The Neurologist[JOURNAL]
Sun
200 papers
Association Between Naples Prognostic Score and All-Cause and Cardiovascular Mortality in Stroke Patients.
Chen L, Liu Y
Neurologist · 2025 Nov · PMID 40255029 · Publisher ↗
OBJECTIVES: Stroke is a primary public health challenge worldwide, with its prognosis profoundly related to inflammation and nutritional status. Naples prognostic score (NPS) is an integrated indicator of combined inflam...
OBJECTIVES: Stroke is a primary public health challenge worldwide, with its prognosis profoundly related to inflammation and nutritional status. Naples prognostic score (NPS) is an integrated indicator of combined inflammation and nutrition. The study aimed to elucidate the link between NPS and all-cause and cardiovascular (CVD) deaths in stroke patients. METHODS: NHANES (2001 to 2018) data set was used. Multivariate corrected Cox models, Kaplan-Meier, and restricted cubic spline analysis were adopted to explore the link between NPS, all-cause, and CVD mortality in stroke patients. Subgroup analyses based on age, sex, BMI, education, alcohol consumption, smoking, hypertension, and diabetes were performed to further explore associations. RESULTS: Totally, 1247 stroke patients were enrolled. High NPS levels were notably linked with a heightened risk of all-cause mortality (HR: 1.320, 95% CI: 1.180-1.470, P <0.001) and CVD death (HR: 1.390, 95% CI: 1.120-1.730, P =0.003) in stroke patients after adjusting for relevant factors. Compared with group 0 (NPS=0), group 2 (NPS=3-4) had a high hazard ratio for all-cause mortality (HR: 2.920, 95% CI: 1.820-4.670, P <0.001) and CVD mortality (HR: 2.610, 95% CI: 1.140-5.970, P =0.023). The RCS suggested a linear link between NPS and both all-cause ( P for nonlinear=0.2202) and CVD deaths ( P for nonlinear=0.9841) in stroke patients. These links were mostly consistent in subgroups. There was no pronounced interaction between status and NPS scores for each subgroup (all P <0.05). CONCLUSIONS: High NPS scores are connected with an augmented risk of all-cause mortality and CVD death in stroke patients. NPS is possibly connected with prognosis in stroke patients.
Propensity Score Matching Analysis on Risk Factors and Their Diagnostic Value of Frailty in Elderly Patients With Cerebral Infarction.
Gong W, Yuan W, Zhai M … +1 more , Jiang H
Neurologist · 2025 Sep · PMID 40207880 · Publisher ↗
OBJECTIVES: Cerebral infarction is an acute ischemic cerebrovascular disease; elderly patients with cerebral infarction often have frailty syndrome. Therefore, the aim of this study was to analyze the risk factors and th...
OBJECTIVES: Cerebral infarction is an acute ischemic cerebrovascular disease; elderly patients with cerebral infarction often have frailty syndrome. Therefore, the aim of this study was to analyze the risk factors and their diagnostic value of frailty in elderly patients with cerebral infarction. METHODS: In this retrospective cohort study, the medical records (from October 2017 to September 2020) of patients with cerebral infarction (n=395) were analyzed. According to different frailty statuses, patients were divided into the health group (n=166) and the prefrailty group (n=229). The diagnostic value of various parameters for the occurrence of pre-frailty was assessed by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). The risk factors were analyzed by single-factor and multi-factor analyses. RESULTS: Interleukin-6 (IL-6, P <0.001), C-reactive protein (CRP), prealbumin (PA, P <0.001), albumin (ALB, P <0.001), and brain natriuretic peptide (BNP, P <0.001) had higher diagnostic value for the occurrence of prefrailty in elderly patients with cerebral infarction. Single-factor and multi-factor analysis results revealed that the length of stay (LOS), comorbidity with nervous system diseases, high Charlson comorbidity index (CCI), high National Institute of Health stroke scale score, IL-6, BNP, ALB, PA, and creatine kinase might risk the factors for prefrailty occurrence ( P <0.05). After the elimination of interference factors, LOS, high CCI, IL-6, and ALB were confirmed to be key risk factors for the occurrence of prefrailty ( P <0.05). CONCLUSION: LOS, high CCI, IL-6, and ALB are the underlying risk factors for the occurrence of prefrailty in elderly patients with cerebral infarction, which provides a theoretical basis for clinical disease diagnosis.
Exploring Seizure Risks in Cerebral Venous Sinus Thrombosis Based on Thrombosis Site.
Amini Harandi A, Jafari Khaljiri H, Jahangiri Zarkani N … +2 more , Pakdaman H, Khalili N
Neurologist · 2025 Nov · PMID 40191892 · Publisher ↗
OBJECTIVES: Cerebral venous sinus thrombosis (CVST) often leads to seizures, potentially worsening prognosis. This study aimed to assess the relationship between specific occlusion sites and seizure occurrence. METHODS:...
OBJECTIVES: Cerebral venous sinus thrombosis (CVST) often leads to seizures, potentially worsening prognosis. This study aimed to assess the relationship between specific occlusion sites and seizure occurrence. METHODS: We retrospectively analyzed 154 patients diagnosed with CVST in 3 major hospitals in Tehran. Medical records detailing sinus involvement, seizure occurrence, and baseline characteristics were reviewed. Statistical analyses included the χ 2 or the Fisher exact tests, followed by binomial logistic regression to identify independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) curves. RESULTS: The study included 102 women (66.2%) and 52 men (33.8%), with a mean age of 36.4±10.8 years. A total of 35 patients (22.7%) experienced seizures, predominantly generalized tonic-clonic (85.7%). Superior sagittal sinus (SSS) involvement was strongly associated with seizures (odds ratio=3.056, P =0.006), while left transverse sinus involvement showed a marginally significant inverse relationship in univariate analysis ( P =0.027), which became nonsignificant in the multivariate model ( P =0.056). Trolard vein thrombosis was rare but associated with a high seizure rate (3/4 cases). The ROC for the final model showed moderate predictive ability (AUC=0.676). CONCLUSION: SSS thrombosis significantly predicted seizures in Iranian CVST patients. Although rare, trolard vein involvement may carry a substantial seizure risk. These findings underscore the importance of precise imaging and individualized treatment plans for high-risk CVST patients. By illuminating the role of SSS and trolard vein, this study highlights the need for prospective trials to refine clinical decision-making.
Does Fasting Triglyceride Level Influence Core Infarct Volume in Acute Stroke?
Garg S, Asedi T, Vetter ES … +6 more , Alsadi H, Dukes RA, Schartz CM, Al-Sabbagh MQ, Thirunavukkarasu S, Eswaradass P
Neurologist · 2025 Jul · PMID 40178873 · Publisher ↗
OBJECTIVE: Our study explores the relationship between fasting triglyceride levels and initial infarct volume in acute ischemic stroke (AIS) patients. METHODS: We performed a retrospective chart review and cross-sectiona...
OBJECTIVE: Our study explores the relationship between fasting triglyceride levels and initial infarct volume in acute ischemic stroke (AIS) patients. METHODS: We performed a retrospective chart review and cross-sectional analysis of AIS patients admitted to a tertiary care center in Kansas from 2010 to 2023. Inclusion criteria were AIS patients who (1) underwent CTA and CTP within 24 hours of stroke onset, and (2) had fasting triglyceride levels measured within 24 hours of admission. Infarct volume was calculated using RAPID software (iSchemaView Inc.). Statistical analyses were conducted using STATA (Release 16), with T tests, ANOVA, χ 2 tests, and multivariable linear regression applied as appropriate. RESULTS: We included 178 patients, 52% (n=92) of whom were male, and 31% were aged 61 to 70 years. Mean TG levels were 116.91±70.23 mg/dL, and mean infarct volume was 41.64±53.35 mL. Linear regression showed a significant positive association between TG levels and infarct volume ( P <0.01, β=0.17, 95% CI: 0.06-0.28), with a 0.17 mL increase in infarct volume per unit increase in TG levels. Patients with Embolic stroke of undetermined source (ESUS) had larger infarct volumes compared with those with large artery atherosclerosis ( P <0.05) and the highest mean TG levels (135.61 mg/dL). CONCLUSION: Hypertriglyceridemia was positively associated with larger infarct volumes, particularly in ESUS patients, who had the highest TG levels and larger infarct sizes. These findings suggest that elevated TG may predict worse stroke outcomes and could be a potential therapeutic target for stroke prevention.
Artificial Intelligence-powered Virtual Assistant for Emergency Triage in Neurology.
Daungsupawong H, Wiwanitkit V
Neurologist · 2025 May · PMID 40173019 · Publisher ↗
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Are Noncancerous Gynecologic Conditions or Pregnancy Risk Factors for Ischemic Stroke in Cervical Artery Dissection?
Wahood W, Bucak B, Oakley CI … +1 more , Keser Z
Neurologist · 2025 Jul · PMID 40160110 · Publisher ↗
OBJECTIVE: Cervical artery dissection (CeAD) was previously thought to be more common in men, but recent epidemiology studies show a disproportionate increase in the incidence of CeAD in women. In addition to sex-based d...
OBJECTIVE: Cervical artery dissection (CeAD) was previously thought to be more common in men, but recent epidemiology studies show a disproportionate increase in the incidence of CeAD in women. In addition to sex-based differences in clinical presentation, there are unique biological risk factors for CeAD in women. Identifying risk factors for ischemic stroke in CeAD is crucial in individualizing treatment options. Herein, we utilized an inpatient cohort to investigate whether noncancerous gynecologic conditions or pregnancy are risk factors for ischemic stroke in CeAD. METHODS: The National Inpatient Sample was queried from 2016 to 2020 for patients diagnosed with CeAD using the International Classification of Diseases, 10th edition, correction of the mean codes. Diagnoses of pregnancy/puerperium and noncancerous gynecologic conditions were identified. Among CeAD admissions, acute ischemic stroke (AIS) was also identified. Hierarchical, multivariable regression, adjusted for patient demographics and medical comorbidities, was conducted to assess factors associated with AIS. RESULTS: A total of 34,925 women with CeAD were identified. Of these women, 2.1% were pregnant or up to six weeks postpartum, 1.3% had a noncancerous gynecologic condition, and 0.09% had both active pregnancy/puerperium and a noncancerous gynecologic condition. Noncancerous gynecologic conditions (odds ratio = 1.86, P = 0.012) were found to be an independent risk factor for AIS in CeAD but not active pregnancy/puerperium (odds ratio = 0.84, P = 0.34). CONCLUSION: In this national inpatient sample of female patients with CeAD, the presence of noncancerous gynecologic conditions is associated with an increased risk of AIS. Further studies are needed to validate this observation and help guide the best antithrombotic treatment decisions in this patient population.
Incidence and Risk Factors of Urinary Retention in Acute Ischemic Stroke Patients: A Retrospective Study.
Li J, Miao X, Chen Y … +4 more , Gu J, Zeng Y, Zhu Q, Yao H
Neurologist · 2025 Jul · PMID 40130442 · Publisher ↗
OBJECTIVES: This study aimed to evaluate the incidence and risk factors of urinary retention in acute ischemic stroke (AIS) patients. MATERIALS AND METHODS: A total of 993 patients diagnosed with AIS were analyzed retros...
OBJECTIVES: This study aimed to evaluate the incidence and risk factors of urinary retention in acute ischemic stroke (AIS) patients. MATERIALS AND METHODS: A total of 993 patients diagnosed with AIS were analyzed retrospectively. According to the incidence of urinary retention, these patients were divided into the urinary retention group and the nonurinary retention group. The incidence of urinary retention after AIS was analyzed. Univariate analysis and binary logistic regression analysis were performed to screen the independent risk factors for urinary retention after AIS. RESULTS: The incidence of urinary retention in AIS patients was 10.98% (109/993). According to the results of the univariate analysis, age ( P <0.01), sex ( P =0.020), National Institutes of Health Stroke Scale (NIHSS) <10 ( P <0.01), Barthel Index (BI) <40 ( P <0.01), multiple cerebral infarction ( P =0.002), manual muscle test (MMT) ( P <0.01), urinary tract infection (UTI) ( P <0.01), and benign prostate hyperplasia (BPH) ( P <0.01) were significantly correlated with urinary retention incidence. The binary logistic regression analysis revealed that female (OR: 1.954, 95% CI: 1.065-3.587), BI <40 (OR: 24.067, 95% CI: 11.652-49.713), UTI (OR: 8.214, 95% CI: 3.714-18.169), and BPH (OR: 11.342, 95% CI: 5.460-12.560) were independent risk factors for urinary retention after AIS. CONCLUSIONS: The incidence of urinary retention in AIS patients was 10.98%. BI <40, UTI, and BPH were identified as risk factors for poststroke urinary retention. In addition, being female constituted another risk factor for urinary retention, requiring further study.
Study on Intermittent Theta Burst Stimulation Improves Expression Function and Mechanism in Patients With Aphasia After Stroke.
Bai G, Jiang L, Li Q … +1 more , Qiu P
Neurologist · 2025 Jul · PMID 40104992 · Publisher ↗
OBJECTIVE: To explore the effects of Intermittent Theta Burst Stimulation (iTBS) on the posterior inferior frontal gyrus of the left hemisphere on the expression function of patients with aphasia after stroke, and to exp...
OBJECTIVE: To explore the effects of Intermittent Theta Burst Stimulation (iTBS) on the posterior inferior frontal gyrus of the left hemisphere on the expression function of patients with aphasia after stroke, and to explore the specific mechanism of fractional amplitude of low-frequency fluctuation (fALFF) analysis and degree centrality (DC) analysis of resting-state functional MRI. METHODS: According to the inclusion and exclusion criteria, 40 patients with poststroke aphasia were randomized into a treatment group (iTBS group) and a control group (S-iTBS group). Patients in the iTBS group received iTBS +speech training, and patients in the S-iTBS group received sham iTBS + speech training. The Western aphasia test (Chinese version) was used to assess spontaneous language, naming, retelling, and aphasia quotient before and after treatment; resting-state fMRI scans were performed before and after treatment, and the scanned image data were analyzed to explore specific activated or suppressed brain regions. RESULTS: Compared with before and after treatment, the scores of spontaneous language, naming, retelling, and aphasia quotient of the patients in iTBS group improved significantly, and the spontaneous language, naming, retelling, and aphasia quotient of the patients in S-iTBS group also improved. After the treatment, the scores of naming, retelling and aphasia quotient of the patients in the iTBS group improved significantly compared with that of the patients in the S-iTBS group. The resting-state fMRI results of the 2 groups before and after treatment were fALFF analysis found that the fALFF value increased in multiple brain regions in the left frontal and temporal lobes of the patients in iTBS group. Meanwhile, DC analysis also found increased DC values in multiple frontotemporal brain regions of the left hemisphere of patients in the iTBS group, indicating that the improved activation of the above brain regions of the patients in the iTBS group was significantly compared with that of the patients in the S-iTBS group. CONCLUSIONS: iTBS combined with conventional speech training significantly improved the expression function of patients with aphasia after stroke. After iTBS action on the left hemisphere, increased activation of multiple brain regions in the left hemisphere may be one of the important mechanisms by which iTBS improves expression function in poststroke aphasia patients.
Nomogram Model for Predicting the Functional Outcomes in Patients With Minor Ischemic Stroke Based on Clinical Characteristics and Small Vessel Disease Burden.
He R, Xu X, Chen X … +3 more , Cai H, Huang X, Shu H
Neurologist · 2025 Jul · PMID 40104991 · Publisher ↗
OBJECTIVES: Our purpose is to assess the role of total small vessel disease (SVD) burden affecting the clinical outcome and develop and validate a prognostic nomogram for minor ischemic stroke (MIS) patients. METHODS: Be...
OBJECTIVES: Our purpose is to assess the role of total small vessel disease (SVD) burden affecting the clinical outcome and develop and validate a prognostic nomogram for minor ischemic stroke (MIS) patients. METHODS: Between January 2018 and April 2023, 454 MIS patients were enrolled. The functional outcome was the modified Rankin scale (mRS) score at 90 days. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression model were used to identify prognostic predictors, and then a nomogram was drawn. RESULTS: Our nomogram comprising of systolic blood pressure (SBP), baseline National Institutes of Health Stroke Scale score (NIHSS), total SVD burden scores, coronary heart disease, disabling stroke, progressive stroke, alteplase treatment, and infarction location demonstrated a good discriminative power in both the training set (AUC=0.870; 95% CI: 0.827-0.912) and the internal validation set (AUC=0.876; 95% CI: 0.817-0.935). The calibration curve and DCA in our result showed the model's high degree of calibration and clinical value. The DeLong test was used to compare the AUCs between the nomogram and non-SVD burden score model in the training ( P =0.028) and internal validation sets ( P =0.013), indicating that our nomogram performs significantly better than the non-SVD burden score model. CONCLUSIONS: The SVD burden is an important prognosis factor. Furthermore, the proposed nomogram has good discrimination, calibration, and clinical benefits and is better than the non-SVD burden score model in predicting the outcomes for MIS patients.
Extracorporeal Counterpulsation Therapy Enhances Neurological Outcomes in Patients Experiencing Acute Ischemic Stroke.
Li J, Jia X, Chen X … +5 more , Hu J, He X, Zhang Y, Tang Y, Wu J
Neurologist · 2025 Nov · PMID 40104980 · Full text
OBJECTIVE: The aim of this study was to assess the effects of extracorporeal counterpulsation therapy (ECP) on the short-term outcomes of patients with acute ischemic stroke in the mid-stroke phase. METHODS: A total of 1...
OBJECTIVE: The aim of this study was to assess the effects of extracorporeal counterpulsation therapy (ECP) on the short-term outcomes of patients with acute ischemic stroke in the mid-stroke phase. METHODS: A total of 171 patients with acute ischemic stroke from the Department of Neurology at our hospital were selected and randomly assigned to 2 groups: 84 patients in the ECP group and 87 patients in the control group. Both groups received standard medication and rehabilitation. In addition, extracorporeal counterpulsation was incorporated into the treatment for the ECP group. At the conclusion of the treatment and after 90 days, both groups were evaluated based on the NIHSS and MRS scores. RESULTS: No statistically significant differences were detected between the NIHSS and MRS scores of the 2 groups before and following treatment ( P >0.05). However, on the 90th day, the NIHSS and MRS scores of the ECP group were significantly lower than those of the comparison group ( P <0.05). The difference in the proportion of patients with NIHSS scores ≤1 between the 2 groups was 20.8%, whereas the absolute difference in MRS scores was 14.1%. CONCLUSION: Extracorporeal counter therapy effectively enhances neurological function in patients with ischemic stroke, thereby improving their ability to perform activities of daily living and overall prognosis.
Unilateral Weakness Caused By Spinal Cord Infarction in a Renal Transplant Recipient.
Kim SB, Kim SM, Shin BS … +1 more , Kang HG
Neurologist · 2025 Nov · PMID 40104967 · Full text
INTRODUCTION: Spinal cord infarction has various clinical presentations, depending on the vascular territory involved at the spinal cord level. The most common symptom is bilateral weakness. However, unilateral hemipares...
INTRODUCTION: Spinal cord infarction has various clinical presentations, depending on the vascular territory involved at the spinal cord level. The most common symptom is bilateral weakness. However, unilateral hemiparesis can occur if the sulcal artery is involved. Stroke is the most common and serious cerebrovascular complication associated with kidney transplantation. Clinically asymptomatic renal transplant recipients may experience increased intima-media thickening, which is significantly associated with an increased prevalence of cerebrovascular diseases. CASE REPORT: Herein, we report the case of a 64-year-old adult male with a history of kidney transplantation who presented with sudden-onset right-sided hemiparesis. The patient presented with right shoulder pain, right fingertip paresthesia, and recent dysuria, necessitating catheterization. T2-weighted magnetic resonance imaging at the C2-C3 level revealed hyperintensity corresponding to the right sulcal artery. Diffusion-weighted imaging revealed hyperintensities corresponding to T2 signal abnormalities, with a decreased apparent diffusion coefficient. The patient was diagnosed with cervical spinal cord infarction involving the right sulcal artery at the C2-C3 level. Subsequently, pulsed intravenous methylprednisolone and dual antiplatelet treatment (aspirin and clopidogrel) were administered. The patient showed a rapid and marked improvement in neurological function within 3 days. CONCLUSION: The patient in this case report initially presented with unilateral hemiparesis. The symptoms mimicked those of stroke, making accurate diagnosis challenging. This case highlights the need to consider spinal cord infarction in the differential diagnosis of patients presenting with unilateral hemiparesis. In addition, our findings suggest that spinal cord infarction may be a long-term complication in kidney transplant recipients.
Thalamic Infarctions: A Case Study of Inferolateral and Posterior Choroidal Branch Involvement in a Patient Without Classic Vascular Risk Factors.
Garrido IB, do Espírito Santo BL, Montanaro VVA
Neurologist · 2025 Jul · PMID 40091282 · Publisher ↗
INTRODUCTION: Thalamic infarctions represent a rare subset of ischemic strokes, characterized by a diverse array of clinical manifestations and significant diagnostic challenges. These infarctions can lead to a wide rang...
INTRODUCTION: Thalamic infarctions represent a rare subset of ischemic strokes, characterized by a diverse array of clinical manifestations and significant diagnostic challenges. These infarctions can lead to a wide range of neurological deficits, depending on the specific vascular territory involved. Infarctions within the posterior circulation territory of P2, particularly those affecting the inferolateral and posterior choroidal arteries, are associated with distinct neurological symptoms, including contralateral sensory loss, hemiparesis, hemiataxia, thalamic hand, and various sensory and motor disturbances. CASE REPORT: We present the case of a 47-year-old woman with a unilateral thalamic infarction involving occlusion of the P2 branch of the posterior cerebral artery. The infarction, caused by a paradoxical embolism secondary to a high-grade patent foramen ovale (PFO) with an interatrial septal aneurysm, occurred in the absence of classic vascular risk factors. The patient exhibited a clinical syndrome consistent with ischemic lesions in the inferolateral and posterior choroidal arteries, manifesting as right-sided hemiparesthesia, hemiataxia with neuropathic pain, thalamic hand, dystonia, and tremor in the upper right limb. CONCLUSION: Early and precise clinical identification of thalamic infarctions, especially in rare cases involving multiple vascular territories, is essential for improving patient care and outcomes. Recognizing the spectrum of potential symptoms facilitates effective symptom management, minimizes the risk of secondary complications, and optimize neurological rehabilitation.
Thrombolytic Imaging-to-Needle Time as a Metric for Comparing Telemedicine versus In-Person Evaluation in Acute Ischemic Stroke.
Loggini A, Saleh Velez FG, Henson J … +6 more , Wesler J, Hornik J, Schwertnam A, Dallow K, Grimaldi J, Hornik A
Neurologist · 2025 May · PMID 40085479 · Publisher ↗
OBJECTIVES: Door-to-needle time (DTN) is standard for measuring the efficiency of thrombolytic administration in acute ischemic stroke, with guidelines recommending DTN <60 minutes. DTN can be divided into door-to-imagin...
OBJECTIVES: Door-to-needle time (DTN) is standard for measuring the efficiency of thrombolytic administration in acute ischemic stroke, with guidelines recommending DTN <60 minutes. DTN can be divided into door-to-imaging time (DIT) and imaging-to-needle time (ITN), separated by arrival at the CT scanner. We hypothesize that ITN is more accurate for comparing the mode of evaluation for stroke patients treated with thrombolytics. METHODS: This is a retrospective cohort study of stroke patients treated with thrombolytics at Southern Illinois Health care. Data on demographics, clinical presentation, stroke metrics, thrombolytic complications, and mRS at 1-month were reviewed. Multivariate logistic regression models were applied to evaluate predictors of DTN, ITN, and DIT, with OR and 95% CI. P -value was set at 0.05. RESULTS: Out of 287 patients, 170 were evaluated by telemedicine, 117 in-person. The 2 groups were comparable in demographics and stroke severity. Telemedicine had longer median DTN, in minutes [55 (43 to 70) vs. 42 (34 to 62), P <0.01], and median ITN, in minutes [43 (35-58) vs. 32 (25-48), P <0.01]. There was no statistical difference in DIT between the 2 groups. Adjusted for stroke severity and age, telemedicine was associated with lower odds of DTN <60 minutes (OR: 0.553, 95% CI: 0.328-0.931, P =0.026) and ITN <35 minutes (OR: 0.265, 95% CI: 0.159-0.441, P <0.01). However, telemedicine was not independently associated with DIT <25 minutes, which was instead inversely correlated with age (OR: 0.974, 95% CI: 0.951-0.997, P =0.03). CONCLUSIONS: ITN represents a more accurate metric for comparing telemedicine and in-person evaluations than DTN, as it excludes stroke-specific processes of care and patient-specific factors that are intrinsic to DTN and unrelated to the modality of evaluation.
Diffusion-Weighted Imaging-Based Radiomics Features and Machine Learning Method to Predict the 90-Day Prognosis in Patients With Acute Ischemic Stroke.
Li G, Zhang Y, Tang J … +4 more , Chen S, Liu Q, Zhang J, Shi S
Neurologist · 2025 Mar · PMID 40035203 · Full text
OBJECTIVES: The evaluation of the prognosis of patients with acute ischemic stroke (AIS) is of great significance in clinical practice. We aim to evaluate the feasibility and effectiveness of diffusion-weighted imaging (...
OBJECTIVES: The evaluation of the prognosis of patients with acute ischemic stroke (AIS) is of great significance in clinical practice. We aim to evaluate the feasibility and effectiveness of diffusion-weighted imaging (DWI) image-based radiomics features and machine learning methods in predicting 90-day prognosis among patients with AIS. PATIENTS AND METHODS: We enrolled a total of 171 patients with AIS in this study, including 134 patients with a good prognosis and 37 patients with a poor prognosis, and collected the patients' clinical and DWI image data. Radiomics features from manually sketched ischemic lesions were extracted using the Pyradiomics package of Python, and the best radiomics features were selected by a t test and the least absolute shrinkage and selection operator. The radiomics model and clinical model were constructed using support vector machine and logistic regression, respectively, and the predictive performance of each model was evaluated. RESULTS: We selected 9 features from a total of 851 radiomics features to build the final radiomics model. For predicting the poor prognosis of patients with AIS, the area under the curves, accuracy, sensitivity and specificity of the clinical model, radiomics model in the training set and radiomics model in the testing set were 0.865, 0.930 and 0.906, 81.3%, 92.0% and 90.0%, 81.1%, 76.0% and 75.0%, and 81.3%, 97.0% and 95.0%, respectively. CONCLUSIONS: DWI image-based radiomics features and machine learning methods can accurately predict the 90-day prognosis of patients with AIS, and the radiomics model is superior to the clinical model in predicting prognosis.
Multiphase CTA Collateral Score to Identify Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion.
Xia J, Tu C, Qian H … +3 more , Gu Z, Song D, Xu L
Neurologist · 2025 Mar · PMID 40035202 · Full text
OBJECTIVE: Identification of acute ischemic stroke with large vessel occlusion (AIS-LVO) etiology is crucial for effective revascularization therapy. As collaterals are pivotal in maintaining cerebral perfusion in intrac...
OBJECTIVE: Identification of acute ischemic stroke with large vessel occlusion (AIS-LVO) etiology is crucial for effective revascularization therapy. As collaterals are pivotal in maintaining cerebral perfusion in intracranial atherosclerotic stenosis (ICAS), we investigated whether multiphase CT angiography (mCTA) collateral score can be a diagnosis marker of ICAS-related LVO. METHODS: We reviewed clinical and imaging data from 92 patients who presented with AIS-LVO and underwent mCTA (57 ICAS-related LVO and 35 embolic LVO). Logistic regression was used to identify ICAS-related LVO. The diagnostic accuracy of the mCTA collateral score for identifying ICAS-related LVO was determined using receiver operating characteristic (ROC) analysis. RESULTS: Compared with patients with embolic LVO, those with ICAS-related LVO had a high median mCTA collateral score (4 vs. 3; P<0.0001). The multinomial logistic regression analysis revealed a significant increase in the mCTA collateral score (OR: 3.717, 95% CI: 2.009-6.876, P<0.0001) in patients with ICAS-related LVO. ROC analysis revealed that the optimal cutoff point of the mCTA collateral score to diagnosis the ICAS-related LVO was 3.5, the area under the curve (AUC) was 0.817 (95% CI: 0.736-0.899; P<0.0001), sensitivity was 80.7%, and specificity was 74.3%. Further analysis revealed that patients with a 4 to 5 mCTA collateral score exhibited a significantly higher median modified Rankin Scale (mRS) at discharge compared with those with a 0 to 3 score (P=0.0464). CONCLUSIONS: The mCTA collateral score may be associated with ICAS-related LVO and could be beneficial in identifying the etiology of AIS-LVO.
Validation of an Artificial Intelligence-Powered Virtual Assistant for Emergency Triage in Neurology.
Alessandro L, Crema S, Castiglione JI … +13 more , Dossi D, Eberbach F, Kohler A, Laffue A, Marone A, Nagel V, Pastor Rueda JM, Varela F, Fernandez Slezak D, Rodríguez Murúa S, Debasa C, Claudio P, Farez MF
Neurologist · 2025 May · PMID 39912331 · Publisher ↗
OBJECTIVES: Neurological emergencies pose significant challenges in medical care in resource-limited countries. Artificial intelligence (AI), particularly health chatbots, offers a promising solution. Rigorous validation...
OBJECTIVES: Neurological emergencies pose significant challenges in medical care in resource-limited countries. Artificial intelligence (AI), particularly health chatbots, offers a promising solution. Rigorous validation is required to ensure safety and accuracy. Our objective is to evaluate the diagnostic safety and effectiveness of an AI-powered virtual assistant (VA) designed for the triage of neurological pathologies. METHODS: The performance of an AI-powered VA for emergency neurological triage was tested. Ten patients over 18 years old with urgent neurological pathologies were selected. In the first stage, 9 neurologists assessed the safety of the VA using their clinical records. In the second stage, the assistant's accuracy when used by patients was evaluated. Finally, VA performance was compared with ChatGPT 3.5 and 4. RESULTS: In stage 1, neurologists agreed with the VA in 98.5% of the cases for syndromic diagnosis, and in all cases, the definitive diagnosis was among the top 5 differentials. In stage 2, neurologists agreed with all diagnostic parameters and recommendations suggested by the assistant to patients. The average use time was 5.5 minutes (average of 16.5 questions). VA showed superiority over both versions of ChatGPT in all evaluated diagnostic and safety aspects ( P <0.0001). In 57.8% of the evaluations, neurologists rated the VA as "excellent" (suggesting adequate utility). CONCLUSIONS: In this study, the VA showcased promising diagnostic accuracy and user satisfaction, bolstering confidence in further development. These outcomes encourage proceeding to a comprehensive phase 1/2 trial with 100 patients to thoroughly assess its "real-time" application in emergency neurological triage.
Stroke-Related Factors Influencing Thrombolysis Eligibility and Outcomes.
Giorelli M, Aniello MS, Liuzzi D … +3 more , De Liso A, Accavone D, Negri F
Neurologist · 2025 May · PMID 39912306 · Publisher ↗
OBJECTIVE: Intravenous thrombolysis (IVT) improves outcomes of acute ischemic stroke (AIS) when timely administered. The aim of this study was to collect and analyze data of stroke-related factors which may influence the...
OBJECTIVE: Intravenous thrombolysis (IVT) improves outcomes of acute ischemic stroke (AIS) when timely administered. The aim of this study was to collect and analyze data of stroke-related factors which may influence the performance of stroke-related rescue chains, the use of IVT, and patients' outcomes. METHODS: This study enrolled patients with AIS admitted to our Stroke Unit (SU) between January 1, 2023, and December 31, 2023. We investigated whether age, occurrence of baseline disabling deficits, stroke severity, or stroke location influenced the median Onset-to-Door Time (ODT), the chance of receiving IVT, or the outcomes of AIS in our facility. RESULTS: A total of 208 patients were enrolled. Patients who received IVT had higher baseline National Institute of Health Stroke Scale (NIHSS) scores (12.26±1.2) than those who did not (6.77±0.51) ( P <0.0001). Patients with IVT further showed a greater strength deficit, less ataxia, and lower median ODT (108±20 min) than patients with NO IVT (720±67) ( P <0.0001). Weakness of the lower limbs and higher total NIHSS predicted ODT≤ 3.5 hours and the use of IVT. Ataxia and Posterior Circulation Stroke slowed the rescue chain and were negatively correlated with the use of IVT. CONCLUSIONS: Stroke-related factors may slow the rescue chain and affect the application of IVT for AIS. New evaluation strategies are warranted to overcome the detrimental effects of these factors and to allow clinicians to effectively manage strokes of any severity and location.
Syncope Induced by Dynamic Head and Shoulder Motion in the Setting of Left Subclavian Stenosis.
Fearington FW, Alajbegovic K, Scott JM … +3 more , Brinjikji W, Holmes CR, Khan M
Neurologist · 2025 Mar · PMID 39835436 · Publisher ↗
INTRODUCTION: Dynamic vertebral artery insufficiency is a rare vascular phenomenon characterized by insufficient flow of the posterior cerebral circulation induced by dynamic motion of the head. Prior case reports have b...
INTRODUCTION: Dynamic vertebral artery insufficiency is a rare vascular phenomenon characterized by insufficient flow of the posterior cerebral circulation induced by dynamic motion of the head. Prior case reports have been limited to vertebral artery occlusion by cervical osteophytes or other structural impingements. CASE REPORT: In this case report, we discuss the unusual case of a 61-year-old female with a history of vertigo, diplopia, nystagmus, and left subclavian stenosis admitted to the hospital for syncope elicited by a left head turn and left shoulder raise. Transcranial Doppler (TCD) ultrasound and angiography showed evidence of dynamic vertebrobasilar insufficiency elicited by a left-head turn. Percutaneous stenting of the left subclavian artery led to the resumption of normal vessel flow as assessed by TCD and the resolution of the patient's symptoms. CONCLUSIONS: This case highlights an unusual cause of dynamic vertebrobasilar insufficiency induced by head turn and/or left shoulder raise due to subclavian stenosis, diagnosed by TCD and angiography, and successfully treated with subclavian artery stenting.
Cerebral Venous Sinus Thrombosis as a Unique Initial Presentation of Thyroid Storm.
Algahtani H, Shirah B, Alameen MNA … +1 more , Bin Saeed A
Neurologist · 2025 Jan · PMID 39757588 · Publisher ↗
INTRODUCTION: Thyrotoxicosis is associated with a hypercoagulable state, increasing the risk of thrombotic events like CVST. Literature review reveals thyroid hormone's role in promoting prothrombotic abnormalities, impa...
INTRODUCTION: Thyrotoxicosis is associated with a hypercoagulable state, increasing the risk of thrombotic events like CVST. Literature review reveals thyroid hormone's role in promoting prothrombotic abnormalities, impacting coagulation factors and platelet function. CASE REPORT: This study explores the rare occurrence of thyroid storm complicated by deep cerebral venous sinus thrombosis (CVST) in a young male with no prior history of thyroid disease. Our case emphasizes the importance of considering thyroid disease, including thyroid storm, in patients who present with acute neurological symptoms and signs of hyperthyroidism. CONCLUSIONS: Multidisciplinary management is crucial for optimizing outcomes in both thyroid storm and neurological complications, with collaborative efforts from emergency physicians, endocrinologists, neurologists, and critical care specialists. This study underscores the need for increased awareness and timely intervention in complex presentations of thyroid dysfunction, urging further investigation into underlying mechanisms and therapeutic strategies to enhance patient care and prognosis in such critical scenarios.
Determining Outcomes in Patients With Large Vessel Occlusion and Mild Stroke Who Did or Did Not Receive Thrombolytics and/or Thrombectomy.
Reyes CZA, Castro-Apolo RG, Kincaid H … +2 more , Tabibzadeh N, Yacoub HA
Neurologist · 2025 Jan · PMID 39757587 · Publisher ↗
OBJECTIVES: The utility of thrombolysis and/or thrombectomy in patients with mild stroke and large vessel occlusion (LVO) remains inconclusive. This retrospective study compared short-term and long-term outcomes in patie...
OBJECTIVES: The utility of thrombolysis and/or thrombectomy in patients with mild stroke and large vessel occlusion (LVO) remains inconclusive. This retrospective study compared short-term and long-term outcomes in patients treated with best medical therapy (BMT group) versus with intravenous thrombolytics and/or endovascular thrombectomy (intervention group). METHODS: Patients with acute ischemic stroke (AIS), LVO, and National Institutes of Health Stroke Score (NIHSS) ≤5 were included. Data collected includes demographics; hospital length of stay (LOS); modified Rankin scale (mRS) at admission, discharge, and follow-up; hemorrhagic conversion; and disposition. Bivariate analyses were conducted to compare outcomes between groups. RESULTS: Of the 29 patients, 15 were treated with BMT and 14 underwent intervention. Median hospital LOS was slightly longer in the intervention group (6.5 [IQR=4 to 12] vs. 5 [IQR=3 to 5] d, P=0.070). Everyone in the BMT group had a favorable outcome (mRS 0 to 2) at discharge and follow-up, unlike the intervention group's rate at discharge (100% vs. 71.4%, P=0.042), This gap was closed at follow-up between BMT group (median=33 d, IQR=28 to 48) and intervention group (median=44.5 days, IQR=30 to 48) (100% vs. 85.7%, P=0.224). Hemorrhagic conversion rates were similar between groups. More patients in the BMT group were discharged home (80% vs. 42.9%, P=0.079). CONCLUSIONS: Patients with AIS, low NIHSS, and LVO, who received thrombolytics and/or thrombectomy had longer hospital LOS, higher mRS at discharge and follow-up, and were less likely to be discharged home, though these trends were not statistically significant. Our study is limited by a small sample size and these findings should be further explored in larger studies.
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