Neurology Asia

CACNA1A channelopathy with reversible cerebral ischaemia and vasospasm

Mon, 23 Mar 2026 00:00:00 +0000

The autosomal dominant CACNA1A gene encompasses episodic neurological disorders likely related to calcium-channelopathy. We report on an 8-year-old boy with a pathogenic heterozygous CACNA1A mutation (c.4067C>T) who developed seizures, encephalopathy, and left hemiplegia. Brain magnetic resonance imaging showed restricted diffusion in the right parieto-temporo-occipital lobes with concomitant narrowing of the proximal segments of the right middle cerebral artery. Flow velocities were elevated on transcranial doppler evaluation, confirming vasospasm as a mechanism for the stroke- like episode. Treatment with the calcium channel blocker verapamil resulted in normalisation of TCD flow velocities as well as ischaemic changes on brain magnetic resonance imaging. Our patient is the youngest reported paediatric patient to benefit from the utilisation of serial TCD studies in the detection and management of cerebral vasospasm within the reported CACNA1A population.

A cavernous malformation presenting with homonymous superior quadrantanopia

Ayoung Choi, Keun Tae Kim — Mon, 23 Mar 2026 00:00:00 +0000

Cerebral cavernous malformations (CMs) are vascular lesions that may remain asymptomatic but can cause neurological deficits when located in eloquent brain regions. Retrochiasmal visual pathway involvement is rare, and isolated homonymous quadrantanopia is exceptionally uncommon. A 64-year- old woman presented with a one-year history of progressive visual disturbance. Automated perimetry demonstrated bilateral, congruous superior quadrantanopia with well-demarcated defects. Magnetic resonance imaging revealed a well-circumscribed ovoid lesion in the medial right anterior temporal lobe, adjacent to the roof of the temporal horn. The lesion exhibited mixed T2 signal, a hypointense hemosiderin rim, and prominent susceptibility blooming, consistent with a cavernous malformation. Its location corresponded to Meyer’s loop, the anterior portion of the optic radiation, explaining the congruous superior quadrantanopia. Reports of CMs resulting in visual field loss are exceedingly rare. This case uniquely demonstrates unequivocal involvement of Meyer’s loop, yielding a congruous superior quadrantanopia and expanding the clinical spectrum of CM presentations.

Involvement of temporal artery as a rare presentation of IgG4-related disease

Ayşegül Şeyma Sarıtaş, Eylül Ceren Çağ, Peyker Temiz, Ayşın Kısabay Ak — Mon, 23 Mar 2026 00:00:00 +0000

Immunoglobulin G4-related disease (IgG4-RD) is a chronic systemic condition characterized by fibroinflammatory features that can affect multiple organs. Ophthalmic involvement commonly presents with tumor-like masses, particularly in the lacrimal glands and orbital tissues. However, involvement of temporal artery as a rare manifestation of IgG4-RD has been infrequently reported in the literature. Herein, we present a case demonstrating neuro-ophthalmic involvement in which involvement of temporal artery emerged as a clinical manifestation of IgG4-related disease.

A rare case of combined central and peripheral demyelination associated with neurofascin-155 IgG antibody: Distinctive MRI findings

Sin Yi Leow, Chih-Shan Huang — Mon, 23 Mar 2026 00:00:00 +0000

Combined central and peripheral demyelination (CCPD) is a rare neurological disorder characterized by both central nervous system (CNS) and peripheral nervous system (PNS) demyelination. Its clinical heterogeneity and overlapping features with multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy make diagnosis challenging. We report a 19-year-old man who presented with progressive limb numbness, sensory ataxia, tremor, and unsteady gait. Nerve conduction studies indicated sensorimotor polyneuropathy with axonal changes, and brain MRI revealed abnormal diffusion-weighted imaging signals in multiple white matter regions, with characteristic Dawson fingers on T2-weighted imaging. Serum was positive for neurofascin-155 antibodies, confirming the diagnosis of CCPD. This case highlights the importance of considering CCPD in patients with overlapping CNS and PNS demyelinating features.

Co-occurrence of myotonic dystrophy type 1 and hereditary neuropathy with liability to pressure palsies: A case report

Feng Zhang, Dongchu Li, Xiao Liu, Ming Cheng — Mon, 23 Mar 2026 00:00:00 +0000

This report is the first documented co-occurrence of myotonic dystrophy type 1 (DM1) and hereditary neuropathy with liability to pressure palsies (HNPP); rare neuromuscular disorders with distinct genetic etiologies (DMPK CTG expansion, PMP22 deletion). A 22-year-old soldier underwent clinical evaluation for weakness of both fingers after physical training. Clinical features included percussion myotonia, grip difficulty (DM1), and limb numbness, weakness, absent reflexes (HNPP). NCS showed widespread demyelination; EMG confirmed myotonic discharges. This novel overlap underscores the need for comprehensive neurophysiological and genetic evaluations in atypical presentations. The absence of prior reports suggests coincidental co-occurrence, emphasizing vigilance for multiple pathologies.

Severe and refractory autonomic failure in diffusion- weighted imaging-negative neuronal intranuclear inclusion disease: A case with progressive leukoencephalopathy

Xueming Li, Weijiang Ding, Enwang Xu — Mon, 23 Mar 2026 00:00:00 +0000

Neuronal intranuclear inclusion disease (NIID) is a heterogeneous neurodegenerative disorder most commonly associated with GGC repeat expansions in the NOTCH2NLC gene. Although curvilinear hyperintensity along the corticomedullary junction on diffusion-weighted imaging (DWI) is considered a hallmark diagnostic feature, a proportion of patients present without this characteristic finding. The clinical course and disease activity of DWI-negative NIID remain poorly defined. We describe a 55-year-old man with genetically and pathologically confirmed NIID who exhibited a markedly aggressive autonomic phenotype. After a six-year history of nonspecific dizziness, he developed acute, severe, and refractory autonomic failure, characterized by catheter-dependent urinary retention, pharmacoresistant constipation, and generalized hyperhidrosis. Despite the persistent absence of typical DWI abnormalities, serial brain MRI over a 12-month period demonstrated progressive confluent white matter hyperintensities accompanied by worsening cerebral atrophy. In conclusion, this case highlights that DWI-negative NIID can present with severe, rapidly progressive autonomic dysfunction alongside active structural neurodegeneration. Clinicians should maintain a high suspicion for NIID in patients with atypical leukoencephalopathy and prominent autonomic failure, even in the absence of characteristic DWI findings, to facilitate prompt genetic diagnosis.

Early intervention and sibling imitation in autism spectrum disorder: A twin case report with exploratory SNP analysis

Mon, 23 Mar 2026 00:00:00 +0000

We present a fraternal twin case study that underscores the importance of early diagnosis and targeted intervention in autism spectrum disorder (ASD), demonstrating the potential for substantial symptom reduction or even loss of diagnosis. Despite shared genetics and environment, the twins showed markedly different outcomes: Patient 1 exhibited substantial improvement, and no longer met ASD criteria, while Patient 2 progressed more slowly. Notably, Patient 1 displayed negative imitation, mirroring behaviors of his more severely affected twin. Genetic analysis of Patient 2 revealed ASD- associated variants (CNTNAP2 rs7794745 A/T, NRP2 rs849563 T/G, and OXTR rs2254298 G/G), which are implicated in neuronal development, synaptic pruning, and social cognition. These findings highlight the influence of sibling dynamics in multi-affected families and underscore the need for larger cohort studies to clarify the role of these polymorphisms in ASD within the Azerbaijani population.

Clinical predictors of an acute stroke Vs. stroke mimic among code stroke patients: A single center retrospective study

Jose Leandro Tuason, Cymbeline Perez-Santiago — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: There is an increasing rate of stroke mimics being identified in code stroke pathways, which adds to hospital staff workload and increased financial costs for patients. This study aims to identify clinical predictors that distinguish a true acute stroke from a stroke mimic in code stroke cases and to determine which neurological signs and symptoms are more strongly associated with a confirmed stroke diagnosis.

Methods: A single-center retrospective cross sectional descriptive study was conducted among code stroke patients seen in the Makati Medical Center emergency room from January 2024 to December 2024. Clinical history, baseline characteristics, neurological symptoms, and neurological signs were collected and compared between patients with acute strokes and stroke mimics.

Results: A total of 209 patients (66.77%) were true acute strokes and 104 patients (33.23%) were stroke mimics. Hypertension, Type 2 Diabetes Mellitus, and Atrial fibrillation were more frequently observed in true acute strokes, while a history of epilepsy and psychiatric disorder were more frequently observed in stroke mimics. Dysarthria, hemiparesis, and facial asymmetry, were significant predictors of a true stroke diagnosis. While symptoms of seizure like movements, sensory deficits in one arm or one leg, and loss of consciousness were significantly associated with stroke mimics.

Conclusions: This study highlights the high prevalence of stroke mimics in code stroke activations and reinforces the diagnostic value of key neurologic signs and symptoms that are associated with a true stroke. Incorporating evidence-based screening tools like FAST into stroke pathways may help reduce mimic cases and ease the burden on hospital resources.

The value of serum ZAG levels in predicting the progression and prognosis of acute ischemic stroke

Mon, 23 Mar 2026 00:00:00 +0000

Objective: The aim of this study was to investigate the value of serum zinc-alpha2-glycoprotein (ZAG) levels in predicting the progression and prognosis of acute ischemic stroke (AIS).

Methods: A total of 210 patients with AIS who were hospitalized for 72 hours were included in the case group, and 52 patients undergoing health check-ups at the hospital in the same period were included in the control group. Serum ZAG levels were measured early in the morning on the second day after admission via enzyme-linked immunosorbent assay (ELISA). For patients with AIS, those whose National Institutes of Health Stroke Scale (NIHSS) score progression was greater than 2 were regarded as the progression group, while those whose NIHSS score was less than 2 were regarded as the nonprogression group. Prognosis was assessed via the modified Rankin scale (mRS) score after 90 days: an mRS score > 2 was considered a poor prognosis. Logistic regression was used to analyze whether the serum ZAG level was an independent factor affecting the risk of disease progression and the long-term prognosis of AIS. Nomogram models were developed to predict the progression and prognosis of AIS.

Results: The serum ZAG level was significantly lower in AIS patients than in controls. The binary logistic regression analysis revealed that the serum ZAG level [odds ratio (OR) 0.963, 95% confidence interval (CI): 0.948–0.979, P < 0.01] may be an independent factor for the risk of AIS onset. Subsequent single-factor analysis revealed that the serum ZAG level in the AIS progression group was lower than that in the nonprogression group. Binary logistic regression analysis also revealed that the serum ZAG level was an independent factor (OR 0.968, 95% CI: 0.947–0.991, P = 0.005) for the risk of AIS progression. Consistently, the serum ZAG level in the poor AIS prognosis group was lower than that in the good prognosis group, and binary logistic regression analysis revealed that the serum ZAG level was an independent risk factor for poor prognosis of acute cerebral infarction (OR 0.937, 95% CI: 0.905–0.969; P < 0.01). Nomogram models including the serum ZAG level to predict the progression and prognosis of AIS showed good prediction ability.

Conclusion: There is a close association between serum ZAG levels and the onset of AIS. A lower serum ZAG level may predict AIS progression and long-term poor prognosis.

Prognostic value of systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and white blood cell–mean platelet volume ratio (WMR) in predicting mortality in acute ischemic stroke

Buket Özkara Yılmaz, Abdurrahman Sönmezler — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Systemic inflammatory markers have recently gained attention as potential predictors of clinical outcomes in acute ischemic stroke. This study aimed to evaluate the prognostic value of the Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and White Blood Cell–Mean Platelet Volume Ratio (WMR) in predicting early mortality and neurological status at hospital admission.

Methods: This retrospective study included 140 patients diagnosed with acute ischemic stroke. Demographic data, laboratory parameters, and clinical scores (NIHSS, mRS, GCS) at admission were recorded. Patients were grouped as survivors and non-survivors. Between-group comparisons, correlation analyses, ROC curves, and binary logistic regression were performed to evaluate the predictive role of SII, SIRI, and WMR.

Results: Non-survivors had significantly higher SIRI, SII, and WMR values compared with survivors (p<0.001 for all). SIRI and SII showed moderate positive correlations with baseline NIHSS (r=0.346 and r=0.401) and mRS scores (r=0.368 and r=0.402), while correlating negatively with GCS (r=–0.336 and r=–0.393). ROC analyses demonstrated good diagnostic performance for SIRI (AUC=0.760), SII (AUC=0.724), and WMR (AUC=0.678) in distinguishing mortality. In multivariable logistic regression, SII (OR=36.42; p=0.001), SIRI (OR=1.41; p=0.023), and WMR (OR=0.05; p=0.003) were identified as independent predictors of mortality.

Conclusion: Higher SIRI, SII, and WMR values are strongly associated with early mortality and worse neurological status in acute ischemic stroke. These readily available and low-cost inflammatory indices may assist in rapid risk stratification and early clinical decision-making in the acute phase.

Acute anterior choroidal artery infarction: Clinical predictors of prognosis

Emre Kumral, Hüseyin Nezih Özdemir, Zeynep Yamazhan — Mon, 23 Mar 2026 00:00:00 +0000

Objectives: The clinical and prognostic features of acute anterior choroidal artery (AChA) stroke have not been sufficiently investigated in the context of new treatment approaches.

Methods: This AChA stroke study was a prospective, observational cohort study conducted at a stroke center from July 1, 2020, to September 30, 2024, enrolling patients aged 28 to 85 years within 48 hours of symptom onset. Demographic and clinical characteristics were analyzed for all patients. Clinical characteristics were compared between groups with good outcomes (modified Rankin Scale score, 0-2) and poor outcomes (modified Rankin Scale score, 3-6), as well as between those treated with or without intravenous rt- PA or endovascular treatment.

Results: 115 patients were studied. An NIHSS score of 6 or more at discharge increased the risk of poor outcome (P <0.001). Multivariable regression analysis showed that age (P = 0.04), smoking (P = 0.009), infarct size >15 mm (P = 0.036), and clinical progression (P < 0.001) were positively associated with poor outcome, whereas dual antiplatelet treatment was negatively associated with poor outcome (P = 0.014). Despite thrombolysis, 16 of 30 patients (53%) had an mRS score >2 at 90 days (P <0.005). Thrombectomy was performed in 18 patients, and 10 of them (56%) had mRS scores >2 at 90 days, compared to 8 (44%) with mRS scores ≤2 (P =0.023).

Conclusion: There was no benefit from the thrombolysis within the therapeutic window in patients with AChA strokes. Additional treatments are needed and therapeutic trials should be designed, for example, new dual antiplatelet agents, bridging strategies such as thrombectomy after thrombolysis.

Role of in-hospital blood pressure and stroke severity in predicting 3-month functional outcomes after acute ischemic stroke: Experience from a Malaysian tertiary centre

Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: The optimal inpatient blood pressure (BP) target after acute ischemic stroke (AIS) remains uncertain, particularly in Asian populations. We evaluated whether mean in-hospital BP during the first five days is associated with 3-month functional outcomes, and examined the relative contribution of stroke severity.

Methods: We included 200 patients from April 2024 to April 2025 who were admitted with Acute Ischemic Stroke (AIS) at a tertiary hospital in Malaysia. Blood pressure was measured every 4 hourly and daily mean BP (days 1–5) was calculated. Functional status at 3 months was presented as either good outcome (mRS 0-2) or poor outcome (mRS 3-6).

Results: Discharge mRS was the only independent predictor of clinical outcome (OR 0.04; 95% CI 0.01–0.16; p<0.001).

Conclusion: Mean inpatient BP during first 5 days post-AIS was not independently predictive of 3-month outcome. However, we found that discharge mRS score remained strongest predictor.

Expression and significance of HMOX1, STAT3, ferritin, GPX4, and hs-CRP in patients with ischemic stroke

Li Chen, Lei Cui, Yi-Fei Ji, Xin Li — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Ischemic stroke (IS) is a leading cause of global mortality and disability, and as such, reliable biomarkers for its early diagnosis and prognosis are needed. This study explored the expression and clinical relevance of HMOX1, STAT3, ferritin, GPX4, and hs-CRP in patients with IS.

Methods: The serum levels of these biomarkers in 159 patients with IS and 150 healthy controls were compared and analyzed across subgroups stratified by neurological severity, infarct size, and clinical outcomes.

Results: IS patients showed higher levels of HMOX1, STAT3, ferritin, and hs-CRP, as well as lower GPX4 levels, than healthy controls (all p < 0.05). Biomarker levels differed significantly among mild-, moderate-, and severe-stroke groups, as well as across different infarct sizes. Diabetes history increased the infarction deterioration risk by 2.86-fold. Among the biomarkers, hs-CRP, ferritin, and GPX4 demonstrated predictive value for disease progression, with AUC values of 0.608, 0.611, and 0.729, respectively, while HMOX1 and STAT3 did not distinguish progression status.

Conclusion: Serum levels of HMOX1, STAT3, ferritin, GPX4, and hs-CRP are potential biomarkers for assessing IS severity and prognosis.

Development and validation of a predictive model for pneumonia risk in ICU patients with stroke: A retrospective cohort study using the MIMIC-IV 3.0 database

Mon, 23 Mar 2026 00:00:00 +0000

Background: Stroke is a leading cause of death and disability worldwide, with poststroke complications such as pneumonia significantly increasing mortality and healthcare burden. Existing models for predicting pneumonia risk in stroke patients have limitations, particularly in ICU settings.

Methods: This retrospective study utilized the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to construct a nomogram predicting pneumonia risk in stroke patients within the ICU. The nomogram integrated multiple risk factors identified through univariate and multivariate logistic regression analyses.

Results: The study included 6542 stroke patients, with 11.5% developing pneumonia. Key predictive factors included breath rate, white blood cell, calcium, mean corpuscular hemoglobin concentration (MCHC), mechanical ventilation, antibiotics, pulmonary circulation disorders, metastatic cancer, and weight loss. The nomogram demonstrated good discrimination ability and calibration, with an AUC of 0.821 in the training set and 0.809 in the test set.

Conclusions: The nomogram provides a valuable tool for clinicians to assess pneumonia risk in stroke patients in the ICU, potentially improving patient outcomes and reducing the burden of pneumonia. Further research is needed for external validation and to incorporate additional variables.

Golden hours at risk: Prehospital delays in acute ischemic stroke and their impact on public awareness and emergency response

Mon, 23 Mar 2026 00:00:00 +0000

Background: Timely intervention is essential in the management of acute ischemic stroke, as delays in treatment initiation can significantly worsen clinical outcomes. Despite advancements in stroke care, prehospital delays remain a major barrier to accessing reperfusion therapies. This study aimed to investigate the sociodemographic, clinical, and cognitive factors contributing to prehospital delays and to assess their impact on treatment accessibility and outcomes.

Methods: This prospective observational study was conducted at the Emergency Department of Eskişehir Osmangazi University, a regional stroke center, between March 2018 and February 2019. Adult patients (≥18 years) presenting with a first-time suspected ischemic stroke were enrolled. Data were collected through structured interviews with patients and/or their relatives and supplemented by official emergency medical service records. Variables analyzed included sociodemographic characteristics, symptom recognition time, mode of transport, and awareness of stroke symptoms.

Results: A total of 436 patients were included. Most patients (78.6%) resided in urban areas, while 19.7% lived alone. The majority (72%) experienced sudden symptom onset. Intravenous rtPA was administered to 26.4%, and mechanical thrombectomy was performed in 12.4% of patients. Ambulance use was significantly higher among rural residents (p < 0.001). The mean time from symptom onset to hospital arrival (symptom-to-door) was 362 ± 400 minutes. Key contributors to prehospital delays included delayed symptom recognition and delayed contact with emergency services. Higher educational attainment of the first responder was significantly associated with shorter recognition-to-arrival times. Patients with typical stroke symptoms (e.g., unilateral weakness, speech impairment) reached the hospital faster than those with non-specific symptoms like imbalance. Patients or relatives who correctly identified stroke symptoms had significantly shorter delays in all key time intervals (p < 0.001). Those educated through public seminars, healthcare professionals, or social media showed faster recognition and response times compared to those informed by friends or with no prior knowledge.

Conclusion: Prehospital delay remains a key obstacle to timely stroke management. Factors such as education level, living situation, symptom awareness, and the source of stroke-related information significantly influence early hospital presentation. Public health strategies should emphasize stroke education, particularly for high-risk populations, through both digital media and community outreach. Improved coordination between emergency services and stroke centers is also critical for enhancing access to timely, life-saving interventions.

Efficacy and safety of early butylphthalide initiation in acute ischemic stroke: A multicenter, randomized, clinical trial (BENEFIT) protocol

Mon, 23 Mar 2026 00:00:00 +0000

Background: Acute ischemic stroke (AIS) is a major cause of disability and death worldwide. While time windows for reperfusion therapies are well defined, the optimal timing for neuroprotective agents remains unknown. This study aims to investigate whether early initiation (<3 hours) of DL- 3-n-butylphthalide (NBP), a promising neuroprotective agent, leads to better outcomes compared to late initiation (3-6 hours) in AIS patients.

Methods: This study is an exploratory, prospective, multicenter, randomized, open-label trial with blinded endpoint assessment. The study plans to recruit approximately 200 AIS patients presenting within 3 hours of symptom onset from around 20 stroke centers in China. Patients will be randomized in a 1:1 ratio into either the early group (<3 hours of intravenous NBP administration) or the late group (3–6 hours of intravenous NBP administration). The treatment regimen consists of 100 mL of NBP administered intravenously twice daily for 12±2 days. The primary objective of the study is to evaluate the efficacy and safety of early versus late intravenous administration of NBP in AIS patients and to explore the optimal therapeutic time window for neuroprotection. The primary outcome is the proportion of patients achieving an excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0–2, at 90±7 days post-randomization. Secondary outcomes include changes in stroke severity scores, rates of neurological deterioration, stroke recurrence, and safety outcomes.

Conclusion: This trial will provide valuable evidence for the efficacy and safety of early versus late initiation of intravenous NBP for improving 90-day functional outcomes in patients with AIS. This trial will provide evidence regarding the optimal timing of neuroprotective therapy in AIS and potentially establish a new therapeutic paradigm. Registration details: ClinicalTrials.gov (NCT06472921), registered on June 19, 2024.

Investigation of the efficacy of extracorporeal shock wave therapy in post-stroke patients on spasticity, functionality and range of motion: a randomized controlled trial

Mehmet CANLI, Salam Khlaif Jaber ALAASEMİ, Şafak KUZU , Anıl ÖZÜDOĞRU — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Spasticity is among the most frequent and most serious symptoms requiring treatment in stroke patients. The aim of this trial was to determine the effects of extracorporeal shock wave therapy (ESWT) on spasticity and upper extremity function in stroke patients.

Methods: A total of 48 stroke patients, each having experienced a stroke at least 6 months prior, were randomly assigned to two groups: the control group (n=24) and the ESWT group (n=24). Patients in the control group received only a conventional treatment program, while those in the ESWT group received radial ESWT (rESWT) in addition to the conventional treatment. Both groups underwent treatment sessions twice a week for two weeks. Spasticity severity, upper extremity functionality, and range of motion were evaluated both before and after treatment.

Results: Statistically significant improvements were observed in spasticity severity, upper extremity functionality, and range of motion values in both groups after treatment (p<0.05). However, the groups were not superior to each other (p>0.05).

Conclusion: Based on the results of the study, we concluded that adding rESWT to conventional treatment did not contribute to greater improvement in upper limb spasticity and functionality in stroke patients.

CTA-derived hemodynamic parameters and inflammatory biomarkers in predicting post- embolization vasospasm in ruptured intracranial aneurysms

Jun Wang, Zongping Wang, Qingdong Jin, Cong Zhang, Shilong Fu, Guofeng Wang — Mon, 23 Mar 2026 00:00:00 +0000

Objective: To investigate the predictive value of CTA-derived hemodynamic parameters and readily accessible systemic inflammatory indices for post-embolization vasospasm (PEV) and 3-month functional outcomes in patients with ruptured intracranial aneurysms (RIAs).

Methods: In this prospective cohort study, 230 patients undergoing endovascular coiling within 72 hours of ictus were enrolled. Computational fluid dynamics (CFD) simulations based on preoperative CTA were used to quantify hemodynamic parameters (TAWSS, OSI, RRT). Preoperative serum procalcitonin (PCT), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were also measured. The primary outcome was 3-month functional status, dichotomized into improved (GOS 4–5) versus poor (GOS 1–3) outcomes.

Results: Poor outcomes occurred in 29.8% of the development cohort and 30.8% of the validation cohort. Multivariable analysis identified Hunt–Hess grade IV–V, TAWSS, PCT, and NLR as independent predictors of poor functional outcome. The resulting nomogram demonstrated excellent discrimination (AUC = 0.89 in the development cohort; AUC = 0.85 in the validation cohort) and satisfactory calibration. PEV developed in 21.3% of the development cohort and was significantly associated with poor outcomes.

Conclusion: Integrating CTA-derived hemodynamic parameters with readily available systemic inflammatory indices reliably predicts PEV and functional outcomes in RIAs, providing a clinically applicable tool for early risk stratification.

Clinical analysis, treatment process and experience of 4 cases of carotid artery web

Yong Zhu, Feng Long, Ting Peng, Biao Zhou, Qingyong Wang — Mon, 23 Mar 2026 00:00:00 +0000

Objectives: Carotid artery web (CaW) is a vascular anomaly linked to cryptogenic ischemic stroke, especially in young patients without traditional vascular risk factors. This study analyzes the clinical characteristics, treatment strategies, and outcomes of four patients diagnosed with CaW.

Methods: A retrospective analysis of four patients diagnosed with CaW from January 2018 to January 2022 was conducted. Treatment strategies varied: two patients received thrombolysis and mechanical embolectomy, while two received mechanical embolectomy alone. All patients were placed on long-term anti-platelet therapy.

Results: The cases consisted of 3 males and one female, with an average age of 48 year; the patients presented with acute ischemic symptoms. Imaging confirmed CaW in each patient, with two undergoing thrombolysis and mechanical embolectomy, and two undergoing mechanical embolectomy alone. Follow-up (12-36 months) showed no recurrence of stroke or ischemic symptoms.

Conclusions: CaW is a significant, though rare, cause of ischemic stroke, especially in middle-aged males. A combined approach of thrombolysis or mechanical embolectomy, followed by long-term anti- platelet therapy, is effective in preventing stroke recurrence. Further studies are needed to establish standardized treatment guidelines.

Epilepsy-related knowledge and attitudes of nursing students

Serdar Sarıtaş, Sultan Tarlacı, Seher Cevik Aktura, Seyhan Citlik Saritas — Mon, 23 Mar 2026 00:00:00 +0000

Objective: This study aimed to determine the epilepsy-related knowledge and attitudes of nursing students.

Method: The descriptive and cross-sectional study was conducted on 986 nursing students from the nursing faculty of a state university in eastern Türkiye. Data were collected using a sociodemographic information form, the Epilepsy Knowledge Scale, and the Epilepsy Attitudes Scale. Descriptive statistics, t-tests, one-way ANOVA, linear regression analysis, and Cronbach’s alpha internal consistency coefficient were used for data analysis.

Results: The average age of participants was 21.18±1.79 years, with 67.2% being female, 27.5% 4th-year students, and 89.5% did not have a family member with epilepsy. The mean scores for the Epilepsy Knowledge Scale and the Epilepsy Attitudes Scale were 9.65±4.04 and 57.16±7.85, respectively. Gender, academic year, source of information, personal experience witnessing an epileptic seizure, providing care to an epilepsy patient, and the location of witnessing a seizure were significant predictors of epilepsy-related knowledge. Gender and knowledge about epilepsy were significant predictors of attitudes towards epilepsy.

Conclusion: The study revealed that nursing students had moderate levels of knowledge about epilepsy and positive attitudes towards the condition.

Analysis of influencing factors and construction of nomogram model for short term prognosis in patients with tuberculous meningitis

Dan Yi, Kun Li, Nian Wang, JiYao Qiu, Qian Wang, Yong Xu, Mei Chen, RuiSong Wang — Mon, 23 Mar 2026 00:00:00 +0000

Objective: To identify risk factors and develop a nomogram for predicting short-term prognosis in tuberculous meningitis (TBM).

Methods: This retrospective study analyzed 99 TBM patients (70 with good and 29 poor prognosis patients based on modified Rankin Scale) from Guiyang Public Health Treatment Center (February 2023–June 2024). Clinical variables were compared, and logistic regression used to identify prognostic factors. A nomogram was constructed and validated using ROC, calibration, and decision curve analyses.

Results: Age, hydrocephalus, acute cerebral infarction, and cerebrospinal fluid (CSF) chloride/ADA levels independently predicted poor prognosis (P < 0.05). ROC analysis revealed AUCs of 0.69 (age), 0.65 (hydrocephalus), 0.58 (cerebral infarction), 0.76 (CSF chloride), and 0.73 (CSF ADA). The combined nomogram model demonstrated superior predictive performance (AUC: 0.86) versus individual factors. Calibration and decision curves confirmed high accuracy and clinical utility.

Conclusion: The nomogram incorporating age, hydrocephalus, acute cerebral infarction, CSF chloride, and ADA levels effectively predicts short-term TBM prognosis with robust clinical applicability.

Altered level of consciousness in the emergency department before and after coronavirus disease-19: A four-year multicenter study

Keun Tae Kim, Jong-Geun Seo, Jung A Park, Doo Hyuk Kwon — Mon, 23 Mar 2026 00:00:00 +0000

Background: New-onset altered level of consciousness (ALC) is a frequent and critical presentation in emergency departments (EDs), requiring prompt recognition and management. The coronavirus disease-19 pandemic has significantly affected emergency care systems, yet its impact on ALC remains poorly understood. This study aimed to compare the etiology, patient flow, and outcomes of ALC before (BC) and after (AC) the COVID-19 pandemic.

Methods: In this retrospective multicenter study, board-certified faculty from emergency medicine, internal medicine, and neurology reviewed 17,913 patients with ALC from four university-affiliated EDs serving a population of approximately five million individuals in South Korea. Patients were classified into BC (February 2018 – January 2020) and AC (March 2021 – February 2023). ALCs in the ED were categorized into 10 etiologies by multidisciplinary consensus review.

Results: The incidence of ALC in the ED was 3.1%. The incidence of ALC increased significantly from 2.5% in BC to 3.7% in AC (P<0.001). Metabolic cause was the most common etiology (24.8%), followed by systemic infection (18.0%). Intracranial etiologies accounted for 29.7% of the total. Admission rate increased from 54.5% to 59.3% (P<0.001), while ICU admissions declined and ED deaths rose. Overall mortality increased from 13.5% to 18.4% (P < 0.001), and post-admission mortality from 16.3% to 21.3% (P<0.001). The highest mortality was associated with ALCs due to cardiogenic and vascular etiologies (26.8%).

Conclusion: The observed shifts in etiologies, patient flow, and mortality between BC and AC reflect pandemic-driven changes in emergency care, underscoring the need for multidisciplinary strategies and scalable emergency care systems.

Diagnostic accuracy of Ultrasound and Carpal tunnel syndrome-6 scoring system for diagnosis of Carpal tunnel syndrome taking nerve conduction study as gold standard

Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Comparative analysis of different diagnostic tools will help clinicians in choosing the appropriate test for the diagnosis of Carpal Tunnel Syndrome (CTS), is able to shorten the time of diagnosis and treatment. The purpose of this study was to assess the diagnostic accuracy of ultrasonography and the CTS-6 scoring system with reference to nerve conduction test as gold standard for the diagnosis of CTS.

Methods: This cross-sectional study was conducted at neurology department of Federal Government Polyclinic, Islamabad for one year. All patients presenting with signs and symptoms of CTS, and fulfilling the eligibility criteria were enrolled in the study. Enrolled participants underwent the nerve conduction study, ultrasonography, and the CTS-6 score to diagnose CTS. The diagnosis established by nerve conduction study (NCS) was considered as a gold standard.

Results: The sensitivity of CTS-6 scoring method was found to be 63.6%, and the specificity was found to be 78.3%, considering nerve conduction test as standard. On the other hand, the sensitivity of ultrasound technique was found to be 86.7%, specificity was found to be 70.3%, considering nerve conduction test as standard.

Conclusion: The sensitivity and specificity of ultrasound and CTS-6 scoring method was found to have moderate diagnostic accuracy in establishing diagnosis of CTS.

Diagnostic and clinical value of mixed–sensory nerve conduction velocity differences between wrist–elbow and second finger–wrist segments in carpal tunnel syndrome

GÜLÇİN YENİCE, HALİT FİDANCI, HALİL CAN ALAYDIN, ZÜLFİKAR ARLIER — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: This study aimed to evaluate the diagnostic utility of the nerve conduction velocity difference between the mixed (wrist–elbow) and sensory (second finger–wrist) segments of the median nerve (WE–FW).

Methods: This prospective study included 40 CTS patients (61 extremities) and 40 healthy controls (40 extremities). Diagnosis was based on clinical findings. The Visual Analog Scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were administered to the CTS group. The WE–FW was derived from orthodromic (WE–FW/O) and antidromic (WE–FW/A) sensory conduction studies in the second finger–wrist segment of the median nerve, using both onset and peak latencies.

Results: There were no significant differences in age or sex between groups (p>0.05). WE–FW/O and WE–FW/A values were significantly higher in CTS patients than controls (p<0.001 for all). Sensitivities of WE–FW/O (onset and peak latency) were 84.1% and 77.3%, with specificities of 85.0% and 77.5%. WE–FW/A sensitivities were 83.3% (onset) and 81.5% (peak), with 82.5% specificity for both. WE–FW/O (peak latency; p=0.044, r=0.306) and WE–FW/A (onset latency; p=0.005, r=0.376) positively correlated with clinical CTS severity. Both parameters also significantly correlated with VAS and DASH scores.

Conclusions: WE–FW shows strong diagnostic potential in CTS. This novel method correlates with clinical and neurophysiological severity, and may serve as valuable adjuncts in diagnosis and follow-up.

Correlation between Systemic Inflammatory Response Index (SIRI) and disease severity in patients with Guillain-Barré syndrome

Mon, 23 Mar 2026 00:00:00 +0000

Background: Guillain-Barré syndrome (GBS) is a peripheral neuropathy with variable clinical severity, and in severe cases, it can lead to significant neurological dysfunction and respiratory failure. In this study, we evaluated the relationship between the Systemic Inflammatory Response Index (SIRI), derived from a complete blood count, and neurological severity in patients with GBS.

Methods: The data of 40 consecutive patients diagnosed with definitive GBS between January 1, 2021, and March 1, 2023, at a tertiary care center were retrospectively analyzed. Demographic data, vital signs at presentation, and laboratory results were recorded. SIRI (neutrophils × monocytes / lymphocytes) was calculated from initial blood counts. Disease severity was defined using the Hughes Functional Grading Scale (HFGS) at the worst disease stage, with a score of ≥4 considered a “severe” clinical presentation. The performance of SIRI in predicting severe GBS was evaluated using receiver operating characteristic (ROC) curve analysis, the Youden index, and logistic regression.

Results: The median age of the patients was 58 years (interquartile range: 42–73), and 52% were male. The median SIRI was significantly higher in the severe group (n = 27, 68%) compared to the mild group (n = 13, 32%) [1.69 (1.33–2.85) vs. 1.39 (0.90–2.02); p = 0.013]. A moderate positive correlation was found between SIRI and the worst HFGS score (r = 0.554, p < 0.001). In ROC analysis, at a cut-off value of ≥1.43, SIRI predicted severe GBS with 77.4% sensitivity and 77.8% specificity (area under the curve = 0.771, Youden index = 0.552). In multivariate logistic regression, SIRI ≥ 1.43 (odds ratio = 5.8, 95% confidence interval: 2.0–17.0), initial HFGS score ≥ 3, and age ≥ 60 years remained independent predictors of a severe clinical course.

Conclusion: The SIRI value at presentation is an independent and easily applicable biomarker for predicting neurological severity in GBS. The SIRI threshold of ≥1.43 may assist in identifying patients requiring early intensive care monitoring or aggressive treatment; however, these findings should be validated in multicenter, prospective studies.

Clinical characteristics and prognosis of neuralgic amyotrophy of the brachial plexus: A retrospective study in the Thai population

Sahaphum Taemeeyapradit, Saharat Aungsumart, Narupat Suanprasert — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Neuralgic amyotrophy, or Parsonage-Turner syndrome, is an underrecognized brachial plexopathy characterized by acute shoulder pain followed by weakness and atrophy. Limited data exist on its clinical spectrum in Thailand. The objective of this study is to describe the clinical features, electrophysiological and MRI findings, and disease course of neuralgic amyotrophy in a Thai cohort.

Methods: We retrospectively reviewed 27 adult patients diagnosed with neuralgic amyotrophy of brachial plexus at the Neurological Institute of Thailand (2017–2024). Data included clinical presentation, nerve conduction studies, MRI findings, Medical Research Council (MRC) strength scores, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) functional outcomes.

Results: The median patient age was 54 years; most were male. All presented with acute pain followed by focal weakness and atrophy, most often affecting shoulder abduction, external rotation, and elbow flexion. Triggers were identified in 25.9%, most commonly post-vaccination. Upper trunk involvement predominated. Radial nerve motor amplitudes were reduced in 51.9%, but sensory abnormalities were infrequent (18.5%). MRI showed T2 hyperintensity in 72.7% and gadolinium enhancement in 40.9%. Corticosteroids were administered to 74% of patients. Early treatment (≤30 days) was associated with significantly better QuickDASH (p = 0.0284) and MRC (p = 0.0172) scores. Most patients achieved meaningful recovery within 6 months, with peak motor improvement at second follow-up.

Conclusion: This study details clinical and MRI features of neuralgic amyotrophy in Thai patients, emphasizing early diagnosis and corticosteroid treatment to improve functional outcomes.

Autonomic dysfunction in Indonesian patients with Parkinson’s disease

Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Autonomic dysfunction is a prevalent non-motor symptom in Parkinson’s disease (PD) and significantly affects patients’ quality of life. Despite its clinical importance, data on autonomic dysfunction in Indonesian PD populations were scarce. This study aims to characterize autonomic dysfunction and examine its associations with demographic and clinical subgroups in Indonesian PD patients using the SCOPA-AUT INA instrument.

Methods: We conducted a cross-sectional study involving 45 PD patients from the outpatient neurology clinic at Dr. Cipto Mangunkusumo Hospital between April 2023 and April 2024. Autonomic dysfunction was assessed using the SCOPA- AUT INA. Patients were grouped by age, sex, disease duration, disease severity, comorbidities, and anti-parkinsonian medications. Statistical analyses included chi-square, Kruskal–Wallis, Mann–Whitney U, and Spearman correlation tests.

Results: Autonomic dysfunction (SCOPA-AUT INA score ≥10) was present in 77.8% of subjects, with gastrointestinal (93.3%) and urinary (91.1%) symptoms being the most prevalent. Older patients (≥60 years) showed significantly higher SCOPA-AUT INA scores and urinary symptom severity. Longer disease duration was significantly associated with cardiovascular symptoms. Discrepancies were noted between categorical and continuous analyses of SCOPA-AUT INA, highlighting the challenge of defining cutoffs.

Conclusion: Autonomic dysfunction is highly prevalent in Indonesian PD patients, particularly among older individuals. The findings support the relevance of age and disease duration in shaping autonomic symptom profiles. SCOPA-AUT cutoff scores warrant further validation in larger, multicenter cohorts to improve clinical applicability.

Evaluation of 5-phenylindazoles on LRRK2 inhibition using cellular-based assay and molecular docking

Mon, 23 Mar 2026 00:00:00 +0000

LRRK2 has been widely recognised as a critical drug target as it is relevant for both familial and idiopathic cases of Parkinson’s disease (PD). Increased LRRK2 kinase activity has been observed in PD patients regardless of their genetic status. This study investigated seventeen 5-phenylindazole derivatives as LRRK2 kinase inhibitors by monitoring Rab10 phosphorylation at Thr73 (a direct LRRK2 substrate) and LRRK2 phosphorylation at Ser935 in HEK293 cells expressing either wild- type or G2019S LRRK2. Molecular docking was used to analyse protein-ligand interactions at the atomic level. In wild-type LRRK2 cells, four small molecules (4h, 4i, 4n and 4o) induced a modest, non-significant inhibition of Rab10 Thr73 phosphorylation (ranging from 27% to 35%), but LRRK2 Ser935 phosphorylation remained unaffected. Whereas no significant inhibition of either LRRK2 Ser935 and Rab10 Thr73 phosphorylation was observed in the LRRK2-G2019S cells treated with any of the 5-phenylindazole derivatives. Computational analysis revealed that these compounds preferentially bind to the open-inactive conformation of LRRK2, a characteristic of type II kinase inhibitors. However, due to their compact molecular scaffolds, these small molecules only partially occupied the extended type II binding pocket, limiting the allosteric engagement necessary for potent inhibition. In conclusion, this structure-activity relationship study demonstrates that while type II binding mode selectivity was modestly achieved, scaffold extension is required to increase molecular size and achieve fuller occupancy of the extended type II pocket.

Movement disorders in adults with metabolic encephalopathy: A chart-based cross-sectional study

Paulo Cataniag, Jed Noel Ong, Cid Czarina Diesta — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objectives: The objective of this study was to determine the prevalence and characteristics of movement disorders in adult patients diagnosed with various types of metabolic encephalopathies in the Philippines.

Methods: This is a descriptive cross-sectional study based on a 7-year chart review of admitted adult patients diagnosed with any of the fifteen different types of metabolic encephalopathy who experienced movement disorders during their hospital stay. Movement disorders were characterized based on phenomenology, onset, and distribution.

Results: Out of 9,773 neurologic referrals, 2,055 patients (17%) were diagnosed with metabolic encephalopathy, mainly the hypoxic-ischemic type. Only 4% (76) exhibited involuntary movements, primarily linked to hypoxic-ischemic encephalopathy. Three movement disorders were reported: myoclonus (64), tremor (10), and parkinsonism (2). The 6th decade was the most common age for these disorders, predominantly in males. Most cases appeared acutely within 7 days after onset of encephalopathy and were mostly diffuse and multifocal.

Conclusion: The findings highlight myoclonus as the predominant movement disorder in metabolic encephalopathy, particularly in hypoxic-ischemic and uremic types.

Evaluation of semicircular canals in patients with vestibular migraine with suppression head impulse paradigm test and video head impulse test

Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Vestibular migraine (VM) is a prevalent disorder characterized by recurrent episodes of spontaneous vertigo, which may occur with or without headaches. This study aimed to evaluate the vestibular system in individuals with VM using the video head impulse test (vHIT) and suppression head impulse paradigm (SHIMP).

Methods: In this study, 20 individuals diagnosed with VM according to the Bárány Society criteria were included in the VM group, and 20 individuals without vertigo symptoms were included as controls. All participants underwent both vHIT and SHIMP tests. The Beck Depression Inventory (BDI) and Dizziness Handicap Inventory (DHI) were also administered to assess depression and dizziness.

Results: No significant differences in vestibular- ocular reflex (VOR) gains were observed between the VM and control groups across all semicircular canal (SCC) planes. Overt saccades were noted in 12 VM patients in the right lateral SCC, and in 9 patients in the left lateral SCC. Covert saccades were observed in 1 patient in each of the right and left lateral SCCs. No saccades occurred in the anterior or posterior SCCs. The SHIMP test revealed no significant differences in gain or anti-compensatory saccades between the groups. However, significant differences were observed in the BDI and DHI scores (p = 0.000).

Conclusion: vHIT and SHIMP testing do not effectively identify vestibular dysfunction during the inter-attack period in VM patients. However, overt saccades may serve as potential indicators of dysfunction. Both otoneurological evaluation and psychological assessment are crucial in the comprehensive evaluation of VM patients.

Light-induced sensory dysregulation in migraine: Evidence from blink reflex habituation analysis

Hakan Şilek — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: Migraine involves altered brainstem sensory processing and photophobia affects 90% of patients. The blink reflex (BR) evaluates trigeminal-brainstem circuits non-invasively, but photic stimulation effects on BR habituation remain unexplored. This study aimed to investigate BR habituation changes following photic stimulation in episodic migraine patients versus healthy controls.

Methods: Thirty episodic migraine patients (ICHD-3 criteria) and 30 age-gender-matched controls underwent BR testing during interictal periods. Primary outcomes were changes in R1 amplitude and R2 areas (ipsilateral/contralateral) after standardized photic stimulation (6 Hz, 1200 cd/m², 60 seconds). Delta values (Δ = post-pre) were compared using Mann-Whitney U tests with Bonferroni correction.

Results: Baseline BR parameters were comparable between groups. Controls showed physiological habituation with increased R1 amplitude (median Δ = +42.3 μV) and reduced R2 areas (ipsilateral: -41.2 μV·ms, contralateral: -118.5 μV·ms). Migraine patients demonstrated impaired habituation with minimal R1 changes (+3.8 μV) and paradoxical R2 area increases (+2.4 and +31.7 μV·ms). All differences were significant (p < 0.001) with large effect sizes (r = 0.72-0.86).

Conclusion: Migraine patients exhibit profound BR habituation deficits following photic stimulation, reflecting brainstem sensory inhibition dysfunction. This approach may serve as an objective biomarker for migraine-related brainstem pathology.

Psychiatric comorbidity may affect the quality of life in pediatric migraine patients, independently of pain frequency and PedMIDAS score

Mon, 23 Mar 2026 00:00:00 +0000

Background: Migraine is a prevalent neurological disorder in children, often accompanied by psychiatric comorbidities (PC) such as depression, anxiety, and attention deficit hyperactivity disorder (ADHD). These conditions significantly affect children’s lives, particularly their self-esteem, social relationships, and overall quality of life (QOL). However, research on the combined impact of migraine and PC on pediatric QOL remains limited.

Methods: This study included 175 children aged 8–17 years from the Pediatric Neurology Outpatient Clinic of a tertiary hospital. Among them, 75 were diagnosed with migraine and 100 served as controls. Data on sociodemographic factors, migraine-related disability (PedMIDAS), PC, and QOL (KINDLR questionnaire) were collected.

Results: Major depression, ADHD, and oppositional defiant disorder were significantly more prevalent in the migraine group compared to controls. Children with episodic migraine and PC had markedly lower self-esteem, poorer social relationships, and overall QOL than those without comorbidities. Conversely, no significant QOL differences were observed between children with and without PC in the chronic migraine group. Furthermore, no correlation was found between PedMIDAS scores and QOL in migraine patients. Psychiatric comorbidities were associated with lower QOL in children with migraine, particularly in those with episodic migraine, with notable reductions in self-esteem and social relationships. PedMIDAS, while useful for assessing migraine-related disability, may not fully reflect the QOL differences associated with PC.

Conclusion: Comprehensive evaluation of both QOL and PC is essential for effective management and follow-up of pediatric migraine patients.

Diagnostic value of red blood cell indices and peripheral inflammatory markers in migraine patients during the interictal period

AYFER ERTEKİN — Mon, 23 Mar 2026 00:00:00 +0000

Objectives: Current data show that migraine patients exhibit a widespread pro-inflammatory systemic state, present even during the interictal period, becoming even more pronounced during attacks. This study aimed to investigate the potential of red blood cell indices and peripheral inflammatory biomarkers (PIB) measured in the interictal period to distinguish migraine from tension-type headache (TTH).

Methods: This retrospective cross-sectional study included 410 individuals aged 18 to 69 years, comprising 213 (52.0%) with migraine and 197 (48.0%) with tension-type headache (TTH). Peripheral markers of inflammation, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), white blood cell (WBC) count, C-reactive protein (CRP), pan-immune inflammation value (PIV), systemic immune inflammation index (SII) and other blood indices such as hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), mean platelet volume (MPV), platelet distribution width (PDW), ferritin, vitamin B12 and folic acid values were calculated.

Results: Interictal hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), ferritin, mean platelet volume (MPV), platelet distribution width (PDW), and LMR were significantly lower, whereas red cell distribution width (RDW), platelet count (PLT), PLR, NLR, C-reactive protein (CRP), PIV, and SII were significantly higher in migraine patients compared with TTH patients. The ROC curve analysis revealed that a PIV cutoff of 206.09 demonstrated 94.8% sensitivity and 89.3% specificity, while an SII cutoff of 535.28 resulted in 91.5% sensitivity and 89.3% specificity in distinguishing migraine from TTH.

Conclusions: The SII and PIV indices may be potential biomarkers for distinguishing migraine from TTH. These indices may also help monitor treatment efficacy based on individual inflammatory response profiles during clinical follow-up.

Aberrant brain functional connectome in migrainures revealed by resting-state fMRI

Mon, 23 Mar 2026 00:00:00 +0000

Previous studies have shown abnormalities in brain functional networks in different brain regions in migraineures, but the neural mechanisms underlying the whole brain functional connectome in migraineures remain unclear. We used resting-state functional magnetic resonance imaging (rsfMRI) to study abnormalities in the functional connectome of migraineures. In this study, we collected rsfMRI data from 39 migraineures and 17 healthy controls. The network-based statistic method was used to evaluate functional connectome differences between the two groups. We used Pearson correlation analysis to explore the relationship between abnormal functional connectivity and clinical characterisation. After network-based statistic analysis (p < 0.01, permutation = 500), compared to healthy controls, migraineurs showed an abnormal subnetwork of 76 nodes and 179 edges. The nodes were mainly located in the basal ganglia and sensorimotor areas. Functional connectivities between the caudate nucleus and occipital lobe and sensorimotor areas were significant positive correlated with visual analogue scale (p < 0.02). Abnormalities in the functional connectivity of the basal ganglia and sensorimotor areas are involved in the pathological mechanisms of migraine, while the caudate nucleus is a potential imaging marker for migraine.

Olfactory bulb volume changes across Alzheimer’s disease stages

Sadettin Ersoy, Aysenur Buz Yasar, Elif Hazal Ersoy, Murat Yilmaz — Mon, 23 Mar 2026 00:00:00 +0000

Background: Olfactory dysfunction is commonly seen in Alzheimer’s disease (AD) and has been reported in many studies. In this study, we measured the olfactory bulb volume (OBV) and olfactory sulcus depth (OSD) by MRI to see if they can help in distinguishing between healthy controls and different stages of Alzheimer’s disease (AD).

Methods: This retrospective cross-sectional study included 125 participants, divided according to clinical stage (Control, Mild AD, Moderate AD, and Severe AD). OBV and OSD were measured by MRI. Welchs ANOVA were used to compare the mean OBV and OSD between the groups. Multiple linear regression was performed to check the relationship of OBV with stage, age, and gender. ROC analysis was used to find the diagnostic cutoff values.

Results: Mean OBV varied by stage: 81.2±19.2 mm³ (Controls), 89.1±26.9 mm³ (Mild AD, vs Controls p=0.12), 60.3±19.8 mm³ (Moderate AD, vs Controls p<0.001), and 42.4±17.3 mm³ (Severe AD, vs Controls p<0.001). OSD showed no significant differences (p>0.05). Regression analysis indicated a significant association between OBV and AD stage (B=-18.39 for AD vs. controls, p<0.001) and a positive association with age (B=0.844, p=0.008). ROC analysis for AD (EVRE 3-4 vs. EVRE 1-2) yielded an AUC of 0.706 (95% CI: 0.612–0.800, p=0.001), with a cut-off of 56.25 mm³ providing 96.7% sensitivity and 40.0% specificity.

Conclusions: OBV was significantly lower in moderate and severe AD, which shows that it may have diagnostic value in later stages of the disease. However, there was no significant decrease in Mild AD, meaning it may not be useful for early screening. Long-term studies are needed for understand if OBV can predict the progression to AD.

Fat-suppressed T2-weighted fluid attenuated inversion recovery MR images allow efficient skull stripping in brain tumors using a brain extraction tool

Mon, 23 Mar 2026 00:00:00 +0000

Objective: To explore the efficacy of fat-saturated T2-weighted fluid attenuated inversion recovery MRI (fs-FLAIR) in skull stripping for the treatment of brain tumors.

Methods: MR images of brain tumors (gliomas, N=46; meningioma, N=51) were retrospectively collected, in which MRI protocols included contrast-enhanced T1-weighted MRI (T1C), fs-FLAIR or non-fs FLAIR MRI (nfs-FLAIR), T1-weighted MRI (T1), and T2-weighted fast spin echo MRI (T2). Skull stripping was implemented using the Brain Extraction Tool (BET) and evaluated with the Dice similarity coefficient as a comparison to manually segmented brain areas. To test the differences in Dice coefficients across different MR modalities, paired t tests and independent t test were utilized. Spearman’s correlation analysis was used to determine the correlations between Dice coefficients and scanning parameters.

Results: No significant correlations were observed between Dice coefficients and scanning factors influencing image contrast in the fs- FLAIR images of the two datasets, whereas significant correlations were observed with T1, T1C, T2, and nfs-FLAIR images. In gliomas, fs-FLAIR has the best skull-stripping performance, and the Dice coefficients were generally greater than 0.80 (maximum of 0.90). In contrast, most Dice coefficients were less than 0.8 in other sequences. All Dice coefficients of the fs-FLAIR images were significantly greater than those of T1, T2, and T1C images (p < 0.0001). Similar skull-stripping performances were observed in fs-FLAIR images of meningiomas and gliomas. Moreover, compared with nfs-FLAIR, fs-FLAIR resulted in higher Dice coefficients, with a maximum Dice coefficient of 0.87.

Conclusion: Fs-FLAIR allows fast and accurate skull stripping for brain tumors, and has the potential to aid in the development of intelligent diagnosis methods for these tumors.

Analysis of functional score in adult primary brain tumor patients: A single institution study

Mon, 23 Mar 2026 00:00:00 +0000

Objectives: This study investigates the relationships between preoperative functional scores, tumor type, size, and location, as well as postoperative functional outcomes in brain tumor patients.

Methods: A retrospective cohort design analyzed medical records of adult brain tumor patients at Cipto Mangunkusumo Hospital (RSCM) from 2021 to 2022. Inclusion criteria were adults aged 17 years and older diagnosed with primary brain tumors confirmed by CT or MRI imaging. Consecutive sampling was utilized for selection. Data analysis included univariate tests for descriptive statistics and bivariate hypothesis tests (Mann-Whitney, T-test, Kruskal-Wallis, ANOVA) to assess variable relationships, with significance set at p < 0.05.

Results: From 456 samples, 255 met the criteria for analysis. The median age was 44 years, with a predominance of females (66.7%). Meningiomas were the most common tumor type (43.5%). The median tumor size was 27.972 cc, with 91.4% located supratentorially. Preoperative Karnofsky Performance Status (KPS) scores had a median of 80%. Significant relationships were found between tumor type and preoperative KPS scores (p < 0.001) and a weak negative correlation between tumor size and KPS scores (correlation coefficient = -0.194). Supratentorial tumors had higher preoperative KPS scores compared to infratentorial tumors (median 80% vs. 75%, p < 0.05).

Conclusion: Tumor characteristics significantly influence functional outcomes in brain tumor patients, highlighting the importance of these factors in management strategies.

The value of adropin levels in determining the severity of pediatric mild traumatic brain injury in the emergency department: A prospective study

MEVLANA GUL, Esra LALOGLU — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: The presence of mild traumatic brain injury (mTBI) in paediatric patients poses significant challenges in terms of diagnosis, particularly with regard to determining which patients require neuroimaging procedures. Adropin, a peptide hormone with neuroprotective properties, has been proposed as a biomarker of brain injury. The present study examined the association between serum adropin levels and mTBI severity in children, with the classification of subjects based on clinical and radiological risk factors.

Methods: In this prospective study, 56 paediatric patients (aged 0–18 years) with mTBI and 57 age-matched controls were enrolled. The mTBI patients were stratified into low-, intermediate-, and high-risk categories based on clinical presentation and computed tomography (CT) findings. Serum adropin was measured using an enzyme-linked immunosorbent assay (ELISA). Group comparisons were performed with one-way analysis of variance (ANOVA) and Bonferroni post hoc tests; receiver operating characteristic (ROC) analysis was used to determine cut-off values, sensitivity, and specificity.

Results: A significant increase in mean serum adropin levels was observed in the mTBI group compared to the control group (4815.04 ± 2970.26 vs 1385.48 ± 290.50 pg/mL; p < 0.001). Within the mTBI cohort, adropin levels increased with risk status, reaching the highest levels in high-risk patients and in those with temporoparietal trauma. ROC analysis identified a cut-off of 1650.5 pg/mL to differentiate mTBI from controls (sensitivity 84%, specificity 82%) and 5520 pg/mL to distinguish high- from low-risk mTBI (sensitivity 85%, specificity 80%).

Conclusion: Serum adropin levels appear to reflect injury severity in mTBI and may aid risk stratification and imaging decisions. In order to confirm these findings and to define the role of adropin and related biomarkers, further research is required in the form of larger studies.

Systemic inflammatory biomarkers for predicting clinical deterioration in traumatic brain injury

Mon, 23 Mar 2026 00:00:00 +0000

Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Identifying patients at risk of early clinical deterioration is essential for timely intervention.

Methods: We retrospectively analyzed adult patients with mild to moderate TBI admitted to a tertiary care center. Three biomarkers were calculated from admission labs: red cell distribution width-to-platelet ratio (RPR), C-reactive protein-to-albumin ratio (CAR), and neutrophil-to-lymphocyte ratio × RPR (NLTRP). The primary outcome was deterioration within 5 days, defined as a ≥2-point decline in Glasgow Coma Scale or need for mechanical ventilation. The secondary outcome was 28-day mortality.

Results: Of 378 patients, 67 (17.7%) deteriorated and 30 (10.3%) died within 28 days. RPR (AUC 0.614, p=0.003) and CAR (AUC 0.609, p=0.005) predicted early deterioration. RPR (AUC 0.719, p<0.001), CAR (AUC 0.650, p=0.006), and NLTRP (AUC 0.645, p=0.008) predicted mortality. In multivariate analysis, CAR independently predicted early deterioration (OR 1.715, 95% CI 1.310–2.246).

Conclusion: RPR, CAR, and NLTRP are inexpensive, routinely available markers that may assist in early risk stratification of mild to moderate TBI. Validation in prospective multicenter studies is warranted.

Effect of ligustrazine hydrochloride injection combined with hyperbaric oxygen therapy on postoperative complications, cerebral blood flow, and serum levels of sFKN and HMGB1 in patients with severe traumatic brain injury

Shengwei Yang, Guancheng Hu, Hua Fu, Xingyun Quan — Mon, 23 Mar 2026 00:00:00 +0000

Objective: To investigate the effects of ligustrazine hydrochloride injection combined with hyperbaric oxygen therapy on postoperative complication rates, cerebral blood flow, and serum levels of soluble fractalkine (sFKN) and high mobility group box protein 1 (HMGB1) in patients with severe traumatic brain injury (STBI).

Methods: A total of 102 patients with severe TBI, treated at our hospital from February 2020 to February 2023, were randomly assigned into two groups using a sealed envelope method. Each group consisted of 51 patients. Both groups underwent decompressive craniectomy. The control group received hyperbaric oxygen therapy, while the observation group received ligustrazine hydrochloride injection combined with hyperbaric oxygen therapy, with treatment lasting for 1 month. The degree of National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), Mini- Mental State Examination (MMSE), cerebral blood flow parameters (vertebral artery [VA], basilar artery [BA], middle cerebral artery [MCA], anterior cerebral artery [ACA], posterior cerebral artery [PCA] blood flow velocities), serum brain injury markers (S100β protein, neuron-specific enolase [NSE], glial fibrillary acidic protein [GFAP]), and serum levels of sFKN and HMGB1 were compared before and 1 month after treatment. The incidence of postoperative complications and the 6-month prognosis were also recorded.

Results: One month after treatment, the observation group showed significantly lower NIHSS scores and higher GCS and MMSE scores compared to the control group (P < 0.05). Blood flow velocities in the VA, BA, MCA, ACA, and PCA were significantly lower in the observation group than in the control group (P < 0.05). Additionally, serum levels of S100β, NSE, and GFAP were significantly lower in the observation group (P < 0.05). Serum levels of sFKN and HMGB1 were also significantly lower in the observation group (P < 0.05). The incidence of hydrocephalus, postoperative seizures, brain herniation, and cerebral vasospasm was significantly lower in the observation group (P < 0.05). At 6 months post-treatment, the observation group had a better overall prognosis than the control group (P < 0.05).

Conclusion: Ligustrazine hydrochloride injection combined with hyperbaric oxygen therapy significantly improves cerebral blood flow, reduces serum levels of sFKN and HMGB1, alleviates brain injury, enhances neurological recovery, and effectively reduces postoperative complications, leading to improved long-term prognosis in patients with STBI.

Emergency assessment of vertigo using CT optic nerve sheath diameter: A novel approach to etiology differentiation and prognosis

Kemal Özmen, Burak Demirci, Abuzer Coşkun — Mon, 23 Mar 2026 00:00:00 +0000

Background: Differentiating central from peripheral vertigo in the emergency department (ED) remains a major diagnostic challenge, as early clinical findings frequently overlap. Computed tomography (CT) is widely used for initial imaging but has limited sensitivity for posterior fossa lesions. Measurement of the optic nerve sheath diameter (ONSD) on CT has emerged as a promising surrogate marker of intracranial pressure (ICP), yet its utility in vertigo patients has not been fully elucidated.

Methods: We retrospectively analyzed 294 adult patients who presented to a tertiary ED with acute vertigo between January 2022 and December 2023. Patients were classified as central (n=119) or peripheral (n=175) vertigo based on clinical and radiological findings. ONSD was measured bilaterally at 3 mm behind the globe on axial CT images. Comparisons between groups and subgroups were performed using independent samples t-test, one-way ANOVA with Bonferroni post-hoc test, and Chi-square analysis. Associations with hospitalization and mortality were also assessed.

Results: Mean ONSD values were significantly higher in central vertigo (5.13 ± 0.68 mm) than in peripheral vertigo (4.81 ± 0.41 mm, p<0.001). Among central subgroups, patients with infarction (5.18 ± 0.63 mm) and hemorrhage (5.22 ± 0.82 mm) exhibited increased diameters, whereas those with cerebellar masses demonstrated lower ONSD (4.62 ± 0.65 mm), closer to peripheral values. Right-sided lesions produced the largest diameters (5.27 ± 0.64 mm), followed by left-sided (5.00 ± 0.72 mm) and no lesion (4.81 ± 0.42 mm) groups (p<0.001). Hospitalized patients had higher ONSD (5.12 ± 0.67 mm) compared to discharged patients (4.80 ± 0.41 mm, p<0.001). Mortality cases (n=5) displayed markedly elevated values (6.24 ± 1.04 mm) versus survivors (4.92 ± 0.52 mm, p<0.001).

Conclusions: CT-derived ONSD is a valuable adjunct for differentiating central from peripheral vertigo and may predict hospitalization and mortality. Importantly, cerebellar masses exhibited distinct ONSD behavior compared to acute vascular lesions, underscoring the need to consider pathophysiological heterogeneity in interpretation. Integration of ONSD into ED protocols may enhance risk stratification and clinical decision-making.

Development of a questionnaire dedicated to neurogenic lower urinary tract dysfunction and localization- a pilot study

Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: There is a significant knowledge gap and paucity of symptom questionnaires to assess neurogenic lower urinary tract dysfunction (NLUTD). This study aimed to localize the level, nature and severity of NLUTD using a self-made set of questions that can be used to evolve a NLUTD specific questionnaire.

Methods: This cross-sectional, observational single centre pilot study included patients with non-obstructive NLUTD. Based on inputs from literature, experts and patients, a set of questions was generated, henceforth called the AIIMS-J NLUTD questionnaire (AIIMS-J NUDQ). The expected clinical type and level of bladder involvement was classified into frontal, suprapontine, suprasacral infrapontine and sacral or infra-sacral lesions. The answers on the AIIMS-J NUDQ were noted for each level of bladder involvement to delineate localization specific questions and evolve a diagnostic algorithm for neurogenic bladder.

Results: The AIIMS-J NUDQ had two different sets of questions. The first set had responses in the form of yes and no while the second set focused on quantification of symptoms. In the pilot study of 72 patients, bladder involvement was localised to frontal level in 11.1%, suprapontine (34.7%), suprasacral (37.5%), sacral/infra-sacral (9.7%) and UMN bladder with shock (7.0%). Specific features were observed in the different bladder types. Ten discriminatory questions were defined to aid localization of NLUTD and a diagnostic algorithm formulated.

Conclusions: Analysis of bladder dysfunction in neurological disorders using the AIIMS-J NUDQ demonstrated it was able to espouse specific bladder related symptoms that could help in localization of NLUTD.

Deep vein thrombosis and pulmonary embolism in neurosurgical patients

Tat Seng Wong, Jie Cheng Chew, Nicholas Ming Zher Chee, Kalai Arasu Muthusamy — Mon, 23 Mar 2026 00:00:00 +0000

Objective: Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a major risk of illness and death in neurosurgical patients. This study aims to determine the incidence of VTE in neurosurgical patients, investigate the risk factors for their development.

Methods: All admission records of neurosurgical patients between 1st January 2023 and 31st December 2023 to our centre were reviewed retrospectively to identify cases of VTE. Patient demographics, surgical details, postoperative immobilization, and risk factors were recorded and analysed using logistic regression analyses.

Results: A total of 1,000 neurosurgical patients were included, with 27 (2.7%) developing VTE, comprising 5 (0.5%) DVT and 22 (2.2%) PE. Univariate analysis revealed hypotension (OR: 84.43, p < 0.001), tachycardia (OR: 68.43, p < 0.001), SpO2 <90% (OR: 19.38, p < 0.001), respiratory rate >30 per minute (OR: 9.65, p = 0.005), surgery during admission (OR: 3.77, p = 0.002), prolonged hospital stay (OR: 1.04, p < 0.001), and low Glasgow Coma Scale (GCS) upon admission (OR: 0.84, p < 0.001) as significant predictors of VTE. Multivariate analysis determined three independent risk factors: tachycardia (adjusted OR: 28.61, p < 0.001), prolonged hospital stay (adjusted OR: 1.03, p < 0.001), and paralysis or lower extremity immobilization (adjusted OR: 5.53, p = 0.007).

Conclusion: Paralysis or lower extremity immobilization, prolonged hospital stays, and tachycardia are independent predictors of VTE in neurosurgical patients. Identifying high risk patients based on risk factors and implementing individualized thromboprophylaxis strategies is crucial to reduce morbidity and mortality.

Miller Fisher syndrome: A comprehensive review and clinical insights

Ji Wang, Kang Liu, Donghui Shen — Mon, 23 Mar 2026 00:00:00 +0000

Miller Fisher syndrome (MFS) is a variant of Guillain-Barré syndrome (GBS), characterized by the clinical triad of ophthalmoplegia, ataxia and areflexia. Anti-ganglioside GQ1b antibodies, detected in 80–90% of cases, play a central role in molecular mimicry-driven pathogenesis. While albuminocytological dissociation in cerebrospinal fluid (CSF) and electrophysiological findings (e.g., sensory axonal neuropathy, absent H-reflex) aid diagnosis, overlap syndromes with GBS or Bickerstaff brainstem encephalitis (BBE) necessitate early recognition to guide management. This review summarize current evidence on MFS pathogenesis, diagnostic challenges, and treatment paradigms, while proposing novel hypotheses on genetic predispositions and calcium-dependent antibody mechanisms.

A narrative review of aging-targeted mechanisms and interventions in Alzheimer’s disease

Khaled Abdel-sater — Mon, 23 Mar 2026 00:00:00 +0000

Background & Objective: The biggest risk factor for Alzheimer’s disease (AD) is aging, contributing to impaired clearance of tau and amyloid-beta (Aβ) proteins, microglial senescence, endoplasmic reticulum (ER) stress, lipid dysregulation, and excitotoxicity. This review investigates how aging speeds up the pathophysiology of AD and evaluates emerging geroscience-based interventions targeting biological aging mechanisms to delay or prevent cognitive decline.

Methods: A narrative review of the literature from 2015 to 2025 was conducted, integrating longitudinal studies, meta-analyses, and preclinical models that examine the aging-AD interface. The MEDLINE, Embase, Cochrane, Google Scholar, and PubMed databases were searched using specifically related keywords, such as ageing, AD, AD pathology, anti-aging strategies, and AD therapies.

Results: An initial search identified 320 publications. After screening for relevance and removing duplicates, 220 studies were excluded and 30 duplicates removed, leaving 72 eligible studies for synthesis in this narrative review. These included preclinical, clinical, and meta-analytic data examining aging mechanisms and geroscience-based interventions in Alzheimer’s disease. Most of these studies discussed aging-related mechanisms—glymphatic dysfunction, APOE ε4-associated lipid transport impairment, BDNF depletion, and glutamate excitotoxicity—, and anti-ageing strategies such as lifestyle interventions (e.g., physical activity, sleep optimization, cognitive engagement) and medical and biological therapies for AD.

Conclusion: Targeting aging mechanisms offers a paradigm shift in AD prevention and treatment; however, multidisciplinary collaboration is essential to translate geroscience into clinical practice. The integration of lifestyle and pharmacological strategies may yield synergistic neuroprotective benefits. Future research should focus on integrated, multimodal interventions that combine lifestyle modification with pharmacological and biological therapies. Tailored approaches—based on genetic risk profiles (e.g., APOE status), comorbidities, and individual aging trajectories—may optimize clinical outcomes. To evaluate the long-term safety and effectiveness of innovative treatments like senolytics, epigenetic modulators, and stem cell-based therapies in older populations, extensive, longitudinal clinical trials are also required. Developments in biological age biomarkers, machine learning, and systems biology have the potential to improve risk assessment and therapy customization.