The Neurologist[JOURNAL]
Sun
200 papers
Off-label Use of Intravenous Thrombolysis in an Acute Ischemic Stroke Patient With Multiple Contraindications.
Kargiotis O, Tsiamaki E, Angelopoulou A … +6 more , Zafeiropoulou I, Gkliati M, Zampakis P, Chroni E, Tsivgoulis G, Ellul J
Neurologist · 2026 May · PMID 41912449 · Publisher ↗
INTRODUCTION: Intravenous thrombolysis (IVT) is a powerful treatment for acute ischemic stroke, yet its use remains limited due to numerous absolute and relative contraindications. CASE REPORT: We present the case of a 5...
INTRODUCTION: Intravenous thrombolysis (IVT) is a powerful treatment for acute ischemic stroke, yet its use remains limited due to numerous absolute and relative contraindications. CASE REPORT: We present the case of a 54-year-old man who received intravenous thrombolysis (IVT) for an early recurrent wake-up ischemic stroke caused by a tandem left internal carotid artery and M2 middle cerebral artery occlusion, occurring <48 hours after the initial ischemic event, which had been misdiagnosed as a peripheral-type facial nerve palsy. Moreover, in the context of the initial work-up, the patient had undergone a diagnostic lumbar puncture <24 hours before IVT. Despite the history of a very recent acute ischemic stroke, which is listed as a contraindication for IVT, as well as the recent lumbar puncture, the patient demonstrated marked clinical improvement without any complications. CONCLUSION: IVT may be considered even in the presence of multiple relative contraindications, provided the risks and benefits are carefully weighed for each patient.
Clinical Utility of POCUS Hands-On Training Course in Neurocritical Care: Trainee's Perspective.
Liu CH, Hsieh MJ, Tang SC … +4 more , Lu JX, Huang ES, Jeng JS, Chan L
Neurologist · 2026 May · PMID 41912447 · Publisher ↗
OBJECTIVES: Few studies have evaluated the applicability of a point-of-care ultrasound (POCUS) training program in neurocritical care. In this study, we aimed to investigate the clinical utility of expert-endorsed topics...
OBJECTIVES: Few studies have evaluated the applicability of a point-of-care ultrasound (POCUS) training program in neurocritical care. In this study, we aimed to investigate the clinical utility of expert-endorsed topics of the integrated POCUS program from a trainee's perspective. METHODS: Between 2022 and 2024, we held an annual "1-day POCUS hands-on training program." The program was comprised of a "3-hour lecture" followed by a "5-hour hands-on workshop" on the following topics: carotid duplex examination, transcranial color-coded Doppler techniques, ultrasound examination for posterior circulation, chest ultrasonography, and echocardiography. Sixty trainees were recruited each year and were separated into 10 groups during hands-on workshop rotation. The trainees were asked to complete an anonymous survey after the workshop to evaluate their opinions, which was rated using a 5-point Likert scale and open questions. In addition, the trainees were required to complete multiple-choice tests both before and after the lecture. RESULTS: A total of 179 trainees (85 attending physicians and 94 resident doctors) were recruited. The median clinical utility rating scores were 5 for all topics, and the mean score was highest for the carotid duplex lecture (4.91±0.29) and lowest for the echo-guided lumbar puncture lecture (4.38±0.97). In addition, the mean posttest score was significantly higher than the pretest score (9.65±1.86 vs. 7.69±1.70, P <0.001). CONCLUSIONS: Our study suggested the POCUS topics suitable for neurocritical care should integrate medical care and cerebral vascular evaluations, including anterior and posterior circulation. Our results may help to guide training courses and assessment tool design in the future.
Ischemic Stroke and Mitral Annular Caseous Calcification: A Neglected Embolic Risk in Cardio-Neurological Interface?
Yilmaz E, Duzgun SA, Arsava EM … +4 more , Çakir BS, Soylu ZB, Hazirolan T, Topcuoglu MA
Neurologist · 2026 May · PMID 41912382 · Publisher ↗
OBJECTIVES: Case reports indicate that caseous mitral annulus calcification (MAC), also termed mitral annulus caseous granuloma, may contribute to stroke and systemic embolism. This retrospective case-control study aimed...
OBJECTIVES: Case reports indicate that caseous mitral annulus calcification (MAC), also termed mitral annulus caseous granuloma, may contribute to stroke and systemic embolism. This retrospective case-control study aimed to assess the prevalence of caseous MAC detected through cardiac computed tomography (CT) in an acute stroke cohort and to identify factors associated with its occurrence. METHODS: A total of 149 patients with acute ischemic stroke who underwent emergency cardiac CT, 300 acute ischemic stroke patients who did not undergo cardiac CT, and 268 individuals who underwent cardiac CT but had no history of stroke were included. The first group was consecutively selected (January 2022 to November 2024), while the other 2 groups were identified through propensity matching based on age and sex. Various regression models were applied to determine the degree of association. RESULTS: Caseous MAC was detected in 5.4% of stroke patients who underwent cardiac CT, a prevalence significantly higher than in the control group (1.1%, P =0.02). Regression models demonstrated that caseous MAC significantly ( P =0.011) and independently increased stroke risk by a factor of 7.57 to 10.81 (95% CI: 1.54-36.20). CONCLUSIONS: These findings suggest that caseous mitral annulus calcific granuloma may be a potential cause of embolic stroke. Further prospective, multicenter studies are needed to validate these results.
Cerebral Flow Dysregulation Encephalopathy Following Carotid Stenting Procedure: Multiparametric CT and EEG Characteristics.
Ricci E, Furlanis G, Ajčević M … +9 more , Vincis E, Prandin G, Mancinelli L, Palacino F, Quagliotto M, Caruso P, Ukmar M, Naccarato M, Manganotti P
Neurologist · 2026 May · PMID 41875075 · Full text
INTRODUCTION: Cerebral hypoperfusion syndrome (CHS) involves a range of neurological symptoms originally recognized as a complication of carotid endarterectomy but also observed after carotid artery stenting. CHS is a ra...
INTRODUCTION: Cerebral hypoperfusion syndrome (CHS) involves a range of neurological symptoms originally recognized as a complication of carotid endarterectomy but also observed after carotid artery stenting. CHS is a rare cause of stroke mimic, posing a challenging differential diagnosis, especially in the hyperacute phase. CASE PRESENTATION: In this case report, we investigate the potential diagnostic and predictive roles in the acute phase through a novel approach using multiparametric CT [including non-enhanced CT (NECT), single-phase CT angiography (CTA), perfusion CT (CTP)] and electroencephalogram (EEG) in a 75-year-old male with acute hypoperfusion encephalopathy/cerebral flow dysregulation after carotid stenting. Follow-up imaging was performed with NECT, CTP, and EEG at 24 and 72 hours. CONCLUSIONS: This clinical case supports the hypothesis that multiparametric CT, combined with EEG and clinical evaluation, may be useful in the differential diagnosis between CHS, ischemic events, status epilepticus, and stroke mimics in the emergency setting. Moreover, the repeated use of these tests offers a valuable and innovative approach to monitoring the clinical progression of this condition.
Safety and Effectiveness of Routine Tenecteplase Use in a Large Telestroke Network.
Dutta A, Sarkar A, Gupta S … +39 more , Chakraborty U, Mondal C, Banerjee S, Das D, Paul A, Samanta SS, Sarkar S, Chakrabarty S, Barik C, Bhowmick D, Jatua SK, Das S, Misra S, Ray B, Das P, Das B, Das B, Naskar A, Roy D, Biswas B, Das AK, Das D, Sarkar A, Alam R, Pal K, Das KK, Datta SK, Ghosh S, Naskar SK, Majumdar P, Ghosh AK, Sen S, Ghosh S, Mandal NC, Datta SS, Biswas AK, Saren S, Bandopadhyay M, Ray BK
Neurologist · 2026 May · PMID 41775282 · Publisher ↗
OBJECTIVES: Tenecteplase is an emerging alternative to Alteplase in the management of acute ischemic stroke (AIS). Strong evidence supports the noninferiority of Tenecteplase compared with Alteplase in AIS. Tenecteplase...
OBJECTIVES: Tenecteplase is an emerging alternative to Alteplase in the management of acute ischemic stroke (AIS). Strong evidence supports the noninferiority of Tenecteplase compared with Alteplase in AIS. Tenecteplase is often preferred due to its affordability, ease of administration, and superior recanalization potential in large vessel occlusion. In this study, we report on the safety and effectiveness of routine Tenecteplase use in a large telestroke network in eastern India. METHODS: This retrospective observational study analyzes patient records collected under the Swasthya Ingit Telestroke Program in West Bengal, India. AIS patients who underwent thrombolysis in the 41 hospitals of the Swasthya Ingit Telestroke Network between January 2022 and December 2024 were included in this study. Patients receiving Tenecteplase were compared with those receiving Alteplase. The percentage of patients achieving a good outcome (defined as a score of 0 to 2 on the modified Rankin scale at 90 d), the rate of symptomatic intracranial hemorrhage, and all-cause mortality within 3 months were the main parameters of comparison between the 2 thrombolytic agents. RESULTS: A total of 1526 patients were included in this study. Of these, 1389 patients received Tenecteplase, while 137 patients received Alteplase. Mixed-effects multivariable logistic regression did not demonstrate any association between the thrombolytic agent used and favorable outcomes [Tenecteplase odds ratio: 1.03 (95% CI: 0.56-1.87), P =0.93], symptomatic intracranial hemorrhage [Tenecteplase odds ratio: 0.63 (95% CI: 0.21-1.87), P =0.41], or all-cause mortality [Tenecteplase odds ratio: 0.54 (95% CI: 0.24-1.24), P =0.15]. CONCLUSION: The routine use of Tenecteplase for managing acute ischemic stroke appears to be safe and effective in real-world practice.
Optical Coherence Tomography Abnormalities in NOTCH3 Mutation Carriers: A Matched Case-Control Study From UK Biobank.
Vallamchetla SK, Badr A, Li X … +4 more , Wang Y, Meschia JF, Dumitrascu OM, Lin MP
Neurologist · 2026 May · PMID 41662691 · Publisher ↗
OBJECTIVES: This study aims to identify retinal biomarkers of NOTCH3 mutation carriers using optical coherence tomography (OCT) data from the UK Biobank. METHODS: We conducted a cross-sectional, matched case-control stud...
OBJECTIVES: This study aims to identify retinal biomarkers of NOTCH3 mutation carriers using optical coherence tomography (OCT) data from the UK Biobank. METHODS: We conducted a cross-sectional, matched case-control study of individuals with or without NOTCH3 mutation from the UK Biobank between 2006 and 2010. All participants had macular OCT scan and cognitive assessment. Cases were identified based on pathogenic/likely pathogenic NOTCH3 mutations and 1:1 matched with controls based on age, sex, hypertension, diabetes mellitus, and cigarette smoking status. Baseline characteristics and cognitive test scores were compared using χ 2 or Mann-Whitney U test appropriately. Macular thickness at central, inner, and outer subfields and at each retinal layer was compared using Wilcoxon signed-rank test. RESULTS: Our analysis included 134 participants (67 cases, 67 controls) with a mean age of 54 ± 9 years. NOCTH3 mutation carriers performed worse in prospective memory ( P =0.043), verbal and numerical reasoning ( P =0.178), visual memory ( P =0.227), and processing speed ( P =0.101) than matched controls. There were no differences in visual acuity between the 2 groups. NOTCH3 mutation carriers had significantly thinner macular inner subfield at the superior ( P =0.006), temporal ( P =0.008), and nasal ( P =0.034) quadrants, and significantly thinner macular RNFL ( P =0.008) compared with age-, sex-, and vascular risk factor-matched controls. CONCLUSION: The presence of NOTCH3 mutation is associated with reduced thickness in the inner macular subfield and macular RFNL. These retinal changes may reflect early pericyte dysfunction and microvascular ischemia. Longitudinal studies are needed to assess the temporal relationship between these retinal changes, cerebrovascular disease progression, and clinical severity of disease.
Observation of the Angioplasty Effect of Stent-Retriever Thrombectomy in Acute Intracranial Atherosclerotic Artery Stenosis: A Case Series Analysis.
Cai X, Zhu K, Wang Y … +3 more , Chen H, Xiao C, Sun J
Neurologist · 2026 May · PMID 41636284 · Full text
Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of ischemic stroke worldwide, and endovascular treatment is the primary therapeutic approach, but the clinical recanalization rate is low. Cli...
Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of ischemic stroke worldwide, and endovascular treatment is the primary therapeutic approach, but the clinical recanalization rate is low. Clinical practice has revealed the occurrence of an angioplasty effect following endovascular treatment, which may explain the low recanalization rate. Four patients with ICAS who underwent endovascular therapy were included in this retrospective case series. Demographic, medical histories, treatment, and outcome data were extracted. After undergoing stent-retriever thrombectomy, patients were monitored to assess whether the stenosis showed transient improvement only. The blood flow was observed for 10 to 30 minutes by digital subtraction angiography (DSA), and stent implantation was considered. Clinical data were collected on 4 patients with ICAS who received endovascular treatment. Therefore, we propose the angioplasty effect of stent-retriever thrombectomy, which holds significant value in guiding endovascular treatment.
Development and Validation of a Grading Scale to Predict Functional Outcome in Acute Stroke Patients Treated With intravenous Thrombolytics in the Rural Setting.
Loggini A, Bonin Pinto C, Hornik J … +6 more , Robayo LB, Schwertnam A, Dallow K, Knapp L, Hornik A, Saleh Velez FG
Neurologist · 2026 Mar · PMID 41575839 · Publisher ↗
OBJECTIVES: To develop an accurate and easy-to-use predictive tool of short-term functional outcome for ischemic stroke patients treated with thrombolysis in the rural setting. METHODS: This multicenter retrospective stu...
OBJECTIVES: To develop an accurate and easy-to-use predictive tool of short-term functional outcome for ischemic stroke patients treated with thrombolysis in the rural setting. METHODS: This multicenter retrospective study involved the Southern Illinois Healthcare rural stroke network registry as derivative cohort, and the University of Oklahoma Health Sciences Center stroke database as validation cohort. Demographics, clinical, laboratory, and radiographic data were collected. Short-term outcome at 30 days was divided in good (mRS ≤2) bad (mRS ≥5). A backward logistic regression analysis was developed by clinical significance of the dependent variables and a 5-point predictive score system was developed based on clinical plausibility and practicality. Calibration curve was designed. The score was tested on the validation cohort. P value was set at 0.05 for all statistical analyses. RESULTS: Of 222 patients included in the derivation cohort, 35 (16%) had poor short-term outcome. In a backward logistic regression model, baseline mRS (OR: 1.511, 95% CI: 1.047-2.182, P =0.02), and NIHSS (OR: 1.136, 95% CI: 1.063-1.214, P <0.01) were independently associated with poor short-term outcome. Age also had a strong trend toward significance (OR: 1.045, 95% CI: 0.995-1.093, P =0.05). Additional variables were re-entered in the final predictive model based on clinical plausibility and practicality. The 5-point predictive score was then created adding one point for each of the following variables: age >75, cardiac disease, baseline mRS >2, NIHSS ≥20, and GFR <40. The c-statistic of the model was 0.79, 95% CI: 0.71-0.87. In the validation cohort of 200 patients, the model performed with a c-statistic of 0.75, 95% CI: 0.64-0.86. Good outcome was predicted with a c-statistic of 0.71, 95% CI: 0.64-0.77 in the derivation cohort, and 0.69, 95% CI: 0.62-0.76 in the validation cohort. CONCLUSIONS: This predictive score is an accurate and easy-to-use tool to help providers in the rural settings facilitate early conversations with stroke patients and their families. Providing rural settings with affordable and accurate prognostic tools is a crucial step in bridging the gap in stroke care between urban and rural settings.
Variability in Lumbar Puncture Assessment in Patients With Papilledema From Idiopathic Intracranial Hypertension: A Multi-Institutional Review.
Richman M, Foroozan R
Neurologist · 2026 Mar · PMID 41575836 · Publisher ↗
OBJECTIVES: The evaluation of papilledema often requires lumbar puncture (LP) to measure opening pressure and analyze cerebrospinal fluid (CSF). However, opening pressure can be reported in different units (eg, cm H 2 O,...
OBJECTIVES: The evaluation of papilledema often requires lumbar puncture (LP) to measure opening pressure and analyze cerebrospinal fluid (CSF). However, opening pressure can be reported in different units (eg, cm H 2 O, mm Hg), and the ordering practices of CSF constituents can vary. This study aims to evaluate the pattern of opening pressure assessment and CSF laboratory ordering practices in patients with papilledema due to idiopathic intracranial hypertension (IIH). METHODS: This was a retrospective review across 3 institutions based in Houston, TX. Information was obtained for patients with optic disc edema suspected of papilledema due to IIH who presented between 2009 and 2024. Patients were included if their records contained an LP procedure note for the evaluation of papilledema. Opening pressure units and CSF constituents were recorded. RESULTS: A total of 227 charts were included, consisting of 317 opening pressure measurements and 245 cases with at least 1 documented CSF laboratory order. We found that units of measurement for opening pressure were reported as cm H 2 O (71%), cm (10%), no units (9%), mm H 2 O (3%), mm Hg (3%), cm CSF (2%), mm (1%), and cm/H 2 O (1%). Among the CSF samples sent for analysis, 99% included cell count, 97% included glucose, 95% included protein, 75% included culture, and 35% included additional laboratory measures. CONCLUSIONS: Inconsistencies in LP measurement units and CSF laboratory orders may lead to misinterpretation, potentially impacting patient care for those suspected of having papilledema due to IIH. We recommend greater standardization of the assessment of LP results for those undergoing evaluation for papilledema suspected due to IIH.
Early Institution of Immunotherapy Alters the Course of Temporal Lobe Epilepsy With GAD65 Antibody: A Clinical Report.
Pump H, Feyissa AM
Neurologist · 2026 Mar · PMID 41575783 · Publisher ↗
INTRODUCTION: Glutamic acid decarboxylase 65 (GAD65) antibody-associated temporal lobe epilepsy (GAD65-TLE) is a rare form of autoimmune-associated epilepsy characterized by medically refractory seizures and cognitive de...
INTRODUCTION: Glutamic acid decarboxylase 65 (GAD65) antibody-associated temporal lobe epilepsy (GAD65-TLE) is a rare form of autoimmune-associated epilepsy characterized by medically refractory seizures and cognitive decline. Diagnosis typically requires antibody testing and clinical correlation, and treatment options include immunotherapy and antiseizure medications (ASMs). However, many patients experience persistent or worsening symptoms despite ongoing treatment. CASE REPORT: A 20-year-old woman presented with mild cognitive impairment and focal aware seizures that gradually progressed in frequency and severity. A diagnostic workup revealed GAD65-TLE, and the patient began treatment with intravenous methylprednisolone infusions and antiseizure medications within 6 months of her presentation. After 20 months of treatment, the patient was on stable doses of levetiracetam and lamotrigine and finished tapering immunosuppressive therapy with methylprednisolone. The frequency of her focal aware seizures significantly decreased, whereas the focal impaired aware and focal bilateral tonic-clonic seizures resolved. The patient was able to return to all of her previous daily activities. CONCLUSIONS: In patients presenting with new-onset seizures characterized by unusual semiology and frequent focal aware seizures, it is crucial to consider GAD65-TLE in the list of potential diagnoses. Delayed diagnosis may lead to resistance to both ASMs and immunotherapy. This case report emphasizes how prompt identification and early initiation of immunotherapy can significantly impact the course of the disease.
Cervical Artery Dissection Diagnosed Following Chiropractic Cervical Manipulation: A STOP-CAD Subanalysis.
Aleyadeh R, Zedde M, Marto JP … +40 more , Henninger N, Said J, Frontera JA, Sharma R, Leker RR, Secchi TL, Indraswari F, Quereshi AY, Zhou LW, Poppe AY, Nzwalo H, Wall VC, Fonseca AC, Klein P, Liebeskind DS, Martins SCO, Ghannam M, Dantu V, Ortiz Gracia JG, De Marco G, Bakradze E, Penckofer M, Balabhadra A, Omran SS, Chang C, Leon Guerrero CR, Muddasani V, von Rennenberg R, Guo X, Elangovan C, AlMajali M, Velez FS, Shahripour RB, Mandel DM, Zubair A, Elnazeir M, Krishnaiah B, Stretz C, Yaghi S, Maalouf N
Neurologist · 2026 Mar · PMID 41557514 · Publisher ↗
OBJECTIVES: Cervical artery dissection (CeAD) is an important cause of ischemic stroke in young adults. Nearly 100 million annual chiropractic cervical manipulations are performed in the United States. The relationship b...
OBJECTIVES: Cervical artery dissection (CeAD) is an important cause of ischemic stroke in young adults. Nearly 100 million annual chiropractic cervical manipulations are performed in the United States. The relationship between manipulation and CeAD remains controversial. METHODS: We analyzed patients in the multicenter STOP-CAD registry (n=4023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between manipulation-associated and nonmanipulation-associated cases using χ 2 and t tests. Multivariable logistic regression identified key factors associated with manipulation-related CeAD. RESULTS: About 1 in 20 CeAD cases in this registry reported antecedent cervical manipulation. In multivariable binary logistic regression, compared with patients without prior manipulation, those with prior manipulation were younger (OR per year 0.98, 95% CI: 0.97-0.99, P =0.014), more often female (OR: 1.64, 95% CI: 1.21-2.23, P =0.001), less often diabetic (OR: 0.24, 95% CI: 0.08-0.78, P =0.018), presented with neck pain (OR: 2.80, 95% CI: 2.08-3.77, P <0.001), and had higher odds of isolated vertebral artery dissection (OR: 2.15, 95% CI: 1.57-2.94, P <0.001). Recurrent ischemic stroke rates were similar between groups. CONCLUSIONS: Given the very high number of manipulations performed annually, the absolute risk of secondary CeAD is extremely low. Manipulation-associated cases have distinct clinical features, occurring more often in younger women with vertebral dissections. Whether manipulation acts as a precipitating trigger or patients with early CeAD symptoms seek manipulation remains unresolved.
Application of Artificial Intelligence in the Diagnosis and Treatment of Moyamoya Disease: Current Status, Challenges, and Future Prospects.
Ying P, Wu H, Ren H … +1 more , Li L
Neurologist · 2026 Mar · PMID 41553732 · Publisher ↗
BACKGROUND: Various artificial intelligence-based medical technologies have been used for diagnosing and treating diseases. Although moyamoya disease (MMD) poses a significant threat to the lives of patients, artificial...
BACKGROUND: Various artificial intelligence-based medical technologies have been used for diagnosing and treating diseases. Although moyamoya disease (MMD) poses a significant threat to the lives of patients, artificial intelligence (AI) use in MMD is still limited. REVIEW SUMMARY: This study aims to review the literature on predicting, diagnosing, and treating MMD with AI, as well as to discuss its current status, challenges, and future directions. Using AI in treating MMD can enhance diagnostic accuracy and treatment outcomes. AI-driven imaging analysis aids in the early detection of vascular abnormalities linked to MMD, facilitating timely intervention and management. In addition, machine learning (ML) algorithms can analyze large data sets from clinical trials and patient records to identify patterns and predict outcomes, informing personalized treatment plans. CONCLUSIONS: AI has shown great potential in the diagnosis and treatment of MMD. The application of AI in treating MMD represents a promising frontier that may revolutionize clinical practices.
Eculizumab as a Fast-Acting Therapy in a Myasthenic Crisis Patient With Poor Response to Efgartigimod: A Case Report.
Zhang Z, Guo X, Luo T … +6 more , Yang M, Ma T, Du X, Wang Z, Huang X, Zhang Y
Neurologist · 2026 Mar · PMID 41553721 · Publisher ↗
INTRODUCTION: Myasthenic crisis (MC) is the most serious manifestation of myasthenia gravis (MG) and it poses a big challenge in clinical management. Plasma exchange and intravenous immunoglobulin are the first-line ther...
INTRODUCTION: Myasthenic crisis (MC) is the most serious manifestation of myasthenia gravis (MG) and it poses a big challenge in clinical management. Plasma exchange and intravenous immunoglobulin are the first-line therapy for MC, but a subset of patients exhibit poor response. Recently, neonatal Fc receptor (FcRn) inhibitors and complement inhibitors showed great efficacy in MC. However, there is no report on whether eculizumab can serve as a rescue therapy for patients who have not responded to efgartigimod. CASE REPORT: This case report describes a Chinese patient with generalized MG who experienced an acute exacerbation and suffered from MC. Despite poor responsiveness to efgartigimod, the patient was successfully rescued with eculizumab. Under regular treatment with eculizumab once every 2 weeks, the patient achieved a status of minimal symptom expression. However, the efficacy of eculizumab in MC has yet to be confirmed through more clinical trials. CONCLUSIONS: This case report hints the potential of complement inhibitors as viable treatments alternative for MC patients who poorly respond to antibody-clearing therapy. Besides, further research is necessary to determine the preferred or suitable treatment option for specific patients.
Cluster Analysis of Different Impaired Cognitive Domains in Patients With Post-Stroke Cognitive Impairment.
Ma Y, Li W, Yang T … +4 more , He X, Yang Y, Tang Y, Han L
Neurologist · 2026 Mar · PMID 41439427 · Publisher ↗
OBJECTIVES: A cluster analysis was conducted to classify the 7 different cognitive domains affected by PSCI patients, to explore the correlation and similarity between cognitive domains and provide a basis for targeted i...
OBJECTIVES: A cluster analysis was conducted to classify the 7 different cognitive domains affected by PSCI patients, to explore the correlation and similarity between cognitive domains and provide a basis for targeted intervention. METHODS: We collected demographic and disease-related data from 724 PSCI patients. We used Python 3.8 software to perform K-means clustering and hierarchical clustering on the 7 cognitive domains assessed by the MoCA scale, and used the silhouette coefficient to determine the optimal number of clusters k. RESULTS: The results of K-means clustering and hierarchical clustering show that the 7 dimensions of MoCA can be grouped into 2 categories. Cluster 1 scored lower in the cognitive areas of visual space and executive function, attention, language, abstraction, and delayed recall, whereas cluster 2 had higher scores in the naming and orientation domains. The scores in all cognitive domains of cluster 1 are lower than those of cluster 2, indicating severe cognitive impairment. Compared with cluster 2, the subjects in cluster 1 have poor physical health, living conditions, economic status, and social support ability. CONCLUSIONS: The 7 dimensions of MoCA can be divided into 2 categories. In clinical practice, health care professionals should pay special attention to the severity of the patient's condition, the affected area, and individual differences, and develop precise and personalized treatment plans to improve the patient's cognitive function and quality of life.
"Inverse" Foster Kennedy Syndrome: A Case Report.
Hosny R
Neurologist · 2026 Mar · PMID 41431965 · Publisher ↗
INTRODUCTION: Foster Kennedy syndrome classically occurs in frontal space-occupying lesions (SOL). It describes the appearance of optic atrophy in one eye and optic nerve swelling in the other. Optic atrophy occurs due t...
INTRODUCTION: Foster Kennedy syndrome classically occurs in frontal space-occupying lesions (SOL). It describes the appearance of optic atrophy in one eye and optic nerve swelling in the other. Optic atrophy occurs due to direct compression from lesion (on the ipsilateral side) and optic nerve head swelling occurs due to increased intracranial tension due to mass effect (on the contralateral side). CASE REPORT: We report a case of a 37-year-old female presenting with a right SOL, yet left optic nerve atrophy and right optic nerve head swelling; inverse Foster Kennedy syndrome. CONCLUSION: Inverse Foster Kennedy syndrome is a rare entity that should be taken into consideration when reviewing a patient with optic atrophy in one eye and swelling in the other.
Efficacy of Carotid Artery Stenting Without Embolic Protection Device for Carotid Stenosis: A Retrospective Cohort Study from a Major Neurointerventional Center.
Siroos S, Taheri M, Rahmatian A … +3 more , Firouznia K, Khazaei M, Ghanaati H
Neurologist · 2026 Jan · PMID 41355753 · Publisher ↗
OBJECTIVES: This study aims to assess the effectiveness and safety of carotid artery stenting (CAS) as a method for reducing the risk of stroke in patients with carotid stenosis (CS). METHODS: This retrospective cohort s...
OBJECTIVES: This study aims to assess the effectiveness and safety of carotid artery stenting (CAS) as a method for reducing the risk of stroke in patients with carotid stenosis (CS). METHODS: This retrospective cohort study analyzed all patients with internal carotid artery (ICA) stenosis who underwent CAS at a single neurointerventional center from January 2016 to September 2022. Patients with concurrent intracranial stenosis, previous CEA, interfering neurological disorders, or incomplete data were excluded. Preoperative evaluations included comprehensive clinical assessments, and CAS procedures were conducted without embolic protection devices (EPDs). Postoperative monitoring involved intensive care unit (ICU) observation and MRI in selected cases. RESULTS: The study included 91 patients (mean age 69.2±10.2 y, 65.9% male). The right ICA was involved in 46 patients and the left in 45 patients. The degree of stenosis significantly decreased from 80.58±12.53% to 16.61±9.54% post-CAS. Early neurological complications were observed in 5.4% of patients. Transient bradycardia during the procedure was common but resolved with atropine. One patient experienced prolonged bradycardia, but it resolved without lasting effects. Two patients had transient contralateral paresis postprocedure; one showed diffusion restriction on MRI but both recovered fully. Severe complications included one death due to intracranial hemorrhage and one case of hemiplegia with partial recovery over 3 months. Follow-up ultrasound in 30 patients showed no instances of restenosis. CONCLUSIONS: CAS significantly reduces CS and potentially aids in stroke prevention. The findings suggest that CAS without EPDs may achieve similar early outcomes, particularly in regions with limited EPD access.
White Matter Structural Network Dysfunction Mediates the Effect of Hypertension on Cognitive Decline in Parkinson Disease.
Shu L, Li S, Lin L … +3 more , Yu Y, Liao B, Lu T
Neurologist · 2026 Jan · PMID 41288295 · Full text
OBJECTIVES: Hypertension (HBP) is a risk factor for the development of motor and cognitive functions in Parkinson disease (PD) patients, but the specific mechanism is unclear. This study investigated white matter structu...
OBJECTIVES: Hypertension (HBP) is a risk factor for the development of motor and cognitive functions in Parkinson disease (PD) patients, but the specific mechanism is unclear. This study investigated white matter structural network abnormalities and their mediation effect of cognitive decline in patients with PD and HBP. METHODS: PD patients with HBP and normal blood pressure (HBP and non-HBP) underwent conventional and multi-shell diffusion magnetic resonance imaging (MRI) at baseline. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at baseline and 12-month follow-up. Enlarged perivascular spaces (EPVS) in the basal ganglia and midbrain were assessed at baseline. White matter structural network based on the diffusion MRI was constructed. The mediation effect and correlations of EPVS and the network metrics with cognitive function were analyzed. RESULTS: At 12-month follow-up, the cognitive decline was found in the HBP group. Global connectivity was impaired in the HBP group. The number and maximum diameter of EPVS were higher in the HBP group. The nodal connectivity was impaired in the HBP group and associated with the cognitive function at baseline and follow-up. Both global and nodal network metrics, as well as the counts of EPVS mediated the effect of HBP on the cognitive decline. CONCLUSIONS: The PD patients with HBP had worse cognitive function. Hypertensive impairment of white matter connectivity may be the underlying mechanism of cognitive decline in PD patients.
Ischemic Stroke Associated With Pulmonary Arteriovenous Malformations: Two Case Reports and a Literature Review.
García-Alcántara G, Vera-Lechuga R, Martínez-García B … +8 more , Moreno-López C, López-Rebolledo R, Gómez Del Olmo V, Cruz-Culebras A, García-Madrona S, Matute MC, Masjuan J, De Felipe A
Neurologist · 2026 Jan · PMID 41163492 · Publisher ↗
INTRODUCTION: Pulmonary arteriovenous malformations (PAVMs) are infrequently associated with ischemic stroke. PAVMs rarely cause large vessel occlusions (LVO), whereas medium (MeVOs) and distal vessel occlusions (DVOs) a...
INTRODUCTION: Pulmonary arteriovenous malformations (PAVMs) are infrequently associated with ischemic stroke. PAVMs rarely cause large vessel occlusions (LVO), whereas medium (MeVOs) and distal vessel occlusions (DVOs) are more common. Isolated PAVMs are uncommon but may cause paradoxical embolisms. CASE REPORTS: We describe 2 clinical cases of patients with ischemic stroke associated with PAVMs. One patient suffered a stroke caused by a MeVO and was successfully treated with intravenous thrombolysis (IVT). Transcranial Doppler ultrasound (TCD) with bubble test revealed a right-to-left shunt, but transesophageal echocardiography (TEE) ruled out a patent foramen ovale (PFO) in both patients. The presence of PAVMs was confirmed by pulmonary computed tomography angiography (CTPA), and they were successfully treated with embolization. The patients received antiplatelet therapy for secondary prevention, and no recurrence of ischemic events occurred during the follow-up period (12 mo for case 1 and 24 mo for case 2). CONCLUSIONS: Pulmonary arteriovenous malformations are rarely associated with ischemic stroke. Embolization is considered the treatment of choice for these patients. After the procedure, antiplatelet therapy is generally recommended, although anticoagulation may be indicated in selected patients.
The Effects of Transcranial Direct Current Stimulation on Acute Ischemic Stroke-A Randomized, Double-blind, Sham-Controlled Study.
Kim SH, Kim T, Koo J … +3 more , Park O, Jeong H, Song IU
Neurologist · 2026 Jan · PMID 41133756 · Publisher ↗
OBJECTIVES: Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has shown potential in enhancing motor recovery and cognitive function in chronic stroke patients. However, the a...
OBJECTIVES: Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has shown potential in enhancing motor recovery and cognitive function in chronic stroke patients. However, the application of tDCS in the acute setting of ischemic stroke remains largely unexplored. METHODS: This randomized, double-blind, sham-controlled study enrolled 60 acute ischemic stroke patients within 2 days of onset. Participants were randomly assigned to receive either real tDCS or sham stimulation for 5 sessions over 7 days. The primary outcomes were changes in the Fugl-Meyer (FM) motor scale, National Institutes of Health Stroke Scale (NIHSS) scores, incidence of early neurological deterioration, and favorable functional outcome (modified Rankin Scale ≤2) at 3 months poststroke. RESULTS: Early neurological deterioration occurred in 6.7% of the tDCS group and 26.7% of the sham group, but this difference did not reach statistical significance ( P =0.065). No significant differences were observed between the tDCS and sham groups in terms of FM scores, NIHSS scores, or favorable functional outcomes at 3 months. No significant group-by-time interactions were found for FM scores ( P =0.481) or NIHSS scores ( P =0.157). CONCLUSIONS: This study demonstrates that tDCS can be safely administered in the acute phase of ischemic stroke. While no significant effects on motor function or neurological outcomes were observed compared with sham stimulation, the trend toward reduced early neurological deterioration warrants further investigation.
Acute Bilateral Hearing Loss: An Unheard of Thalamic Syndrome.
Graveran-Perez K, Kaminoff L, Reyes CZ … +2 more , Ambrose T, Miller E
Neurologist · 2026 Jan · PMID 41099456 · Publisher ↗
INTRODUCTION: Despite the involvement of the thalamus in the auditory pathway, hearing loss is not commonly recognized as a sequela of thalamic hemorrhage. Interestingly, only a few case reports in the literature describ...
INTRODUCTION: Despite the involvement of the thalamus in the auditory pathway, hearing loss is not commonly recognized as a sequela of thalamic hemorrhage. Interestingly, only a few case reports in the literature describe thalamic hemorrhage as a cause of sudden sensorineural hearing loss (SSHL). The use of brainstem evoked potentials (BAEPs) to evaluate hearing loss in these patients has not been reported in the literature. CASE REPORT: A 56-year-old man presented to the emergency room for an acute onset of hearing loss and left perioral and foot numbness. On neurological examination, he was found to have mild left hemiparesis, sensory deficit, ataxia, and complete hearing loss. His National Institutes of Health Stroke Scale was 6. Initial noncontrast head computed tomography (CT) showed a focal acute parenchymal hemorrhage in the right thalamus and posterior limb of the internal capsule. Magnetic resonance imaging (MRI) of the brain confirmed the presence of the right thalamocapsular hematoma, and the gradient echo sequence demonstrated remote hematoma in the left lentiform nucleus. Otolaryngology was consulted and diagnosed the patient with idiopathic sudden sensorineural hearing loss. Given the unclear etiology, BAEPs were pursued and revealed an intact brainstem auditory pathway and suggested reduced activity in thalamic auditory regions. He was discharged on prednisone taper and referred for formal outpatient audiometry testing. CONCLUSIONS: This case highlights sensorineural hearing loss as a potential thalamic syndrome and the utilization of BAEPs as diagnostic tools in suspected central origin of hearing impairment.
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