The Neurologist[JOURNAL]
Sun
200 papers
Does Initiation of Disease Modifying Therapy in Patients With Radiologically Isolated Syndrome Reduce their Risk of Conversion to Multiple Sclerosis? A Critically Appraised Topic.
Vanood A, Zalewski NL, Marks LA … +2 more , O'Carroll CB, Valencia Sanchez C
Neurologist · 2025 Sep · PMID 40905620 · Publisher ↗
BACKGROUND: Radiologically Isolated Syndrome (RIS) is defined as incidentally found MRI abnormalities that are radiographically indistinguishable from multiple sclerosis (MS) and is considered a presymptomatic disease st...
BACKGROUND: Radiologically Isolated Syndrome (RIS) is defined as incidentally found MRI abnormalities that are radiographically indistinguishable from multiple sclerosis (MS) and is considered a presymptomatic disease state of MS. Age <37 years, infratentorial or spinal cord lesions, gadolinium-enhancing lesions on index imaging, and positive cerebrospinal fluid oligoclonal bands have been identified as risk factors for conversion to MS. There are no existing guidelines regarding the role of disease-modifying therapy (DMT) in RIS patients. OBJECTIVE: The objective of this study was to critically assess the current evidence regarding the impact of initiating DMT for patients with RIS on the time to first clinical attack of MS. METHODS: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, medical librarian, and content experts in the field of neuroimmunology. RESULTS: A multicenter, prospective, randomized, double-blind, placebo-controlled trial was chosen for critical appraisal. This trial examined the impact of treatment with dimethyl fumarate (DMF) versus placebo on the risk of conversion from RIS to MS over a 96-week study period. Patients in the DMF arm were found to have an 82% reduction in risk of clinical attack. DMF patients also had a smaller number of new/newly enlarging T2 hyperintense lesions compared with placebo. No subgroup analyses were performed to elucidate risk factors for conversion. CONCLUSIONS: While initiation of DMT in RIS does appear to reduce the time to first clinical attack of MS, the risk factors that should prompt initiation of DMT in this patient population require further study.
Diagnostic Yield of Pelvic MRV in Patients With Embolic Stroke of Undetermined Source (ESUS): A Scoping Review and Metanalysis.
Al-Sabbagh MQ, Camerucci E, Abbas Hussain SM … +7 more , Pasya SKR, Asedi T, Vetter E, Dukes R, Al-Nuaimi DM, Thirunavukkarasu S, Eswaradass P
Neurologist · 2025 Nov · PMID 40814971 · Publisher ↗
BACKGROUND: There is a controversy in the literature regarding the role of pelvic venous abnormalities screening through Magnetic Resonance Venogram (MRV) in patients with Embolic Stroke of Undetermined Source (ESUS) and...
BACKGROUND: There is a controversy in the literature regarding the role of pelvic venous abnormalities screening through Magnetic Resonance Venogram (MRV) in patients with Embolic Stroke of Undetermined Source (ESUS) and Patent Foramen Ovale (PFO). We aimed to describe diagnostic yield of pelvic MRV in ESUS patients. REVIEW SUMMARY: A systematic search was carried out using PubMed, ScienceDirect, and Google Scholar on the 5th of January of 2024, following PRISMA guidelines. We retrieved 6 cross-sectional and cohort studies, 2 case series, as well as 12 case reports with a total of 1321 patients and a mean age of 51 years. Only cross-sectional and cohort studies were included in the qualitative synthesis. The diagnostic yield of pelvic MRV in all included ESUS patients was 10% (95% CI: 8-12). In ESUS patients with a negative lower extremity DVT, the diagnostic yield was 9% (95% CI: 7-10). Patients with ESUS and PFO had significantly higher prevalence of abnormal pelvic MRV findings, OR=3.63 (95% CI: 1.53-8.61, P <0.01). All reviewed studies utilized pelvic MRV, except 4 reports, which used pelvic CTV and MRA. CONCLUSION: Pelvic venous abnormalities are relatively common findings in ESUS patients with a PFO and negative lower extremity DVT. Pelvic MRV can be considered in these situations. Future research should strive to provide clear guidance on clinical decision-making and cost-effectiveness of utilizing this valuable tool using randomized, controlled, and comparative studies.
Study on the Effects of Early Nasoenteric Tube Nutritional Support Assisted by Gastroscopy on Aspiration and Prognosis in Patients With Hypertensive Cerebral Hemorrhage.
Guo M
Neurologist · 2025 Nov · PMID 40791074 · Publisher ↗
OBJECTIVE: To evaluate the impact of early gastroscopy-assisted nasoenteric tube nutritional support on aspiration and prognosis in patients with hypertensive cerebral hemorrhage. METHODS: A total of 150 patients with hy...
OBJECTIVE: To evaluate the impact of early gastroscopy-assisted nasoenteric tube nutritional support on aspiration and prognosis in patients with hypertensive cerebral hemorrhage. METHODS: A total of 150 patients with hypertensive cerebral hemorrhage (December 2021-December 2023) were randomized into a control group (n=75) receiving nasogastric tube nutritional support and a study group (n=75) receiving gastroscopy-assisted nasoenteric tube nutritional support. Outcomes included the incidence of aspiration and aspiration pneumonia, aspiration risk (assessed by the ICU aspiration risk scale), nutritional indicators (hemoglobin, albumin, pre-albumin, and transferrin), and prognostic scores (GCS and APACHE II). RESULTS: The study group had significantly lower incidence rates of aspiration (8.00%) and aspiration pneumonia (6.67%) compared with the control group (33.33% and 20.00%, respectively, P <0.05). Preintervention measures showed no significant differences between groups ( P >0.05). Postintervention (weeks 1 and 2), the study group exhibited significantly improved aspiration risk scores, higher nutritional indicator levels, and better prognostic outcomes (higher GCS scores and lower APACHE II scores) compared with the control group ( P <0.05). CONCLUSIONS: Gastroscopy-assisted nasoenteric tube nutritional support reduces aspiration risk and incidence in patients with hypertensive cerebral hemorrhage, enhancing nutritional status and improving prognosis.
Severe Fibrinolytic Disorder Caused by Intravenous Thrombolysis in a Patient With Acute Ischemic Stroke: A Case Report and Literature Review.
Liu Y, Li Y, Zhao Z … +2 more , Wu J, Wang J
Neurologist · 2025 Sep · PMID 40778444 · Publisher ↗
INTRODUCTION: Acute ischemic stroke (AIS) is one of the leading causes of morbidity and mortality in adults worldwide. Intravenous injection of recombinant tissue plasminogen activator is an established and effective tre...
INTRODUCTION: Acute ischemic stroke (AIS) is one of the leading causes of morbidity and mortality in adults worldwide. Intravenous injection of recombinant tissue plasminogen activator is an established and effective treatment for AIS patients. The most common adverse effects of alteplase are hemorrhagic complications. CASE REPORT: In this report, we highlight a rare but severe complication-primary fibrinolysis-following alteplase administration. A 68-year-old man without any cardiocerebral vascular diseases presented with the sudden onset of hemiplegia on the right. The initial National Institutes of Health Stroke Scale (NIHSS) score was 3, consisting of motor dysfunction in the right upper limb (score of 1) and lower limb (score of 2). Brain computed tomography (CT) revealed no evidence of hemorrhage. We conducted a standard dose of intravenous alteplase (IVT) for this patient. However, the patient had a terrible fibrinolytic system with extremely low fibrinogen after 8 hours of IVT (FIB <0.01, Clauss method). Immediate administration of 10 units of cryoprecipitate restored coagulation function, with significant improvement observed within 48 hours. CONCLUSION: This case underscores the importance of vigilant coagulation monitoring in AIS patients undergoing alteplase therapy. Furthermore, infusion of cryoprecipitate for these patients indicated obvious therapeutic effects.
Regulation of Gut Microbiota in Acute Ischemic Stroke Patients.
Arslan Y, Çayir A, Kocabiyik Ö … +1 more , Şenoğlu N
Neurologist · 2025 Sep · PMID 40767112 · Publisher ↗
OBJECTIVES: There is a bidirectional relationship between stroke and infection, with stroke increasing susceptibility to infections and contributing to poorer clinical outcomes and higher mortality rates. Stroke-induced...
OBJECTIVES: There is a bidirectional relationship between stroke and infection, with stroke increasing susceptibility to infections and contributing to poorer clinical outcomes and higher mortality rates. Stroke-induced dysmotility, impaired gut barrier integrity, and systemic dissemination of resident gut microbiota have recently been implicated in the pathogenesis of poststroke infections. We hypothesize that early modulation of the gut microbiota within the first week of acute stroke may help prevent or mitigate post-stroke infections, mortality, and morbidity. METHODS: This prospective study was conducted between 2020 and 2024 and included patients with moderate-to-severe acute stroke who were monitored in the intensive care unit (ICU) for at least 4 weeks. Probiotic agents containing Saccharomyces Boulardii were administered to the study group either orally or through a nasogastric tube. National Institutes of Health Stroke Scale (NIHSS) scores, patient survival rates, and poststroke infections were recorded during the first month and compared with those of the control group, who were not given probiotics. RESULTS: The study group had significantly lower rates of poststroke infection and mortality ( P= 0.010 and P= 0.023, respectively). In addition, NIHSS scores were significantly higher in the control group ( P =0.032). Laboratory analyses revealed significantly higher neutrophil and platelet counts, C-reactive protein (CRP), and total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels were also significantly higher in the control group ( P <0.05). CONCLUSION: This study demonstrated that probiotic administration may reduce the risk of poststroke infections, improve functional outcomes, and decrease both mortality and morbidity in patients with acute ischemic stroke.
TriAGe+ Score and NSE for Detecting Acute Ischemic Stroke in Acute Isolated Dizziness: A Propensity Score Matching Analysis.
Zhang Z, Shang J, Wan L … +5 more , Qi D, Zhang Q, Wang C, Wang P, Hou L
Neurologist · 2025 Sep · PMID 40767019 · Publisher ↗
OBJECTIVES: Acute isolated dizziness often presents diagnostic challenges, as peripheral vestibular disorders (PVD) and acute ischemic stroke (AIS) symptoms overlap. This study aimed to evaluate the diagnostic effectiven...
OBJECTIVES: Acute isolated dizziness often presents diagnostic challenges, as peripheral vestibular disorders (PVD) and acute ischemic stroke (AIS) symptoms overlap. This study aimed to evaluate the diagnostic effectiveness of the TriAGe+ score, serum neuron-specific enolase (NSE), and their combination in differentiating AIS from PVD. METHODS: A retrospective analysis was conducted on patients hospitalized for acute isolated dizziness in our hospital. Propensity score matching (PSM) was used to balance general demographic characteristics between patient groups. Univariate and multivariate logistic regression analyses were conducted to investigate the associations of TriAGe+ scores and NSE levels with acute cerebral infarction. The predictive performance of these parameters was assessed using receiver operating characteristic (ROC) curves. RESULTS: A total of 256 eligible patients were enrolled, and 78 pairs were successfully matched using PSM. After PSM, these covariates were well balanced. Logistic regression analysis revealed that NSE level (OR=1.409, 95% CI: 1.233-1.611, P <0.001) and TriAGe+ score (OR=1.938, 95% CI: 1.244-1.851, P <0.001) were independent risk factors. ROC analysis demonstrated that NSE alone had a sensitivity of 74.36%, specificity of 84.62%, and an AUC of 0.82, while the TriAGe+ score had a sensitivity of 67.95%, specificity of 69.23%, and an AUC of 0.74. Combining NSE level and TriAGe+ score resulted in a sensitivity of 74.36%, specificity of 84.62%, and an improved AUC of 0.87. CONCLUSION: Elevated TriAGe+ scores and serum NSE levels are associated with an increased risk of AIS in patients with acute isolated dizziness. Their combination may enhance predictive accuracy.
Posterior Reversible Encephalopathy Syndrome With Spinal Cord Involvement.
Rohm Z, Annapureddy N, Byram K … +1 more , Shah S
Neurologist · 2025 Sep · PMID 40742228 · Publisher ↗
INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) results from the failure of cerebrovascular autoregulation with subsequent extravasation of intravascular fluid into the cerebral interstitial space. PRES...
INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) results from the failure of cerebrovascular autoregulation with subsequent extravasation of intravascular fluid into the cerebral interstitial space. PRES may rarely affect the spinal cord, termed PRES with spinal cord involvement (PRES-SCI). CASE REPORT: A 34-year-old woman with untreated treated systemic lupus with lupus nephritis presented with altered mental status, blurred vision, and seizures. Initial blood pressure was 189/120 mm Hg. The neurological exam was notable for encephalopathy, but otherwise there were no focal motor or sensory deficits. Brain magnetic resonance imaging (MRI) showed posterior predominate T2-hyperintense lesions in a pattern suggestive of PRES. Spine MRI revealed a nonenhancing longitudinally extensive lesion involving most of the cervical and thoracic spinal cord. Investigations for alternative causes of myelitis, including serum antimyelin oligodendrocyte glycoprotein and antiaquaporin-4 antibodies, were negative. The patient's encephalopathy, blurred vision, and seizures gradually resolved with blood pressure control. CONCLUSIONS: PRES-SCI is a relatively rare but likely under-recognized variant of PRES. This diagnosis should be considered in patients with severe acute hypertension and nonenhancing longitudinally extensive T2-hyperintense spinal cord lesions. Patients may exhibit signs and symptoms of myelopathy or, conversely, may demonstrate minimal myelopathic features despite striking MRI abnormalities. Early recognition of PRES-SCI may obviate the need for further testing or empiric myelitis treatment.
Psittacosis Combined With Central Nervous System Infection and Acute Cerebral Infarction: A Case Report Based on Metagenomic Next-Generation Sequencing.
Tian S, Xiao Y, Dong C
Neurologist · 2025 Sep · PMID 40637448 · Publisher ↗
INTRODUCTION: The diagnosis of psittacosis is still challenging due to the high risk of underdiagnosis and misdiagnosis. Here, we reported our diagnostic experience with psittacosis in combination with central nervous sy...
INTRODUCTION: The diagnosis of psittacosis is still challenging due to the high risk of underdiagnosis and misdiagnosis. Here, we reported our diagnostic experience with psittacosis in combination with central nervous system (CNS) infection and acute cerebral infarction (CI). CASE REPORT: A 62-year-old gentleman presented to our department due to episodic vertigo for 4 hours. Pulmonary CT scan revealed high-density shadows in the right upper lobe, and brain MRI initially excluded new CI lesions. Seven days later, the patient began to show fever, with the highest temperature of 39.3°C. Pulmonary CT scan showed pneumonia. Cerebral MR was performed as the patient showed loss of consciousness and convulsion, which indicated pontine infarction. The patient was eventually transferred to the ICU due to severe pneumonia complicated by type I respiratory failure and acute respiratory distress syndrome (ARDS). Metagenomic next-generation sequencing (mNGS) confirmed psittacosis, and then the patient was treated with a regimen of piperacillin-tazobactam, moxifloxacin, and minocycline. However, the patient continued to have a fever and exhibited irritability after withdrawal of sedative medication, thereby, CNS infection was suspected. Upon cerebrospinal fluid collection following lumbar puncture, mNGS sequencing indicated Candida albicans infection. MR revealed progression of infarction featured by increased lesions in the right cerebellum, right pons, right fronto-parietal-temporal-occipital, and right corona radiata. CONCLUSION: We reported a case report of psittacosis combined with CNS infection based on the mNGS sequencing, along with acute CI based on conventional imaging technique.
Clinical and Imaging Characteristics of Thalamic Infarction Combined With Moderate-to-Severe Stenosis of the Posterior Cerebral Artery: A Single-Center Experience.
Xin B, Ye X, Liang X … +4 more , Wang Y, Cai Y, Sun J, Cai X
Neurologist · 2025 Sep · PMID 40637436 · Full text
INTRODUCTION: Ten patients with thalamic infarction caused by moderate-to-severe posterior cerebral artery (PCA) stenosis confirmed by computed tomography angiography (CTA) were enrolled. To better assess the vascular pa...
INTRODUCTION: Ten patients with thalamic infarction caused by moderate-to-severe posterior cerebral artery (PCA) stenosis confirmed by computed tomography angiography (CTA) were enrolled. To better assess the vascular pathology, high-resolution magnetic resonance imaging (HRMRI) was subsequently used to evaluate the PCA in detail. In addition, we retrospectively analyzed clinical features, treatments, and prognostic outcomes. CASE REPORT: Ten patients were included, 7 males and 3 females, with an average age of 67.8±6.6 years. Past history includes: smoking (50%), drinking (30%), hypertension (70%), diabetes mellitus (40%), hyperlipidemia (10%), and cerebral infarction (10%). Clinical manifestations include sensory disorders (60%), motor disorders (50%), cognitive and consciousness disorders (10%), and language impairment (20%). HRMRI suggested that the PCA was moderately or severely stenosed in 4 cases, mildly stenosed in 5 cases, and normal in 1 case. It also suggested the presence of PCA atherosclerotic plaques in 9 patients. CONCLUSION: Antiplatelet therapy proves effective for this patient population. HRMRI identified atherosclerotic plaques mainly in the PCA's P1 and P2 segments. P1 stenosis often impairs consciousness, while P2 stenosis typically causes sensory/motor deficits. HRMRI aids in evaluating stenosis and plaque features for diagnosis and treatment guidance.
Development and Application of a Machine Learning-Based Predictive Model for Carotid Restenosis After Interventional Surgery in Elderly Ischemic Stroke Patients.
Wu X, Wang X, Lin H … +3 more , Zhang Y, Jiang Y, Jiang B
Neurologist · 2025 Nov · PMID 40497747 · Publisher ↗
OBJECTIVE: This study aims to develop a machine learning-based risk prediction model for carotid restenosis in elderly ischemic stroke patients after interventional surgery. METHODS: We collected clinical data from 371 e...
OBJECTIVE: This study aims to develop a machine learning-based risk prediction model for carotid restenosis in elderly ischemic stroke patients after interventional surgery. METHODS: We collected clinical data from 371 elderly ischemic stroke patients who underwent carotid interventional surgery between January 2020 and December 2023, as training dataset. Various machine learning methods were applied to analyze and compare the predictive performance of different models. In addition, data from 75 cases collected between January and June 2024 was as a validation set to assess model applicability. RESULTS: Six factors influencing carotid restenosis were identified: homocysteine (Hcy), platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), Interleukin-6 (IL-6), and C-reactive protein (CRP). Machine learning models were developed, with the Gradient Boosting Machine showing the best performance (AUROC=0.969). Other models included support vector machine (AUROC=0.962), logistic regression (AUROC=0.945), decision tree (AUROC=0.885), and extreme gradient boosting (AUROC=0.753). The GBM model's predictive variable ranking was Hcy, IL-6, CRP, PDW, PLT, and MPV. In the validation set, the GBM model demonstrated excellent performance, with an AUC 0.939, sensitivity 0.909, specificity 0.969, accuracy 0.960, negative predictive value 0.984, and positive predictive value 0.833. CONCLUSION: Our research showed that compared with other machine learning algorithms, the GBM model demonstrates the best accuracy and stability in predicting the risk of carotid restenosis after interventional surgery in elderly ischemic stroke patients, and it has high clinical application value.
Determinants of the Recommendation of High-Resolution Vessel Wall Imaging for Young Patients With Posterior Circulation Ischemic Strokes.
Li M, Liu Y, Zhou F … +3 more , Xu Y, Zhang J, Qiu S
Neurologist · 2025 Sep · PMID 40464148 · Publisher ↗
OBJECTIVES: High-resolution vessel wall imaging (HRVWI) has emerged as a crucial diagnostic method for improving the etiological classification of ischemic strokes, especially in younger patients. This study seeks to ide...
OBJECTIVES: High-resolution vessel wall imaging (HRVWI) has emerged as a crucial diagnostic method for improving the etiological classification of ischemic strokes, especially in younger patients. This study seeks to identify the factors that influence neurologists' decisions to recommend HRVWI for young individuals experiencing posterior circulation strokes. METHODS: In this retrospective study, we assessed the effect of HRVWI on the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification among patients aged 45 years or younger with acute ischemic strokes in the posterior circulation. Logistic regression analysis was performed to determine the factors that predict HRVWI recommendations. RESULTS: Among 135 young stroke patients, 57 underwent HRVWI. The patients who received HRVWI were slightly younger (mean age 35.75 vs. 37.85 y; P =0.07). The use of HRVWI significantly changed the TOAST classification, increasing the identification of strokes attributed to other determined causes (ODC) from 28.2% to 50.9% and decreasing strokes of undetermined causes (UDC) from 18.0% to 7.0%. Notably, vertebrobasilar artery dissections (VBADs) were more frequently detected in the HRVWI group (82.8%) compared with the non-HRVWI group (21.1%). Multivariate logistic regression identified younger age, vertebrobasilar artery tortuosity, and stenosis or occlusion as significant predictors for HRVWI scans (age: P =0.044; tortuosity: P =0.006; stenosis or occlusion: P =0.021; respectively). CONCLUSIONS: HRVWI may be considered for young stroke patients with abnormal arterial structures in the posterior circulation, as it significantly enhances the etiological classification of ischemic strokes.
Current Approach to Perioperative Evaluation of Neurological Diseases.
Ertürk Çetin Ö, Totuk Ö, Güngör Doğan İ … +10 more , Eryiğit Baran G, Taşdelen B, Darici D, Erci E, Çetin Erci G, Çetinkaya Tezer D, Bekdik P, Adiyeke E, Demir S, Şahin Ş
Neurologist · 2025 Sep · PMID 40462627 · Publisher ↗
BACKGROUND: The perioperative period refers to the 3 phases of the surgical procedure: preoperative, intraoperative, and postoperative. Proper management of chronic diseases in the perioperative period plays a critical r...
BACKGROUND: The perioperative period refers to the 3 phases of the surgical procedure: preoperative, intraoperative, and postoperative. Proper management of chronic diseases in the perioperative period plays a critical role in improving patient outcomes and requires a multidisciplinary approach. Perioperative management of neurological diseases can be challenging due to their chronic nature and the necessity for multiple drug use in neurological disorders, which may potentially interact with anesthetics. REVIEW SUMMARY: This review summarizes the perioperative management of various neurological disorders, including epilepsy, dementia, acute confusional state, movement disorders, stroke, demyelinating diseases, neuromuscular disorders, sleep disorders, and headache. CONCLUSION: Perioperative management of patients with neurological diseases requires a comprehensive, multidisciplinary approach tailored to the specific needs of each condition. Adherence to evidence-based guidelines not only ensures patient safety but also enhances recovery, reducing morbidity and mortality in this vulnerable patient population.
Isolated Foot Drop: An Unusual Presentation of a Disabling NIHSS 0 Stroke.
Couto R, Oliveira AL, Diogo M … +1 more , Rodrigues M
Neurologist · 2025 Jul · PMID 40455049 · Publisher ↗
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Feasibility and Implementation of Wake-Up Stroke Protocol for Treatment of Acute Ischemic Stroke in a Rural Stroke Network of the Midwest.
Loggini A, Dallow K, Henson J … +3 more , Hornik J, Schwertman A, Hornik A
Neurologist · 2025 Jul · PMID 40454789 · Publisher ↗
OBJECTIVES: The indication for thrombolytic therapy in "wake-up strokes" based on diffusion-positive and FLAIR-negative lesions on MRI has been introduced in the most recent AHA/ASA stroke guidelines. While this protocol...
OBJECTIVES: The indication for thrombolytic therapy in "wake-up strokes" based on diffusion-positive and FLAIR-negative lesions on MRI has been introduced in the most recent AHA/ASA stroke guidelines. While this protocol is well established in urban centers, rural hospitals often face challenges due to limited resources and the availability of MRI scanners in the emergency department (ED). Here, we report on the successful implementation of the wake-up stroke protocol within our stroke network, highlighting the planning and execution process, its safety, and outcomes. METHODS: After 2 months of planning, involving neurology, ED, radiology, and nursing leadership, the "wake-up stroke" protocol was implemented in our rural stroke network system in September 2022. Consecutive patients who received thrombolytics by the protocol were reviewed. For each patient, variables regarding demographics, relevant medical comorbidities and medications, clinical presentation, laboratory values, relevant timing of stroke metrics, complications of thrombolytic therapy, and mRS at 30 days were collected. The group was compared with a randomly severity-matched group of patients who received thrombolytic therapy by standard treatment (within 4.5 h from last known well). RESULTS: Five consecutive acute ischemic stroke patients treated with thrombolytic therapy were identified. Mean age ± SD was 71.2 ± 7.2 years. Of the patients, 60% were males (n = 3). The most common reason for unknown time of symptom onset was nighttime sleep in 60% (n = 3) of the cohort. The median NIHSS (IQR) was 7 (6 to 13). Of the patients, 60% (n = 3) had a M2 occlusion on MR angiogram. The median interval between LKW and needle treatment was 11.68 (IQR: 5.32 to 13.23) hours. Compared with standard treatment, the wake-up stroke group had similar rate of complications (none in each group) and similar rate of mRS <2 at 1 month (60% vs 80%, P = 0.49). CONCLUSIONS: The implementation of the wake-up stroke protocol in our network was feasible, with the safety and outcomes of thrombolytics delivered by the protocol comparable to standard treatment. This study supports the utilization of the wake-up stroke protocol in real-world rural practice, highlighting its potential to improve access to high-quality stroke care in underserved areas.
Efficacy of Human Urinary Kallidinogenase in Real-world Patients With Acute Ischemic Stroke: A Matched Comparison.
Zhang Y, Luo X, Song X … +4 more , Li J, Liu Y, Wang L, Tan G
Neurologist · 2025 Nov · PMID 40387155 · Full text
OBJECTIVES: We aimed to investigate the efficacy and safety of human urinary kallidinogenase (HUK) in real-world patients with acute ischemic stroke (AIS). METHODS: AIS patients with prospective follow-up between April 2...
OBJECTIVES: We aimed to investigate the efficacy and safety of human urinary kallidinogenase (HUK) in real-world patients with acute ischemic stroke (AIS). METHODS: AIS patients with prospective follow-up between April 2019 and June 2022 were enrolled in this study. Based on their treatment, the eligible patients were separated into 2 groups: the HUK group and the non-HUK group. Propensity score matching (PSM) analysis was used to reduce the biases from the unequal distribution of initial characteristics. The validated clinical composite scoring system was used to evaluate the neurological recovery. The safety outcomes include stroke recurrence, all-cause mortality, and major complications. RESULTS: A total of 312 patients were enrolled in each of the 2 groups, and there were no significant differences in baseline characteristics between them. After treatment, both groups of AIS patients achieved favorable neurological outcomes. The National Institute of Health Stroke Scale (NIHSS) scores at discharge (3.47±3.41 vs. 4.37±2.85) demonstrated better neurological recovery in the HUK group. At the 90-day assessment, patients in the HUK group exhibited a higher incidence of favorable functional outcome (modified Rankin Scale score of 0 to 2, 74.68% vs. 60.58%), and lower risk of stroke recurrence (2.88% vs. 6.73%). The all-cause mortality (1.60% vs. 2.24%) was not significantly different between both groups. CONCLUSIONS: HUK improved neurological and functional outcomes in patients with AIS in a large real-world population and had an acceptable safety profile.
Embolic Hippocampal Infarct From Ipsilateral Tandem Carotid Stenosis: A Case Report and Lesson on Hippocampal Dual Vascular Supply.
Brown SJ, Nikolova J, Nitu M … +2 more , Cramer J, Dumitrascu O
Neurologist · 2025 Jul · PMID 40366115 · Publisher ↗
INTRODUCTION: Although primarily supplied by the vertebrobasilar system, the hippocampus is partially supplied by ipsilateral carotid artery branches through the anterior choroidal artery or a prominent posterior communi...
INTRODUCTION: Although primarily supplied by the vertebrobasilar system, the hippocampus is partially supplied by ipsilateral carotid artery branches through the anterior choroidal artery or a prominent posterior communicating artery. We report a patient with acute hippocampus infarction likely due to symptomatic ipsilateral tandem carotid stenosis and discuss acute vascular-mediated hippocampal injury. CASE REPORT: An 80-year-old female with obesity, dyslipidemia, hypertension, alcohol use disorder, history of breast cancer on letrozole, and traumatic brain injury was brought into our emergency department for 24 hours of confusion. On examination, she exhibited limited registration, recall, and executive dysfunction with otherwise normal language, visuo-spatial orientation, and praxis. Brain MRI showed a small area of diffusion restriction in the anterior right hippocampus with matched FLAIR hyperintensity, consistent with acute infarction. Computed tomography angiogram head and neck showed 90% stenosis of the proximal right internal carotid artery (ICA), <50% narrowing of the proximal left ICA, and moderate bilateral narrowing of the paraclinoid ICAs, all due to calcific atheromatous plaques. The etiology of the hippocampal infarction was suspected embolism from the ipsilateral severe carotid stenosis. Planning for right cervical carotid revascularization ensued. CONCLUSION: This case highlights the dual hippocampal vascular supply and that hippocampal embolic infarcts could be a sign of a symptomatic severe carotid artery stenosis that may require urgent revascularization for stroke secondary prevention.
Atypical Frontal Release Signs in Acute Anterior Cerebral Artery Infarction and Striatal Dopaminergic Dysfunction: A Case Report.
Yamada G, Toyoda T, Kuno T … +2 more , Katada E, Matsukawa N
Neurologist · 2025 Jul · PMID 40353593 · Publisher ↗
INTRODUCTION: Dystonic hand postures are uncommon in patients with frontal lobe infarction. Here, we report the first case of a patient with frontal lobe infarction presenting with unique dystonic hand postures-specifica...
INTRODUCTION: Dystonic hand postures are uncommon in patients with frontal lobe infarction. Here, we report the first case of a patient with frontal lobe infarction presenting with unique dystonic hand postures-specifically, a pointing gun posture and full-finger extension posture-in combination with frontal release signs. CASE REPORT: A 68-year-old man with a prior diagnosis of probable Parkinson disease acutely developed speech and communication impairment, along with reduced voluntary motor function in the right lower extremity. Neurological examination revealed apathy, motor and sensory aphasia, and flaccid paralysis of the right lower limb. Brain magnetic resonance imaging showed an ischemic stroke involving the left superior frontal gyrus, cingulate gyrus, and corpus callosum. Dopamine transporter single-photon emission computed tomography revealed reduced tracer accumulation in the left striatum. Ten days after stroke onset, the patient exhibited a pointing gun posture in the right hand. A repeat neurological examination revealed a grasp reflex. Removing grasped objects led to a transient index finger extension with flexion of the other fingers or a transient full extension of all fingers. The former resembled a pointing gun posture, while the latter, a newly described phenomenon, was termed the full-finger extension posture. In addition, groping movements with the pointing gun posture were observed. CONCLUSION: Atypical frontal release signs, including the pointing gun posture and full-finger extension posture, may reflect specific thalamocortical excitation resulting from a combination of contralateral striatal dopaminergic denervation and frontal lobe infarction involving the supplementary motor area.
Involvement of Posterior Circulation Accounts for Higher Disability in Ischemic Strokes With NIHSS ≤3 But Not With NIHSS 4-5.
Giorelli M, Leone R, Altomare S … +1 more , Digiovanni A
Neurologist · 2025 Jul · PMID 40337884 · Publisher ↗
OBJECTIVES: Minor strokes are defined as ischemic cerebrovascular accidents that present with mild symptoms scoring ≤5 on the National Institute of Health Stroke Scale (NIHSS). We aimed to investigate whether features re...
OBJECTIVES: Minor strokes are defined as ischemic cerebrovascular accidents that present with mild symptoms scoring ≤5 on the National Institute of Health Stroke Scale (NIHSS). We aimed to investigate whether features related to stroke characteristics, location, severity, or symptoms could predict the risk of disability after minor strokes. METHODS: Minor strokes (105) were divided into 2 subgroups: those with baseline NIHSS ≤3 and those with baseline NIHSS 4-5. Comorbidities, occurrence of disability, stroke location, etiology, and outcomes were examined in the 2 subgroups and in those who developed a modified Rankin scale (mRs) of 0 to 1 or mRs >1. RESULTS: No-IVT minor strokes in the NIHSS 4-5 subgroup were associated with more disability compared with the NIHSS ≤3 subgroup ( P >0.05). Residual disability (mRS >1) was associated with a higher incidence of posterior circulation strokes (PCS) ( P =0.0015), large vessel stenosis ( P =0.01), and PCS-related symptoms (imbalance, gait ataxia, and eye movement disorders) not accounted for by NIHSS, in strokes with baseline NIHSS ≤3. Disability (mRS >1) was associated with baseline disabling symptoms, which NIHSS effectively and reliably captured in patients with stroke with NIHSS 4-5. CONCLUSIONS: Symptoms that might predict unfavorable outcomes are not well captured by the available clinical instruments that are usually used to evaluate and score acute ischemic stroke at onset. When deciding on the management of minor stroke, clinicians must consider and judge all potentially disabling deficits, in addition to the pure scores of the adopted evaluation scales.
Predictors of Mortality and Neurological Complications in a Large Cohort of Patients With COVID-19: A Retrospective Single-Center Cohort Study.
Moradi Choghakabodi P, Hosseinzadeh M, Yakhchali Dehkordi N … +2 more , Pouladzadeh M, Shalilahmadi D
Neurologist · 2025 May · PMID 40331788 · Publisher ↗
OBJECTIVES: This study aimed to investigate the association between the baseline clinical and laboratory characteristics of patients with COVID-19 and their risk of subsequent development of neurological complications an...
OBJECTIVES: This study aimed to investigate the association between the baseline clinical and laboratory characteristics of patients with COVID-19 and their risk of subsequent development of neurological complications and mortality. METHODS: This retrospective, single-center cohort study included patients with COVID-19 who presented to the Emergency Department of Razi Hospital. Patients' charts were reviewed to collect baseline clinical and laboratory data. RESULTS: Of 2205 patients with COVID-19, 1473 (66.8%) developed various neurological complications in addition to other symptoms. Among the 168 patients who died, 66.66%, 43.5%, and 25% had a history of neurological disorders, encephalopathy, and stroke, respectively. Disease severity was significantly associated with comorbidities, hypoxemia, hypoalbuminemia, hypophosphatemia, elevated ESR, hypomagnesemia, stroke, and encephalopathy (P<0.05). The risk of death remained strongly linked to older age, comorbidities, severe infection, ICU admission, and extended hospitalization (P<0.05), even after adjustments, indicating they are potential confounders for other variables. More importantly, in non-critically ill patients, there was no significant association between the risk of death and hypoxemia, anemia, thrombocytopenia, hypomagnesemia, stroke, and encephalopathy (P>0.05). Moreover, the association between encephalopathy and other factors was greatly influenced by disease severity. Nonetheless, older age, comorbidities, and anemia remained significant predictors of stroke even after adjusting for confounders (P<0.05). CONCLUSIONS: The high rates of neurological disorders among deceased patients with COVID-19 underscores the need for early prediction and management of these complications. Moreover, neurological disorders were linked to an increased risk of death because they tend to be present in critically ill patients admitted to the ICU with extended hospitalization.
Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review.
Bai J, Zhao Y, Wang Z … +8 more , Qin P, Huang J, Cheng Y, Wang C, Chen Y, Liu L, Zhang Y, Wu B
Neurologist · 2025 Jul · PMID 40331253 · Publisher ↗
BACKGROUND: Stroke-associated pneumonia (SAP), a highly lethal complication following stroke, is closely linked to dysregulation of the "brain-gut-lung axis." Accumulating evidence indicates that stroke triggers intestin...
BACKGROUND: Stroke-associated pneumonia (SAP), a highly lethal complication following stroke, is closely linked to dysregulation of the "brain-gut-lung axis." Accumulating evidence indicates that stroke triggers intestinal alterations through the brain-gut axis, while multiple studies confirm that gut-derived changes can mediate pneumonia through the gut-lung axis. However, the mechanisms connecting stroke-induced intestinal dyshomeostasis to SAP remain incompletely elucidated, and the multiorgan interaction mechanisms of the "brain-gut-lung axis" in SAP pathogenesis require further exploration. REVIEW SUMMARY: This systematic literature review systematically searched databases, including PubMed, using the keywords "stroke," "gastrointestinal microbiome," and "bacterial pneumonia," incorporating 80 mechanistic studies. Key findings reveal that stroke initiates a cascade of "neuro-microbial-immune" pathway interactions along the brain-gut-lung axis, leading to intestinal dyshomeostasis characterized by microbiota and metabolite alterations, barrier disruption, immune dysregulation, inflammatory responses, and impaired gut motility. These intestinal perturbations ultimately disrupt pulmonary immune homeostasis, promoting SAP development. In addition, stroke directly induces vagus nerve injury through the brain-gut axis, resulting in impaired swallowing and cough reflexes that exacerbate aspiration-related pulmonary infection risks. CONCLUSIONS: Elucidating the role of the brain-gut-lung axis in SAP pathogenesis provides critical insights into its underlying mechanisms. This paradigm highlights intestinal homeostasis modulation and vagus nerve stimulation as promising therapeutic strategies for SAP prevention and management, advancing a multitargeted approach to mitigate poststroke complications.
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