The Neurologist[JOURNAL]
Sun
200 papers
Shortened NIHSS for Rapid Stroke Assessment in Emergency Care Settings.
Rahnemayan S, Ala A, Taghizadeh N … +3 more , Sadeghi-Hokmabadi E, Entezari I, Shams Vahdati S
Neurologist · 2025 May · PMID 39722575 · Publisher ↗
OBJECTIVES: The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess ischemic stroke severity, but its full 11-item version can be time-consuming. This study evaluates the NIHSS-8, a shortened vers...
OBJECTIVES: The National Institutes of Health Stroke Scale (NIHSS) is widely used to assess ischemic stroke severity, but its full 11-item version can be time-consuming. This study evaluates the NIHSS-8, a shortened version, for its efficacy compared with NIHSS-11 in an emergency department setting. METHODS: A cohort study was conducted from May 2018 to May 2019 at Imam Reza Hospital, Tabriz, Iran. Patients with suspected acute stroke were assessed using both NIHSS-11 and NIHSS-8. The modified Rankin Scale (mRS) was used to evaluate patient outcomes at discharge. Correlations between NIHSS-8, NIHSS-11, and mRS were analyzed, and diagnostic performance metrics were calculated. RESULTS: The study included 292 patients with a mean age of 70.40 years. Approximately 68.5% of patients were categorized as having moderate stroke severity using NIHSS-11, with a similar 67.1% using NIHSS-8. The correlation between NIHSS-11 and NIHSS-8 scores was high (intraclass correlation coefficient of 0.970). Both scales showed strong relationships with mRS at discharge but were not significantly correlated with long-term outcomes. NIHSS-8 demonstrated a sensitivity of 97.5% and specificity of 96.9%, while NIHSS-11 showed 100% sensitivity and 96.9% specificity. CONCLUSIONS: NIHSS-8 is a reliable and efficient alternative to NIHSS-11 for assessing stroke severity in emergency departments. It provides high sensitivity and specificity while being less time-consuming, making it suitable for rapid stroke assessment and triage.
Basilar Dolichoarteriopathy and Early Clinical Deterioration in Acute Isolated Pontine Infarction.
Oge DD, Arsava EM, Topcuoglu MA
Neurologist · 2025 May · PMID 39670326 · Publisher ↗
OBJECTIVES: Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic b...
OBJECTIVES: Early clinical worsening (ECW) in acute isolated pontine infarcts (AIPI) is frequent, associated with poor prognosis, and its predictors have not been adequately clarified. A possible role of dolichoectatic basilar artery (BA) anatomy in ECW in patients with AIPI is herein studied. METHODS: In 146 AIPI patients, infarcts were grouped into tegmental, lateral, anterolateral, anteromedial horizontally; and low, mid, mid-up, and upper pontine vertically. BA dolichoectasia was categorized according to Smoker criteria. An additional criteria of BA laterality angle was described. The length between the infarct long-axis and BA cross-sectional center was measured, and named as "branch length (BL)." ECW was defined as any increase in NIHSS. RESULTS: ECW was seen in 22 (15%) patients. Univariate analysis documented a higher female ratio (22% vs. 10%, P =0.007), higher atrial fibrillation (18% vs. 7%, P =0.067), more common anteromedial infarct location (77% vs. 49%, P =0.025), and Smoker category-3 BA height (32% vs. 10%, P =0.043) in these patients. In anteromedial infarcts, BL was longer (8.3 vs. 6.1 mm, P =0.052), and reaching to significance in those located at mid-up/upper pontine level (1.22 vs. 0.62 mm, P =0.006). BL >4.4 mm showed an acceptable discriminatory capacity for ECW with an AUC of ROC: 0.615 (95% CI: 0.511-0.712). A regression model indicated female sex (β±SE=1.129±0.551, P =0.040), BL (per 4.4 mm, β±SE=1.236±0.614, P =0.044), and BA height-category-3 (β±SE=1.711±0.645, P =0.008) as independent predictors for ECW. CONCLUSIONS: Some features of basilar dolichoarteriopathy, such as the extreme location of the height of the BA tip and the length of the involved perforator in the prepontine cistern, may be predictors of early clinical worsening in acute isolated pontine infarcts.
Ethnicity as a Risk Factor for Early Neurological Deterioration: A Post Hoc Analysis of the Secondary Prevention of Small Subcortical Strokes Trial.
Goldstein ED, Liew SQR, Shu L … +2 more , Rocha A, Yaghi S
Neurologist · 2025 Mar · PMID 39648718 · Publisher ↗
OBJECTIVES: Nearly 25% of those with a small vessel stroke will develop early neurological deterioration (END). The objectives of this study were to identify clinical risk factors for small vessel stroke-related END and...
OBJECTIVES: Nearly 25% of those with a small vessel stroke will develop early neurological deterioration (END). The objectives of this study were to identify clinical risk factors for small vessel stroke-related END and its associated impact on functional outcomes in an ethnically diverse data set. METHODS: We performed a post hoc analysis of the "Secondary Prevention of Small Subcortical Strokes" trial. The primary outcome was END defined as progressive or stuttering stroke-related neurological symptoms. Standard descriptive and inferential statistical methods were used for analysis. Functional outcomes are reported by modified Rankin Scale score and analyzed by the Wilcoxon signed-rank test. RESULTS: In all, 69 participants met the inclusion criteria; 21 (30%) had END. Of the cohort, Spanish, Hispanic, or Latino ethnicity (grouping per trial definition) most frequently developed END [11 (52.4%) vs 4 (8.3%), P < 0.001] with a higher adjusted likelihood of END (odds ratio: 14.1, 95% CI: 2.57-76.7, P = 0.002). Black or African-American race less commonly had END [3 (14.3%) vs 21 (43.8%), P = 0.03] but lost significance after adjustment (odds ratio: 1.46, 95% CI: 0.26-8.17, P = 0.67) due to powering. END was associated with a higher mean modified Rankin Scale (2.06 ± 0.94 vs 1.17 ± 0.79, P = 0.006) but did not differ in the shift analysis. CONCLUSIONS: We found that Spanish, Hispanic, or Latino ethnicity was the most consistent risk factor for END though it was without meaningful functional outcome differences.
Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke.
Jiao Y, Wang X, Guan Y … +4 more , Wang X, Li Z, Xiang X, Zhang Z
Neurologist · 2025 May · PMID 39648705 · Publisher ↗
OBJECTIVE: This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS). METHODS: Sixty patients with acute ischemi...
OBJECTIVE: This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS). METHODS: Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment. RESULTS: A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference ( P >0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group. CONCLUSIONS: Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.
Expansive Arterial Remodeling and Its Risk Factors in Cerebral Infarction: A Retrospective Study.
Gong B, Pian Y, Yang Q … +1 more , Zhang J
Neurologist · 2025 May · PMID 39618341 · Publisher ↗
OBJECTIVE: Cerebral infarction (CI) is a prevalent and frequently occurring condition. However, the association between expansive remodeling in the carotid artery system and CI is still uncertain. This study aims to inve...
OBJECTIVE: Cerebral infarction (CI) is a prevalent and frequently occurring condition. However, the association between expansive remodeling in the carotid artery system and CI is still uncertain. This study aims to investigate the significance of the carotid artery system and aortic arch (AA) remodeling for the prevention and treatment of CI. METHODS: We collected data from 821 patients who underwent computed tomography angiography at our hospital, performed statistical analysis, and compared it with various clinical data. RESULTS: We found that the diameters and detection rates of the common carotid artery (CCA), internal carotid artery (ICA), carotid bifurcation, and AA were significantly greater in the CI group than in the without CI group ( P <0.05). The number of carotid sinus plaque (CSP) and the length of aortic arch plaque (AAP) were considered to be 2 important factors in predicting CCA remodeling. Moreover, the thickness of AAP was considered to be an important factor in predicting AA remodeling. CONCLUSIONS: Patients with CI exhibited a significant increase in the diameter of the carotid system and AA, which correlated with certain features of arterial plaque. Hence, early detection of arterial plaques, along with interventions to delay or potentially reverse expansive arterial remodeling, may be effective in preventing and treating CI.
Increased Intracranial Pressure in Myelin-Oligodendrocyte Glycoprotein Antibody-Associated Disease.
Rempe T, Elfasi A, Alkabie S … +8 more , Christy A, Rodriguez E, Castrodad-Molina R, Buchowicz B, Cuascut FX, Hutton G, Kinkel R, Graves J
Neurologist · 2025 Jan · PMID 39618340 · Publisher ↗
OBJECTIVES: To assess characteristics of increased intracranial pressure (ICP) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS: This is a multicenter retrospective review of 84 MOGAD c...
OBJECTIVES: To assess characteristics of increased intracranial pressure (ICP) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS: This is a multicenter retrospective review of 84 MOGAD cases at the University of Florida, Baylor College of Medicine, the University of California San Diego, and Providence Health and Services, Portland, Oregon, to identify cases with a documented increased opening pressure >25 cm H2O. A literature review was conducted to identify previously reported MOGAD cases with an opening pressure >25 cm H2O. RESULTS: Of 28 MOGAD cases with available opening pressures, 6 (21.4%) patients (age: 5 to 36 y; 2/6 females) had documented increased ICP with an opening pressure of 26 to 46 cm H2O and optic nerve head edema on funduscopic examination. The increased ICP occurred in the setting of bilateral optic neuritis in all cases. In 5/6 patients, this was the initial presentation of the disorder. Anti-MOG titers were 1:40 (n = 1), 1:100 (n = 4), and 1:1000 (n = 1). In our literature review, we identified 13 additional MOGAD cases with ICP elevations in the setting of meningo-cortical presentations (n = 10), as well as bilateral optic neuritis (n = 3). CONCLUSIONS: Increased ICP may occur in MOGAD and may be more common in patients with optic neuritis or meningoencephalitis.
Spectrum of Intracranial Hemorrhages in Cerebral Venous Thrombosis: A Pictorial Case Series and Review of Pathophysiology and Management.
Jha S, Kulanthaivelu K, Raja P … +4 more , Kenchiah R, Ramakrishnan S, Kulkarni GB, Asranna A
Neurologist · 2025 Jan · PMID 39618313 · Publisher ↗
OBJECTIVE: We aim to provide a pictorial representation of the broad spectrum of intracranial hemorrhages associated with cerebral venous thrombosis (CVT), emphasizing atypical locations and rare intracerebral hemorrhage...
OBJECTIVE: We aim to provide a pictorial representation of the broad spectrum of intracranial hemorrhages associated with cerebral venous thrombosis (CVT), emphasizing atypical locations and rare intracerebral hemorrhage (ICH) types. We also hypothesize the pathophysiology leading to atypical locations of the ICH in CVT and the outcomes with anticoagulation therapy. BACKGROUND: ICH complicates about 40% of cases with CVT and is known to cause various types of ICH, including subarachnoid hemorrhage (SAH) and subdural hemorrhage (SDH). A combination of hemorrhages is also reported. METHODS: Patients with computed tomography and magnetic resonance imaging findings consistent with CVT examined between January 2011 and June 2014 were included in this retrospective review. Demographic and clinical data and imaging findings were reviewed with particular attention to the type and location of ICH and sinus involvement. Treatment details and 3-month outcomes, assessed using the modified Rankin Scale, were analyzed. RESULTS: Eleven patients (9 males), ranging in age from 22 years to 58 years, were included. The most common clinical presentations were headache (n = 8) and seizures (n = 7). Intraparenchymal hemorrhages were most common (n = 7), followed by SDH and SAH (n = 4), intraventricular hemorrhage (IVH; n = 3), and juxtacortical hemorrhage (n = 1). All patients who received anticoagulation therapy (n = 11) experienced complete resolution of their symptoms, and the median modified Rankin Scale was 0. CONCLUSIONS: The spectrum of intracranial hemorrhages seen in association with CVT is broad, encompassing atypical locations like basal ganglia, external capsule, and cerebellar hemispheres, and involves multiple intracranial compartments-IVH, SAH, and SDH. While SAH and SDH are seen with superior sagittal sinus thrombosis, ICH is common with lateral sinus thrombosis, and IVH with deep venous thrombosis.
Risk Factors and a Prediction Model for Hemorrhagic Transformation in Acute Ischemic Stroke With Atrial Fibrillation.
Fu W, Zhang J, Bi Q … +5 more , Lu Y, Liu L, Zhou X, Wang J, Wang F
Neurologist · 2025 Jan · PMID 39618245 · Publisher ↗
OBJECTIVES: To identify the risk factors of hemorrhagic transformation (HT) and to establish a prediction model for HT in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). METHODS: From January 2015...
OBJECTIVES: To identify the risk factors of hemorrhagic transformation (HT) and to establish a prediction model for HT in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). METHODS: From January 2015 to December 2018, patients with AIS and AF were enrolled. Demographics, lesion features, and blood test results were collected. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of HT. The receiver operating curve (ROC) curve was utilized to determine the cutoff values and the efficiency of the variables. A predictive model was subsequently developed based on the identified independent risk factors. RESULTS: A total of 259 patients were included. Age [odds ratio (OR): 1.094; 95% CI: 1.048-1.142; P <0.001], LDL-C (OR: 0.633; 95% CI: 0.407-0.983; P =0.042), uric acid (OR: 0.996; 95% CI: 0.991-0.999; P =0.031), Alberta Stroke Program Early CT Score (ASPECTS) (OR: 0.700; 95% CI: 0.563-0.870; P <0.001), cerebral cortex infarction (OR: 0.294; 95% CI: 0.168-0.515; P <0.001), and massive cerebral infarction (OR: 3.683; 95% CI: 3.025-5.378; P <0.001) were independently associated with HT. We have developed a model incorporating these variables. The area under the curve of the predictive model was 0.87 (95% CI: 0.83-0.92), demonstrating satisfactory predictive ability with a sensitivity of 83.5% and a specificity of 76.4%. CONCLUSIONS: Our predictive model, which integrates age, LDL-C, uric acid, ASPECTS, cerebral cortex infarction, and massive cerebral infarction, can be used to predict HT after AIS in patients with AF, thereby facilitating the mitigation of adverse outcomes.
Short-Term Frequently Relapsing Ischemic Strokes Followed by Rapidly Progressive Dementia in CADASIL: A Case Report and Literature Review.
Geng Y, Cai C, Li H … +3 more , Zhou Q, Wang M, Kang H
Neurologist · 2025 May · PMID 39588856 · Publisher ↗
INTRODUCTION: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease with slow natural progression. Ischemic strok...
INTRODUCTION: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease with slow natural progression. Ischemic stroke and cognitive impairment are its most common clinical symptoms. Here, we report a rare 50-year-old woman who had rapid disease progression with c.457C>T, p.Argl53Cys heterozygous mutation in exon 4 of NOTCH3 and discuss the possible reasons. Furthermore, we summarized the clinical and neuroimaging characteristics of 14 CADASIL patients with Arg153Cys mutation in exon 4. CASE REPORT: The proband suffered acute ischemic stroke 5 times in 5 months, followed by rapidly progressive dementia (RPD) and inability to live independently, though she didn't have vascular risk factors and had been under standardized secondary prevention therapy since the first stroke. Magnetic resonance imaging showed extensive white matter hyperintensities, numerous ischemic infarcts and microbleeds, and severe brain atrophy. Her elder brother and other patients with Arg153Cys mutation in exon 4 all did not progress so quickly. Her multiple strokes may be associated with the poor self-regulation of vessels, which may promote the occurrence of RPD. Antiplatelet and anticoagulant drugs were difficult to prevent ischemic strokes. Severe imaging findings may indicate rapid progression of CADASIL. In addition, we found that headache was a very frequent symptom in CADASIL patients with Arg153Cys mutation in exon 4, accounting for 76.9%. CONCLUSIONS: CADASIL can also appear to have rapid progression, as illustrated by our proband, which is worthy of clinicians' attention and intervention timely. Headache may present in a relatively higher proportion of CADASIL patients with Arg153Cys mutation in exon 4.
The Efficacy for Hypertensive Intracerebral Hemorrhage Between Neuroendoscopic Surgery and Conservative Treatment: A Retrospective Observational Study.
Huo G, Lan Y, Feng Y … +2 more , Gao X, Chen C
Neurologist · 2025 Mar · PMID 39575625 · Publisher ↗
OBJECTIVES: This study aims to investigate the efficacy of neuroendoscopic surgery in the treatment of hypertensive intracerebral hemorrhage (HICH). METHODS: A total of 193 patients diagnosed with HICH were divided into...
OBJECTIVES: This study aims to investigate the efficacy of neuroendoscopic surgery in the treatment of hypertensive intracerebral hemorrhage (HICH). METHODS: A total of 193 patients diagnosed with HICH were divided into 2 groups in this study: the observation group (n=101) received neuroendoscopic surgery, whereas the control group (n=92) underwent conservative treatment. Then, the outcomes between these 2 groups were compared and assessed. RESULTS: In the pretreatment phase, there were no significant differences in the levels of inflammation and neurological function scores between these 2 groups ( P >0.05). After 3 months of treatment, the observation group displayed significantly shorter median hospital stay, lower average hospital costs, and faster hematoma resorption time, along with reduced levels of tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), interleukin (IL)-6 and IL-8, aquaporin-4 (AQP4), macrophage migration inhibitory factor (MIF), matrix metalloproteinase-9 (MMP-9), granulocyte macrophage colony stimulating factor (GM-CSF), Nerve Deficiency Scale (NDS), Graeb score, and national institute of health stroke scale (NIHSS) compared with the control group ( P <0.05). In addition, the observation group exhibited higher rate of hematoma clearance and better glasgow outcome scale (GOS) score compared with the control group ( P <0.05). The effective treatment rate in the observation group was notably superior to that in the control group (89.11% vs. 73.91%, P <0.05). CONCLUSIONS: Neuroendoscopic surgery is an effective treatment for HICH, with alleviating the inflammatory response and enhancing the neurological function. The treatment shows promising outcomes and justifies extensive implementation.
Outcomes and Antithrombotic Regimens in Nonvalvular Atrial Fibrillation Patients With Acute Ischemic Stroke and Competing Large-Artery Atherosclerosis.
Xue S, Na R, Dong J … +6 more , Qiu X, Wei M, Kong Q, Wang Q, Li F, Wang Y
Neurologist · 2025 Mar · PMID 39570078 · Publisher ↗
OBJECTIVES: This study aimed to investigate the outcomes and effectiveness of different antithrombotic regimens at discharge in nonvalvular atrial fibrillation (NVAF) patients with acute ischemic stroke (AIS) and competi...
OBJECTIVES: This study aimed to investigate the outcomes and effectiveness of different antithrombotic regimens at discharge in nonvalvular atrial fibrillation (NVAF) patients with acute ischemic stroke (AIS) and competing large artery atherosclerosis (LAA) mechanisms. METHODS: In an observational study, we retrospectively analyzed the clinical and follow-up data of NVAF patients with AIS from January 2018 to December 2021 (NCT04080830). The subjects were grouped into 2 groups based on the presence or absence of competing LAA mechanisms. Stroke severity, short-term prognosis, and ischemic recurrence (a composite of ischemic stroke/TIA, myocardial infarction, or systemic embolism after index stroke), were compared between the 2 groups. Antithrombotic regimens at discharge were further categorized into antiplatelet and anticoagulant subgroups to analyze their effectiveness. RESULTS: Five hundred-one NVAF patients with AIS (129 with and 372 without competing LAA mechanisms) were included. Compared with the other group, the group with competing LAA mechanisms had a higher proportion of patients with a nondisabling mRS score (P <0.001), lower mortality rates at the 90-day follow-up ( P =0.048), and higher 180-day ischemic outcomes ( P =0.023). Subgroup analysis showed that the ischemic outcomes were not significantly different ( P =0.166) between the anticoagulant and antiplatelet subgroups in patients with competing LAA mechanisms. In contrast, it was numerically higher in the anticoagulant subgroup. CONCLUSION: NVAF patients with AIS due to competing LAA mechanisms had mild severity and a comfortable short-term prognosis; however, these patients had a higher risk of ischemic events. The optimal antithrombotic regimens in these patients remain unclear, and stroke mechanisms should be considered.
Enoxaparin Failure in Patient With Cerebral Venous Sinus Thrombosis and Prothrombin G20210A Mutation: Case Report.
Polavarapu A, Bhushan A, Duarte-Celada W … +2 more , Windisch T, Bhushan B
Neurologist · 2025 May · PMID 39505562 · Full text
INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is a rare, serious, and complex cerebrovascular disease. The prothrombin G20210A mutation is the second most common inherited thrombophilia and is considered to be on...
INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is a rare, serious, and complex cerebrovascular disease. The prothrombin G20210A mutation is the second most common inherited thrombophilia and is considered to be one of the etiologies of CVST. The optimal heparinoid medication for treatment remains a topic of debate. CASE REPORT: This case report describes a young woman with CVST who did not respond to low-molecular-weight heparin (LMWH). The patient was initially treated with LMWH; however, her symptoms and clot burden in the sagittal sinus worsened, and coagulation studies showed no evidence of therapeutic anticoagulation despite good compliance. Unfractionated heparin was then initiated, and the patient's symptoms improved dramatically within 24 hours, along with the recanalization of the cerebral venous sinuses. Genetic testing revealed a heterozygous mutation in the prothrombin gene (G20210A). This mutation is a known risk factor for CVST. However, it is unclear why the patient did not respond to LMWH but responded appropriately to unfractionated heparin. CONCLUSION: This case report highlights the potential for LMWH resistance in patients with CVST and prothrombin gene mutations. These findings also emphasize the importance of close monitoring of coagulation parameters and clinical response in patients with CVST receiving LMWH.
MELAS Presenting as Bilateral Symmetric Occipital and Temporal Cortices Lesions: A Case Report and Literature Review.
Liu Q, Wang Z, Shi J … +6 more , Wang W, Wen C, Zhu Y, Chen X, Xing X, Su Y
Neurologist · 2025 Mar · PMID 39450883 · Publisher ↗
INTRODUCTION: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode (MELAS) is one of the most common maternally inherited mitochondrial diseases. The stroke-like episode affecting the cortical...
INTRODUCTION: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode (MELAS) is one of the most common maternally inherited mitochondrial diseases. The stroke-like episode affecting the cortical cortex is the hallmark of MELAS; however, it rarely presents as simultaneously bilateral symmetric cortices lesions. CASE REPORT: We reported a case of MELAS in a 46-year-old female patient with bilateral symmetric occipital and internal temporal cortices involvements on brain magnetic resonance imaging (MRI). A literature review of MELAS patients and a retrospective analysis were performed. She had a family history of diabetes. Although she denied a history of diabetes, elevated blood glucose was noted after admission, and diabetes was diagnosed. Laboratory examination revealed elevated lactate acid and creatine kinase levels in blood. Cranial computed tomography (CT) image demonstrated basal ganglia calcification, as well as subtle decreased attenuation in bilateral symmetric occipital and internal temporal cortices. Brain magnetic resonance imaging (MRI) demonstrated symmetric gyriform hyperintensity in bilateral occipital lobes and internal temporal lobes in both grey and white matter on fluid-attenuated inversion recovery (FLAIR) images with restricted diffusion on diffusion weighted images (DWI). A genetic test revealed a point mutation in the mtDNA(3243A > G) by blood examination. Literature review showed that there were 231 eligible patients with MELAS identified from 212 published papers. Symmetric cortical involvements were seen in 15 (6.5%) patients on brain MRI. CONCLUSIONS: MELAS should be considered as a potential diagnosis in the patients with bilateral symmetric stroke-like cortices lesions.
Stem Cells Treatment for Subarachnoid Hemorrhage.
Wang W, Wang Y, Gao L
Neurologist · 2025 Mar · PMID 39450602 · Publisher ↗
BACKGROUND: Subarachnoid hemorrhage (SAH) refers to bleeding in the subarachnoid space, which is a serious neurologic emergency. However, the treatment effects of SAH are limited. In recent years, stem cell (SC) therapy...
BACKGROUND: Subarachnoid hemorrhage (SAH) refers to bleeding in the subarachnoid space, which is a serious neurologic emergency. However, the treatment effects of SAH are limited. In recent years, stem cell (SC) therapy has gradually become a very promising therapeutic method and advanced scientific research area for SAH. REVIEW SUMMARY: The SCs used for SAH treatment are mainly bone marrow mesenchymal stem cells (BMSCs), umbilical cord mesenchymal stem cells (hUC-MSCs), dental pulp stem cells (DPSCs), neural stem cells (NSCs)/neural progenitor cell (NPC), and endothelial progenitor cell (EPC). The mechanisms mainly included differentiation and migration of SCs for tissue repair; alleviating neuronal apoptosis; anti-inflammatory effects; and blood-brain barrier (BBB) protection. The dosage of SCs was generally 10 6 orders of magnitude. The administration methods included intravenous injection, nasal, occipital foramen magnum, and intraventricular administration. The administration time is generally 1 hour after SAH modeling, but it may be as late as 24 hours or 6 days. Existing studies have confirmed the neuroprotective effect of SCs in the treatment of SAH. CONCLUSIONS: SC has great potential application value in SAH treatment, a few case reports have provided support for this. However, the relevant research is still insufficient and there is still a lack of clinical research on the SC treatment for SAH to further evaluate the effectiveness and safety before it can go from experiment to clinical application.
Rocky Mountain Spotted Fever Encephalitis and "Starry Sky" Pattern on MRI: A Case Report.
Mikhaiel JP, Parasram M, Park J … +5 more , Cappucci S, McGuone D, Falcone GJ, Sheth KN, Gilmore EJ
Neurologist · 2025 Jan · PMID 39382206 · Publisher ↗
INTRODUCTION: Rocky Mountain Spotted Fever (RMSF) is a tick-borne disease caused by Rickettsia rickettsii ( R. rickettsii ). RMSF presents after a tick bite with fever, rash, and headache but can also cause more serious...
INTRODUCTION: Rocky Mountain Spotted Fever (RMSF) is a tick-borne disease caused by Rickettsia rickettsii ( R. rickettsii ). RMSF presents after a tick bite with fever, rash, and headache but can also cause more serious neurological manifestations. We report a case of RMSF encephalitis presenting with altered sensorium and rapid progression to coma, fever, and petechial rash, and an magnetic resonance imaging (MRI) brain notable for a "starry sky" pattern. CASE REPORT: A 61-year-old woman presented with confusion and fever and was diagnosed with a urinary tract infection. Two days later, she became comatose. MRI brain revealed lacunar infarcts in the right centrum semiovale and splenium of the corpus callosum. Lumbar puncture was notable for neutrophilic pleocytosis and elevated protein with negative bacterial and viral cultures. Empiric meningitis therapy was initiated, and she was transferred to our institution. On transfer, she was febrile, comatose, and had a diffuse petechial rash. Repeat MRI brain demonstrated diffuse, innumerable punctate foci of diffusion restriction with susceptibility-weighted signal attenuation throughout cerebral hemispheres in a "starry sky" pattern. Skin biopsy revealed perivascular lymphocytic infiltrates. Serologic RSMF antibody titers were obtained, and doxycycline was initiated for presumed RMSF encephalitis. The family opted to pursue palliative measures, given no clinical improvement. RSMF titers and postmortem PCR from brain tissue were positive for R. rickettsii. CONCLUSIONS: This case report highlights the clinical presentation of RMSF encephalitis. RMSF encephalitis should be suspected in a patient presenting with encephalopathy, fever, petechial rash, and MRI brain findings of diffuse punctate foci of diffusion restriction and susceptibility-weighted signal attenuation in a "starry-sky" pattern.
Advancements in Imaging for the Diagnosis of Wake-up Stroke.
Li Y, Ma CH
Neurologist · 2025 Jan · PMID 39382203 · Publisher ↗
BACKGROUND: The concept of wake-up stroke (WUS) as a distinct subtype of acute ischaemic stroke, characterized by an uncertain onset time, traditionally resulted in the exclusion of patients from intravenous thrombolysis...
BACKGROUND: The concept of wake-up stroke (WUS) as a distinct subtype of acute ischaemic stroke, characterized by an uncertain onset time, traditionally resulted in the exclusion of patients from intravenous thrombolysis treatment. REVIEW SUMMARY: Advancements in neuroimaging have prompted a shift in the approach to intravenous thrombolysis treatment, moving away from a strict focus on the onset time window toward consideration of the tissue time window. This paradigm shift has expanded the opportunity for a larger cohort of patients with WUS to receive timely and effective treatment, ultimately leading to improved prognosis. CONCLUSIONS: This study reviews the WUS pathogenesis and the progress of various imaging diagnostic techniques to clarify the WUS onset time and select the optimal treatment plan.
C9orf72 Gene-Associated Frontotemporal Dementia Mimicking Autoimmune Pathology.
Hoshina Y, Moser C, Wright MA … +5 more , Sunderman E, Livsey CT, Spoth E, Clardy SL, Cliatt Brown CJ
Neurologist · 2025 Jan · PMID 39382125 · Publisher ↗
INTRODUCTION: The C9orf72 mutation can manifest in diverse clinical ways, including rapid cognitive decline, parkinsonism, or late-life neuropsychiatric symptoms, sometimes mimicking autoimmune encephalitis. CASE REPORT:...
INTRODUCTION: The C9orf72 mutation can manifest in diverse clinical ways, including rapid cognitive decline, parkinsonism, or late-life neuropsychiatric symptoms, sometimes mimicking autoimmune encephalitis. CASE REPORT: A 64-year-old female presented to the autoimmune neurology clinic with rapidly progressive dementia (RPD) associated with episodes of headache, confusion, auditory hallucinations, and abnormal electroencephalogram. She was treated empirically at an outside hospital for possible autoimmune encephalitis with intravenous methylprednisolone, but there was no improvement, and rapid cognitive decline continued. Family history was notable for RPD with akinetic mutism in her sister, sudden severe depression followed by parkinsonism with progressive dementia in her father in his 60s, and late-life gradually progressive dementia in her mother. Additional testing revealed a low titer positive contactin-associated protein-like 2 (CASPR2) immunoglobulin G (IgG) in the serum and elevated CSF 14-3-3 protein. CSF CASPR2 IgG and real-time quaking-induced conversion for Creutzfeldt-Jakob disease were negative. Brain MRI showed normal parenchymal volume. Genetic testing was conducted, which identified a heterozygous pathogenic hexanucleotide tandem repeat expansion in the C9orf72 gene. CONCLUSION: This case underscores the phenotypic variability of C9orf72 mutation and the importance of a detailed family history exploring young or atypical deaths and neuropsychiatric symptoms or behavioral changes. Genetic etiologies are crucial to consider in those with a family history concerning autosomal dominant inheritance patterns of early-onset dementia, parkinsonism, or late-onset psychiatric disease. Emphasis is placed on considering alternative etiologies early, particularly when there is no response to first-line immunomodulation for suspected autoimmune dementia.
West Nile Virus Neuroinvasive Disease: Lessons From Two Cases.
Taga A, Filippatou A, Divakaruni SS … +2 more , Pardo C, Green K
Neurologist · 2024 Nov · PMID 39353873 · Full text
BACKGROUND AND OBJECTIVE: West Nile neuroinvasive disease (WNND) displays a wide range of clinical manifestations due to its involvement of various structures within the central nervous system and peripheral nervous syst...
BACKGROUND AND OBJECTIVE: West Nile neuroinvasive disease (WNND) displays a wide range of clinical manifestations due to its involvement of various structures within the central nervous system and peripheral nervous system, often including prolonged unresponsiveness as the presenting symptom. METHODS AND RESULTS: We describe 2 patients presenting with coma and bilateral thalamic lesions on brain magnetic resonance imaging, found to have WNND after extensive workup. These cases illustrate some of the challenges associated with evaluating coma in general and specifically in diagnosing WNND. CONCLUSION: The clinical diagnosis of WNND requires a high index of suspicion, particularly in immunocompromised and elderly patients. Brain and spine magnetic resonance imaging findings can help narrow down the differential diagnosis, although other diseases may manifest similarly. Serological studies on the cerebrospinal fluid are essential to confirm the diagnosis but have inherent limitations. Given these challenges, WNND should be considered in all patients living in endemic areas who present with unexplained altered mental status during the late summer and early fall seasons.
Pharmacological Dissociation in Hemicrania Continua With Persistent Visual Aura Evolved From Episodic Migraine: A Case Report.
Grosberg BM, Friedman DI, Robbins MS … +1 more , Verhaak AMS
Neurologist · 2024 Nov · PMID 39353868 · Publisher ↗
OBJECTIVE: To report a case of hemicrania continua (HC) and persistent visual aura without infarction in a patient with previous episodic migraine with visual aura, whose persistent aura symptoms improved only after trea...
OBJECTIVE: To report a case of hemicrania continua (HC) and persistent visual aura without infarction in a patient with previous episodic migraine with visual aura, whose persistent aura symptoms improved only after treatment with divalproex sodium. BACKGROUND: Once regarded as highly specific for migraine, visual aura has been associated with trigeminal autonomic cephalalgias, including HC. In previous descriptions of HC and episodes of typical visual aura, the aura occurred exclusively with severe headache exacerbations and, like the pain, resolved with indomethacin. METHODS: Case report and literature review. RESULTS: A 54-year-old man with a history of episodic migraine with visual aura reported a gradual onset of HC with persistent visual aura of 15 months duration. General medical and neurological examinations were normal, including imaging studies. HC's headache responded to indomethacin, while the visual aura was recalcitrant, only improving with oral divalproex sodium treatment. CONCLUSION: As our patient experienced HC, which evolved from episodic migraine, we hypothesize that migraine and HC may share a common pathophysiology. However, the persistence of the visual aura, despite the abolition of pain and autonomic features with a therapeutic dose of indomethacin, and the subsequent successful treatment of the aura with divalproex sodium, suggest that aura and HC headache arise from distinct and dissociable mechanisms.
Clinical Features, Management, and Recurrence of Acute Ischemic Stroke Occurring in Patients on Oral Anticoagulant Treatment for Nonvalvular Atrial Fibrillation: A Real-World Retrospective Study.
Grifoni E, Pagni B, Sansone T … +25 more , Baldini M, Bertini E, Giannoni S, Di Donato I, Sivieri I, Iandoli G, Mannini M, Giglio E, Vescera V, Brai E, Signorini I, Cosentino E, Micheletti I, Cioni E, Pelagalli G, Dei A, Giordano A, Dainelli F, Romagnoli M, Mattaliano C, Schipani E, Murgida GS, Di Martino S, Francolini V, Masotti L
Neurologist · 2024 Nov · PMID 39344366 · Publisher ↗
OBJECTIVES: The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA...
OBJECTIVES: The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA for nonvalvular atrial fibrillation (NVAF). METHODS: We retrospectively analyzed data on NVAF patients with AIS on direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) admitted to our Stroke Unit from 2017 to 2022. Ninety-day modified Rankin Scale (mRS), 90-day, and 12-month stroke recurrences were recorded. RESULTS: A total of 169 patients (53.2% female, mean age 82.8±6.7 y), 117 (69.2%) on DOAC, and 52 on VKA (30.8%), were enrolled. Mean age, in-hospital mortality, and 90-day mRS ≥4 were significantly higher in VKA patients. 63.4% of VKA patients had subtherapeutic INR, whereas 47.1% of DOAC patients were on low-dose (14.2% off-label). Large vessel occlusion and embolic etiology were more frequent in VKA patients (34.6% vs. 26.4%, P =0.358; 92.3% vs. 74.3%, P =0.007, respectively), whereas lacunar strokes were more frequent in DOAC patients (19.8% vs. 12.2%, P =0.366). Among patients on VKA before AIS 86.4% were switched to DOAC, whereas a DOAC-to-VKA and a DOAC-to-DOAC switch were done in 25.4% and 11.7%, respectively. Stroke recurrence occurred in 6.4% of patients at 90 days and 10.7% at 12 months. Anticoagulant switching was not associated with stroke recurrences. CONCLUSIONS: In our study, nonembolic etiology was more frequent in DOAC patients and anticoagulant switching did not reduce the risk of stroke recurrence. Prospective multicentric studies are warranted.
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