首页神经病学最新一期 http://n.首页neurology.org 首页神经病学RSS提要——最新一期 1526 - 632 x 2023年8月29日12:00:00:000AM 首页 0028 - 3878 首页 http://n.首页neurology.org/icons/banner/title.gifhttp://n.首页neurology.org < ![CDATA[特征和临床意义的白质病变患者的成人烟雾病]]> http://n.首页neurology.org/cgi/content/short/101/9/1?rss=1 2023 - 08 - 28 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000207573 hwp: master-id首页:神经病学;WNL.0000000000207573 美国神经病学学会首页 特点和临床意义的白质病变患者的成人烟雾病 2023-08-29 修正 101年 9 1 1 hw_mjid:首页神经病学;101/9/1 < ![CDATA[是合理的驾驶时(峰值)火车?]]> http://n.首页neurology.org/cgi/content/short/101/9/377?rss=1 < p >许多癫痫发作明显影响意识,但在癫痫,可以快速瞬变脉冲群的发作癫痫样的活动有临床相关的对认知的影响吗?这个问题最初是由施瓦布评估1941年<一口> 1 < /一口>谁显示延迟反应时间成比例的癫痫小发作爆炸持续时间只有几秒钟甚至更长的时间。从那时起,研究人员已经证明瞬态的影响反复认知障碍与头皮脑电图包括焦排放的影响在一个特定的半球或叶。2 <一口> < /一口>最近颅内工作提供了更多functional-anatomic细节<一口> 3,4 < /一口>和机械的研究。<一口> 5、6 < / >共舞,然而大多数临床医生、临床上下文敏感和没有明确量化指导,仍不愿“治疗发作脑电图。”<一口> 2 < /一口> < / p > 克林,j·K。戴维斯分校k。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207651 hwp: master-id首页:神经病学;WNL.0000000000207651 美国神经病学学会首页 诊断测试评估,所有神经心理学/行为,脑电图;看到癫痫/发作,患者安全,脑电图 它是合理的驾驶时(峰值)火车? 2023-08-29 社论 101年 9 377年 379年 hw_mjid:首页神经病学;101/9/377 < ![CDATA[当心碰头:洞察大脑白质束成熟大学生运动员]]> http://n.首页neurology.org/cgi/content/short/101/9/380?rss=1 < p >白质损伤是一种常见的发现传统磁共振diffusion-weighted成像(驾车)在中度和重度创伤性脑损伤患者。扩散张量成像(DTI),最近的一个模型来源于酒后驾驶,允许计算的几个扩散指标反映水扩散的强度和方向。这些扩散指标可以产生重要的纤维束的健康和完整的信息。例如,分数各向异性(FA)措施水分散在纤维束的主要轴FA越高表明更高的纤维密度或髓鞘形成,而径向扩散系数(RD)措施扩散性垂直于纤维轴突,RD越高表明低束髓鞘形成或潜在呼吸道损伤。最近,越来越多的DTI的研究已经报道的变化扩散指标轻度创伤性脑损伤患者(mTBI)包括改变FA和RD。< / p > 庄,c, D。下班,a·J。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207775 hwp: master-id首页:神经病学;WNL.0000000000207775 美国神经病学学会首页 核磁共振,醉酒驾车,青春期,大脑创伤,队列研究 当心碰头:洞察大脑白质束成熟的大学生运动员 2023-08-29 社论 101年 9 380年 381年 hw_mjid:首页神经病学;101/9/380 < ![CDATA[国家趋势的脑静脉窦支架植入治疗特发性颅内高血压]]> http://n.首页neurology.org/cgi/content/short/101/9/402?rss=1 <秒> <圣> < /圣> < p >目标脑静脉窦支架(VSS)已经成为一个新的手术治疗严重特发性颅内高血压(IIH),和它的受欢迎程度一直在上升。本研究探讨了最近的时间趋势的VSS和其他手术颅内高压症治疗在美国。< / p > < /秒>Methods

Adult patients with IIH were identified from the 2016–2020 National Inpatient Sample databases, and surgical procedures and hospital characteristics were recorded. Temporal trends of procedure numbers for VSS, CSF shunts, and optic nerve sheath fenestrations (ONSFs) were assessed and compared.

Results

A total of 46,065 (95% CI 44,710–47,420) patients with IIH were identified, of whom 7,535 patients (95% CI 6,982–8,088) received surgical IIH treatments. VSS procedures increased 80% (150 [95% CI 55–245] to 270 [95% CI 162–378] per year, p < 0.001). Concurrently, the number of CSF shunts decreased by 19% (1,365 [95% CI 1,126–1,604] to 1,105 [95% CI 900–1,310] per year, p < 0.001), and ONSF procedures decreased by 54% (65 [95% CI 20–110] to 30 [95% CI 6–54] per year, p < 0.001).

Discussion

Practice patterns for surgical IIH treatment in the United States are rapidly evolving, and VSS is becoming increasingly common. These findings highlight the urgency of randomized controlled trials to investigate the comparative effectiveness and safety of VSS, CSF shunts, ONSF, and standard medical treatments.

Khunte, M。陈,H。Colasurdo, M。查图尔维迪,S。Malhotra,,。甘地,D。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207245 hwp: master-id首页:神经病学;WNL.0000000000207245 美国神经病学学会首页 特发性颅内高血压,其他脑血管疾病/中风 国家趋势的脑静脉窦支架植入治疗特发性颅内高血压 2023-08-29 临床/科学报告 101年 9 402年 406年 hw_mjid:首页神经病学;101/9/402
< ![CDATA[英语,和说西班牙语的美国墨西哥患者中风的结果]]> http://n.首页neurology.org/cgi/content/short/101/9/407?rss=1 <秒> <圣> < /圣> < p >目标我们检验语言偏好与90天的卒中后的结果在美国墨西哥(MA)的病人。< / p > < /秒>Methods

Patients with ischemic stroke and intracerebral hemorrhage from the population-based Brain Attack Surveillance in Corpus Christi project (2009–2018) were compared by language preference in 90-day neurologic, functional, and cognitive outcomes using weighted Tobit regression. Models were adjusted for demographics, initial NIH Stroke Scale (NIHSS), medical history, stroke characteristics, and insurance status.

Results

Of 1,096 stroke patients, 926 were English-speaking and 170 were Spanish-only–speaking. Spanish speakers were older (p < 0.01), received less education (p < 0.01), had higher initial NIHSS values (p = 0.02), had higher prevalence of atrial fibrillation (p < 0.01), and had lower prevalence of smoking (p = 0.01) than English speakers. In fully adjusted models, Spanish-only speakers had worse neurologic outcome (NIHSS, range 0–44 [higher worse], mean difference: 1.93, p < 0.01) but no difference in functional outcome measured by activities of daily living/instrumental activities of daily living or cognitive outcome compared with English speakers.

Discussion

This population-based study found worse neurologic but similar functional and cognitive stroke outcomes among Spanish-only–speaking MA patients compared with English-speaking MA patients.

巴尔加斯,。张,G。施,X。、Lisabeth l D。Morgenstern, l . B。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207275 hwp: master-id首页:神经病学;WNL.0000000000207275 美国神经病学学会首页 所有脑血管疾病/中风、包容、多样性、股本、反种族主义、和社会正义(想法),健康差异,结构和健康问题社会决定因素 中风的结果在英语和西班牙语墨西哥的美国病人 2023-08-29 临床/科学报告 101年 9 407年 411年 hw_mjid:首页神经病学;101/9/407
< ![CDATA[挽歌与复视医生]]> http://n.首页neurology.org/cgi/content/short/101/9/412?rss=1 < p > < qd > < p >他与髓鞘的伤疤< / p > < p >在自己和他人,< / p > < p >主动攻击的明亮的示踪剂< / p > < p >在核磁共振成像,和陨石坑< / p > < p >轴突消失了;暗色< / p > < p >替换红、视力模糊、复视,< / p > < p >什么眼睛告诉他的大脑和< / p > < p >他的病人告诉他,试图遵循< / p > < p >移动手指,< / p > < p >试图平衡。< / p > < p >他带领他的病人在困难的斜坡上< / p > < p >复发和缓解,穿过灌木丛< / p > < p >自己的T细胞的白质< / p > < p >爬在伏击中,自我与自我。< / p > < p >他带领他的病人在药物;< / p > < p >这样一个令人眼花缭乱的人群保持< / p > < p > T细胞、B细胞、抗体,< / p > < p >陷入错误的方面,< / p > < p >从野蛮的尝试。所以他的病人< / p > < p >选择穿刺或药片< / p > < p >正如他自己做出了他的选择,< / p > < p >女士和< / p > < p >那些别人生活。< / p > < p >女士的原因,像,以至于把< / p > < p >对我们我们的身体,还不清楚。< / p > < p >,最近的证据表明病毒< / p > < p >几乎都有,叫做巴尔,< / p > < p >触发它。我不知道如果他认为,< / p > < p >但这是一个新的病毒,一个< / p > < p >的原因我们也不完全知道,< / p > < p >虽然杀害了500万< / p > < p > 3年以来,在我们物种,尽管疫苗,< / p > < p >发现他的免疫防御系统无法保存。< / p > < p >另一个专家将接管他的诊所< / p > < p >但他的病人会错过医生< / p > < p >的复视帮助他看到他们真正< / p > < p >,他照顾他们。< / p > < / qd > < / p > 格林斯潘,B。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207283 hwp: master-id首页:神经病学;WNL.0000000000207283 美国神经病学学会首页 多发性硬化症 医生和复视的挽歌 2023-08-29 人文学科在神经学首页 101年 9 412年 412年 hw_mjid:首页神经病学;101/9/412 < ![CDATA[珍珠和Oy-sters:亨廷顿疾病表现为原发性进行性失语:语义的]]> http://n.首页neurology.org/cgi/content/short/101/9/414?rss=1 < p >我们提出的语义变体原发性进行性失语的患者呈现功能亨廷顿病(HD)。病人最初发达进步语言障碍包括受损的命名和对象知识和单字原图理解然后发达舞蹈病和行为变化。大脑的核磁共振显示左前颞叶和海马萎缩。神经FDG PET / CT显示降低新陈代谢的左侧尾状核头。杭丁顿蛋白基因测试显示扩大39 CAG重复1等位基因。本例中概述了大量重叠HD和额颞叶大叶性变性症状的临床表现,并提供评论这些神经退行性疾病的调查。< / p > 克拉克,a·J。程度,D。弗莱舍,R。富勒姆,M。艾哈迈德,r . M。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207428 hwp: master-id首页:神经病学;WNL.0000000000207428 美国神经病学学会首页 亨廷顿氏舞蹈症,失语症,额颞叶痴呆认知障碍的评估/痴呆,三核苷酸重复的疾病 珍珠和Oy-sters:亨廷顿疾病表现为原发性进行性失语:语义 2023-08-29 RESIDENT &amp; FELLOW SECTION 101年 9 414年 417年 hw_mjid:首页神经病学;101/9/414 < ![CDATA[发作痫性放电的预测能力Fitness-to-Drive评估]]> http://n.首页neurology.org/cgi/content/short/101/9/e866?rss=1 <秒> <圣> < /圣> < p >背景和目标本研究旨在评估和预测发作痫性放电的影响(ied)驾驶能力测试和驾驶模拟器使用简单的反应。< / p > < /秒>Methods

Patients with various epilepsies were evaluated with simultaneous EEGs during their response to visual stimuli in a single-flash test, a car-driving video game, and a realistic driving simulator. Reaction times (RTs) and missed reactions or crashes (miss/crash) during normal EEG and IEDs were measured. IEDs, as considered in this study, were a series of epileptiform potentials (>1 potential) and were classified as generalized typical, generalized atypical, or focal. RT and miss/crash in relation to IED type, duration, and test type were analyzed. RT prolongation, miss/crash probability, and odds ratio (OR) of miss/crash due to IEDs were calculated.

Results

Generalized typical IEDs prolonged RT by 164 ms, compared with generalized atypical IEDs (77.0 ms) and focal IEDs (48.0 ms) (p < 0.01). Generalized typical IEDs had a session miss/crash probability of 14.7% compared with a zero median for focal and generalized atypical IEDs (p < 0.01). Long repetitive bursts of focal IEDs lasting >2 seconds had a 2.6% miss/crash probabilityIED. Cumulated miss/crash probability could be predicted from RT prolongation: 90.3 ms yielded a 20% miss/crash probability. All tests were nonsuperior to each other in detecting miss/crash probabilitiesIED (zero median for all 3 tests) or RT prolongations (flash test: 56.4 ms, car-driving video game: 75.5 ms, simulator 86.6 ms). IEDs increased the OR of miss/crash in the simulator by 4.9-fold compared with normal EEG. A table of expected RT prolongations and miss/crash probabilities for IEDs of a given type and duration was created.

Discussion

IED-associated miss/crash probability and RT prolongation were comparably well detected by all tests. Long focal IED bursts carry a low risk, while generalized typical IEDs are the primary cause of miss/crash. We propose a cumulative 20% miss/crash risk at an RT prolongation of 90.3 ms as a clinically relevant IED effect. The IED-associated OR in the simulator approximates the effects of sleepiness or low blood alcohol level while driving on real roads. A decision aid for fitness-to-drive evaluation was created by providing the expected RT prolongations and misses/crashes when IEDs of a certain type and duration are detected in routine EEG.

Krestel, H。、Schreier d R。Sakiri E。冯Allmen,。Abukhadra, Y。Nirkko,。Steinlin, M。罗斯诺夫,F。Markhus, R。,施耐德,G。Jagella C。马西斯,J。Blumenfeld, H。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207531 hwp: master-id首页:神经病学;WNL.0000000000207531 美国神经病学学会首页 诊断测试评估,青春期,患者安全,所有癫痫发作的/,脑电图 预测能力Fitness-to-Drive发作痫性放电的评估 2023-08-29 金博宝手机版官网首页 101年 9 e866 e878 hw_mjid:首页神经病学;101/9 / e866
< ![CDATA[自然历史和发展轨迹的致病变种STXBP1]] > http://n.首页neurology.org/cgi/content/short/101/9/e879?rss=1 <秒> <圣> < /圣> < p >背景和目标致病性变异在<我> STXBP1 < / I >是神经发育障碍的主要遗传原因之一。尽管越来越多的个体诊断癫痫的历史,对这个群的自然历史和发展轨迹和端点为未来治疗的研究仅限于发作控制。< / p > < /秒>Methods

We performed a cross-sectional retrospective study using standardized questionnaires for clinicians and caregivers of individuals with STXBP1-related disorders capturing medical histories, genetic findings, and developmental outcomes. Motor and language function were assessed using Gross Motor Function Classification System (GMFCS) scores and a speech impairment score and were compared within and across clinically defined subgroups.

Results

We collected data of 71 individuals with STXBP1-related disorders, including 44 previously unreported individuals. Median age at inclusion was 5.3 years (interquartile range 3.5–9.3) with the oldest individual aged 43.8 years. Epilepsy was absent in 18/71 (25%) of individuals. The range of developmental outcomes was broad, including 2 individuals presenting with close to age-appropriate motor development. Twenty-nine of 61 individuals (48%) were able to walk unassisted, and 24/69 (35%) were able to speak single words. Individuals without epilepsy presented with a similar onset and spectrum of phenotypic features but had lower GMFCS scores (median 3 vs 4, p < 0.01) than individuals with epilepsy. Individuals with epileptic spasms were less likely to walk unassisted than individuals with other seizure types (6% vs 58%, p < 0.01). Individuals with early epilepsy onset had higher speech impairment scores (p = 0.02) than individuals with later epilepsy onset.

Discussion

We expand the spectrum of STXBP1-related disorders and provide clinical features and developmental trajectories in individuals with and without a history of epilepsy. Individuals with epilepsy, in particular epileptic spasms, and neonatal or early-onset presented with less favorable motor and language functional outcomes compared with individuals without epilepsy. These findings identify children at risk for severe disease and can serve as comparator for future interventional studies in STXBP1-related disorders.

Thalwitzer, k . M。Driedger, j . H。,西安,J。Saffari,。米基罗,P。, Bölsterli, B. K., Ruggiero, S. M., Sullivan, K. R., Datta, A. N., Kellinghaus, C., Althaus, J., Wiemer-Kruel, A., van Baalen, A., Pampel, A., Alber, M., Braakman, H. M. H., Debus, O. M., Denecke, J., Hobbiebrunken, E., Breitweg, I., Diehl, D., Eitel, H., Gburek-Augustat, J., Preisel, M., Schlump, J.-U., Laufs, M., Mammadova, D., Wurst, C., Prager, C., Löhr-Nilles, C., Martin, P., Garbade, S. F., Platzer, K., Benkel-Herrenbrueck, I., Egler, K., Fazeli, W., Lemke, J. R., Runkel, E., Klein, B., Linden, T., Schröter, J., Steffeck, H., Thies, B., von Deimling, F., Illsinger, S., Borggraefe, I., Classen, G., Wieczorek, D., Ramantani, G., Koelker, S., Hoffmann, G. F., Ries, M., Helbig, I., Syrbe, S. 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207550 hwp: master-id首页:神经病学;WNL.0000000000207550 美国神经病学学会首页 所有的儿童,发育障碍,癫痫/癫痫、婴儿痉挛症,所有基因 自然历史和发展轨迹的个人STXBP1致病变种 2023-08-29 金博宝手机版官网首页 101年 9 e879 e891 hw_mjid:首页神经病学;101/9 / e879
< ![CDATA[神经障碍的发生率和长期功能结果住院患者感染Pre-Omicron COVID-19变体]]> http://n.首页neurology.org/cgi/content/short/101/9/e892?rss=1 <秒> <圣> < /圣> < p >背景和目标多种神经系统疾病已报告演示或冠状病毒疾病的并发症2019 (COVID-19)感染病例。本研究的目的是确定其发病率动力学和长期功能的结果。< / p > < /秒>Methods

The Neuro-COVID Italy study was a multicenter, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurologic disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020–June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms, or death.

Results

Among 52,759 hospitalized patients with COVID-19, 1,865 patients presenting 2,881 new neurologic disorders associated with COVID-19 infection (neuro-COVID) were recruited. The incidence of neuro-COVID cases significantly declined over time, comparing the first 3 pandemic waves (8.4%, 95% CI 7.9–8.9; 5.0%, 95% CI 4.7–5.3; 3.3%, 95% CI 3.0–3.6, respectively; p = 0.027). The most frequent neurologic disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%), and cognitive impairment (13.7%). The onset of neurologic disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by most patients with neuro-COVID (64.6%) during follow-up (median 6.7 months), and the proportion of good outcome increased throughout the study period (r = 0.29, 95% CI 0.05–0.50; p = 0.019). Mild residual symptoms were frequently reported (28.1%) while disabling symptoms were common only in stroke survivors (47.6%).

Discussion

Incidence of COVID-associated neurologic disorders decreased during the prevaccination phase of the pandemic. Long-term functional outcome was favorable in most neuro-COVID disorders, although mild symptoms commonly lasted more than 6 months after infection.

伯莱塔,S。Cristillo, V。、相机、G。,Morotti Colleoni C。Pellitteri, G。,Viti B。比安奇,E。、Gipponi年代。Grimoldi, M。瓦伦特,M。古德曼爵士年代。Cotelli, m . S。,帕伦博,P。Gelosa, G。、Meletti年代。Schenone C。Ottaviani D。菲利皮主持,M。埋,。, Basilico, P., Tancredi, L., Cortelli, P., Braga, M., De Giuli, V., Servidei, S., Paolicelli, D., Verde, F., Caproni, S., Pisani, A., Lo Re, V., Massacesi, L., Roccatagliata, D. V., Manganotti, P., Spitaleri, D., Formenti, A., Piccoli, M., Marino, S., Polverino, P., Aguglia, U., Ornello, R., Perego, E., Siciliano, G., Merlo, P., Capobianco, M., Pantoni, L., Lugaresi, A., Angelocola, S., De Rosa, A., Sessa, M., Beghi, E., Agostoni, E. C., Monaco, S., Padovani, A., Priori, A., Silani, V., Tedeschi, G., Ferrarese, C., for Neuro-COVID Italy 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207534 hwp: master-id首页:神经病学;WNL.0000000000207534 美国神经病学学会首页 结果研究,COVID-19,队列研究,发病率的研究 神经功能障碍的发生率和长期功能结果住院患者感染Pre-Omicron COVID-19变体 2023-08-29 金博宝手机版官网首页 101年 9 e892 e903 hw_mjid:首页神经病学;101/9 / e892
< ![CDATA[动脉瘤发病率和生活质量在筛查未破裂颅内动脉瘤患者的亲属:前瞻性研究]]> http://n.首页neurology.org/cgi/content/short/101/9/e904?rss=1 <秒> <圣> < /圣> < p >背景和目标筛查未破裂颅内动脉瘤(uia)是有效的一级亲属(罗斯福)动脉瘤性蛛网膜下腔出血患者(aSAH表示)。患者筛查是否同样有效的罗斯福UIA是未知的。我们确定筛选的收益率在这样的罗斯福,破裂的风险评估和治疗的决定被发现的动脉瘤,识别潜在的高风险的子组,研究了筛选对生活质量(QoL)的影响。< / p > < /秒>Methods

In this prospective cohort study, we included FDRs, aged 20–70 years, of patients with UIA without a family history of aSAH who visited the Neurology outpatient clinic in 1 of 3 participating tertiary referral centers in the Netherlands. FDRs were screened for UIA with magnetic resonance angiography between 2017 and 2021. We determined UIA prevalence and developed a prediction model for UIA risk at screening using multivariable logistic regression. QoL was evaluated with questionnaires 6 times during the first year after screening and assessed with a linear mixed-effects model.

Results

We detected 24 UIAs in 23 of 461 screened FDRs, resulting in a 5.0% prevalence (95% CI 3.2–7.4). The median aneurysm size was 3 mm (interquartile range [IQR] 2–4 mm), and the median 5-year rupture risk assessed with the PHASES score was 0.7% (IQR 0.4%–0.9%). All UIAs received follow-up imaging, and none were treated preventively. After a median follow-up of 24 months (IQR 13–38 months), no UIA had changed. Predicted UIA risk at screening ranged between 2.3% and 14.7% with the highest risk in FDRs who smoke and have excessive alcohol consumption (c-statistic: 0.76; 95% CI 0.65–0.88). At all survey moments, health-related QoL and emotional functioning were comparable with those in a reference group from the general population. One FDR with a positive screening result expressed regret about screening.

Discussion

Based on the current data, we do not advise screening FDRs of patients with UIA because all identified UIAs had a low rupture risk. We observed no negative effect of screening on QoL. A longer follow-up should determine the risk of aneurysm growth requiring preventive treatment.

犯罪,洛杉矶。范Tuijl, r . J。、Greving j . P。、Velthuis b K。van der Schaaf i C。Wermer, m . j . H。Verbaan D。Vandertop, w . P。Zuithoff: p。Rinkel, g·j·E。、Ruigrok y . M。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207475 hwp: master-id首页:神经病学;WNL.0000000000207475 美国神经病学学会首页 中风预防、脑血管疾病/中风患病率研究,蛛网膜下腔出血 动脉瘤发病率和生活质量在筛查未破裂颅内动脉瘤患者的亲属:前瞻性研究 2023-08-29 金博宝手机版官网首页 101年 9 e904 e912 hw_mjid:首页神经病学;101/9 / e904
< ![CDATA[缺血性中风亚型之间的联系和中风严重性:动脉粥样硬化的风险在社区研究]]> http://n.首页neurology.org/cgi/content/short/101/9/e913?rss=1 <秒> <圣> < /圣> < p >背景和目标卒中后残疾发生缺血性中风亚型,栓塞中风的建议,更具破坏性的。这种差异是否由于并发症的差异或差异程度的时候中风事件是未知的。主要的假设是,参与者与栓塞中风会更严重的中风住院和死亡的风险更高,而血栓性中风参与者甚至考虑混杂因素随着时间的推移,与第二个假设这个协会将在种族和性别差异。< / p > < /秒> <秒> <圣> < /圣> < p >方法在社区(ARIC)研究参与者与动脉粥样硬化风险事件裁决缺血性中风,中风的严重程度和死亡率数据,并完成协变量都包括在内。Multinomial logistic regression models determined the association between stroke subtype (embolic vs thrombotic) and admission NIH Stroke Scale (NIHSS) category (minor [≤5], mild [6–10], moderate [11–15], severe [16–20], and very severe [>20]) adjusted for covariates from visits most proximal to the stroke. Separate ordinal logistic models evaluated for interaction by race and sex. Adjusted Cox proportional hazard models estimated the association between stroke subtype and all-cause mortality (through December 31, 2019).

Results

Participants (N = 940) were mean age 71 years (SD = 9) at incident stroke, 51% female, and 38% Black. Using adjusted multinomial logistic regression, the risk of having a more severe stroke (reference NIHSS ≤5) was higher among embolic stroke vs thrombotic stroke patients, with a step-wise increase for embolic stroke patients when moving from mild (odds ratio [OR] 1.95, 95% CI 1.14–3.35) to very severe strokes (OR 4.95, 95% CI 2.34–10.48). After adjusting for atrial fibrillation, there was still a higher risk of having a worse NIHSS among embolic vs thrombotic strokes but with attenuation of effect (very severe stroke OR 3.91, 95% CI 1.76–8.67). Sex modified the association between stroke subtype and severity (embolic vs thrombotic stroke, p interaction = 0.03, per severity category, females OR 2.38, 95% CI 1.55–3.66; males OR 1.75, 95% CI 1.09–2.82). The risk of death (median follow-up 5 years, interquartile range 1–12) was also increased for embolic vs thrombotic stroke patients (hazard ratio 1.66, 95% CI 1.41–1.97).

Discussion

Embolic stroke was associated with greater stroke severity at the time of the event and a higher risk of death vs thrombotic stroke, even after careful adjustment for patient-level differences.

约翰森,m . C。陈,J。施耐德,a . l . C。卡尔森,J。海特,T。他说,K。、Patole年代。戈特斯曼,r F。Coresh, J。、Koton年代。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207535 hwp: master-id首页:神经病学;WNL.0000000000207535 美国神经病学学会首页 其他脑血管疾病/中风,所有脑血管疾病/中风、包容、多样性、股本、反种族主义、和社会正义(想法),流行病学队列研究、风险因素 缺血性中风亚型之间的联系和中风严重性:动脉粥样硬化风险在社区研究 2023-08-29 金博宝手机版官网首页 101年 9 e913 e921 hw_mjid:首页神经病学;101/9 / e913
< ![CDATA[机械血栓切除术对于大型缺血性中风:系统回顾和荟萃分析]]> http://n.首页neurology.org/cgi/content/short/101/9/e922?rss=1 <秒> <圣> < /圣> < p >背景和目标有越来越多的证据表明血管内血栓切除术(EVT)患者大缺血性梗塞核心和大血管闭塞(LVO)。本研究的目的是比较EVT vs医疗管理的有效性和安全性(毫米)使用的系统回顾和荟萃分析观察性研究和随机对照试验(相关的)。< / p > < /秒>Methods

We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to mechanical thrombectomy for large ischemic core from inception until February 10, 2023. The primary outcome was independent ambulation (modified Rankin Scale [mRS] 0–3). Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. The quality of articles was evaluated through the Cochrane risk assessment tool and the Newcastle-Ottawa Scale. This study was registered in PROSPERO (CRD42023396232).

Results

A total of 5,395 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded by review of the title, abstract, and full text. Finally, 3 RCTs and 10 cohort studies met the inclusion criteria. The RCT analysis showed that EVT improved the 90-day functional outcomes of patients with large ischemic core with high-quality evidence, including independent ambulation (mRS 0–3: RR 1.78, 95% CI 1.28–2.48, p < 0.001) and functional independence (mRS 0–2: RR 2.59, 95% CI 1.89–3.57, p < 0.001), but without significantly increasing the risk of symptomatic intracranial hemorrhage (sICH: RR 1.83, 95% CI 0.95–3.55, p = 0.07) or early mortality (RR 0.95, 95% CI 0.78–1.16, p = 0.61). Analysis of the cohort studies showed that EVT improved functional outcomes of patients without an increase in the incidence in sICH.

Discussion

This systematic review and meta-analysis indicates that in patients with LVO stroke with a large ischemic core, EVT was associated with improved functional outcomes over MM without increasing sICH risk. The results of ongoing RCTs may provide further insight in this patient population.

李,问。Abdalkader, M。Siegler, j·E。、Yaghi年代。Sarraj,。公元前,坎贝尔,V。柳,a·J。、Zaidat O . O。Kaesmacher, J。Pujara D。、Nogueira r G。储蓄者,j·L。李,L。,汉族,问。戴,Y。唱,H。杨问。阮,t . N。秋,Z。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207536 hwp: master-id首页:神经病学;WNL.0000000000207536 美国神经病学学会首页 所有脑血管疾病/中风 机械血栓切除术对于大型缺血性中风:系统回顾和荟萃分析 2023-08-29 金博宝手机版官网首页 101年 9 e922 e932 hw_mjid:首页神经病学;101/9 / e922
< ![CDATA[早期静脉溶栓和双重抗血小板治疗轻度Noncardioembolic缺血性中风患者]]> http://n.首页neurology.org/cgi/content/short/101/9/e933?rss=1 <秒> <圣> < /圣> < p >背景目标尚不清楚静脉溶栓(溶)优于早期双重抗血小板治疗(榫眼)在急性轻度缺血性中风。本研究的目的是比较早期的诊断与榫眼的安全性和有效性。< / p > < /秒>Methods

Data of mild noncardioembolic stroke patients with admission NIH Stroke Scale (NIHSS) score ≤3 who received IVT or early DAPT in the period 2018–2021 were extracted from a nationwide, prospective stroke unit registry. Study endpoints included symptomatic intracerebral hemorrhage (sICH), early neurologic deterioration ≥4 NIHSS points (END), and 3-month functional outcome by modified Rankin scale (mRS).

Results

A total of 1,195 mild stroke patients treated with IVT and 2,625 patients treated with DAPT were included. IVT patients were younger (68.1 vs 70.8 years), had less hypertension (72.8% vs 83.5%), diabetes (19% vs 28.8%), and a history of myocardial infarction (7.6% vs 9.2%), and slightly higher admission NIHSS scores (median 2 vs median 1) when compared with DAPT patients. After propensity score matching and multivariable adjustment, IVT was associated with sICH (4 [1.2%] vs 0) and END (adjusted odds ratio [aOR] 2.8, 95% CI 1.1–7.5), and there was no difference in mRS 0–1 at 3 months (aOR 1.3, 95% CI 0.7–2.6).

Discussion

This analysis from a prospective nationwide stroke unit network indicates that IVT is not superior to DAPT in the setting of mild noncardioembolic stroke and may eventually be associated with harm. Further research focusing on acute therapy of mild stroke is highly warranted.

Classification of Evidence

This study provides Class III evidence that IVT is not superior to DAPT in patients with acute mild (NIHSS score ≤3) noncardioembolic stroke. The study lacks the statistical precision to exclude clinically important superiority of either therapy.

图片。克雷布斯,S。Miksova D。Badic,我。Gattringer, T。, Fandler-Höfler, S., Marko, M., Greisenegger, S., Knoflach, M., Lang, W., Ferrari, J., for Austria Stroke Unit Collaborators 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207538 hwp: master-id首页:神经病学;WNL.0000000000207538 美国神经病学学会首页 所有脑血管疾病/中风,第三类,梗塞 患者早期静脉溶栓和双重抗血小板治疗轻度Noncardioembolic缺血性中风 2023-08-29 金博宝手机版官网首页 101年 9 e933 e939 hw_mjid:首页神经病学;101/9 / e933
< ![CDATA[神经生理学状态动力学基础急性神经恢复心脏骤停后]]> http://n.首页neurology.org/cgi/content/short/101/9/e940?rss=1 <秒> <圣> < /圣> < p >背景和目标痫性活动和爆炸抑制神经生理学签名反映心脏骤停后严重的脑损伤。我们旨在描绘昏迷的进化神经生理学功能集合体与心脏骤停复苏手术结束后,从昏迷状态中。< / p > < /秒>Methods

Adults in acute coma after cardiac arrest were included in a retrospective database involving 7 hospitals. The combination of 3 quantitative EEG features (burst suppression ratio [BSup], spike frequency [SpF], and Shannon entropy [En]) was used to define 5 distinct neurophysiology states: epileptiform high entropy (EHE: SpF ≥4 per minute and En ≥5); epileptiform low entropy (ELE: SpF ≥4 per minute and <5 En); nonepileptiform high entropy (NEHE: SpF <4 per minute and ≥5 En); nonepileptiform low entropy (NELE: SpF <4 per minute and <5 En), and burst suppression (BSup ≥50% and SpF <4 per minute). State transitions were measured at consecutive 6-hour blocks between 6 and 84 hours after return of spontaneous circulation. Good neurologic outcome was defined as best cerebral performance category 1–2 at 3–6 months.

Results

One thousand thirty-eight individuals were included (50,224 hours of EEG), and 373 (36%) had good outcome. Individuals with EHE state had a 29% rate of good outcome, while those with ELE had 11%. Transitions out of an EHE or BSup state to an NEHE state were associated with good outcome (45% and 20%, respectively). No individuals with ELE state lasting >15 hours had good recovery.

Discussion

Transition to high entropy states is associated with an increased likelihood of good outcome despite preceding epileptiform or burst suppression states. High entropy may reflect mechanisms of resilience to hypoxic-ischemic brain injury.

阿莫林,E。郑,w l。静,J。Ghassemi, M . M。李,j·W。吴,O。,赫尔曼,s T。庞,T。Sivaraju,。,,N。赫希,L。Ruijter, b . J。Tjepkema-Cloostermans, m . C。Hofmeijer, J。范Putten, M . j . a . M。威斯多佛,m . B。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207537 hwp: master-id首页:神经病学;WNL.0000000000207537 美国神经病学学会首页 预后、昏迷、急救护理、脑电图 神经生理学状态动力学基础急性心脏骤停后神经功能的恢复 2023-08-29 金博宝手机版官网首页 101年 9 e940 e952 hw_mjid:首页神经病学;101/9 / e940
< ![CDATA[微观结构改变土地开发在大学足球和排球运动员:纵向扩散磁共振成像研究]]> http://n.首页neurology.org/cgi/content/short/101/9/e953?rss=1 <秒> <圣> < /圣> < p >背景和目标重复的影响在高接触美式足球等运动可以影响大脑的微观结构,可以使用扩散磁共振成像研究。大多数成像研究是横断面,不包括接触球员控制,或缺乏先进tract-specific显微结构的指标。我们旨在调查纵向变化的高接触大学运动员相比,接触使用先进的扩散磁共振成像和自动化纤维量化控制。< / p > < /秒> <秒> <圣> < /圣> < p >方法我们研究大脑组织在高接触(足球)和接触(排球)大学生运动员4年的随访。入选标准包括大学和团队招生。排除标准包括神经外科的历史,严重的脑损伤,主要神经或滥用药物。我们研究了扩散指标以及土地使用嵌套的长度线性mixed-effects模型确定的急性和慢性影响subconcussive和震荡性的影响,并与临床扩散变化之间的联系,行为,与体育运动有关的措施。< / p > < /秒> <秒> <圣> < /圣> < p >结果49 24足球和排球运动员总扫描(271)包括在内。足球运动员有显著不同的轨迹在多个微观结构指标和大片。Longitudinal increases in fractional anisotropy and axonal water fraction, and decreases in radial/mean diffusivity and orientation dispersion index, were present in volleyball but absent in football players (all findings |T-statistic|> 3.5, p value <0.0001). This pattern was present in the callosum forceps minor, superior longitudinal fasciculus, thalamic radiation, and cingulum hippocampus. Longitudinal differences were more prominent and observed in more tracts in concussed football players (n = 24, |T|> 3.6, p < 0.0001). An analysis of immediate postconcussion scans (n = 12) demonstrated a transient localized increase in axial diffusivity and mean/radial kurtosis in the uncinate and cingulum hippocampus (|T| > 3.7, p < 0.0001). Finally, within football players, those with high position-based impact risk demonstrated increased intracellular volume fraction longitudinally (T = 3.6, p < 0.0001).

Discussion

The observed longitudinal changes seen in football, and especially concussed athletes, could reveal diminished myelination, altered axonal calibers, or depressed pruning processes leading to a static, nondecreasing axonal dispersion. This prospective longitudinal study demonstrates divergent tract-specific trajectories of brain microstructure, possibly reflecting a concussive and repeated subconcussive impact-related alteration of white matter development in football athletes.

Goubran, M。米尔斯,b D。皮质,M。Karimpoor, M。Mouchawar, N。萨米,S。丹尼斯,e . L。埃克斯,C。米切尔,L。Boldt, B。道格拉斯,D。、DiGiacomo p S。罗森博格,J。格兰特,G。Wintermark, M。,贝·d·B。Zeineh, M。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207543 hwp: master-id首页:神经病学;WNL.0000000000207543 美国神经病学学会首页 醉酒驾车、脑外伤 微观结构改变束发展大学足球和排球运动员:一个纵向扩散磁共振成像研究 2023-08-29 金博宝手机版官网首页 101年 9 e953 e965 hw_mjid:首页神经病学;101/9 / e953
< ![CDATA[法国晚发性筛疾病患者特点:见解从2022年的法国筛注册]]> http://n.首页neurology.org/cgi/content/short/101/9/e966?rss=1 <秒> <圣> < /圣> < p >背景和目标法国筛疾病注册成立于2004年研究自然病程的患者。它迅速成为一个主要的工具来评估酶替代治疗的长期疗效(ERT)市场释放alglucosidase-alfa后。< / p > < /秒>Methods

Approximately 10 years after publication of the baseline characteristics of the 126 initial patients of the French Late-Onset Pompe Disease registry, we provide here an update of the clinical and biological features of patients included in this registry.

Results

We describe 210 patients followed at 31 hospital-based French neuromuscular or metabolic centers. The median age at inclusion was 48.67 ± 14.91 years. The first symptom was progressive lower limb muscle weakness, either isolated (50%) or associated with respiratory symptoms (18%), at a median age of 38 ± 14.9 years. At inclusion, 64% of the patients were able to walk independently and 14% needed a wheelchair. Positive associations were found between motor function measure, manual motor test, and 6-minute walk test (6MWT) results, and these parameters were inversely associated with the time taken to sit up from a lying position at inclusion. Seventy-two patients had been followed for at least 10 years in the registry. Thirty-three patients remained untreated a median of 12 years after symptom onset. The standard ERT dose was administered for 177 patients.

Discussion

This update confirms previous findings for the adult population included in the French Pompe disease registry, but with a lower clinical severity at inclusion, suggesting that this rare disease is now diagnosed earlier; thanks to greater awareness among physicians. The 6MWT remains an important method for assessing motor performance and walking ability. The French Pompe disease registry provides an exhaustive, nationwide overview of Pompe disease and can be used to assess individual and global responses to future treatments.

Lefeuvre C。,安东尼奥,M。Bouhour F。Tard C。Salort-Campana E。拉格朗日E。Behin,。唯一,G。、Noury J.-B。、Sacconi年代。Magot,。Nadaj-Pakleza,。神父,。Beltran), S。Spinazzi, M。Cintas, P。狐狸,D。米肖德,M。、Bedat-Millet A.-L。Prigent, H。Taouagh, N。Arrassi,。Hamroun D。、Attarian年代。Laforet, P。, for Pompe Study Group 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207547 hwp: master-id首页:神经病学;WNL.0000000000207547 美国神经病学学会首页 所有临床神经病学、肌肉疾病首页,队列研究 在法国晚发性筛疾病患者特点:见解从法国筛注册于2022年 2023-08-29 金博宝手机版官网首页 101年 9 e966 e977 hw_mjid:首页神经病学;101/9 / e966
< ![CDATA[珍珠和Oy-sters:严重的发作的心搏停止在颞叶癫痫]]> http://n.首页neurology.org/cgi/content/short/101/9/e978?rss=1 < p >猝发的心搏停止是一种罕见的疾病相关主要可引起晕厥的颞叶癫痫,摔倒,头部创伤。它也涉及在癫痫的原因不明的猝死率增加。我们报告一例儿童癫痫史的33岁的女人面对3年复发性晕厥。Video-EEG显示颞叶癫痫发作性心搏停止。心电图显示,逐步恶化的心动过缓、心搏停止和心动过速。MRI显示焦点在正确的岛叶皮质与皮质增厚模糊的灰白色物质界面,符合狭隘焦皮质发育不良。病人从lacosamide clobazam因为关心公关间隔延长和被称为心脏起搏器安置。发作性心搏停止应视为不明原因复发性晕厥的罕见但严重的原因,尤其是在患者癫痫发作的历史。管理包括抗癫痫药物方案优化,考虑癫痫手术,和转诊心脏心搏停止持续时间超过6秒时踱步。< / p > 乐意地,a . C。、Daruvala年代。Ayub, N。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207396 hwp: master-id首页:神经病学;WNL.0000000000207396 美国神经病学学会首页 所有癫痫/癫痫,癫痫监控 珍珠和Oy-sters:严重的颞叶癫痫的发作性心搏停止 2023-08-29 RESIDENT &amp; FELLOW SECTION 101年 9 e978 e981 hw_mjid:首页神经病学;101/9 / e978 < ![CDATA[教学实验:钙化的假瘤神经轴设置的遗传性出血性毛细血管扩张和癫痫发作]]> http://n.首页neurology.org/cgi/content/short/101/9/e982?rss=1 < p >我们报告一个50岁的男人出现癫痫大发作癫痫发作。检查包括核磁共振大脑的展示不同类地加强重点,可能出血性,在左枕叶区域(图1)。一个血管病因可能是由于患者的遗传性出血性毛细血管扩张的历史。此外,数字减影血管造影显示一个不规则的脸红与早期静脉引流的没有显示动静脉畸形(AVM)。手术切除的标本显示大量钙化(图2)。最后病理诊断的钙化假瘤神经轴(CAPNON),可能起源于一个AVM遗迹。<一口> 1 < /一口>他们是罕见的,生长缓慢的病变认为形成二次组织的侮辱。这个发现在AVM的好处是2倍;脑自动调整维护,和未来的监测血管造影是可避免的。CAPNONs曾被观察到在创伤、感染、肿瘤、炎症。2 <一口> < /一口>完整切除术术中证实了血管造影和术后MRI。病人没有并发症,回到他控制发作神经基线。< / p > 德布斯,l . H。Helton,。、Belakhlef年代。沙玛,S。拉希米,s . Y。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207385 hwp: master-id首页:神经病学;WNL.0000000000207385 美国神经病学学会首页 核磁共振,所有脑血管疾病/中风,动静脉畸形,癫痫发作 教学实验:钙化假瘤的神经轴设置遗传性出血性毛细血管扩张和癫痫发作 2023-08-29 RESIDENT &amp; FELLOW SECTION 101年 9 e982 e983 hw_mjid:首页神经病学;101/9 / e982 < ![CDATA[教学实验:径向压缩神经病变继发于肱三头肌肌肉的辅助腹]]> http://n.首页neurology.org/cgi/content/short/101/9/e984?rss=1 < p >一名43岁男子提出了5个月的左手疼痛,伸肌无力,背感觉损失。没有历史的创伤、感染或状况的症状。神经系统检查显示萎缩和软弱的医学研究委员会规模)(4/5左肱桡肌,手腕和手指伸肌的肌肉。针刺和触摸感觉减少背部的左手。Nerve conduction velocity showed a reduction in compound muscle action potential (1.0 mV) and sensory nerve action potential (14 μV) amplitudes in the left radial nerve. No conduction blocks or focal slowing were recorded. EMG also showed active denervation of the brachioradialis and forearm extensor muscles, sparing the triceps. An axonal radial sensorimotor neuropathy proximal to the brachioradialis muscle was diagnosed. Left arm MRI, ultrasound, and surgical exploration showed an entrapment of the radial nerve in the upper arm due to a triceps accessory muscle belly (Figures 1 and 2). Muscle anatomical variants are an infrequent cause of radial nerve entrapment, and images are crucial to identify this etiology.1,2

巴斯蒂亚,P。梅洛,R。Matamala, j . M。厄尔,N。Acosta,我。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207394 hwp: master-id首页:神经病学;WNL.0000000000207394 美国神经病学学会首页 超声波,周围神经病变,肌电图 教学实验:径向压缩神经病变继发于辅助腹部肱三头肌的肌肉 2023-08-29 RESIDENT &amp; FELLOW SECTION 101年 9 e984 e985 hw_mjid:首页神经病学;101/9 / e984
< ![CDATA[动脉瘤:我们应该屏幕有家族史的人呢?]]> http://n.首页neurology.org/cgi/content/short/101/9/e986?rss=1 < p >为什么这是一个重要的问题?为了更好地理解,我们需要首先考虑动脉瘤和为什么他们可以很严重。动脉瘤的风险是,扩大,它可能破裂(或<我> < / I >破裂),这可能会导致因脑出血中风。众所周知,一个人经历破裂动脉瘤是死亡风险高的从这样一个事件(30%)。此外,长期的神经疾病的风险高的人破裂动脉瘤。之前有研究表明,一个人有两个或多个一级亲属(罗斯福)经历了破裂动脉瘤有11%的机会在动脉瘤本身。对这些人来说,一生有20%的机会,动脉瘤破裂。如果一个人有一位罗斯福有动脉瘤破裂,他们应该检查以确定他们是否有现有的未破裂动脉瘤然后监控的发展随着时间的推移,动脉瘤。然而,如果一个人是没有发现动脉瘤破裂?他们的亲属也应该动脉瘤筛查吗? < / p > Karceski, S。 2023 - 08 - 28 - t12:45:29 07:00 信息:doi 10.1212 / / WNL.0000000000207772 hwp:资源id:神经病学;10首页1/9 / e986 美国神经病学学会首页 动脉瘤:我们应该屏幕有家族史的人呢? 2023-08-29 病人的页面 101年 9 e986 e988 hw_mjid:首页神经病学;101/9 / e986
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