals show higher deaths (78.9%), yet higher AAMR is observed in Black and Hispanic populations, showing racial disparities. Regionally, the West shows the highest AAMR, while non-metropolitan areas show higher mortality than metropolitan areas. CONCLUSION: The trend of mortality in individuals with both Alzheimer's disease and Diabetes Mellitus has increased in the past two decades, but there is a sharp rise observed after 2020 that may show the impact of the COVID-19 pandemic. These findings emphasized public health strategies.
Natural history and 12-month progression of multiple system atrophy in a Chinese cohort.
Feng T, Wang H, Wang J … +13 more , Tang B, Liu CF, Chen H, Mao W, Zhou Q, Rascol O, Meissner WG, Bidani A, Rieckmann A, Åström DO, Chan P, Shang H, Cui L
BMC Neurol · 2026 Jun · PMID 42286509 · Full text
BACKGROUND: Understanding disease natural history is important for the development of potential treatments for people with MSA. We describe the natural progression of early MSA in a Chinese population. METHODS: Observati...
BACKGROUND: Understanding disease natural history is important for the development of potential treatments for people with MSA. We describe the natural progression of early MSA in a Chinese population. METHODS: Observational, 12-month study conducted in 8 sites across China. Eligible participants were aged 40-75 years, with possible or probable MSA of the parkinsonian (MSA-P) or cerebellar (MSA-C) subtype, and anticipated survival of ≥ 3 years. Disease progression was analyzed using a linear mixed model of Total UMSARS (Part I + II) progression, including baseline, Month 6 and Month 12 data. RESULTS: A total of 89 participants with a mean ± SD time since diagnosis of 0.4 ± 0.6 years were enrolled. Of these 52% had MSA-C and 48% participants had MSA-P. The mean ± SE [95%CI] rate of Total UMSARS progression was 1.27 ± 0.13 [1.01, 1.53] points per month. Participants showed a progression of 0.64 ± 0.06 [0.51, 0.76] points/month on UMSARS Part I and 0.62 ± 0.07 [0.47, 0.77] points/month on UMSARS Part II. Differences in the rates of UMSARS progression between patients with MSA-P and MSA-C were not statistically significant (p > 0.05). CONCLUSIONS: This is the first multicenter natural history study of MSA progression conducted in China. While prior studies have indicated a predominance of MSA-C in Asian populations, we found a more even split of MSA-C and MSA-P subtypes. In this early population, patients showed an average progression rate of ~ 15 Total UMSARS points/year; rates of progression were similar between the two subtypes and were in alignment with previous studies that assessed disease progression using UMSARS in Western populations. TRIAL REGISTRATION: Clinicaltrals.gov, NCT05453058 (registered June 16, 2022).
Identification of signal-based gait features and blood analytes associated with stroke status and walking speed in mild acute ischemic stroke.
Şahin Erdoğan M, Özgün M, Kaya D … +2 more , Akanyeti O, Saybaşılı H
BMC Neurol · 2026 Jun · PMID 42286488 · Full text
BACKGROUND: Assessment of mild acute ischemic stroke (mAIS) can be difficult, especially in regions where access to neuroimaging is limited. Integrating routine blood analyses with wearable gait assessments may aid in th...
BACKGROUND: Assessment of mild acute ischemic stroke (mAIS) can be difficult, especially in regions where access to neuroimaging is limited. Integrating routine blood analyses with wearable gait assessments may aid in the identification of mAIS and estimation of functional outcomes. In this pilot study, we focus on identifying candidate gait and blood analytes associated with stroke status and functional outcomes in mAIS. METHODS: Video, smartphone, and blood data were collected from 22 mAIS patients and nine healthy controls. Ridge-penalized logistic regression nomograms were developed; one to estimate the stroke status using gait, and a second one to estimate walking speed of patients using blood analytes. RESULTS: Our gait-based nomogram identified mAIS with an area under the curve (AUC) of 0.878, while blood-based nomogram estimated walking speed with an AUC of 0.906 (both optimism-corrected). Identified gait features for stroke status included lower xgyr_energy, xgyr_max, xgyr_std, zgyr_energy and zacc_rms, and higher zgyr_iqr, while higher age, blood urea nitrogen (BUN), and lower estimated glomerular filtration rate (eGFR) and mean corpuscular hemoglobin concentration (MCHC) were associated with slower walking. CONCLUSIONS: We show the feasibility of integrating gait statistics with blood analytes to identify mAIS and estimate walking speed. The nomograms showed strong discrimination and calibration within our small cohort. These findings point to the potential of multimodal signal-based features in stroke detection and rehabilitation planning, particularly in low-resource settings.
Long-term physical activity, brain structure, and cognitive function: a systematic review of longitudinal observational evidence.
Shettigar D, Sukumar S, Kadavigere R … +10 more , Vaishali K, Panakkal NC, Dkhar W, Pradhan A, Chandrasekaran B, Palaniswamy HP, Paramashiva PS, Ravichandran S, Muthu SS, Kamath K
BMC Neurol · 2026 Jun · PMID 42277754 · Full text
BACKGROUND: Physical inactivity is a key modifiable risk factor for dementia, and physical activity is proposed to confer neuroprotective effects on brain structure and cognitive function. OBJECTIVES: To synthesize longi...
BACKGROUND: Physical inactivity is a key modifiable risk factor for dementia, and physical activity is proposed to confer neuroprotective effects on brain structure and cognitive function. OBJECTIVES: To synthesize longitudinal observational evidence on associations between long-term habitual physical activity and brain structural outcomes and cognitive function across adult age groups. METHODS: Five databases were searched from inception to August 2024. Eligible studies enrolled adults aged ≥ 18 years without cognitive impairment or dementia, used validated accelerometry or self-report physical activity assessment, and employed longitudinal observational designs with a minimum 12-month exposure-to-outcome window. Risk of bias was assessed using the ROBINS-E tool. RESULTS: Twenty studies were included in the review. Higher habitual physical activity was consistently associated with preserved hippocampal and prefrontal grey matter volume and attenuated white matter microstructural decline. Executive function and processing speed showed the most consistent cognitive associations, with evidence of a dose-response accumulation effect across adulthood. Associations appeared amplified in APOE-ε4 carriers. Bidirectional analyses indicated preserved brain structure also predicted subsequent physical activity, suggesting reverse causation cannot be excluded. All 20 studies were rated "some concerns" on the ROBINS-E scale. CONCLUSION: Longitudinal observational evidence is consistent with the hypothesis that sustained habitual physical activity is associated with preserved brain structure and attenuated cognitive decline, though causal inference is not warranted given the limitations of the observational design.
Late-onset severe axonal polyneuropathy in mut0 methylmalonic acidemia after liver-kidney transplantation: a genotype-informed case report.
Griffo M, Magri F, Furlan F … +14 more , Bernardi E, Menni F, Tagliaferri F, Testa S, Ronchi D, Petrillo S, Piemonte F, Gagliardi D, Parisi M, Padelli S, Velardo D, Molitierno N, Corti S, Comi GP
BMC Neurol · 2026 Jun · PMID 42277733 · Full text
BACKGROUND: Liver-kidney transplantation in methylmalonic acidemia (MMA) improves metabolic control but does not eliminate neurological risk. Peripheral neuropathy is increasingly recognized in transplanted patients, yet...
BACKGROUND: Liver-kidney transplantation in methylmalonic acidemia (MMA) improves metabolic control but does not eliminate neurological risk. Peripheral neuropathy is increasingly recognized in transplanted patients, yet its pathophysiology and surveillance strategies remain poorly defined. CASE PRESENTATION: We describe a severe axonal sensorimotor polyneuropathy that occurred 12 years after combined liver and kidney transplantation in a 20-year-old patient with mut0 methylmalonic acidemia (MMA), compound heterozygous for MMUT gene mutations and lacking fibroblast MCM enzymatic activity. Clinical, electrophysiological, and biochemical investigations were performed, including cerebrospinal fluid analysis, anti-ganglioside antibody testing, and measurement of circulating biomarkers of neuroaxonal injury (NfL) and mitochondrial dysfunction (FGF21, GDF15). Electrophysiological studies demonstrated a purely axonal process with active denervation. Cerebrospinal fluid protein and cell count were normal, anti-ganglioside antibodies were negative, and neuroimaging was unremarkable, excluding Guillain-Barré syndrome variants. Plasma NfL was markedly elevated (4083 pg/mL, 204× ULN), exceeding levels reported in hereditary and acquired neuropathies. FGF21 (1682 pg/mL) and GDF15 (1438 pg/mL) indicated mitochondrial stress. CONCLUSIONS: This case demonstrates that neurological stability is not guaranteed in mut0 MMA even 12 years post-transplantation. Management included switching from tacrolimus to everolimus and optimizing vitamin B12 supplementation. We propose NfL, FGF21, and GDF15 as monitoring tools for MMA transplant recipients.
Clazosentan in aneurysmal subarachnoid hemorrhage: an updated systematic review and meta-analysis of efficacy and safety.
Alsakti AM, Ghazwi ZHA, AlOtaibi AK … +10 more , Alharbi MA, Aldeaiji LA, Binshmilan AB, Alanazi NMM, Alsharif RE, Aldehaim FM, Alhindi BA, Alodhaib NA, Saleh A, Altamimi A
BMC Neurol · 2026 Jun · PMID 42277709 · Full text
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurological condition associated with high morbidity and mortality. Delayed cerebral ischemia (DCI), largely driven by cerebral vasospasm, re...
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening neurological condition associated with high morbidity and mortality. Delayed cerebral ischemia (DCI), largely driven by cerebral vasospasm, remains a major determinant of poor outcomes. Clazosentan, a selective endothelin A receptor antagonist, reduces vasospasm, but its impact on clinical outcomes remains uncertain. This study aimed to evaluate its association with vasospasm-related and clinical outcomes, and its safety profile. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Cochrane Library, and Google Scholar were searched through March 2026. Outcomes included vasospasm, cerebral infarction, DINDs, functional outcomes, mortality, and adverse events. Random-effects models (DerSimonian-Laird estimator) were applied, and predefined subgroup analyses were performed by clazosentan dose, comparator type (placebo vs. fasudil hydrochloride), aneurysm treatment modality, and study design (randomized controlled trials (RCTs) vs. observational cohort studies). Certainty of evidence for each outcome was rated using the GRADE framework, with RCT and cohort evidence rated as separate bodies of evidence. RESULTS: Sixteen studies (17 reports; 7 RCTs comparing clazosentan with placebo and 9 cohort studies comparing clazosentan with fasudil hydrochloride) were included. In RCTs clazosentan was associated with statistically significant reductions in angiographic vasospasm and rescue-therapy use (high GRADE certainty), and in vasospasm-related cerebral infarction and DINDs (moderate certainty, downgraded for publication bias). In pooled observational data versus fasudil hydrochloride, directionally concordant reductions were observed for angiographic vasospasm (low certainty) and vasospasm-related infarction (very low certainty), but no statistically significant differences were observed for DINDs or rescue therapy. However, no statistically significant differences were observed in functional outcomes or mortality in either body of evidence (moderate certainty for poor functional outcome and mortality in RCTs; very low certainty for favourable functional outcome and mortality in cohort studies). Larger effect estimates were observed with 10-15 mg doses in aggregate study-level analyses; because dose was assigned at the study level rather than randomized within patients, these gradients are descriptive rather than confirmatory of a within-patient dose-response relationship. Study design-stratified analysis showed concordant reductions in vasospasm and cerebral infarction across RCTs and cohorts, while effects on DINDs, rescue therapy, and hypotension reached significance only in RCTs. Clazosentan was associated with increased risks of anemia, hypotension, pleural effusion, pulmonary edema, and pneumonia, with no statistically significant difference in cerebral hemorrhage. CONCLUSION: Across both bodies of evidence, clazosentan was associated with statistically significant reductions in angiographic vasospasm and vasospasm-related ischemic complications in aSAH, but these surrogate gains did not translate into statistically significant improvements in survival or functional recovery in either randomized or observational evidence, and were accompanied by clinically relevant increases in anemia, hypotension, and pulmonary complications. Observational comparisons with fasudil are at serious-to-critical risk of confounding by indication, treatment selection, and temporal changes in care, and should be considered hypothesis-generating. Because demonstrable improvement in patient-centered endpoints (survival, functional recovery) has not been shown, Routine use is not supported by current evidence; any role for clazosentan is likely limited to selected high-risk patients in whom the anticipated reduction in ischemic complications is explicitly judged to outweigh the systemic harm.
Oculomotor phenotypes and longitudinal video-oculography dynamics in anti-GAD65 antibody-associated neurological syndromes: a case series and literature review.
Dai F, Cui S, Guo Y … +1 more , Wang J
BMC Neurol · 2026 Jun · PMID 42277687 · Full text
BACKGROUND: Anti-glutamic acid decarboxylase (GAD) antibody-associated neurological syndromes encompass a heterogeneous group of immune-mediated disorders in which ocular involvement is increasingly recognized but remain...
BACKGROUND: Anti-glutamic acid decarboxylase (GAD) antibody-associated neurological syndromes encompass a heterogeneous group of immune-mediated disorders in which ocular involvement is increasingly recognized but remains insufficiently characterized. Data on clinical features, neuroimaging, and longitudinal ocular motor findings are limited. METHODS: We retrospectively reviewed four patients diagnosed with anti-GAD antibody-associated neurological syndromes presenting with ocular manifestations at our center between 2019 and 2025. Clinical features, ocular motor findings, laboratory and neuroimaging results, treatment, and outcomes were collected. Longitudinal video-oculography (VOG) was analyzed in one patient. A literature review was performed to summarize reported ocular and vestibulo-ocular abnormalities. RESULTS: All four patients (2 males, 2 females; onset age 53-68 years) exhibited ocular symptoms, three presented with ocular symptoms early in the disease course; however, in one case (Case 4), the temporal association between the initial ocular symptom and the final diagnosis remained uncertain. Diplopia, nystagmus, and ptosis were the predominant findings. Early brain and orbital Magnetic Resonance Imaging (MRI) were unremarkable, while cerebellar atrophy developed in one patient during relapse. All patients were positive for serum anti-GAD65 antibodies; one also had anti-titin antibodies with elevated creatine kinase(CK). VOG in one patient demonstrated worsening saccadic velocity and pursuit gain during relapse, consistent with cerebellar dysfunction. Literature review of 61 articles showed that diplopia and nystagmus were the most frequently reported features, with characteristic vestibulo-ocular abnormalities including multistep saccades and square-wave oscillations. Based on clinical and literature findings, we further identified recurrent oculomotor patterns across cases. CONCLUSIONS: Ocular symptoms may represent early clinical features of anti-GAD antibody-associated neurological syndromes, although the temporal relationship may vary across patients and should be interpreted with caution in atypical cases. Downbeat nystagmus may serve as an early marker of cerebellar involvement. Longitudinal VOG provides objective insights into disease evolution. Importantly, we propose a structured oculomotor phenotype framework and highlight longitudinal VOG as a tool for tracking dynamic cerebellar dysfunction, which may facilitate earlier recognition and monitoring of disease progression.
Stroke risk factors and outcomes in Trinidad and Tobago: the START study.
Seecheran NA, Maharaj N, Swarath S … +25 more , Maharajh A, Gowrie-Sankar S, Charles R, Lobin R, Richard S, Battersby S, Rohit K, Nanan S, Rohit K, Maharaj R, Lalla A, Juman Z, Thackoorcharan S, Bissram S, Frederick JM, Ramcharan P, Seecheran V, Seecheran R, Peram L, Motilal S, Giddings S, Sandy S, Ramlackhansingh A, Maraj N, Panday A
BMC Neurol · 2026 Jun · PMID 42277678 · Full text
INTRODUCTION: This study aimed to assess the risk factors, associations and outcomes of stroke at an academic tertiary medical center in Trinidad and Tobago. METHODS: This cross-sectional observational study with longitu...
INTRODUCTION: This study aimed to assess the risk factors, associations and outcomes of stroke at an academic tertiary medical center in Trinidad and Tobago. METHODS: This cross-sectional observational study with longitudinal follow-up evaluated 546 patients admitted with stroke at the Eric Williams Medical Sciences Complex (EWMSC) from January 2023 to January 2024. Patients' comorbidities, medications, and neuroimaging findings were recorded. Disability and survival outcomes utilizing the modified Rankin Scale (mRS) were assessed during their inpatient status and at three months post-hospitalization. RESULTS: The average age represented was 65 years, with 56% males. Of a total of 546 patients who presented with acute neurologic deficits, 410 were diagnosed with a stroke, with the remaining 136 (25%) with a transient ischemic attack (TIA). Of the stroke cases, 328 (80%) were ischemic, 78 (19%) were hemorrhagic, and 5 (1%) were with ischemic lesions complicated by hemorrhagic transformation. The overall inpatient mortality rate was 16%, and the 3-month mortality rate was 26%. Gender was associated with an increased odds of having a stroke compared to a transient ischemic attack (p-value 0.036). Chronic kidney disease (CKD) was associated with an increased odds ratio (OR) of hemorrhagic stroke (OR = 11.10; 95% confidence interval (CI) 3.39-36.36, p-value 0.020). Diabetes mellitus (DM) (OR 1.72, 95% CI 1.08-2.73, p-value 0.02; OR 1.51, 95% CI 1.03-2.21; p-value 0.037), subarachnoid hemorrhage (SAH) (OR 5.45, 95% CI 1.72-17.32, p-value 0.004; OR 4.14, 95% CI 1.29-13.25, p-value 0.017), intraparenchymal hemorrhage (IPH) (OR 4.83, 95% CI 2.76-8.48, p-value < 0.001; OR 3.17, 95% CI 1.87-5.37, p-value < 0.001) and middle cerebral artery (MCA) infarct (OR 3.02, 95% CI 1.87-4.89, p-value < 0.001; OR 2.34, 95% CI 1.54-3.57, p-value < 0.001) were associated with in-hospital and 3-month mortality respectively. Atrial fibrillation (AF) (OR 2.47, 95% CI 1.08-5.64, p-value 0.031) was associated with in-hospital mortality. Age (OR 1.02, 95% CI 1.01-1.04, p-value 0.004), heart failure with reduced ejection fraction (HFrEF) (OR 4.88, 95% CI 1.15-20.68, p-value 0.032) and anterior cerebral artery (ACA) infarct (OR 2.27, 95% CI 1.13-4.56, p-value 0.022) were associated with 3-month mortality. Age was positively correlated with mRS (p-value 0.013). Ischemic stroke had a median mRS of 3, while hemorrhagic stroke had a median mRS of 5 (p-value < 0.001). CONCLUSION: This study demonstrated high-risk subgroups, disability and mortality outcomes in patients with stroke in Trinidad. Conventional risk factors such as age, CKD, DM, AF, and HFrEF with specific neuroradiologic findings (SAH, IPH, MCA and ACA infarcts) were all negatively associated with adverse outcomes in stroke patients in Trinidad. This information may be clinically pertinent in devising comprehensive strategies to attenuate stroke burden. Further, large-scale prospective studies are required to confirm these epidemiologic results. TRIAL REGISTRATION NUMBER: NCT05256550. This study was prospectively registered on 02/15/2022 on clinicaltrials.gov.
Clinical presentation domains and venous anatomical patterns in cerebral venous thrombosis: a retrospective cohort study.
Radfar A, Hooshmandi E, Ostovan VR … +4 more , Hooshmandi S, Poursadeghfard M, Fadakar N, Bayat M
BMC Neurol · 2026 Jun · PMID 42271279 · Full text
BACKGROUND: Cerebral venous thrombosis (CVT) presents with heterogeneous clinical manifestations that may partly reflect differences in venous anatomical involvement. However, systematic evaluation of structured clinical...
BACKGROUND: Cerebral venous thrombosis (CVT) presents with heterogeneous clinical manifestations that may partly reflect differences in venous anatomical involvement. However, systematic evaluation of structured clinical presentation domains in relation to distinct venous involvement patterns remains limited. METHODS: We conducted a retrospective observational cohort study of consecutive adult patients with radiologically confirmed CVT at a tertiary referral center between 2017 and 2025. Presenting symptoms were categorized into predefined, non-mutually exclusive clinical presentation domains, and venous anatomical involvement was classified as isolated superficial thrombosis, isolated parenchymal thrombosis, or combined superficial and parenchymal thrombosis. Domain distributions and overall presentation burden were compared across anatomical patterns, and associations between clinical domains and venous involvement were examined using multinomial logistic regression. RESULTS: Among 325 patients (median age 39.4 years; 68% female), superficial venous involvement was observed in 68.9%, combined involvement in 22.5%, and isolated parenchymal thrombosis in 8.6%. Intracranial hypertension-related presentation was independently associated with combined thrombosis compared with isolated superficial involvement (adjusted OR 3.30, 95% CI 1.07-10.14). Visual presentation was inversely associated with isolated parenchymal thrombosis (adjusted OR 0.20, 95% CI 0.04-0.94). Other clinical domains, including cortical irritation-related presentation and deep cerebral dysfunction, were not independently associated with venous anatomical patterns. Overall presentation burden did not differ significantly across anatomical groups. CONCLUSION: Predefined clinical presentation domains show selective but limited associations with venous anatomical patterns in CVT. Intracranial hypertension-related presentation was associated with combined venous involvement, whereas the inverse association between visual presentation and isolated parenchymal thrombosis should be interpreted cautiously. Substantial clinical overlap across anatomical groups underscores the complex and multifactorial nature of clinical-anatomical relationships in CVT. CLINICAL TRIAL REGISTRATION: Not applicable. This study was an observational retrospective cohort study and was not registered as a clinical trial.
Bilateral immune-mediated optic neuritis following HPV vaccination in an adolescent: diagnostic challenges and a rare clinical presentation.
Mohamed MSG, Alanazi RAI, Alharbi FMA
BMC Neurol · 2026 Jun · PMID 42265653 · Full text
BACKGROUND: Optic neuritis (ON) is an inflammatory condition of the optic nerve that causes damage to the myelin sheath and nerve fibers, leading to acute visual impairment. While often idiopathic, ON is increasingly rec...
BACKGROUND: Optic neuritis (ON) is an inflammatory condition of the optic nerve that causes damage to the myelin sheath and nerve fibers, leading to acute visual impairment. While often idiopathic, ON is increasingly recognized in association with immune-mediated triggers, including post-vaccination phenomena. The proposed pathophysiology involves molecular mimicry, where vaccine-induced antigens trigger a cross-reactive immune response against myelin basic protein. Distinguishing vaccine-associated ON from primary demyelinating diseases, such as Multiple Sclerosis (MS) or Neuromyelitis Optica Spectrum Disorder (NMOSD), poses as significant diagnostic challenge, particularly in adolescents. Prompt differentiation is essential to guide clinical management and therapeutic interventions. CASE PRESENTATION: We report a case of a previously healthy 15-year-old female who presented with a two week history of painful visual loss in the right eye, occurring seven days after quadrivalent HPV vaccination. Examination revealed marked asymmetry in visual acuity and a right-sided relative afferent pupillary defect (RAPD). Other cranial nerves (III-XII), motor, sensory, and cerebellar examinations were unremarkable; no papilledema was noted. Laboratory investigations and cerebrospinal fluid (CSF) analysis were normal, except for mild microcytic anemia. MRI of the brain, orbits, and spine demonstrated bilateral optic nerve and perineural enhancement without evidence of demyelinating plaques, confirming bilateral optic neuritis. Autoimmune serology and metabolic panels (ANA, B12, folate, zinc) were within normal limits; serum AQP4-IgG and MOG-IgG were not available at the time of writing the report. The patient received five days of intravenous methylprednisolone, resulting in substantial visual recovery at follow-up. CONCLUSION: This case demonstrates the diagnostic complexity of optic neuritis in adolescents and highlights the necessity of maintaining a high index of clinical suspicion for vaccine-associated immune-mediated events. Although bilateral optic neuritis temporally associated with vaccination is rare and the precise pathophysiological link remains a subject of ongoing debate, a thorough assessment of the clinical chronology and temporal relationship to immunization can facilitate a prompt diagnosis. Timely intervention with corticosteroids is essential to mitigate progression and prevent permanent visual sequelae. However, long-term longitudinal surveillance is mandatory to distinguish such monophasic episodes from the initial manifestation of a chronic demyelinating disease.
The neuroprotective and therapeutic potential of resveratrol for traumatic spinal cord injuries: a systematic review.
Moselmani M, Khayat D, Ajami S … +3 more , Mansour A, Rammal G, Alaaeddine N
BMC Neurol · 2026 Jun · PMID 42265649 · Full text
Traumatic spinal cord injuries are frequent CNS injuries that occur due to circumstances such as falls or accidents. Traumatic spinal cord injuries are more common in the older age group and in men, with high incidence a...
Traumatic spinal cord injuries are frequent CNS injuries that occur due to circumstances such as falls or accidents. Traumatic spinal cord injuries are more common in the older age group and in men, with high incidence and prevalence explained by the absence of an efficient pharmacological or neurosurgical treatment. Traumatic SCI can be classified as primary or secondary injuries that can eventually lead to death or physical dependence. Resveratrol is a stilbene polyphenol plant extract that has shown promising remedial effect on a wide spectrum of injuries and diseases including cardiovascular diseases, cancers, neurodegenerative diseases and CNS injuries. Many studies tried to pinpoint if there is any neuroprotective effect targeted against the damage caused by traumatic spinal cord injury. Therefore, the aim of this systematic review is to systemically assess and analyze these findings to take a stand from the hypothesis. This systematic review adheres to PRISMA guidelines (2020), when the process started by a comprehensive search strategy from 2015 to 2025 tailored for four databases. Primary and secondary screening were done to finally retrieve eight articles out of the initially discovered 456 studies. Data extraction, analysis and quality assessment were then done to synthesize the appropriate results and findings. The consistent results showed that resveratrol significantly modulates traumatic SCI and offers neuroprotection leading to improvement in motor function recovery as a result of preserving more motor neurons, upregulating autophagy but downregulating apoptosis, neuroinflammation, oxidative stress and ferroptosis through specific biochemical molecular pathways. Therefore, resveratrol shows promise for treating traumatic spinal cord injury which encourages the conduction of more robust preclinical studies and early phase clinical trials.
Time-dependent risk of sleep disorders in patients with epilepsy: a nationwide cohort study.
Lee SW, Kang C, Choi U … +2 more , Jung H, Bae Y
BMC Neurol · 2026 Jun · PMID 42265626 · Full text
BACKGROUND: Sleep disturbances are common yet underrecognized comorbidities in epilepsy, adversely affecting seizure control and quality of life. This study aimed to evaluate the long-term risk and risk factors of sleep...
BACKGROUND: Sleep disturbances are common yet underrecognized comorbidities in epilepsy, adversely affecting seizure control and quality of life. This study aimed to evaluate the long-term risk and risk factors of sleep disorders among patients with newly diagnosed epilepsy using a nationwide cohort with 10 years of follow-up. METHODS: Data were obtained from the Korean National Health Insurance Service (2002-2013). Newly diagnosed patients with epilepsy (ICD-10 codes G40-G41; n = 2,414) were matched by age and sex to controls (n = 24,140) without a prior history of sleep disorders (ICD-10 codes F51, G47). The primary outcome was the incidence of newly diagnosed sleep disorders. Incidence rates (IRs), incidence rate ratios (IRRs), and adjusted hazard ratios (aHRs) were calculated using multivariable and time-stratified Cox regression models. RESULTS: During follow-up, 15.0% of patients with epilepsy and 8.1% of controls developed sleep disorders, corresponding to IRs of 41.1 and 20.1 per 1,000 person-years (IRR = 2.05, 95% CI = 1.83-2.29). The risk was highest within the first two years after epilepsy diagnosis (aHR = 2.48, 95% CI = 1.93-3.11) and declined thereafter. Younger patients (< 60 years), men, and former smokers exhibited higher risks. CONCLUSIONS: Patients with epilepsy were associated with an increased risk of developing sleep disorders, particularly in the early post-diagnosis period and among younger male patients and former smokers. These findings emphasize the need for early screening and management. Future studies incorporating medication profiles and diverse populations may further clarify these associations.
Adult-onset ocular flutter-opsoclonus spectrum across diverse neurological disorders: a video-oculographic case series.
Skacik P, Sivak S, Kurca E
BMC Neurol · 2026 Jun · PMID 42260453 · Full text
BACKGROUND: Ocular flutter and opsoclonus are rare ocular motor disorders most often associated with paraneoplastic or autoimmune conditions, although their full aetiological spectrum in adults remains incompletely defin...
BACKGROUND: Ocular flutter and opsoclonus are rare ocular motor disorders most often associated with paraneoplastic or autoimmune conditions, although their full aetiological spectrum in adults remains incompletely defined. Because the distinction between ocular flutter and opsoclonus may be challenging using routine video-oculographic tracings alone, the broader term flutter-opsoclonus spectrum is used in this study. METHODS: We conducted a retrospective case series of adult patients evaluated between September 2024 and February 2026 at a tertiary neurology centre, in whom high-frequency saccadic oscillations consistent with the flutter-opsoclonus spectrum were documented using video-oculographic recordings alongside comprehensive neurological assessment. RESULTS: Five patients with distinct underlying disorders were identified, comprising autoimmune, neurodegenerative, prion-related, and demyelinating aetiologies. These included anti-glutamic acid decarboxylase stiff-person spectrum disorder, relapsing anti-NMDA receptor encephalitis with dual antibody positivity, multisystem atrophy of the cerebellar subtype, sporadic Creutzfeldt-Jakob disease, and advanced progressive multiple sclerosis. Flutter-opsoclonus spectrum abnormalities frequently co-occurred with additional ocular motor findings, including saccadic intrusions, various forms of nystagmus, and deficits of smooth pursuit and saccades. CONCLUSIONS: This series expands the recognised aetiological spectrum of adult-onset flutter-opsoclonus spectrum abnormalities and highlights their diagnostic value as clinical signs of potentially serious neurological disease. Objective eye-movement recording facilitates detection and should be considered in patients presenting with unexplained cerebellar syndromes, encephalopathies, or complex movement disorders.
Knowledge, attitude, and practice toward post-stroke depression among stroke caregivers: a cross-sectional study and path analysis.
Zhang W, Zhang H, Xu Y … +1 more , Fan H
BMC Neurol · 2026 Jun · PMID 42260430 · Full text
Post-stroke depression (PSD) significantly affects stroke recovery, and caregivers play a crucial role in managing this condition. However, little is known about caregivers' knowledge, attitude, and practice (KAP) regard...
Post-stroke depression (PSD) significantly affects stroke recovery, and caregivers play a crucial role in managing this condition. However, little is known about caregivers' knowledge, attitude, and practice (KAP) regarding PSD in China. This study aims to evaluate the KAP of caregivers of stroke patients concerning PSD and identify factors influencing these dimensions. A cross-sectional study was conducted at the China Rehabilitation Research Center, Beijing. A total of 497 valid questionnaires, covering demographic information, knowledge, attitude, and practice related to PSD, were collected from caregivers of stroke patients. Statistical analysis included descriptive statistics, logistic regression, and structural equation modeling (SEM). The mean age of caregivers was 42.65 ± 13.97 years, with the majority being women (62.98%) and married (81.49%). The average knowledge score was 18.37 ± 9.77 (57.4% of the maximum score), indicating insufficient knowledge. The scores of attitude and practice were 33.17 ± 3.89 (82.92%) and 22.51 ± 3.13 (90.04%), respectively, indicating a positive attitude and favorable practice. Significant differences were found in knowledge based on gender, education, income, stroke duration, and whether patients had undergone depression screening. Knowledge was positively associated with attitude (OR = 1.11, 95% CI: 1.08-1.15, p < 0.001) and practice (OR = 1.07, 95% CI: 1.02-1.12, p = 0.006). SEM analysis revealed positive associations between knowledge, attitude, and practice (all p < 0.001), with knowledge and attitude influencing practice. Caregivers exhibited insufficient knowledge about PSD, particularly regarding the recognition of PSD symptoms, its potential severity (e.g., association with self-harm or suicidal tendencies), and appropriate management strategies, but displayed positive attitudes and practices. Factors like stroke duration, depression screening, and caregiver education significantly influenced these dimensions. These knowledge gaps may limit caregivers' ability to identify and respond appropriately to PSD, despite their generally positive attitudes and practices. The findings suggest the need for targeted and structured educational interventions to improve caregivers' ability to recognize and manage PSD, which may ultimately enhance patient outcomes and caregiving quality.
Revision rate and postoperative volume development of chronic subdural hematomas after burr hole craniotomy in combination with tranexamic acid vs. surgery alone - a single-center propensity score-matched analysis.
Scheer M, Witte H, Guenzerodt P … +3 more , Beuchel V, Mauer UM, Schulz C
BMC Neurol · 2026 Jun · PMID 42260407 · Full text
BACKGROUND: Chronic subdural hematoma (cSDH) is a common intracranial hemorrhage in elderly patients and is associated with substantial postoperative recurrence rates. Tranexamic acid (TXA) has been proposed as an adjuva...
BACKGROUND: Chronic subdural hematoma (cSDH) is a common intracranial hemorrhage in elderly patients and is associated with substantial postoperative recurrence rates. Tranexamic acid (TXA) has been proposed as an adjuvant therapy to reduce recurrence by targeting hyperfibrinolysis; however, its efficacy and impact on hematoma volume evolution remain controversial. METHODS: We performed a retrospective cohort study of adult patients who underwent burr-hole evacuation with subdural drainage for cSDH at a single neurosurgical center between 2012 and 2024. Patients receiving postoperative TXA within 48 h for at least 30 days were compared with patients treated surgically without TXA. Propensity score matching (1:1) was applied to balance baseline characteristics. The primary outcome was revision surgery for recurrent cSDH within 3 months. Secondary outcomes included postoperative hematoma volume evolution and all-cause mortality. RESULTS: After matching, 73 patients were included in each group with well-balanced baseline characteristics. Revision surgery within 90 days occurred less frequently in the TXA group compared with controls (8.2% vs. 19.2%; OR 0.40, 95% CI 0.14-1.12; p = 0.042), although the confidence interval marginally crossed unity, indicating limited precision. Median time to revision was 8 days in the TXA group and 11 days in the control group. Mortality was numerically lower in the TXA group, with no deaths observed, compared with one death (1.4%) in the control group. Preoperative, postoperative, and one-month follow-up hematoma volumes were comparable between groups, and no significant difference in absolute volume reduction was detected. CONCLUSION: Postoperative adjuvant TXA therapy after surgical evacuation of cSDH was associated with a lower rate of recurrence requiring revision surgery, without an observed increase in mortality; however, the confidence interval marginally crossed unity, and the findings should be regarded as hypothesis-generating. TXA did not significantly influence short-term hematoma volume reduction. Prospective randomized studies are needed to confirm these findings and define optimal dosing strategies.
Endovascular treatment versus standard medical management in primary M3 or M4 occlusion stroke in clinical practice: the oriental-MeVO registry.
Zhu Y, Zhang C, Yang H … +10 more , Tao C, Li R, Jing X, Wang L, Liu T, Song J, Hu H, Wang A, Wang J, Hu W
BMC Neurol · 2026 Jun · PMID 42260395 · Full text
BACKGROUND: Clinical evidence of the potential treatment benefit of endovascular treatment (EVT) for M3 occlusion of the middle cerebral artery (MCA) is sparse. This study aims to compare EVT versus standard medical mana...
BACKGROUND: Clinical evidence of the potential treatment benefit of endovascular treatment (EVT) for M3 occlusion of the middle cerebral artery (MCA) is sparse. This study aims to compare EVT versus standard medical management (SMM) for acute M3 and M4 occlusion stroke. METHODS: This multicenter, retrospective study collected data on patients with acute ischemic stroke from an M3 or M4 occlusion from 25 comprehensive stroke centers between 09/2019 and 09/2024. The primary endpoint was the proportion of excellent outcome (modified Rankin Scale [mRS] 0-1) at 90 days. Safety measures included symptomatic intracranial hemorrhage (sICH) within 24 h and mortality at 90 days. RESULTS: A total of 342 patients with M3 or M4 occlusions were enrolled in the final analysis (EVT, 170; SMM, 172). In the primary analysis, there was no significant difference in EVT cohort versus SMM cohort regarding the rates of excellent outcome (mRS 0-1, 36.5% versus 37.2%, adjusted risk ratio [aRR], 0.88 [95% CI, 0.64-1.22]; P = 0.45), overall distribution of mRS score (adjusted common odds ratio [aOR], 0.94 [95% CI, 0.69-1.26]; P = 0.66), and functional independence (mRS 0-2, 53% versus 55.2%, aRR, 0.76 [95% CI, 0.55-1.05]; P = 0.10). There was no significant difference in safety measures between EVT and SMM cohorts in terms of sICH (aRR, 1.04 [95% CI, 0.63-1.72]; P = 0.85) and 90-day mortality (aRR, 0.76 [95% CI, 0.43-1.34]; P = 0.35). Successful revascularization was correlated with excellent outcome at 90 days (aRR, 2.79 [95% CI, 1.42-5.51]; P = 0.003) in the EVT cohort. CONCLUSIONS: EVT appears to be a safe and technically feasible treatment option for primary isolated M3 and M4 occlusions with clinical outcomes similar to SMM. TRIAL REGISTRATION: URL: www.chictr.org.cn; Unique identifier: ChiCTR2500096954, February 10, 2025.
Prophylactic anti-seizure medication for post-traumatic seizures in Chinese PICUs: current practices and knowledge gaps.
Ji J, Wang Q, Li Z … +3 more , Fang B, Wang L, Qian S
BMC Neurol · 2026 Jun · PMID 42260360 · Full text
OBJECTIVE: To evaluate current practices and asses knowledge gaps in the use of prophylactic anti-seizure medication (ASM) for managing pediatric post-traumatic epilepsy (PTE) in Mainland China, with a particular focus o...
OBJECTIVE: To evaluate current practices and asses knowledge gaps in the use of prophylactic anti-seizure medication (ASM) for managing pediatric post-traumatic epilepsy (PTE) in Mainland China, with a particular focus on clinical decision-making of pediatric intensive care unit (PICU) physicians. METHODS: A nationwide cross-sectional survey of 271 physicians across 30 tertiary hospital PICUs in 23 provinces was conducted between December 2023 and March 2024. The questionnaire assessed ASM utilization, treatment selection and duration, management of adverse events, and awareness of PTE risk factors. Descriptive statistics were used for data analysis. RESULTS: Among the surveyed physicians, 72.7% reported prescribing prophylactic ASM, with levetiracetam (52.3%), phenobarbital (23.4%), and sodium valproate (22.3%) being the most common. The duration of treatment varied considerably: 29.4% of physicians continued prophylactic ASM up to 3 months following traumatic brain injury, whereas 22.3% of them limited the course to ≤ 7 days. Routine electroencephalogram monitoring was conducted by 78.7% of physicians. Common adverse events, including hepatotoxicity, rashes, and cognitive effects, were reported by 40.6% of the physicians. Notably, 85% of physicians continued ASM despite observing these complications. Hence, substantial knowledge gaps exist, particularly regarding the criteria for discontinuing ASM. SIGNIFICANCE: Significant variability exists in prophylactic ASM practices across PICUs in China, influenced by inconsistent adherence to guidelines, physician experience, and interdisciplinary collaborations. These findings highlight the urgent need to develop standardized protocols and conduct evidence-based training to optimize PTE prevention. Further research is warranted to device individualized ASM regimens tailored to the severity of the injury, age of the patients, and neurodevelopmental outcomes.
Combined assessment of triglyceride-glucose index and stress hyperglycemia ratio to predict all-cause mortality in critically ill patients with intracerebral hemorrhage.
Song C, Hu Z, Zhang J
BMC Neurol · 2026 Jun · PMID 42252426 · Full text
BACKGROUND: The triglyceride-glucose (TyG) index and stress hyperglycemia ratio (SHR) are emerging biomarkers in cerebrovascular disease, but their combined prognostic value for mortality among critically ill patients wi...
BACKGROUND: The triglyceride-glucose (TyG) index and stress hyperglycemia ratio (SHR) are emerging biomarkers in cerebrovascular disease, but their combined prognostic value for mortality among critically ill patients with intracerebral hemorrhage (ICH) has not been well elucidated. Therefore, this study aimed to assess the prognostic value of the combined TyG index and SHR for all-cause mortality in patients with ICH. METHODS: This retrospective study included patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Based on the quartiles of the TyG index and the median of the SHR, the study cohort was categorized into eight groups. The primary outcome was 28-day all-cause mortality, with in-hospital all-cause mortality as the secondary outcome. The association of the combined TyG index and SHR with all-cause mortality was assessed through Kaplan-Meier curves, Cox proportional hazards regression models, restricted cubic splines (RCS) curves, and subgroup analyses. RESULTS: The study included a total of 1,095 patients with a median age of 72.73 years (IQR 61.65-82.46), of whom 53.70% were male. The 28-day mortality and in-hospital mortality rates were 20.37% and 15.16%, respectively. Compared to the reference group (TyG ≤ 9.15 and SHR ≤ 1.02), patients with TyG > 9.15 and SHR > 1.02 demonstrated the highest risk for both 28-day mortality (HR 2.483, 95% CI 1.497-4.121) and in-hospital mortality (HR 3.182, 95% CI 1.604-6.310). The ROC also confirmed the combined TyG index and SHR had more robust predictive power for 28-day mortality and in-hospital mortality than the TyG index and SHR itself. Subgroup analyses further revealed consistent associations of the combined TyG index and SHR with both 28-day mortality and in-hospital mortality. CONCLUSIONS: Combined TyG index and SHR assessment served as a critical prognostic tool for critically ill patients with ICH.
Management of Bell's palsy in a 2-month-old following COVID-19 infection: a case report and review of the literature.
Bannout AA, Hussein FH, Haddad LR
BMC Neurol · 2026 Jun · PMID 42251316 · Full text
BACKGROUND: Bell's palsy (idiopathic peripheral facial nerve paralysis) is uncommon in children and is particularly rare in infants younger than one year of age. Its occurrence following viral infections, including coron...
BACKGROUND: Bell's palsy (idiopathic peripheral facial nerve paralysis) is uncommon in children and is particularly rare in infants younger than one year of age. Its occurrence following viral infections, including coronavirus disease 2019 (COVID-19), is exceedingly rare. We report a case of Bell's palsy in an infant following COVID-19 infection and provide a review of the relevant pediatric literature. CASE PRESENTATION: We report the case of a 2-month-old female infant who developed left-sided facial weakness shortly after a COVID-19 infection. She had previously been healthy, except for a COVID-19-positive upper respiratory infection at the age of 4 weeks. Three weeks after her infection resolved, her parents noticed the sudden onset of left facial drooping, which progressed over the following three days. A diagnosis of peripheral facial nerve palsy following COVID-19 infection was proposed. Given the absence of clear treatment guidelines for infants, management options were carefully considered. The patient was ultimately started on oral prednisolone in addition to protective eye care. She demonstrated gradual clinical improvement during treatment, and at follow-up several weeks later, complete recovery of normal facial movement was observed. CONCLUSIONS: This case highlights that Bell's palsy, although extremely rare in infancy, may occur following a viral infection such as COVID-19. A prompt and thorough evaluation is essential to exclude alternative causes of facial paralysis. Despite no clear guidelines or recommendations favoring corticosteroid treatment vs conservative management in this age category, a decision of pharmacologic treatment was taken. In this case, corticosteroid treatment was well tolerated, and no adverse events were observed. Further studies are needed to evaluate the correlation between COVID-19 infection and facial palsy in infants, and to further assess the efficacy and safety of oral prednisolone in this age group.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe