BMC Neurology[JOURNAL]
Sun
200 papers
Diagnostic overshadowing in primary progressive multiple sclerosis with coexisting tethered cord syndrome and long-standing urological dysfunction: a case report and literature review.
Alsalloum T, Alsamman H, Alkerdi R … +1 more , Alassad G
BMC Neurol · 2026 Jul · PMID 42402566 · Full text
BACKGROUND: Primary progressive multiple sclerosis (PPMS) may be diagnostically challenging when coexisting structural spinal abnormalities produce overlapping neurological and urinary manifestations. Tethered cord syndr...
BACKGROUND: Primary progressive multiple sclerosis (PPMS) may be diagnostically challenging when coexisting structural spinal abnormalities produce overlapping neurological and urinary manifestations. Tethered cord syndrome (TCS) and PPMS can both present with progressive myelopathy and lower urinary tract symptoms, increasing the risk of diagnostic overshadowing. CASE PRESENTATION: A 42-year-old woman with a history of sacrococcygeal meningocele and prior surgical resection presented with a 20-year history of urinary dysfunction and a 2-year history of progressive ascending sensory symptoms and mild paraparesis. Her symptoms had initially been attributed to her structural and surgical history. However, neurological examination, brain and whole-spine MRI, and CSF analysis demonstrated characteristic demyelinating lesions and positive oligoclonal bands. She fulfilled the 2024 McDonald criteria for PPMS. Because ocrelizumab was unavailable locally, rituximab was initiated as an off-label alternative. CONCLUSION: This case highlights the importance of considering a concurrent neuroinflammatory disorder in patients with pre-existing structural spinal pathology and chronic urinary dysfunction. Careful integration of clinical, radiological, and CSF findings is essential to avoid diagnostic delay in complex dual-pathology presentations.
Screen time patterns and cognitive screening outcomes (MoCA-Ina) in adolescents: a cross-sectional study.
Gunawan PY, Andraina A, Wijaya JH … +2 more , Arjuna YYE, Gunawan PY
BMC Neurol · 2026 Jul · PMID 42401849 · Full text
BACKGROUND: Adolescent screen exposure is increasing, yet clinically interpretable thresholds for cognitive risk are unclear. This study examined associations between daily screen time and cognitive screening performance...
BACKGROUND: Adolescent screen exposure is increasing, yet clinically interpretable thresholds for cognitive risk are unclear. This study examined associations between daily screen time and cognitive screening performance and derived a screen-time cutoff associated with cognitive impairment. METHODS: We conducted an observational cross-sectional study (March-April 2022) at a private junior high school in Indonesia during online learning. Students completed digital questionnaires reporting educational and recreational screen time and a directly reported overall estimate; a computed overall (educational + recreational) was generated to assess reporting consistency. Cognitive function was assessed using the MoCA-Ina, with < 24 as the primary impairment threshold based on recent psychometric evidence favoring lower cutoffs for improved classification accuracy. RESULTS: Sixty-seven adolescents were included (34 girls, 50.7%; 33 boys, 49.3%), with median age 13.0 years (12.0-16.0) and median MoCA-Ina 25.0 (19.0-31.0). MoCA-Ina did not differ by sex (girls 25.0 [19.0-31.0] vs. boys 26.0 [20.0-30.0]; p = 0.244). Recreational screen time correlated inversely with MoCA-Ina (ρ = -0.446, p < 0.001), as did overall screen time (ρ = -0.360, p = 0.003), whereas educational screen time was not associated (ρ = -0.061, p = 0.624). In adjusted regression, overall screen time remained negatively associated with MoCA-Ina (β = -0.24 per hour/day; 95% CI - 0.41 to - 0.07; p = 0.007), while age was positively associated (β = 0.96; 95% CI 0.07 to 1.85; p = 0.034). All variance inflation factors were below 2.5, indicating no substantial multicollinearity. ROC analysis showed fair discrimination (AUC 0.66; optimism-corrected AUC after bootstrap internal validation [1,000 resamples]: 0.63) with an optimal cutoff > 8.97 h/day (sensitivity 83.3%, specificity 48.8%, PPV 47.6%, NPV 84.0%); risk of impairment was higher above the cutoff (RR 2.98; 95% CI 1.15-7.72; p = 0.010; OR 4.77; 95% CI 1.40-16.31). CONCLUSIONS: High daily screen exposure was associated with poorer cognitive screening performance. The > 8.97-hour/day threshold represents a preliminary, hypothesis-generating cutoff that may help identify adolescents at elevated likelihood of cognitive impairment, pending external validation in larger, more diverse samples. TRIAL REGISTRATION: 071/K-LKJ/ETIK/II/2022.
Cognitive functioning, verbal memory performance, and ADHD-related symptoms in late-preterm children.
Nasrallah E, Andrawes J, Joubran H … +2 more , Shukha M, Elias N
BMC Neurol · 2026 Jul · PMID 42401814 · Full text
BACKGROUND: Preterm infants have a higher risk for low intelligence quotient (IQ) levels, attention deficit hyperactivity disorder (ADHD), and verbal memory problems compared to full term infants. However, still there is...
BACKGROUND: Preterm infants have a higher risk for low intelligence quotient (IQ) levels, attention deficit hyperactivity disorder (ADHD), and verbal memory problems compared to full term infants. However, still there is limited evidence regarding the late preterm group, which accounts for the largest group of prematurely born children. OBJECTIVES/AIMS: To compare IQ levels, ADHD symptoms, and verbal memory performance between children born late preterm and full-term. METHODS: A retrospective cohort study with prospective follow-up assessments, included 100 children who are 8-11 years old, 69 were born full term and 31 were born in the late preterm period, each child underwent evaluation by a specialized clinical psychologist, which included an IQ test, assessment for symptoms of ADHD and auditory memory problems. RESULTS: There was no significant difference between the two groups in general IQ scores, including verbal and performance scores (p = 0.13, 0.91, and 0.14 respectively). In the subtest analysis, the preterm group demonstrated lower performance in the Similarities subtest (p = 0.005, OR 0.56, 95% CI 0.37-0.84). There was no significant difference in Rey auditory verbal memory performance, p-value results ranged between 0.08 and 0.91. ADHD assessment questionnaires filled out by the parents and teachers showed no significant difference between the groups (p = 0.96, 0.47 respectively). CONCLUSION: Our findings suggest that late preterm children have comparable IQ levels, ADHD symptoms, and verbal memory performance to those born at full term.
Association between continuous metabolic syndrome score and incident dementia: a longitudinal study of middle-aged and older Chinese adults.
Lin L, Liu H, Long D … +1 more , Fan C
BMC Neurol · 2026 Jul · PMID 42399845 · Full text
BACKGROUND: While metabolic syndrome (MetS) is a well-established driver of cognitive decline, conventional dichotomous diagnostic criteria fail to capture the cumulative and synergistic allostatic load of metabolic dysf...
BACKGROUND: While metabolic syndrome (MetS) is a well-established driver of cognitive decline, conventional dichotomous diagnostic criteria fail to capture the cumulative and synergistic allostatic load of metabolic dysfunction. We investigated the longitudinal association between an age- and sex-standardized continuous MetS severity score and risk of incident dementia in a nationally Chinese cohort. METHODS: This prospective analysis utilized data from the China Health and Retirement Longitudinal Study. A continuous MetS score was calculated at baseline integrating waist circumference, triglycerides, high-density lipoprotein cholesterol, mean arterial pressure, and fasting blood glucose via validated linear models, and then quartiled (lowest quartile as reference). Incident dementia was ascertained during the Wave 4 follow-up using a rigorous, multidimensional diagnostic protocol. The dose-response relationship was evaluated using restricted cubic splines (RCS) and logistic regression. RESULTS: Among 4,920 dementia-free participants at baseline, 667 (13.56%) developed dementia over the follow-up. RCS modeling revealed a significant, linear dose-response association between increasing MetS scores and dementia risk. Each 1-SD increment in the MetS score was independently associated with a 12% higher risk of dementia (OR = 1.12, 95% CI: 1.01-1.24). Participants in the highest quartile group faced a 48% increased risk compared to those in the lowest quartile (OR = 1.48, 95% CI: 1.07-2.04). This risk amplification was uniquely pronounced among non-obese individuals (BMI < 24 kg/m; P-interaction = 0.378). CONCLUSIONS: An elevated continuous MetS score is a robust, independent predictor of incident dementia in middle-aged and older adults. Transitioning from binary criteria to a continuous MetS metric provides a nuanced, dose-dependent assessment of dementia risk.
Dynamic alterations of thrombotic molecular markers in acute ischemic stroke patients after intravenous thrombolysis: a prospective cohort study.
Sun W, Xie S, Liu F … +5 more , Xie Y, Zhu Y, Wu P, Zhu J, Liu X
BMC Neurol · 2026 Jul · PMID 42399738 · Full text
BACKGROUND: Thrombotic molecular markers include the thrombin-antithrombin complex (TAT), plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-plasminogen activator inhibitor-1 c...
BACKGROUND: Thrombotic molecular markers include the thrombin-antithrombin complex (TAT), plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC). These molecular markers facilitate the early assessment of coagulation and fibrinolysis system functions, as well as vascular endothelial injury; however, their clinical application following intravenous thrombolysis for acute ischemic stroke (AIS) remains unclear. Therefore, our study aims to evaluate the dynamic levels of these novel thrombosis-related molecular markers within 24 h after intravenous thrombolysis in patients with AIS and analyze their relationship with patients outcome. METHODS: We conducted a retrospective cohort study based on the data of 77 patients with AIS who underwent alteplase intravenous thrombolysis between November 2022 and February 2024. Thrombotic molecular markers were evaluated at four time points: prior to thrombolysis, 1 h after thrombolysis, 6 h after thrombolysis, and 24 h after thrombolysis. Based on the modified Rankin scale (mRS) score at day 90 post-discharge, patients were categorized into the excellent outcome group (mRS ≤ 1) and the non-excellent outcome group (mRS > 1). Stepwise multivariate logistic regression was employed to analyze the association between 90-day functional outcomes and the measured variables. The area under the receiver operating characteristic curve (AUC) was utilized to assess the predictive ability of novel thrombotic markers. RESULTS: Our study demonstrated that, compared to the non-excellent outcome group, the excellent outcome group exhibited significant lower serum TAT levels both prior to thrombolysis and at 6 h post-thrombolysis (all p < 0.05), and serum TM and t-PAIC levels were also significantly elevated in the excellent outcome group at 1 h, 6 h, and 24 h following thrombolysis (all p < 0.05). Stepwise logistic regression analysis indicated that increased serum TM and t-PAIC levels at 24 h post-thrombolysis were protective factors for a excellent 90-day outcome. The AUC values of TM, t-PAIC, and TM combined with t-PAIC for predicting 90-day functional outcomes were 0.918 (sensitivity 80.0%; specificity 85.7%), 0.658 (sensitivity 91.4%; specificity: 45.2%), and 0.984 (sensitivity: 97.1%; specificity 97.6%), respectively. CONCLUSION: Thrombotic molecular markers might serve as indicators for the early monitoring of dysfunction in the coagulation-fibrinolysis system and endothelial injury following intravenous thrombolysis for AIS. TM and t-PAIC exhibit predictive value regarding the outcome of intravenous thrombolysis in AIS, providing insights for future research on the protective role of TM in AIS.
The relationship between physical activity levels and measures of cognition and disease severity in prodromal Parkinson's disease: A longitudinal study.
Seyedmirzaei H, Nakhostin-Ansari A, Rafiei N … +2 more , Khaboushan AS, Abdolalizadeh A
BMC Neurol · 2026 Jul · PMID 42393590 · Full text
BACKGROUND: Physical activity has been studied for its potential role in reducing motor symptoms of Parkinson's disease (PD). However, its impact on its prodromal phase remains underexplored. METHODS: We included 108 peo...
BACKGROUND: Physical activity has been studied for its potential role in reducing motor symptoms of Parkinson's disease (PD). However, its impact on its prodromal phase remains underexplored. METHODS: We included 108 people with prodromal PD from the Parkinson's Progression Markers Initiative. We assessed their four-year longitudinal data of Physical Activity Scale for the Elderly, Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale scores 1-3, Hopkins Verbal Learning Test-Revised, Letter-Number Sequencing test, and the Symbol Digit Modalities Test. RESULTS: Our linear mixed-effects model regression showed that physical activity (as assessed by the total, household-related, leisure-related, and work-related scores) had no significant associations with disease severity and cognitive function (p-values > 0.05). CONCLUSIONS: Our study found no significant associations between physical activity levels and cognitive function or PD symptoms. However, methodological limitations of the study suggest the need for further research to better understand the effects of physical activity on prodromal PD. TRIAL REGISTRATION: This study is a secondary analysis of de-identified data obtained from the Parkinson's Progression Markers Initiative (PPMI) observational cohort and did not directly involve prospective participant enrollment or intervention by the investigators. The PPMI study itself was registered on ClinicalTrials.gov (Identifier: NCT01141023) on 2010-06-10.
Aseptic meningitis as an uncommon presentation of polyarteritis nodosa: a case report with focused literature synthesis.
Li Y, Nie G, Lian L … +7 more , Yu Y, Wang Z, Wang Y, Cui X, Qian S, Xie K, Zhang H
BMC Neurol · 2026 Jul · PMID 42393587 · Full text
BACKGROUND: Central nervous system (CNS) involvement in polyarteritis nodosa (PAN) is uncommon and typically manifests as ischemic or hemorrhagic events. Presentation as sterile meningitis is rare and may lead to diagnos...
BACKGROUND: Central nervous system (CNS) involvement in polyarteritis nodosa (PAN) is uncommon and typically manifests as ischemic or hemorrhagic events. Presentation as sterile meningitis is rare and may lead to diagnostic delay. CASE PRESENTATION: A 31-year-old man presented with persistent headache, high - grade fever, and nodular erythema on both calves. Cerebrospinal fluid (CSF) analysis demonstrated lymphocyte-predominant pleocytosis with elevated protein levels, initially suggesting a viral meningitis-like presentation. Despite empirical antiviral therapy, his symptoms failed to improve. On hospital day 7, the development of testicular discomfort and the presence of cutaneous nodules prompted further evaluation. Histopathological examination of a skin biopsy revealed fibrinoid necrosis of small arteries with inflammatory cell infiltration, confirming the diagnosis of PAN. Initiation of glucocorticoid therapy resulted in rapid clinical improvement. LITERATURE SYNTHESIS: A focused review of previously reported cases indicates that PAN may rarely present with meningitis-like features characterized by sterile CSF pleocytosis and lack of response to antimicrobial therapy, with marked improvement following immunosuppressive treatment. CONCLUSION: Aseptic meningitis-like presentation may represent an underrecognized CNS phenotype of PAN. In patients with persistent meningitis-like symptoms, negative infectious workup, and concomitant systemic manifestations such as skin nodules or testicular pain, vasculitis should be considered early to avoid diagnostic delay and improve outcomes.
Preliminary effects of intermittent theta burst stimulation combined with virtual reality-based cycling training on upper extremity function in children with cerebral palsy: a double-blind randomized crossover trial.
Chen IC, Chen CL, Chen HC … +6 more , Chou IJ, Chen RS, Chung CY, Wu KP, Lin KC, Wu CY
BMC Neurol · 2026 Jul · PMID 42393577 · Full text
BACKGROUND: Cerebral palsy is a permanent disorder that affects motor and posture control, significantly impacting the motor function, daily activities, and participation of affected individuals. Virtual reality-based tr...
BACKGROUND: Cerebral palsy is a permanent disorder that affects motor and posture control, significantly impacting the motor function, daily activities, and participation of affected individuals. Virtual reality-based training and repetitive transcranial magnetic stimulation have each demonstrated benefits for cerebral palsy rehabilitation, but their combined effects remain largely unexplored. This randomized controlled crossover trial examined the potential effects of intermittent theta burst stimulation, a patterned form of repetitive transcranial magnetic stimulation, on virtual reality-based cycling training designed to improve upper extremity function in children with spastic cerebral palsy. METHODS: Twelve participants were enrolled and randomized, with eight completing two sequential intervention phases in a counterbalanced order: real stimulation combined with virtual cycling training (n = 10 conditions) and sham stimulation combined with virtual cycling training (n = 10 conditions). The virtual cycling training program included twelve sixty-minute sessions delivered two to three times per week, and stimulation focused on the hand motor region of the involved hemisphere. The outcome measures included the Box and Block Test, the Bruininks-Oseretsky Test of Motor Proficiency, Pediatric Motor Activity Log, Caregiver Functional Use Survey, and Goal Attainment Scales to assess manual dexterity, activity performance, caregiver-reported functional use, and personalized goal attainment, both before and after the intervention. RESULTS: Linear mixed-effects models revealed a significant treatment effect for Goal Attainment Scales scores only (F = 7.474, p = 0.019), with intermittent theta burst stimulation yielding superior results. No significant period, sequence or treatment effects were observed for other outcomes. Between-condition comparisons confirmed a significant difference in Goal Attainment Scales scores (mean difference = 12.63, 95% CI [3.26, 22.08], p < 0.05, Cohen's d = 1.30), while all other measures showed non-significant differences with small effect sizes. CONCLUSIONS: These preliminary findings suggest that a combination of intermittent theta burst stimulation and virtual reality-based cycling training may modestly improve goal-directed upper-extremity function in children with spastic cerebral palsy. However, given the exploratory design and limited sample size, larger studies are required to confirm these findings and establish clinical efficacy. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT04101994) on 22 September 2019. Participant recruitment began on 29 March 2019. Retrospectively registered.
Factors associated with symptom relief and lesion formation in acute ischemic stroke and transient ischemic attack.
Kim AH, Kim SW, Park SY … +2 more , Shin BS, Kang HG
BMC Neurol · 2026 Jul · PMID 42393566 · Full text
BACKGROUND: Patient symptoms have not been a primary consideration in ischemic stroke management. However, symptom evaluation in ischemic stroke may enhance the quality of care and improve prognosis. Therefore, in this s...
BACKGROUND: Patient symptoms have not been a primary consideration in ischemic stroke management. However, symptom evaluation in ischemic stroke may enhance the quality of care and improve prognosis. Therefore, in this study, we aimed to determine the factors associated with symptom relief and lesions in ischemic stroke and transient ischemic attack (TIA). METHODS: This retrospective study included patients with ischemic stroke or TIA between April 2020 and February 2024 in a tertiary regional general hospital. The 2436 patients who met the inclusion criteria were classified based on symptom persistence and the presence of stroke lesions. Factors related to symptom relief and lesion formation were analyzed using comparative and multivariate regression analyses. RESULTS: Through multivariate regression analysis, we identified significant factors, including age, stroke size, absence of white matter hyperintensities, absence of microbleeds, and the National Institutes of Health Stroke Scale (NIHSS) score at admission, that affect symptom relief in patients with ischemic stroke lesions. Significant factors affecting lesion formation in patients with ischemic stroke and symptom relief were the NIHSS score at admission, atrial fibrillation, and alcohol intake. The results demonstrated that pathological changes in the brain, pre-existing brain damage, and stroke lesions can prevent symptom relief. The NIHSS score, which indicates stroke severity, was associated with symptom relief and the presence of stroke lesions. Stroke lesion formation was associated with alcohol intake and the presence of atrial fibrillation. CONCLUSIONS: These findings provide valuable insights for the development of management strategies that improve the treatment and prognosis of patients with acute ischemic stroke.
Plasma D-dimer can predict malignant brain edema after thrombectomy in noncardioembolic acute cerebral infarction.
Zhang W, Jiang Z, Wen Y … +4 more , Zhong X, Zhu M, Ling L, Xing W
BMC Neurol · 2026 Jul · PMID 42393544 · Full text
OBJECTIVE: There is relatively little data on malignant brain edema (MBE) after mechanical thrombectomy (MT) in non cardioembolic acute cerebral infarction caused by anterior circulation large vessel occlusion. Our study...
OBJECTIVE: There is relatively little data on malignant brain edema (MBE) after mechanical thrombectomy (MT) in non cardioembolic acute cerebral infarction caused by anterior circulation large vessel occlusion. Our study attempts to investigate the incidence rate of MBE after successful MT of anterior circulation acute non cardioembolic cerebral infarction, the predictive effect of emergency preoperative plasma D-dimer and clinical prognosis of patients. METHODS: One hundred eighty-six consecutive patients suffered from anterior circulation non cardioembolic acute cerebral infarction who received successful MT were selected. Clinical features, imaging examinations, laboratory tests and treatment characteristics of patients at admission were collected and analyzed. RESULTS: Among 186 patients (aged 64.26 ± 11.62 years; male accounted for 75.81%), 30 cases (16.13%) developed MBE. MBE patients had a low 3-month good prognosis rate and a high mortality rate (P<0.001). After adjusting for confounding factors, ASPECT score at admission (OR=0.322; 95% CI 0.146-0.711; P=0.005), tandem lesions in the location of occluded vessel (OR=6.422; 95% CI 1.799-22.924; P=0.004), collateral circulation score (OR=0.343; 95% CI 0.139-0.845; P=0.020) and emergency preoperative plasma D-dimer (OR=1.155; 95% CI 1.004-1.329; P=0.044) were significantly related to MBE. The area under the ROC curve of predicting MBE using emergency preoperative plasma D-dimer was 0.706 (sensitivity 0.500; specificity 0.859). CONCLUSION: Emergency preoperative plasma D-dimer is associated with MBE in patients with noncardioembolic acute cerebral infarction of anterior circulation after successful MT, although its predictive performance is modest. The presence of MBE reduces the chance of patients' neurological independence at 3 months after MT. These findings are preliminary and require validation in larger prospective studies.
Association of low-dose intra-arterial plus intravenous tirofiban with improved functional outcome in branch atheromatous disease-related stroke patients with early neurological deterioration.
Liu X, Wu M, Zhang Z
BMC Neurol · 2026 Jul · PMID 42393539 · Full text
BACKGROUND: Management of early neurological deterioration (END) in branch atheromatous disease (BAD)-related stroke remains challenging, and intravenous (IV) tirofiban's efficacy is limited. This study aimed to evaluate...
BACKGROUND: Management of early neurological deterioration (END) in branch atheromatous disease (BAD)-related stroke remains challenging, and intravenous (IV) tirofiban's efficacy is limited. This study aimed to evaluate the efficacy and safety of low-dose intra-arterial (IA) combined with IV tirofiban in BAD-related stroke patients experiencing END. METHODS: We retrospectively analyzed patients with BAD-related stroke who experienced END and were treated with tirofiban between May 2020 and December 2024. Based on the administration route of tirofiban, patients were divided into IA + IV (n = 45) or IV (n = 119) groups. The primary efficacy outcome was the proportion with an excellent functional outcome (modified Rankin Scale [mRS] score 0-1) at 90 days. Secondary outcomes included favorable functional outcome (mRS 0-2), National Institutes of Health Stroke Scale (NIHSS) score at multiple timepoints, and early neurological improvement (ENI). Safety outcomes comprised symptomatic intracranial hemorrhage (sICH), any ICH, mortality, and other serious adverse events. RESULTS: After adjustment for four prespecified prognostic factors, the IA + IV group had significantly higher rate of excellent functional outcome compared to the IV group (adjusted odds ratio [OR], 2.99; 95% CI, 1.25-7.16; P = 0.014). This finding was consistent after IPTW adjustment using 10 covariates (OR, 3.68; 95% CI, 1.48-9.14; P = 0.005). The IA + IV group also exhibited significantly lower NIHSS scores at 24 and 72 h and a higher rate of ENI (75.6% vs. 42.9%; adjusted OR, 4.12; 95% CI, 1.85-9.17; P < 0.001). No sICH occurred in either group. The incidence of any ICH (2.2% vs. 0.8%, P = 0.537) and 90-day all-cause mortality (0% vs. 1.7%, P = 0.997) did not differ significantly between IA + IV and IV groups. CONCLUSIONS: In patients with BAD-related stroke experiencing END, adjunctive low-dose IA + IV tirofiban seems associated with higher odds of excellent functional outcome and faster early neurological recovery compared to IV tirofiban alone. The incidence of safety-related adverse events in this study was low; however, due to limited statistical power, the true safety profile requires further validation. Given the limitations of non-randomized design, procedural confounding, and selection bias, further high-level clinical studies are warranted to validate these findings.
Long-segment cervicothoracic spinal cord injury occurring after cerebral angiography: a case report.
Jiang FY, Chen LK, Yang XG … +5 more , Tang YG, Pan HH, Tang M, Liao LF, Huang YM
BMC Neurol · 2026 Jul · PMID 42387450 · Full text
BACKGROUND: Spinal cord injury (CIS) is an exceedingly rare complication of cerebral angiography, with only nine cases since 1962. Pathogenesis remains poorly understood. CASE PRESENTATION: A 67-year-old diabetic woman p...
BACKGROUND: Spinal cord injury (CIS) is an exceedingly rare complication of cerebral angiography, with only nine cases since 1962. Pathogenesis remains poorly understood. CASE PRESENTATION: A 67-year-old diabetic woman presented with dizziness and normal neurological examination. During cerebral angiography, repeated injections of ioversol contrast medium (total 100 mL; approximately 20 min at a single site) were performed into the right subclavian artery for vertebral artery imaging due to vascular tortuosity. The angiography showed normal cerebrovascular morphology, without emboli, stenosis, vasospasm, or dissection. Four hours post-procedure, she developed neck pain and limb weakness progressing to quadriplegia (upper limb strength 3/5, lower limb 2/5) within 10 h. Serial MRI demonstrated longitudinal extension: from C1-C3 cord swelling (10 h) to medulla-T3 hyperintensity (24 h). Dynamic angiography revealed aberrant anastomoses between the thyrocervical trunk-ascending cervical artery and V2-segmental-anterior spinal arteries. Despite high-dose methylprednisolone and intravenous immunoglobulin, motor strength deteriorated (upper limbs 3/5, lower limbs 0/5) without recovery at 1 year. CONCLUSIONS: This case reports a long-segment cervicothoracic CIS following cerebral angiography. Abnormal spinal collateral circulation may have delivered contrast medium to the spinal cord and thereby possibly contributing to the extensive injury observed. This outcome highlights the need for extreme caution with repetitive contrast injections at a single site.
Preoperative volume of mildly delayed time predicts 24-hour complete reperfusion after successful mechanical thrombectomy.
Zhang H, Liu Y, Zhao H … +3 more , Ling Y, Dong Q, Cao W
BMC Neurol · 2026 Jul · PMID 42387438 · Full text
BACKGROUND: Successful macrovascular recanalization after mechanical thrombectomy (MT) does not always ensure tissue-level microvascular reperfusion, highlighting the need for reliable preoperative imaging biomarkers to...
BACKGROUND: Successful macrovascular recanalization after mechanical thrombectomy (MT) does not always ensure tissue-level microvascular reperfusion, highlighting the need for reliable preoperative imaging biomarkers to predict microvascular success. AIMS: To investigate whether the preoperative volume of mildly delay time (DT 2-4 s), as quantified by MIStar CT perfusion (CTP), can predict 24-hour complete reperfusion (CR) in patients achieving successful MT. METHODS: We retrospectively analyzed patients with acute anterior circulation large vessel occlusion treated between January 2015 and December 2022 who achieved successful recanalization (eTICI 2b-3). All participants received baseline and follow-up CTP at 24 h processed by MIStar. CR was defined as 100% reperfusion on follow-up imaging. The relationship between preoperative DT 2-4 s volume and CR was evaluated using multivariable logistic regression and Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Sixty patients (mean age 65 years, 58.3% male) were included, with 36 (60%) achieving CR. Preoperative DT 2-4 s volume was significantly smaller in the CR group (64.8 ± 27.2 ml) compared to the incomplete group (113.5 ± 52.3 ml; p < 0.001). After adjusting for confounders, DT 2-4 s remained independently associated with CR (adjusted OR 0.94; 95% CI 0.9 to 0.98). ROC analysis yielded an AUC of 0.81. A threshold of DT 2-4 s < 95 ml predicted CR with a sensitivity of 0.84, a specificity of 0.81. CONCLUSION: Preoperative DT 2-4 s volume is a novel and sensitive biomarker for predicting 24-hour complete tissue-level reperfusion. It identifies patients at risk of microvascular failure despite successful large-vessel recanalization.
Insulin resistance and the risk of dementia: a systematic review and meta-analysis of prospective cohort studies.
Xu X, Li J, Pan H … +2 more , Zhao B, Wang D
BMC Neurol · 2026 Jul · PMID 42387430 · Full text
BACKGROUND: Mechanistic and cross-sectional studies have indicated a correlation between insulin resistance and dementia; however, further evidence from prospective studies is needed to elucidate the relationship between...
BACKGROUND: Mechanistic and cross-sectional studies have indicated a correlation between insulin resistance and dementia; however, further evidence from prospective studies is needed to elucidate the relationship between insulin resistance and the risk of developing dementia. METHODS: A systematic review and meta-analysis were conducted. Searches were performed in PubMed, EMBASE, and the Cochrane Library for relevant articles published up to December 20th, 2025. Cohort studies investigating the risk of dementia onset associated with insulin resistance were included. RESULTS: A total of ten studies were included in the meta-analysis. Insulin resistance was associated with an increased risk of all-cause dementia (HR = 1.11, 95% CI 1.03-1.21, 9 studies included) and Alzheimer's disease (HR = 1.23, 95% CI 1.01-1.50, 7 studies included). A similar association was observed between insulin resistance and the risk of vascular dementia (HR = 1.04, 95% CI 1.01-1.07, 4 studies included). CONCLUSION: The available evidence suggested that insulin resistance might be associated with an increased risk of all-cause dementia, Alzheimer's disease, and vascular dementia. Further well-designed prospective studies are warranted to clarify the causal relationship between insulin resistance and dementia. TRIAL REGISTRATION: The study was registered with PROSPERO under the registration number CRD42024550842 on June 5th, 2024.
A preliminary analysis of the inflammatory protein landscape in the CSF of mid- to late-stage Parkinson's disease: associations with motor severity and subtypes.
Guo Y, Liu W, Bu W … +3 more , Wang R, Su D, Li H
BMC Neurol · 2026 Jul · PMID 42387333 · Full text
PURPOSE: Parkinson's disease (PD) is a progressive neurodegenerative disorder in which neuroinflammation is recognized as a contributor to clinical progression. This study aimed to characterize the cerebrospinal fluid (C...
PURPOSE: Parkinson's disease (PD) is a progressive neurodegenerative disorder in which neuroinflammation is recognized as a contributor to clinical progression. This study aimed to characterize the cerebrospinal fluid (CSF) inflammatory profile in mid- to late-stage PD patients and identify specific inflammatory proteins with potential clinical relevance to motor symptoms and disease severity. METHODS: In this preliminary retrospective cross-sectional study, CSF samples were obtained from 25 patients with mid- to late-stage PD undergoing evaluation for deep brain stimulation (DBS) (mean disease duration: 10.24 ± 4.65 years) and 15 non-PD controls (essential tremor or dystonia) undergoing identical surgical procedures. The levels of 92 inflammation-related proteins were quantified using the Olink proximity extension assay (PEA). Based on the identified differentially expressed proteins (DEPs), we next performed preliminary exploratory comparisons of inflammatory profiles between the postural instability and gait difficulty (PIGD, n = 10) and tremor-dominant (TD, n = 10) PD subtypes. Additionally, preliminary correlation analyses were performed between the DEPs and Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part-III (MDS-UPDRS-III) scores to generate preliminary observations with limited clinical inference. RESULTS: Using the Olink platform, 28 DEPs were identified between the PD and non-PD groups (p < 0.05). Subsequent protein-protein interaction network analysis identified IFN-γ as the central hub. Exploratory descriptive analyses of TD and PIGD subgroups are provided in Additional file 1: Supplementary Figure S1. Among all DEPs, IL-10RB (r = 0.440, 95% CI [0.054, 0.711], p = 0.028), CD8A (r = 0.415, 95% CI [0.024, 0.696], p = 0.039), and CXCL9 (r = 0.414, 95% CI [0.023, 0.696], p = 0.040) showed moderate correlations with MDS-UPDRS-III scores. CONCLUSION: In profiling 92 CSF inflammation-related proteins from 25 advanced PD patients (Hoehn-Yahr 3-4) and 11 controls, we identified 28 upregulated DEPs. IFN-γ emerged as a topologically connected hub in protein-protein interaction networks, and three proteins (IL-10RB, CD8A, CXCL9) showed moderate correlations with motor scores. As cross-sectional descriptive observations, these findings establish a preliminary framework to generate hypotheses for future mechanistic validation and biomarker discovery, while no functional causality can be inferred from the present results.
Risk factors for cerebral infarction in patients with rheumatoid arthritis: a retrospective case-control study.
Xuan J, Gao X
BMC Neurol · 2026 Jun · PMID 42381002 · Full text
OBJECTIVE: To investigate the risk factors, including relevant autoantibodies, for cerebral infarction in patients with rheumatoid arthritis (RA). METHODS: Thirty-nine RA patients with cerebral infarction admitted to Wei...
OBJECTIVE: To investigate the risk factors, including relevant autoantibodies, for cerebral infarction in patients with rheumatoid arthritis (RA). METHODS: Thirty-nine RA patients with cerebral infarction admitted to Weifang People's Hospital since January 2010 were selected as the RA cerebral infarction group. Seventy-two RA patients without cerebral infarction hospitalized during the same period were randomly selected as the RA non-cerebral infarction group. Gender, age, RA disease duration, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody, anti-Sjögren's syndrome antigen A (anti-SSA) antibody, anti-Sjögren's syndrome antigen B (anti-SSB) antibody, Erythrocyte Sedimentation Rate(ESR), C-Reactive Protein(CRP), swollen joint count(SJC), tender joint count(TJC), patient global assessment(PGA), physician's global assessment (PhGA), as well as the presence of comorbid hypertension, diabetes, and smoking status were compared between the two groups. Additionally, Disease Activity Score-28 using ESR (DAS28-ESR), Disease Activity Score-28 using CRP(DAS28-CRP), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were compared between the two groups. RESULTS: Univariate analysis showed that there were statistically significant differences between the two groups in DAS28-ESR, DAS28-CRP, CRP levels, SJC, PGA, PhGA, SDAI, CDAI, anti-SSB positivity, and comorbid hypertension (P < 0.05), while no statistically significant differences were found in the remaining variables (P > 0.05). Multivariate logistic regression analysis revealed that anti-SSB positivity, SJC ≥ 11, and CRP ≥ 26.85 mg/l were independent risk factors for the occurrence of cerebral infarction in patients with rheumatoid arthritis. The most common clinical manifestation in the RA with cerebral infarction group was hemiplegia. CONCLUSION: Positivity for anti-SSB antibody, SJC ≥ 11, and CRP ≥ 26.85 mg/l were independent risk factors for the occurrence of cerebral infarction in patients with rheumatoid arthritis.
Selective sparing of sartorius and biceps femoris muscles on MRI in post-polio syndrome: a case report of two cases.
Li G
BMC Neurol · 2026 Jul · PMID 42380825 · Full text
BACKGROUND: Post-polio syndrome (PPS) is characterized by progressive muscle weakness and atrophy decades after acute poliomyelitis. While muscle involvement is typically asymmetric and patchy, specific patterns of selec...
BACKGROUND: Post-polio syndrome (PPS) is characterized by progressive muscle weakness and atrophy decades after acute poliomyelitis. While muscle involvement is typically asymmetric and patchy, specific patterns of selective muscle sparing have not been well characterized. CASE PRESENTATION: We report two male patients (ages 36 and 69 years) with a remote history of paralytic poliomyelitis who presented with progressive lower limb weakness and atrophy, fulfilling the March of Dimes diagnostic criteria for PPS. Detailed clinical examination revealed asymmetric motor deficits with right-sided predominance. Comprehensive electrophysiological studies demonstrated chronic neurogenic changes without evidence of active denervation or upper motor neuron involvement. Muscle MRI of the thighs revealed a progressive pattern of selective muscle sparing: Patient 1 demonstrated unilateral preservation of the sartorius and biceps femoris in the newly affected left thigh, with end-stage fatty obliteration of these muscles in the previously affected right thigh; Patient 2 demonstrated bilateral preservation of these muscles, representing an earlier stage of the same pathophysiological process. CONCLUSIONS: This observation suggests that post-polio muscular degeneration follows a hierarchic and progressive pattern. The sartorius and biceps femoris exhibit relative resilience-delayed rather than absolute resistance to degeneration-possibly reflecting unique anatomical, developmental, or pathophysiological protective factors. This MRI pattern may serve as a dynamic imaging clue to support PPS diagnosis and stage assessment, though validation in larger cohorts is required.
Effect of multimodal CT angiography/perfusion sequencing on alteplase door-to-needle time.
Coralic Z, Michaels B, Truong K … +3 more , Wang R, Josephson SA, Kim AS
BMC Neurol · 2026 Jun · PMID 42380802 · Full text
BACKGROUND AND PURPOSE: Multimodal computed tomography angiography and perfusion (CTA/CTP) is increasingly used in the emergency department (ED) evaluation of acute ischemic stroke (AIS) but may delay thrombolysis. We ex...
BACKGROUND AND PURPOSE: Multimodal computed tomography angiography and perfusion (CTA/CTP) is increasingly used in the emergency department (ED) evaluation of acute ischemic stroke (AIS) but may delay thrombolysis. We examined whether the sequencing of multimodal CTA/CTP relative to thrombolytic administration affects door-to-needle (DTN) time. METHODS: We conducted a retrospective cohort study of adult patients with AIS treated with intravenous alteplase at a tertiary, academically affiliated ED that is part of a certified Comprehensive Stroke Center between January 1, 2012, and August 1, 2023. All patients underwent an initial noncontrast CT (NCCT), followed by either a contrast-first workflow (i.e. CTA/CTP) or were given alteplase before proceeding to contrast administration. The primary outcome was DTN time, analyzed using univariate methods and multivariable quantile regression adjusting for stroke severity, pre-alteplase antihypertensive use, thrombectomy (as a correlate for large-vessel occlusion), primary language, and bedside ED pharmacist presence. RESULTS: Among 1,382 AIS encounters, 167 patients met inclusion criteria; 148 underwent CTA/CTP before alteplase and 19 received alteplase before contrast administration. Median DTN time was significantly shorter in the alteplase-first group (20 minutes [interquartile range (IQR), 15-26]) compared with the CTA/CTP-first group (44 minutes [IQR, 32-56]; P<0.001). After adjustment, alteplase-first administration remained independently associated with faster DTN time (-25 minutes; 95% CI, -34 to -16). Higher stroke severity and ED pharmacist presence were also associated with shorter DTN, whereas pre-alteplase antihypertensives, primary language, and thrombectomy were not. CONCLUSIONS: A contrast-first strategy incorporating multimodal CTA/CTP before alteplase administration was associated with approximately twofold longer DTN times. These findings suggest that obtaining CTA/CTP before thrombolytic administration may substantially prolong DTN times. Larger studies are needed to confirm the magnitude of this association and to identify patient populations most likely to benefit from alternative imaging workflows.
One case of acute encephalopathy associated with 16p11.2 deletion and PRRT2 gene mutation.
Shang S, Wang Q, Wang J … +5 more , Song H, Zhang J, Liu X, Gao X, Ding C
BMC Neurol · 2026 Jun · PMID 42380791 · Full text
BACKGROUND: PRRT2 is associated with autosomal dominant paroxysmal kinesigenic dyskinesia (PKD), benign familial infantile epilepsy (BFIE) and other diseases. OBJECTIVE: To explore the phenotypic spectrum associated with...
BACKGROUND: PRRT2 is associated with autosomal dominant paroxysmal kinesigenic dyskinesia (PKD), benign familial infantile epilepsy (BFIE) and other diseases. OBJECTIVE: To explore the phenotypic spectrum associated with PRRT2 mutations, we analyzed a patient carrying a 16p11.2 deletion including PRRT2. METHODS: A retrospective analysis was conducted on the clinical and genetic characteristics of a patient with a 16p11.2 deletion containing PRRT2. A literature search was performed in CNKI, Wanfang, and PubMed from the establishment of the databases to December 2025, using the keywords "acute encephalopathy", "PRRT2", "paroxysmal non-kinesigenic dyskinesia", "ataxia", "copy number variation of chromosome 16", and "16p11.2 deletion", to identify case reports similar to the present case. RESULT: This patient presented with infection-induced acute encephalopathy, acute-onset non-motor-induced movement disorders and ataxia phenotype. Genetic testing indicated a 16p11.2 deletion involving PRRT2, de novo. After immunotherapy and rehabilitation treatment, the patient achieved a favorable prognosis. Literature review identified only two complete international case reports similar to this case (specifically regarding ataxia), and genetic analysis showed that they were respectively a 16p11.2 deletion containing PRRT2 and a PRRT2 gene variation. CONCLUSION: The 16p11.2 deletion containing PRRT2 has been reported for the first time to present as an acute encephalopathy phenotype. Rare cases of paroxysmal non-motor-induced movement disorder (PNKD) and ataxia have also been reported. These findings underscore the importance of timely genetic testing and appropriate genetic counseling for patients presenting with unexplained acute encephalopathy and/or acute episodic non-motor-induced movement disorders, as well as those with ataxia symptoms.
The longer, the better? Investigating the effect of prolonged acoustic stimulation on brief acoustic tinnitus suppression.
Rischer J, Neff P, Langguth B … +3 more , Engelke M, Reissmann A, Schoisswohl S
BMC Neurol · 2026 Jun · PMID 42380788 · Full text
BACKGROUND: Brief acoustic tinnitus suppression following sound stimulation is being studied to better understand the mechanisms underlying tinnitus and short-term suppression of the tinnitus perception. In this context,...
BACKGROUND: Brief acoustic tinnitus suppression following sound stimulation is being studied to better understand the mechanisms underlying tinnitus and short-term suppression of the tinnitus perception. In this context, several kinds of filtered or modulated stimuli have been investigated. However, little research was conducted regarding the effect of stimulation length for brief acoustic tinnitus suppression. METHODS: The aim of the present study was to compare the extent of tinnitus suppression after a 20-minute and a 3-minute acoustic stimulation with an individual best stimulus. Three experimental sessions were completed by 33 participants with chronic subjective tinnitus. In the first two sessions, eight different individualized, filtered, and/or amplitude-modulated stimuli were presented for 3 min each. For each participant, the stimulus which induced the strongest tinnitus loudness suppression (measured with a numeric rating scale in percent compared to baseline loudness) was chosen and then applied for 20 min in a third session. RESULTS: On a group level, no significant difference in tinnitus loudness suppression comparing the 3-minute and the 20-minute acoustic stimulation using the individual best stimulus was observed. However, individual response patterns revealed great diversity as 12 participants showed better suppression after the 20-minute stimulation,12 experienced worse tinnitus suppression and for 9 participants no distinct change was evident compared to 3-minute acoustic stimulation. CONCLUSIONS: Future research should try to characterize the subgroup of tinnitus patients that profits from prolonged acoustic stimulation and search for optimized simulation durations. TRIAL REGISTRATION: This trial was retrospectively registered on 2026/03/04 at ClinicalTrials.gov (ID: NCT07472257).
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