Neurological Sciences[JOURNAL]
Sun
200 papers
Neurovascular-immune mediator dynamics in migraine: State-dependent effects of caffeine.
Khasawneh RR, Almahasneh FA, Abu-El-Rub E … +3 more , Aljariri H, Kasasbeh A, Almazari RA
Neurol Sci · 2026 Jun · PMID 42257903 · Publisher ↗
BACKGROUND: Migraine is a complex neurovascular disorder involving interactions between trigeminovascular, endothelial, and neuroimmune pathways. Dysregulation of key mediators-calcitonin gene-related peptide (CGRP), nit...
BACKGROUND: Migraine is a complex neurovascular disorder involving interactions between trigeminovascular, endothelial, and neuroimmune pathways. Dysregulation of key mediators-calcitonin gene-related peptide (CGRP), nitric oxide (NO), endothelin-1, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α)-is central to its pathophysiology. However, their phase-dependent dynamics and acute responsiveness to caffeine remain unclear. This study evaluated phase-specific alterations in these mediators and their intra-individual response to caffeine. METHODS: A total of 327 participants (174 migraine patients and 153 healthy controls) were included. Migraine patients were assessed across interictal and ictal phases using a within-subject design. During ictal attacks, participants underwent a randomized, double-blind, placebo-controlled crossover intervention with 200 mg caffeine or placebo. Blood samples were collected at baseline (T0) and 60 min post-intervention (T1). Mediators were measured using ELISA and analyzed with linear mixed-effects models. RESULTS: CGRP, NO, IL-6, and TNF-α were significantly elevated during migraine, particularly in the ictal phase, while endothelin-1 was reduced. Caffeine significantly decreased CGRP and NO levels and increased endothelin-1 compared with placebo. IL-6 and TNF-α showed modest reductions. Responses varied between individuals, with greater effects observed in those with higher baseline levels. CONCLUSIONS: Migraine is characterized by dynamic, phase-dependent neurovascular and inflammatory alterations. Acute caffeine administration modulates key mediators, promoting a shift toward a more vasoconstrictive vascular balance and reduced trigeminovascular activation. These effects are influenced by baseline mediator levels, highlighting the importance of state-dependent responsiveness. The findings emphasize the need for temporally sensitive and individualized approaches in understanding migraine pathophysiology and therapeutic modulation.
Early respiratory decline around diagnosis and short-term post-landmark outcomes in amyotrophic lateral sclerosis: a 6-month landmark cohort study.
Horiuchi K, Nakamura S, Ishikawa K … +8 more , Nunomura S, Yamada K, Inoue T, Oiwa K, Fujii S, Oshima Y, Kudo A, Yabe I
Neurol Sci · 2026 Jun · PMID 42257902 · Publisher ↗
BACKGROUND: In amyotrophic lateral sclerosis (ALS), respiratory decisions rely on serial trends rather than a single value. We evaluated whether early respiratory decline around diagnosis provides prognostic information...
BACKGROUND: In amyotrophic lateral sclerosis (ALS), respiratory decisions rely on serial trends rather than a single value. We evaluated whether early respiratory decline around diagnosis provides prognostic information in a real-world landmark framework. METHODS: This single-center retrospective cohort screened 94 consecutive patients diagnosed between April 2019 and December 2025. A 6-month landmark was used. Early decline was estimated from %FVC values between - 30 and + 180 days around diagnosis. The primary model included age and early %FVC decline; robustness analyses included time-varying Cox, piecewise Cox, RMST, included-vs-excluded comparison, death-only analysis, and slope-quality filtering. RESULTS: Of 94 screened patients, 62 met baseline eligibility, 56 had calculable early slope, and 45 entered the landmark cohort; 28 post-landmark composite events occurred. In the Cox model, faster early %FVC decline was associated with higher hazard of death or invasive mechanical ventilation via tracheostomy (HR 1.33 per 1%/month faster decline, 95% CI 1.14-1.55, p < 0.001). PH diagnostics suggested non-proportionality (%FVC p = 0.031; NIV p = 0.034 in the expanded model), so this HR was interpreted as an average follow-up association and complemented by PH-robust analyses. The signal was stronger early than late, remained consistent in a death-only analysis, and favored the slower-decline group by RMST at 24 and 36 months. CONCLUSIONS: In this selected measurement-capable landmark cohort, early respiratory decline provided a clinically meaningful short-to-medium term prognostic signal for post-landmark adverse outcomes. External validation is required before broader generalization beyond measurement-capable landmark populations.
Clinical characteristics and outcomes of dengue-associated transverse myelitis: A systematic review of case reports.
Duarte N, Ruiz O, Refaey A
Neurol Sci · 2026 Jun · PMID 42257899 · Publisher ↗
BACKGROUND: Dengue is a globally prevalent arboviral infection with an expanding spectrum of recognized neurological complications. Dengue-associated transverse myelitis (DATM) is a rare but potentially disabling manifes...
BACKGROUND: Dengue is a globally prevalent arboviral infection with an expanding spectrum of recognized neurological complications. Dengue-associated transverse myelitis (DATM) is a rare but potentially disabling manifestation, and its clinical characteristics and outcomes have not been systematically synthesized. OBJECTIVE: Characterize the level and extent of spinal cord involvement, clinical presentation, management, and outcomes of DATM. METHODS: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Embase (Ovid), and Web of Science were searched from inception through October 2025. Case reports describing transverse myelitis in patients with confirmed dengue infection were included. Data were extracted and synthesized descriptively. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Checklist for Case Reports. RESULTS: Twenty-nine case reports met inclusion criteria. The median age was 38 (IQR 20) years, with male predominance (62.1%). Neurological symptoms developed a median of 6 (IQR 4) days after dengue onset. Urinary retention (79.3%) and paraparesis (69.0%) were the most common presenting features, and a thoracic sensory level was frequently identified (65.5%). Spinal MRI most often demonstrated longitudinally extensive transverse myelitis (65.5%). Corticosteroids were administered in 82.8% of cases. At discharge, 69% had partial recovery and 17.2% complete recovery. Mortality was low (3.4%; one case). CONCLUSIONS: DATM is a rare, early-onset neurological complication of dengue characterized by urinary retention, paraparesis, and frequent thoracic cord involvement, often with longitudinally extensive lesions on MRI. Although most patients experience partial or complete recovery, residual deficits may occur. Evidence is limited to case reports, precluding estimation of incidence or comparative treatment efficacy. Early recognition and exclusion of alternative causes of acute myelopathy are essential.
Antonio D'Ormea (1873-1952) and encephalitis lethargica: the Italian psychiatrist who drew attention to childhood aspects of the disease.
Martini M, Brigo F, Lorusso L … +1 more , Orsini D
Neurol Sci · 2026 Jun · PMID 42257897 · Publisher ↗
Antonio D'Ormea (1873-1952) served as physician and director of the San Niccolò psychiatric hospital in Siena for more than four decades. Guided by deeply held professional and human values, he devoted his career to tran...
Antonio D'Ormea (1873-1952) served as physician and director of the San Niccolò psychiatric hospital in Siena for more than four decades. Guided by deeply held professional and human values, he devoted his career to transforming the institution into a modern scientific center, where clinical practice was integrated with continuous research and mental health was understood as fundamental to individual and social well‑being.A pioneer in the education and care of children and adolescents with intellectual disabilities, D'Ormea developed an innovative medico‑psycho‑pedagogical model grounded in the belief that rehabilitation was possible, even when outcomes varied. His work anticipated later developments in child neuropsychiatry and special education.This historical article reconstructs D'Ormea's professional trajectory, emphasizing his contributions to early 20th‑century psychiatry and, in particular, to the care of minors. Special attention is devoted to his clinical and institutional response to childhood encephalitis lethargica, including the admission and treatment of affected children within the Medical Psycho‑Pedagogical Institute he founded in Siena.
Association of the DTI-ALPS index with motor and non-motor symptoms in Parkinson's disease with postural instability/gait difficulty: a diffusion tensor MRI study.
Ji P, Xie Y, Jia Y … +7 more , Miao X, Li Z, Cheng X, Dai J, Cao D, Wang J, Wang M
Neurol Sci · 2026 Jun · PMID 42257868 · Publisher ↗
OBJECTIVE: To explore brain perivascular fluid diffusivity dynamics indirectly applying diffusion tensor image analysis along the perivascular space (DTI-ALPS) and to elucidate its relationship between motor and non-moto...
OBJECTIVE: To explore brain perivascular fluid diffusivity dynamics indirectly applying diffusion tensor image analysis along the perivascular space (DTI-ALPS) and to elucidate its relationship between motor and non-motor symptoms in Parkinson's disease with postural instability/gait difficulty (PIGD). METHODS: 105 PD patients (categorized into PIGD and non-PIGD subgroups) and 51 healthy control participants (HCs) received brain MRI examinations with DTI and clinical evaluations. Statistical comparisons of DTI-ALPS indices were performed between groups. Associations involving DTI-ALPS indices, motor scores, cognitive function, and sleep quality were examined using partial correlation and mediation analyses. RESULTS: Compared to HCs, PD subgroups exhibited notably reduced left-hemispheric DTI-ALPS index (PIGD: p = 0.006; non-PIGD: p = 0.013). A lower right-hemispheric index was observed exclusively within PIGD group relative to HCs (p = 0.040). With covariates adjusted, left DTI-ALPS index showed inverse association with Unified Parkinson's Disease Rating Scale III (r=-0.347, p = 0.023, p-FDR = 0.046) and PIGD score (r=-0.451, p = 0.002, p-FDR = 0.008), and positive correlation with Frontal Assessment Battery (r = 0.451, p = 0.002, p-FDR = 0.008) scores. After adjustment for education, left ALPS index significantly mediated the association between PIGD score and FAB score, with a significant indirect effect (a*b=-0.140, 95% CI -0.278 to -0.032). CONCLUSIONS: The results indicate that impaired perivascular diffusivity, is more pronounced in PIGD subtype and is markedly linked to motor symptoms intensity and cognitive abilities. DTI-ALPS index may present a possible neural substrate mediating the interplay between motor/non-motor manifestations in PIGD subtype.
Correction to: Rare acute exacerbation of lewis-sumner syndrome mimicking stroke: a case report.
Mambriani S, Brusa R, Politini L … +1 more , Prelle AC
Neurol Sci · 2026 Jun · PMID 42257773 · Publisher ↗
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The bidirectional mechanistic links between Alzheimer's disease and cardiovascular disease.
You J, Yang J
Neurol Sci · 2026 Jun · PMID 42247187 · Publisher ↗
BACKGROUND: Alzheimer's disease (AD) and cardiovascular disease (CVD) are two significant chronic diseases that have a profound impact on the health of the elderly globally. In recent years, an increasing body of researc...
BACKGROUND: Alzheimer's disease (AD) and cardiovascular disease (CVD) are two significant chronic diseases that have a profound impact on the health of the elderly globally. In recent years, an increasing body of research has suggested a potentially intimate association between the two. This review aims to comprehensively summarize the bidirectional pathological mechanisms between AD and CVD and explore their implications for clinical intervention and comorbidity management. METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. English-language literature published between 1985 and 2025 was searched in the databases of Pubmed, Web of Science, Google Scholar, Embase, and Scopus. A total of 4,434 articles were initially identified, and 4,293 studies that did not meet the inclusion criteria were excluded. Eventually, 149 eligible articles were subjected to mechanism integration and a narrative review. RESULTS: This review elucidates that ischemia-hypoxia, lipid metabolism disorders, systemic inflammatory responses, and blood-brain barrier dysfunction caused by chronic cerebral hypoperfusion constitute the four core pathways through which CVD promotes the incidence and exacerbation of AD. Conversely, mechanisms such as autonomic nervous system dysfunction, spillover of central inflammation to the periphery, adverse lifestyle changes, and cardiovascular side effects of therapeutic drugs are the main reasons why AD increases the risk of CVD. CONCLUSION: The findings of this review suggest that AD is not merely a central nervous system disorder but also has a close bidirectional association with CVD through multiple mechanisms. Therefore, a thorough understanding of this "cardio-cerebral axis" mechanism is conducive to identifying early risks in the comorbid population, expanding intervention targets, and facilitating the translation and application of combined management strategies for AD and CVD in clinical practice.
Stroke literacy in a sample of Italian adults: an iceberg model revealing domain-specific gaps beyond apparent emergency awareness.
Bagnato MR, Di Donna MG, Bernocchi F … +11 more , Borrello L, Bracaglia M, Di Mauro G, Di Ruzza MR, Dionisi C, Fanella M, Ferrante M, Marinelli F, Saggese E, Tartaglia M, De Simone R
Neurol Sci · 2026 Jun · PMID 42247171 · Publisher ↗
BACKGROUND AND AIMS: Despite public campaigns, pre-hospital delays in acute ischemic stroke remain substantial, with only modest improvement in onset-to-door times. METHODS: We ran a nationwide cross-sectional survey on...
BACKGROUND AND AIMS: Despite public campaigns, pre-hospital delays in acute ischemic stroke remain substantial, with only modest improvement in onset-to-door times. METHODS: We ran a nationwide cross-sectional survey on ischemic stroke knowledge across four domains: conceptual knowledge, symptom recognition, awareness of time-dependent treatment, and intended emergency action (immediate EMS/112 call). A composite score (≥ 3 correct) was analysed using contingency tests and multivariable logistic regression. RESULTS: Among 1,769 participants, 71% were female, 60% university-educated, 35% were > 40 years, 9% worked in healthcare, and 47% reported a family history of stroke. Only 25% identified "cerebral stroke" and "cerebral ischemia" as synonyms, and 52% rated stroke as severe but ischemia as milder; accuracy was higher in healthcare workers (45% vs 23%, p < 0.001) and higher education (29% vs 22%, p = 0.002). One quarter failed to identify unilateral paralysis as the cardinal symptom, with lower recognition in those aged ≥ 41 years (70-73% vs ~ 77-79%, p = 0.019). Treatment awareness was high (84%) and associated with higher education/healthcare-related exposure (p = 0.007). Intended EMS/112 call was reported by 85% and associated with younger age (p = 0.004) and indirect stroke-care exposure (p = 0.001). Overall, 65% achieved a high composite score; healthcare employment independently predicted a high score (OR 2.02, 95% CI 1.28-3.19), whereas age and educational level were not independently associated. CONCLUSIONS: Findings support an iceberg model of stroke literacy, with surface awareness masking deeper, phase-specific gaps; education should target stroke severity misconceptions and symptom recognition, particularly in older adults.
Development and validation of a nomogram to predict early neurological deterioration in patients with acute ischemic stroke and type 2 diabetes mellitus: the pivotal role of glycemic variability and thrombo-inflammation.
Zhong X, Chen Z, Cao T … +4 more , Fan C, Fu W, Jiang Y, Wu Y
Neurol Sci · 2026 Jun · PMID 42236590 · Publisher ↗
BACKGROUND: Early neurological deterioration (END) is a devastating complication in acute ischemic stroke (AIS) patients with type 2 diabetes mellitus (T2DM). We aimed to develop and validate a clinical nomogram for indi...
BACKGROUND: Early neurological deterioration (END) is a devastating complication in acute ischemic stroke (AIS) patients with type 2 diabetes mellitus (T2DM). We aimed to develop and validate a clinical nomogram for individualized END risk prediction, focusing on acute glycemic variability and thrombo-inflammation. METHODS: This retrospective study included 965 AIS patients with T2DM. END was defined as an NIHSS score increase of ≥ 2 points within 72 h. LASSO and multivariable logistic regression identified independent predictors to construct the nomogram. Model performance was evaluated using the area under the ROC curve (AUC), calibration plots, and decision curve analysis (DCA). Internal validation was performed via 1,000 bootstrap resamples, and the added predictive value was evaluated using the Net Reclassification Improvement (NRI). RESULTS: END occurred in 152 patients (15.8%). Six independent predictors were identified: baseline NIHSS, admission HbA1c, 24-h capillary blood glucose standard deviation (24-h CBG-SD), fibrinogen, hs-CRP, and baseline DWI-ASPECTS. The nomogram exhibited excellent discrimination (AUC 0.815; 95% CI 0.772-0.858), with internal validation confirming minimal overfitting (optimism-corrected AUC 0.802). 24-h CBG-SD emerged as the strongest predictor. Integrating metabolic and thrombo-inflammatory markers provided significant added predictive value over basic clinical features (continuous NRI 0.485, P < 0.001). Calibration showed high concordance, and DCA demonstrated significant net clinical benefit across a 4%-75% threshold range. CONCLUSIONS: Our nomogram provides a reliable and internally validated tool for early END risk stratification in T2DM patients. The findings highlight the critical impact of acute glycemic instability and thrombo-inflammation, suggesting that personalized glycemic management and intensive monitoring are warranted.
Gamma knife thalamotomy provides durable long-term relief from essential tremor: a 30-year single institution experience.
Reyes JS, Bouras A, Hadjipanayis CG … +2 more , Lunsford LD, Niranjan A
Neurol Sci · 2026 Jun · PMID 42230990 · Publisher ↗
BACKGROUND: Gamma Knife (GK) stereotactic radiosurgical thalamotomy is a minimally invasive treatment option for medically refractory essential tremor (ET), but long-term outcome data remain limited. We evaluated three d...
BACKGROUND: Gamma Knife (GK) stereotactic radiosurgical thalamotomy is a minimally invasive treatment option for medically refractory essential tremor (ET), but long-term outcome data remain limited. We evaluated three decades of institutional experience to characterize tremor improvement, functional outcomes, safety, and durability of response after GK thalamotomy. METHODS: We performed a retrospective single-institution cohort study of 163 GK thalamotomy procedures for ET. All procedures targeted the contralateral ventral intermediate nucleus of the thalamus. Primary outcomes included clinical benefit, complete tremor arrest, adverse radiation effects (AREs), and tremor recurrence. Functional outcomes were assessed using pre- and post-treatment Fahn-Tolosa-Marín Tremor Rating Scale (FTM) scores, including tremor, writing, drawing, drinking, and total FTM score. RESULTS: Mean age at treatment was 74.1 ± 11.1 years, and follow-up duration averaged 95.1 months, with a median of 97 months (range, 15-356). Clinical benefit was observed in 152 of 163 procedures (93.3%), with a median time to benefit of 4.0 months (IQR 2.0-6.0). Complete tremor arrest occurred in 39 procedures (23.9%). AREs occurred in 6 procedures (3.7%). Tremor recurrence was documented in 16 procedures (9.8%), with a median time to recurrence of 26.0 months. All functional domains improved significantly after treatment (all p < 0.001). Mean total FTM score improved from 12.26 ± 2.20 to 5.00 ± 4.02. CONCLUSIONS: GK thalamotomy was associated with meaningful and durable tremor improvement in medically refractory ET, with significant functional improvement, infrequent AREs, and low recurrence over long-term follow-up.
Reply to "The role of early immunotherapy in Rasmussen's encephalitis".
Makharia A, Agarwal A, Garg D … +1 more , Srivastava AK
Neurol Sci · 2026 Jun · PMID 42223699 · Publisher ↗
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A brief novel questionnaire to estimate premorbid functional state in acute stroke patients.
Bruno A, Saltz G, Abbott ML … +10 more , Siddu M, Naushad A, Maduraiveeran V, Skariah J, Udeshi K, Tanzeem S, Quevedo-Tejada B, Raja A, Dobbin K, Nichols FT
Neurol Sci · 2026 Jun · PMID 42219412 · Full text
BACKGROUND: During acute stroke evaluation, knowing a patient's premorbid functional state can guide clinical decision and research considerations. The often-utilized modified Rankin scale was not designed and is not wel...
BACKGROUND: During acute stroke evaluation, knowing a patient's premorbid functional state can guide clinical decision and research considerations. The often-utilized modified Rankin scale was not designed and is not well suited for this purpose. Thus, we developed and tested a brief questionnaire to assess a patient's premorbid functional state. METHODS: The novel questionnaire scores range from 0 to 5. Scores 0-2 represent increasing degrees of independent functioning, not at all difficult (0), somewhat difficult (1), and very difficult (2). Scores 3, 4, and 5 represent moderate to severe disabilities. Paired raters independently tested the novel questionnaire on two consecutive days in patients with acute cerebrovascular events. The kappa statistic evaluated reliability of the novel questionnaire and previously established questionnaires were used for concurrent validity testing. RESULTS: In 76 patients, mean age 77 (SD 14) years and 51% women, the overall agreement between the paired raters was 79%. The standard kappa was 0.62 (95% CI 0.47-0.76), p < 0.001, and the weighted kappa was 0.89 (95% CI 0.82-0.96), p < 0.001. The novel questionnaire scores correlated well with the Groningen scale (r = 0.70 and r = 0.67 for the two raters, p < 0.001 for both), and with the Lawton scale (r = -0.77 and r= -0.82 for the two raters, p < 0.001 for both). CONCLUSIONS: This novel brief baseline function questionnaire for assessing a patient's premorbid functional state has acceptable clinimetric properties and could be used to rapidly and reliably score the premorbid baseline function among acute stroke patients.
Parental knowledge, attitudes, and behaviors toward childhood headache: the impact of parental migraine.
Bayır BRH, Ulutaş C, Nazlı E … +19 more , Köklü H, Baştuğ Z, Saraçoğlu TT, Kızılkılıç EK, Aktan C, Çelik HT, Tanık N, Yeşildaş PY, Şahbaz FG, Gürsoy G, Tuncer A, Can FDK, Sayman C, Gölen MK, Yıldız R, Erol TY, Ağırcan D, Çetinkaya Y, Özge A
Neurol Sci · 2026 Jun · PMID 42219401 · Publisher ↗
INTRODUCTION: Headache is one of the most common neurological complaints in children and adolescents. Headache especially migraine in childhood significantly impacts daily life activities, including academic performance,...
INTRODUCTION: Headache is one of the most common neurological complaints in children and adolescents. Headache especially migraine in childhood significantly impacts daily life activities, including academic performance, and social interactions. Therefore, early recognition of migraine in children by parents may be an important step in reducing the social and economic burden caused by migraine. In our study, we aimed to evaluate parents' attitudes and their level of awareness regarding headache. METHOD: This multi-center, prospective, descriptive, cross-sectional, survey-based study included two groups: migraine patients with at least one child under the age of 18, and a healthy control group selected from hospital staff and physician relatives without headache or neurological disease. The questionnaire examined the demographic information of the parents, the characteristics of their children's headaches, and the parents' knowledge and attitudes towards their children's headaches. RESULTS: Our study included a total of 1226 parents, 541 of whom were migraine patients. In the group of migraine, the number of female participants was higher, the duration of education was short, the rate of full-time employment was low, and the number of children was higher (p<0.001, p<0.001, p<0.001, p:0.002, respectively). 22.8% of the participants had children who experienced headaches. The characteristics of children's headaches were similar in both groups, only the phonophobia, photophobia, and nausea were more frequently observed in children of parents with migraine (p=0.008, p=0.024, p=0.005, respectively). The higher incidence of psychiatric disorders (p=0.012), sleep disorders (p=0.041) and headache in their first-degree relatives was observed in the migraine group whose children had headache (p=0.012). The migraine group was more aware about the importance of family history in migraine (p<0.001), the role of environmental and psychological factors (p=0.049). Contrary to expectations, the control group was also more knowledgeable about blurred vision (p=0.013), and speech disorders (p=0.005) that can accompany migraine attacks. Both groups showed high levels of concern about attitudes, perceptions, and potential behavioral responses towards their child's headache complaints. Families with migraine were more likely to suspect migraine when their children had intermittent headaches (p=0.001). CONCLUSION: In conclusion, children show similar headache characteristics except for accompanying symptoms, regardless of the presence of migraine in their families. The presence of migraine in family members is associated with increased awareness of familial risk, but it does not appear to significantly influence healthcare-seeking behavior. These results suggest that educational programs for parents can improve holistic migraine management in children, thus preventing the development of chronic migraine.
Rising incidence of stroke in survivors of severe COVID-19.
Vitiello A, Zovi A
Neurol Sci · 2026 May · PMID 42217096 · Publisher ↗
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Temporal patterns of neurological deterioration in COVID-19 survivors: a longitudinal cohort analysis of post-acute neurological sequelae.
Wang K, Zhang Y, Zhao H … +1 more , Zhao T
Neurol Sci · 2026 May · PMID 42215824 · Publisher ↗
BACKGROUND: Post-acute neurological sequelae of COVID-19 represent a significant clinical challenge. The temporal evolution and predictive factors remain incompletely characterized. METHODS: We conducted a retrospective...
BACKGROUND: Post-acute neurological sequelae of COVID-19 represent a significant clinical challenge. The temporal evolution and predictive factors remain incompletely characterized. METHODS: We conducted a retrospective longitudinal cohort study of 386 COVID-19 survivors with assessments at baseline and 3, 6, 12, and 24 months. Primary outcomes included cognitive function (Montreal Cognitive Assessment [MoCA]), peripheral nerve function (nerve conduction studies [NCS]), and autonomic function (Composite Autonomic Symptom Score-31 [COMPASS-31]). RESULTS: Among 386 participants (mean age 51.92±14.86 years; 53.9% female), cognitive impairment prevalence decreased from 67.6% at baseline to 43.4% at 24 months (P<0.001). Mean MoCA scores improved from 24.61±2.12 to 25.84±2.31. Autonomic dysfunction demonstrated a biphasic pattern with worsening at 6 months (COMPASS-31: 38.49±22.13 vs. 32.81±19.11 at 3 months). Peripheral neuropathy remained stable (42.5% to 45.0%). Independent predictors of persistent cognitive impairment included ICU admission (adjusted odds ratio [aOR] 2.84; 95% CI 1.52-5.31), age ≥65 years (aOR 1.95; 95% CI 1.18-3.22), and depression history (aOR 1.92; 95% CI 1.08-3.41). CONCLUSIONS: Neurological sequelae following COVID-19 demonstrate domain-specific recovery trajectories. Cognitive function improves gradually, autonomic dysfunction exhibits a biphasic pattern, and peripheral neuropathy persists. These findings support targeted, domain-specific rehabilitation strategies.
Concurrent de novo glioblastoma and meningiomatosis: a case report and systematic review of clinical, molecular, and topographical characteristics.
Alioğlu H, Alomari O, Abasova F … +4 more , Osama M, Akgul AC, Silav ZK, Ozoner B
Neurol Sci · 2026 May · PMID 42215822 · Publisher ↗
INTRODUCTION: The co-occurrence of glioblastoma (GBM) and meningioma in a single patient is an exceptionally rare clinical phenomenon, often associated with prior irradiation or genetic syndromes. This study presents a u...
INTRODUCTION: The co-occurrence of glioblastoma (GBM) and meningioma in a single patient is an exceptionally rare clinical phenomenon, often associated with prior irradiation or genetic syndromes. This study presents a unique case of concurrent de novo GBM and meningiomatosis and provides a systematic review of the literature to characterize this rare association. CASE PRESENTATION AND METHODS: A 78-year-old female with a known history of untreated meningiomatosis presented with refractory seizures and aphasia. Imaging revealed multiple stable extra-axial lesions and a new, distinct intra-axial right temporal lesion. The patient underwent a temporal lobectomy with gross total resection. Histopathology confirmed WHO grade 4 GBM (IDH-wildtype). Following multidisciplinary review, she completed adjuvant radiotherapy. At 6-month follow-up, she remained clinically stable with no recurrence. A systematic review was conducted, identifying 34 cases of concurrent GBM and meningioma. Data regarding demographics, topography, molecular profiles, and survival were analyzed. RESULTS: The median age was 63 years (range 30-86), with a slight male predominance (52.9%). Tumors were synchronous in 88.2% of cases. Topographically, 47.1% were "collision" or adjacent tumors, while 32.3% occurred in different hemispheres. Most meningiomas were WHO grade I (79.4%), while 97.1% of glial tumors were grade 4 GBM. Molecular analysis revealed classic independent drivers: 22q loss/NF2 mutations in meningiomas and 10q loss/EGFR amplification in GBMs. Median overall survival was 7 months (range 0.5-24 months), with modern trimodal therapy (Stupp protocol) showing a trend toward extended survival compared to older cohorts (Fig. 1). CONCLUSION: The coexistence of GBM and meningioma appears mostly coincidental, driven by distinct molecular pathways rather than a common progenitor. Despite the benign nature of the associated meningioma, prognosis is dictated by the aggressive GBM component. Early surgical intervention and modern adjuvant therapy remain essential for optimizing survival in these complex cases.
Resting-state EEG markers of cognitive dysfunction in epilepsy: evidence from gamma power, alpha activity, and functional connectivity.
Masoumian FN, Bamdad S, Laganà A … +1 more , Petralia MC
Neurol Sci · 2026 May · PMID 42215811 · Publisher ↗
PURPOSE: Cognitive dysfunction is a common comorbidity in epilepsy, linked to disrupted neural oscillations and network synchronization. Resting-state electroencephalography (EEG) provides a non-invasive approach to iden...
PURPOSE: Cognitive dysfunction is a common comorbidity in epilepsy, linked to disrupted neural oscillations and network synchronization. Resting-state electroencephalography (EEG) provides a non-invasive approach to identify electrophysiological biomarkers of cognitive dysfunction. This study examined relationships between resting-state EEG spectral power, functional connectivity, and cognitive performance among people with epilepsy. METHODS: Sixty-five persons with epilepsy (mean age 38.72 ± 1.63 years) underwent eyes-closed resting-state EEG and Montreal Cognitive Assessment (MoCA). Participants were classified into preserved cognition (nPCCD; MoCA ≥ 26, n = 35) and comorbid cognitive dysfunction (PCCD; MoCA < 26, n = 30) groups. Power spectral density (PSD) and band-powers were extracted from clean EEG, and functional connectivity was assessed via magnitude-squared coherence. Pearson correlations assessed associations between MoCA and band-powers, and group comparisons evaluated inter-group differences. RESULTS: Global gamma power negatively correlated with MoCA scores all (r= -0.30, p = 0.01, n = 65) and PCCD group (r= -0.57, p = 0.0003), indicating higher gamma activity with poorer cognition. The nPCCD group exhibited higher global alpha power than the PCCD group [17.48 ± 2.63 vs. 10.83 ± 1.76 µV²/Hz, p = 0.0091], with topographic significance over bilateral temporal and parietal regions (15 channels, p < 0.05). Functional connectivity differed between groups across frequency bands, most prominently in alpha. (p < 0.05). CONCLUSIONS: Resting-state EEG reveals elevated gamma power significantly correlates with poorer cognitive performance across all participants as well as PCCD, and also reduced alpha power, and altered functional connectivity as neurophysiological markers of cognitive dysfunction in epilepsy. Combining spectral and network-level measures may improve characterization, early identification, and targeted management of cognitive comorbidity in epilepsy.
Iatrogenic cerebral amyloid angiopathy: neuroinflammation and implications for future therapies.
Frol S, Zupan M
Neurol Sci · 2026 May · PMID 42213169 · Publisher ↗
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Clinical characteristics and evolution of dural enhancement in NMOSD: A retrospective case series.
Wu T, Li J, Du J … +3 more , Zhou X, Xue Q, Cao S
Neurol Sci · 2026 May · PMID 42209890 · Publisher ↗
OBJECTIVE: This study aimed to investigate the clinical and neuroimaging characteristics in patients with AQP4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) accompanied by dural enhancement. METHODS: A...
OBJECTIVE: This study aimed to investigate the clinical and neuroimaging characteristics in patients with AQP4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) accompanied by dural enhancement. METHODS: A retrospective analysis was conducted on ten AQP4-NMOSD patients with dural enhancement from two medical centers. All patients underwent serial contrast-enhanced MRI during follow-up. Longitudinal clinical and radiological data were collected to evaluate relapse patterns and temporal changes in dural enhancement. RESULTS: The cohort had a median onset age of 31 years (IQR 24-45) with a male-to-female ratio of 3:7. At enrollment, the median disease duration was 6.2 months (IQR 1.5-35.9), the median attack number was 2 (IQR 1-3), and the median EDSS score was 6.5 (IQR 2.0-8.0). Nine patients were in the acute phase, and one patient was in the remission phase. After enrollment, nine patients received immunosuppressive therapy to prevent relapse, while one patient received prednisone alone. Over a median follow-up period of 39.6 months (IQR 28.2-45.7), five patients treated with biologics remained relapse-free. However, relapses occurred in three patients receiving conventional immunosuppressants, one patient on prednisone, and one patient treated with biologics. At enrollment, except for dural enhancement, nine patients presented with contrast-enhancing lesions in the optic nerve or brain/spinal cord parenchyma, while one patient showed no such lesions. Concurrent leptomeningeal enhancement was observed in seven patients. Dural enhancement persisted or progressed in relapsing patients but reduced in non-relapsing cases during follow-up. CONCLUSIONS: In AQP4-NMOSD, neuroimaging may reveal dural enhancement associated with disease activity.
Development and validation of a prediction model for ischemic stroke recurrence risk in patients with ischemic stroke and atrial fibrillation.
Qin R, Huang X, Qin Q … +2 more , Xu W, Chen L
Neurol Sci · 2026 May · PMID 42209838 · Publisher ↗
BACKGROUND: The recurrence rate of atrial fibrillation (AF)-related ischemic stroke (IS) remains persistently high, significantly increasing patient mortality, disability, and socioeconomic burden. This underscores an ur...
BACKGROUND: The recurrence rate of atrial fibrillation (AF)-related ischemic stroke (IS) remains persistently high, significantly increasing patient mortality, disability, and socioeconomic burden. This underscores an urgent need for a practical tool to predict long-term recurrence risk. This study aimed to investigate the key risk factors for recurrent IS in patients with AF and IS, and to construct and validate a recurrence risk prediction model using LASSO regression. METHODS: We retrospectively enrolled 113 patients with AF complicated by IS between 2017 and 2024, with a follow-up period of up to 7 years. LASSO regression was employed to screen predictive factors and develop a risk model. The model's performance was evaluated using the concordance index (C-index) and the area under the receiver operating characteristic curve (AUC). A restricted cubic spline analysis was conducted to examine the non-linear relationship between age and the risk of recurrent IS. Subgroup analyses were performed using Cox regression models. RESULTS: During the 7-year follow-up, recurrent IS occurred in 45.13% of patients. The LASSO regression-based prediction model, incorporating 19 predictive factors, demonstrated high predictive power with an AUC of 0.917. Furthermore, the model's predictive ability improved over time, achieving a C-index of 0.760 at the seventh year of follow-up. A significant non-linear relationship was identified between age and recurrence risk. CONCLUSION: A LASSO-derived model accurately estimates the long-term risk of recurrent IS after AF-related stroke. Age has a non-linear influence on recurrence, and the efficacy of anticoagulation may be modified by smoking status. These findings support the development of individualized prevention strategies.
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