Background & Objective: Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes characterized by the involvement of the peripheral nervous system. This study aimed to investigate the association between the red blood cell distribution width/albumin ratio (RAR) and the presence of diabetic peripheral neuropathy (DPN). Methods: The association between DPN, RAR, and other variables was examined using logistic regression analysis. To determine the predictive validity and optimal cutoff value of RAR for the presence of DPN, Receiver Operating Characteristic (ROC) curve analysis was performed to calculate the Area Under the Curve (AUC). Results: Compared to those without DPN, patients with DPN had a significantly higher prevalence of hypertension (p=0.006), a higher rate of smoking (p=0.002), and a longer duration of diabetes (p<0.001). Patients with DPN had significantly lower albumin levels (p<0.001), and significantly higher RDW (p<0.001) and RAR (p<0.001) values. As an independent variable, RAR was independently associated with higher odds of DPN (OR: 1.545, 95% CI: 1.235-1.914, p<0.001). The optimal cutoff value for RAR to predict the presence of DPN was determined to be 4.4 %/(g/dL) (Spec.: 99.2%, Sen.: 32.2%, AUC: 0.67). Conclusion: Our findings suggest that RAR is an independent predictor of DPN and may serve as a complementary biomarker compared with RDW or albumin levels alone. Further prospective, multicenter studies with larger sample sizes are needed to more robustly establish the association between RAR and DPN.
Objective: Wolf-Hirschhorn syndrome (WHS) (#194190) is a well-defined microdeletion syndrome characterized by typical facial findings, prenatal and postnatal growth retardation, hypotonia, microcephaly, intellectual disability, and seizures. Clinical findings vary depending on the size of the deletion. WHSC1, WHSC2, LETM1, CPLX1, CTBP1, PIGG, and FGFRL1 were responsible for the clinical findings. The objective of this study was to describe the clinical, cytogenetic, and molecular characteristics of patients diagnosed with WHS and to contribute to the existing literature by presenting our data. Methods: This study retrospectively presents the clinical, cytogenetic, and molecular findings of 18 patients. Results: All the patients had typical facial findings, growth retardation, microcephaly, hypotonia, and intellectual disability. Seizures were present in all patients, except for two. Moreover, 16 patients had thin corpus callosum on cranial magnetic resonance imaging. The diagnosis was confirmed by chromosomal analysis, fluorescence in situ hybridization, and microarray analysis. Conclusion: Confirmation of the diagnosis is important for increasing clinical awareness, appropriate follow-up, of patients and genetic counseling.
Objective: In this study, we evaluated the relationship of plasma and cerebrospinal fluid (CSF) testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels with CSF opening pressure in women diagnosed with idiopathic intracranial hypertension (IIH). Method: We prospectively evaluated 52 female patients (aged 15-45 years) diagnosed with IIH according to modified Dandy criteria. In the plasma and CSF samples collected simultaneously, testosterone and DHEA-S levels were measured using chemiluminescence microparticle immunoassay (CMIA). The patients were assigned into two groups based on CSF opening pressure. The hormone levels were compared and correlation and ROC analyses were performed. Results: In the group with high CSF pressure (>= 40 cmH(2)O), the plasma testosterone, plasma DHEA-S and CSF testosterone levels were found to be significantly higher (p<0.05). In addition, strong positive correlations were observed with CSF opening pressure and plasma testosterone (r=0.856), CSF testosterone (r=0.870) and plasma DHEA-S (r=0.915) levels. In the ROC analysis, the cut-off value was determined as >= 3.45 nmol/L for plasma testosterone, >= 295 & micro;g/dL for plasma DHEA-S and >= 0.08 nmol/L for CSF testosterone. Conclusion: Plasma testosterone and DHEA-S levels showed a significant relationship with CSF opening pressure. These findings suggest that plasma androgen levels can be used as a potential biomarker to predict intracranial pressure in a non-invasive manner.
Background & Objective: Frailty results from an age-associated decline in physiological reserve and function and is prevalent in older adults. In this retrospective cohort study, we aimed to validate the older patients hospitalised with ischemic stroke and hypothesise that frailty is a comparable predictor of adverse outcomes in stroke. Methods: Older patients aged 65 years and above with ischemic stroke admitted to a tertiary hospital in Singapore from 1st January 2019 to 31st December 2019 were identified and categorised into high risk (>15), intermediate risk (5-15) and low risk (<5) of frailty using HFRS. Results: A total of 1,023 patients with ischemic stroke were included in this study. HFRS was categorised as high risk in 271 patients (26.5%), intermediate risk in 544 patients (53.2%) and low risk in 208 patients (20.3%). Patients with higher HFRS scores were older, more likely female, have lower BMI and more comorbidities. Higher HFRS scores was also associated with increased length of stay, 90 day and 1 year mortality, but not 30-day readmission and inpatient mortality. Predictive models which incorporated HFRS and other relevant variables showed good predictive value for long length of stay and 1 year mortality with AUC of 0.811 (0.744 - 0.878) and 0.749 (0.619 - 0.878) respectively. Conclusion: Our study has shown that patients with high risk of frailty have higher healthcare utilisation than low risk patients. Identification of frailty can help stratify care for older frail patients.
Background & Objective: Locally, there are no recommendations on the use of magnesium sulfate (MgSO4) among tetanus patients. Moreover, some neurologists are unaware of its benefits in this cohort. Most start MgSO4 only when the patients are in the severe stage, have signs of dysautonomia, or if the physician is confident in its administration. This paper will determine the effect of MgSO4 on the survival of adult and pediatric non-neonatal tetanus patients in a tertiary hospital in the Philippines. Methods: This study utilized a retrospective cohort study design. Data from a previous study by Lanuza et al. (2024) was utilized. Baseline comparisons of MgSO4 versus non-MgSO4 groups were done using Wilcoxon rank sum test or independent t-test for continuous data while a Fisher Exact test was used for comparison of proportions. Those with a p-value lower than 0.2 were used for Cox regression analysis. Results: Crudely, survival is better in the MgSO4 group, and although this became non-significant when confounders were accounted, the survival in the MgSO4 group was still markedly higher than non-MgSO4 group. In terms of age group, MgSO4 was beneficial in both pediatric and adult patients, but only significant on the latter. The survival of MgSO4 administered non-neonatal tetanus patients was significantly higher among severe tetanus patients and among those without dysautonomia. Conclusion: Administration of MgSO4 in non-neonatal tetanus patients, may be effective in improving survival. Moreover, its benefit is magnified among adult patients, with severe tetanus and those with no dysautonomia.
Background & Objective: Neuropathic pain (NP) is common in hemodialysis patients and severely reduces their quality of life. Diabetes, inflammation, and oxidative stress are factors implicated in the development of NP, regardless of dialysis status. This study explored links between neuropathic pain, oxidative stress, inflammation, and quality of life in hemodialysis patients. Methods: The study prospectively included 113 HD patients, grouped by Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score (NP >= 12, control: <12).The groups were compared in terms of oxidative stress (native thiol, total thiol, disulfide, and Ischemia-Modified Albumin (IMA) levels) and inflammatory parameters (Systemic Immune-inflammation Index (SII)). The groups were also compared in terms of the Charlson Comorbidity Index (CCI), quality of life (SF-36), and disease perception (B-IPQ). Results: The native thiol/total thiol ratio was significantly higher in the NP group; however, disulfide levels, disulfide/native thiol, and disulfide/total thiol ratios were higher in the control group (p<0.05). There was no difference between the groups in terms of other parameters. NP presence was associated with a significant decrease in quality of life in all SF-36 subscales (p<0.05). Thiol/disulfide parameters were identified as independent predictors. Conclusion: The presence of NP in hemodialysis patients is associated with impaired thiol/disulfide homeostasis, independent of diabetes and inflammation. Oxidative stress may play a dominant role in NP pathogenesis and that thiol/disulfide balance is a more sensitive biomarker compared to IMA. oxidative thiol/disulfide ischemia
Background & Objective: Atherosclerosis of the internal carotid artery (ICA) is a major cause of middle cerebral artery (MCA) infarction. This study aimed to investigate the relationship between carotid artery angles and diameters and infarct volume, and to determine the impact of these measurements on in-hospital mortality in patients with MCA infarction. Methods: This retrospective observational cohort study included patients with symptomatic ICA stenosis of 50-95% and no other identifiable etiology who had suffered an MCA infarction. From computed tomography angiography images, we measured the common carotid artery (CCA)-ICA angle, the carotid bifurcation angle, and the diameters of the carotid arteries. Infarct volumes were obtained from diffusion-weighted MRI. Statistical analyses included the independent two-sample t-test, Mann-Whitney U test, Spearman's rho correlation, logistic regression, and receiver operating characteristic (ROC) analysis. Results: A total of 79 patients (46 survivors, 33 non-survivors) were analyzed. Non-survivors had significantly larger infarct volumes (p<0.001). They also exhibited narrower CCA-ICA angles (p=0.001) and wider bifurcation angles (p<0.001). Infarct volume showed a weak but significant correlation with both bifurcation angle (r=0.327, p=0.003) and degree of ICA stenosis (r=0.371, p=0.001). Each 1 degrees increase in bifurcation angle was associated with a 1.433-fold rise in mortality risk (p=0.013). The bifurcation angle had a strong predictive value for mortality (AUC=0.896). Conclusions: In patients with MCA infarction, a wider carotid bifurcation angle and a narrower CCA- ICA angle are associated with in-hospital mortality. A 1 degrees increase in the bifurcation angle increases the risk of in-hospital mortality by 1.433 times.
Background: Ischemic stroke is a leading global cause of disability, accounting for approximately 87% of all stroke cases. Rehabilitation strategies that promote neuroplasticity show promise in improving recovery outcomes, with increased expression of the brain-derived neurotrophic factor (BDNF) gene playing a key role in neuronal survival and synaptic plasticity. However, the effects of rehabilitation therapy on BDNF gene expression in ischemic stroke patients are rarely reported. This study aims to compare BDNF gene expression levels in ischemic stroke patients before and after rehabilitation. Methods: In brief, total RNA was extracted from ischemic stroke patients before (n = 43) and after (n = 22) rehabilitation and converted into cDNA. Out of the 22 post-rehabilitation ischemic stroke patients, only 16 were paired. BDNF gene expression levels of pre- and post-rehabilitation were measured using a quantitative real-time polymerase chain reaction. A Mann-Whitney U test was applied to compare overall BDNF expression levels in ischemic stroke patients, while a Wilcoxon Signed-Rank test was used to assess changes in BDNF expression in the 16 paired ischemic stroke patients who completed the rehabilitation therapy. Results: The results revealed a significant 3.81-fold increase in overall BDNF gene expression in post-rehabilitation ischemic stroke patients (p-value = 0.048), as determined by the Mann-Whitney U test. Notably, the Wilcoxon Signed-Rank test showed a highly significant 7.78-fold increase in BDNF expression in the 16 paired patients post-rehabilitation compared to pre- rehabilitation (p-value = 0.004). Conclusions: The results support the potential of BDNF gene as a molecular marker of rehabilitation- induced neuroplasticity. These findings warrant further validation in larger studies integrating both molecular and clinical outcome measures.
Objective: This study examined the association between migraine and the risk of ischemic stroke (IS) and hemorrhagic stroke (HS). Methods: This retrospective cohort study used data from the Korean National Health Insurance Service (NHIS) and included 13,379 individuals with migraine and 66,895 propensity score-matched controls. The primary outcome was the incidence of IS, and the secondary outcome was HS. Time-stratified Cox proportional hazards models were employed for analysis. Results: Migraine was associated with an increased risk of IS (incidence rate ratio [IRR], 1.78; 95% confidence interval [CI], 1.62-1.95) and HS (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.35-2.18). The risk of IS peaked within the first two years following migraine diagnosis and remained elevated for up to eight years. Conclusion: Migraine is independently associated with an increased long-term risk of both IS and HS, particularly among younger individuals and males, underscoring the need for targeted cerebrovascular surveillance.
Objectives: Migraine is often associated with various gastrointestinal (GI) symptoms and disorders, including Helicobacter pylori (Hp) infection. The aim of this study was to investigate both the relationship between migraine and Hp infection and the relationship between migraine and endoscopic upper GI diseases. Methods: This prospective observational case-control study involved 91 migraine patients and 80 control individuals with no history of migraines presenting with upper GI symptoms. Both groups underwent upper GI endoscopy, and gastric biopsy specimens were histopathologically examined. Headache frequency, duration and pain intensity (measured by VAS) were re-evaluated in the Hp-positive migraine group at week 8 post-eradication. Results: There was no statistically significant difference between migraine and control groups regarding Hp prevalence (p=0.117). Gastroesophageal reflux disease (GERD) was the most prevalent endoscopic upper GI condition in migraine patients (52.7%) than control group. It was statistically significant (p < 0.001). There was no statistically significant association detected between GERD and Hp in migraine subgroups (p =0.966), indicating independence of GERD from Hp. 40.7% of migraine patients had moderate chronic inflammation in the gastric antrum, while this rate was 25.0% in the control group (p=0.037). 30.8% of migraine patients had moderate acute inflammation in the gastric antrum, while this rate was 28.7% in the control group (p=0.036). While moderate acute inflammation was 45.3% in Hp-positive migraine pat & imath;ents, it was 10.5% in Hp-negative migraineurs(p <0.001). While severe chronic inflammation was present in 7.5% of Hp-positive migraine patients, it was absent in Hp-negative migraineurs. Moderate chronic inflammation was observed in 52.8% of Hp-positive and 23.7% of Hp-negative migraine patients, with a significant positive relationship between chronic inflammation and Hp in migraine patients (p<0.001).Although no significant differences in attack frequency and average attack duration was detected between the Hp-positive and Hp-negative migraine subgroups. The pain intensity between migraine subgroups exhibited a significant difference being higher in Hp-positive migraine patients (p= 0.044). In addition, in the Hp-positive migraine group, significant differences were observed in attack frequency(day/month), attack intensity(visual analog scale) and average attack duration(hours) at the 8th week post-eradication compared to the pre-eradication period.The attack frequency in the Hp-positive migraine group who have been treated was 10.0 before treatment and 6.0 after treatment(p<0.001). The attack intensity was 8.0 before treatment and 5.0 after treatment(p<0.001). The average attack duration was 5.0 before treatment and 4.0 after treatment(p<0.001). Conclusion: We conclude that Hp causes more chronic active inflammation in migraine sufferers than in individuals with upper GI symptoms without a history of migraine. In addition, migraine sufferers infected with Hp experienced more severe levels of inflammation compared to those not infected with the bacterium. In Hp-infected migraine patients, the presence of the bacteria may be related to the severity of the pain attacks. Hp eradication therapy may potentially play an important role in headache management in Hp-positive migraineurs with upper GI symptoms in addition to conventional migraine treatments. A positive association was also found between GERD and migraine patients independent of Hp status.
Fukuyama congenital muscular dystrophy (FCMD) is a rare autosomal recessive alpha-dystroglycanopathy typically presenting in infancy with severe hypotonia, intellectual disability, and cortical malformations. Adult-onset phenotypes are uncommon and usually dominated by isolated cardiomyopathy without neurological involvement. We report the first genetically confirmed case of adult-onset FKTN-related dilated cardiomyopathy (DCM) in a Chinese patient harboring a novel homozygous FKTN missense mutation. We present here a 31-year-old man presented with acute heart failure secondary to dilated cardiomyopathy and subsequently developed a generalized tonic-clonic seizure. Neurological examination revealed mild bilateral gastrocnemius atrophy without weakness, preserved cognition, and normal deep tendon reflexes. Serum creatine kinase was markedly elevated (>7,000 U/L). Echocardiography and cardiac MRI confirmed DCM with non-compaction features. Brain MRI was unremarkable. Genetic testing identified a novel homozygous FKTN mutation (c. 1271G>A, p. Gly424Asp). Following treatment with heart failure medication and prophylactic levetiracetam, cardiac function improved, and the patient remained seizure-free during a 12-month follow-up. Conclusions: This case expands the phenotypic spectrum of FKTN-related disorders to include adultonset DCM accompanied by seizures. While the exact mechanism remains to be fully elucidated, the presence of seizures in the absence of cortical malformations highlights a potential functional neurological involvement. Targeted FKTN screening is recommended for adults with unexplained cardiomyopathy and markedly elevated CK.
Background & Objective: Misinformation and misconceptions regarding epilepsy in society contribute to the increasing stigma surrounding the condition and its patients. This study aimed to examine the impact of education provided to high school students about epilepsy on their awareness of seizure intervention, knowledge level, and stigma associated with the condition. Method: This study, designed as a randomized controlled experimental study with pre-test and post-test measurements, collected data between February and May 2024. To gather data, the Student Information Form, the Epilepsy Knowledge Scale, the Epilepsy Stigma Scale, and the Numerical Rating Scale were utilized. A total of 256 high school students participated in the experimental group, while 201 students were included in the control group. Results: The mean total score on the Epilepsy Knowledge Scale in the experimental group increased, indicating a significant improvement compared to the control group (p<0.001, Cohens d=1.57, effect size 0.61). A significant decrease was found in all sub-dimensions and total scores of the Epilepsy Stigma Scale in the experimental group. (p<0.001, Cohens d= -0.92, effect size -0.41). Both groups’ level of competence in seizure intervention was similar before the training (p=0.531); however, a significant increase was noted in the experimental group post-education (p=0.002, Cohens d= 1.74, effect size 0.65). Conclusion: Education given to high school students about epilepsy increases their knowledge and seizure intervention competence and reduces the level of stigma. In light of these findings, it is recommended that educational initiatives aimed at reducing stigma against individuals with epilepsy be widely implemented across the community.
Objection: This study aims to investigate the associations of cumulative small dense low-density lipoprotein cholesterol (sdLDL-C) and changes with cardiovascular disease (CVD) or stroke risk in middle-aged and old adults. Methods: Study data were extracted from the China Health and Retirement Longitudinal Study (CHARLS) database in2011-2015. Associations of cumulative sdLDL-C, sdLDL-C change and sdLDL-C cluster (divided into 3 classes using the k-means cluster analysis) with risk of CVD or stroke were investigated utilizing multivariate logistic regression analysis, which evaluated through odds ratio (OR) with 95% confidence interval (CI). Results: Follow-up until 2020, 662 of 4,353 participants had CVD or stroke. After adjusting for selected covariates, compared to lower cumulative levels of sdLDL-C (<= 82.2), cumulative sdLDL-C levels of (99.4, 120] (OR=1.44, 95%CI: 1.12-1.86) and >120 (OR=1.41, 95%CI: 1.09-1.82) were associated with increased CVD/stroke odds, respectively. Compared to persistent low sdLDL-C change levels, persistent middle, persistent high and increasing sdLDL-C change were all linked to increased odds of CVD/stroke (all P<0.05). Participants with sdLDL-C level of Class 2 and Class 3 had increased odds of CVD/stroke risk, compared to those with sdLDL-C level of Class 1(all P<0.05). Similar associations were observed between sdLDL-C and CVD risk but not with stroke. Conclusions: High cumulative sdLDL-C levels and stably high sdLDL-C change was associated with an increased CVD/stroke risk. Timely monitoring sdLDL-C change may play a pivotal role in mitigating disease incidence, and however, targeted interventions and the underlying mechanisms of these associations need further clarification.
Background & Objective: Spontaneous intracranial hemorrhage (ICH) is associated with high morbidity and mortality. Early identification of patients at risk for poor outcomes is crucial to guide management and optimize intensive care utilization. Glucose-to-potassium ratio (GPR) is an emerging biomarker that may reflect combined metabolic and systemic derangements. The objective of this study is to evaluate the prognostic performance of GPR in predicting in-hospital mortality among patients with spontaneous ICH. Methods: In this retrospective observational study, 168 consecutive patients diagnosed with spontaneous ICH between January and December 2024 were included. Demographics, clinical parameters, laboratory results, and interventions were extracted from electronic medical records. The primary outcome was in-hospital mortality. GPR was calculated from admission serum glucose and potassium levels. Statistical analyses included Mann-Whitney U and chi-square tests for group comparisons, receiver operating characteristic (ROC) curve analysis for predictive performance, and multivariable logistic regression to identify independent mortality predictors. Results: Among 168 patients, 103 (61.3%) survived and 65 (38.7%) died during hospitalization. Non-survivors were older (median 64 vs. 58 years, p = 0.017) and had lower GCS scores (12 vs. 15, p < 0.001). ROC analysis of GPR yielded an area under the curve of 0.718 (95% CI, 0.637-0.800) with an optimal cut-off of >= 37.29, sensitivity of 65.6%, and specificity of 70.8%. In multivariable logistic regression, higher GPR (OR 1.04, 95% CI 1.01-1.07, p = 0.004), older age (OR 1.04, 95% CI 1.01-1.06, p = 0.002), and decompressive craniectomy (OR 3.60, 95% CI 1.52-8.53, p = 0.004) independently predicted in-hospital mortality. Conclusion: GPR is a simple, cost-effective, and readily obtainable biomarker that independently predicts in-hospital mortality in patients with spontaneous ICH. When combined with established predictors such as age and surgical intervention, GPR may facilitate early risk stratification and guide clinical management. Prospective multicenter studies are warranted to further validate these findings.
Background: Access-site complications constitute a substantial portion of the morbidity associated with transfemoral cerebral angiography, yet no standardized protocol exists about early ambulation for patients after digital subtraction angiography and practice patterns vary widely. The objective of this study was to validate the efficacy and safety of early ambulation protocol for transfemoral cerebral angiography patients. Methods: A prospective, two-arm, single-blinded, parallel group, randomized controlled trial was designed enrolling patients undergoing transfemoral cerebral angiography from April, 2023 to February, 2024. The data of demographic and complications, comfort, pain, sleep after digital subtraction angiography were collected and analyzed. Results: A total of 371 patients were enrolled in this study, 190 patients in intervention group,181 patients in control group. 14 patients (3.77%, 2.11%VS5.52%, p=0.104) met the oozing, 9 patients (2.43%, 1.58%VS3.31%, p=0.327) met the palpable hematoma over the femoral artery. In all cases, there was no further oozing or enlarging (13.21%, 12.63%VS13.81%, p=0.761) met difficulty excretion after femoral artery puncture. There was no statistically significant difference in all complications between the two groups. There was no statistically significant difference in comfort score (95.41 +/- 10.38 VS 94.13 +/- 10.84, p=0.247), pain score (1.35 +/- 2.40VS 1.25 +/- 2.18, p=0.696) and sleep score (4.04 +/- 4.20 VS 3.78 +/- 4.26, p=0.566) between the two groups. Conclusions: Transfemoral cerebral angiography is a common procedure with no clear consensus regarding the early activities. Our results show that early ambulation protocol will not increase the postoperative complications of patients, the score of comfort increased, although no statistically significant.
Objective: This study aimed to investigate the auditory startle response (ASR) in the ictal period of primary headache disorders. ASR may serve as a potential marker of brainstem hypersensitivity to external stimuli. Methods: The study included patients diagnosed with episodic migraine (EM, n=13), chronic migraine (CM, n=9), chronic tension-type headache (CTTH, n=9), and medication-overuse headache (MOH, n=8) as well as a control group of healthy individuals (n = 23). Headache diagnoses were established in accordance with the International Classification of Headache Disorders, 3rd edition (ICHD-III). ASR measurements were performed in all participants, and in patients, assessments were conducted in ictal period. ASR parameters were compared across all groups. Results: Total ASR probability was significantly elevated in patients with headache compared to healthy controls. In recordings from the orbicularis oculi muscle, both response duration and area under the curve (AUC) were significantly increased in patients with EM and CM. In contrast, only response duration was prolonged in individuals with CTTH and MOH. The presence of associated symptoms such as photophobia, phonophobia, osmophobia, or allodynia showed no correlation with ASR enhancement. Conclusion: The results demonstrate ASR hyperactivity during the ictal phase in patients with EM, CM, CTTH and MOH, with the most pronounced changes observed in EM and CM. These findings suggest that ASR alterations are associated with the pain component of headache disorders rather than with accompanying sensory symptoms.
Objective: To evaluate the clinical efficacy and safety of intravenous thrombolysis (IVrtPA) combined with carotid artery stenting (CAS) in the treatment of acute cerebral infarction (ACI). Methods: We conducted a single-center retrospective cohort of consecutive adults with anterior-circulation large-vessel occlusion (LVO) and ipsilateral carotid disease between March 2021 and March 2023. Patients receiving intravenous thrombolysis (IVT; alteplase 0.9 mg/kg; 10% bolus then 60-min infusion) plus mechanical thrombectomy (MT) were classified as the control group; those additionally undergoing carotid artery stenting (CAS) for flow-limiting extracranial internal carotid artery (ICA) lesions comprised the intervention group. The primary outcome was good functional outcome (modified Rankin Scale [mRS] 0-2) at 90 days. Safety outcomes were intracranial hemorrhage (ICrH) within 24 h and cumulative ICrH through 7 days. Secondary outcomes included 30-day reinfarction, 90-day all-cause mortality, and 12-month stent patency (duplex/CTA). Result: Among 120 patients (intervention n=40; control n=80), the 90-day mRS 0-2 rate was 70% (28/40) vs 50% (40/80) (P=0.037). Day-7 NIHSS improvement was larger with IVT+MT+CAS (8.03 +/- 1.15 vs 5.39 +/- 2.07; P<0.001). ICrH at 24 h (10.0% vs 7.5%) and cumulative ICrH through 7 days (10.0% vs 7.5%) did not differ significantly. Thirty-day reinfarction and 90-day mortality showed no statistically significant differences. Twelve month stent patency was 90% (36/40). Conclusion: In LVO with significant carotid disease, adding CAS to IVT+MT was associated with improved early neurological recovery and high 12-month stent patency without an excess of early ICrH; confirmation in larger, multicenter cohorts is warranted.
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a severe inflammatory demyelinating disorder of the central nervous system that frequently results in permanent neurological disability, most commonly due to recurrent transverse myelitis. Although physical and psychological health-related quality of life in NMOSD has been widely studied, the impact of optic neuritis (ON) on vision-related quality of life (VRQoL) remains underreported. Methods: This multicenter crosssectional study assessed VRQoL using the National Eye Institute Visual Function Questionnaire-25 (NET VFQ-25) in 52 patients: 30 with prior ON (NMOSD+ON) and 22 without (NMOSD-ON). VFQ-25 scores were analyzed alongside clinical parameters including best-corrected visual acuity (BCVA), disease duration, and ON history. Results: NMOSD+ON patients were older (median 43 vs. 33 years; p = 0.02), had longer disease duration (8.5 vs. 4.5 years), and lower BCVA (p = 0.002). NEI VFQ-25 composite scores were significantly lower in the NMOSD+ON group (75.7 vs. 98.3), with consistently reduced scores across all subscales (p<0.001). Notably, NMOSD-ON patients demonstrated subtle reductions in general vision, near tasks, and distance activities, suggesting subclinical optic nerve involvement. Multivariate regression analysis identified BCVA of both the better and worse-seeing eyes as independent predictors of VRQoL, irrespective of ON history. Conclusions: These findings underscore the sensitivity of NET VFQ-25 as a patient-reported outcome measure for detecting visual compromise in NMOSD, including subtle deficits in patients without clinically overt ON.
Background & Objective: Ulnar nerve repetitive nerve stimulation (RNS) is widely used in the electrophysiological evaluation of myasthenia gravis (MG), but its limited diagnostic sensitivity remains a challenge. This study aimed to directly compare the diagnostic sensitivity of low-frequency (3 Hz) median and ulnar nerve RNS in generalized MG patients positive for acetylcholine receptor (AChR) or muscle-specific kinase (MuSK) antibodies. Methods: In this retrospective single-center study, 35 patients diagnosed with generalized MG and seropositive for AChR or MuSK antibodies were evaluated. All underwent both median and ulnar nerve RNS testing. Electrophysiological recordings were obtained from the abductor pollicis brevis (APB) muscle for the median nerve and the abductor digiti minimi (ADM) muscle for the ulnar nerve. Results: Abnormal decremental responses were more frequent in median nerve RNS than in ulnar nerve RNS, especially among newly diagnosed patients and those with higher AChR antibody levels, although this difference was not statistically significant. Importantly, the mean decrement magnitude was significantly greater in the median nerve compared to the ulnar nerve (17.1% vs. 9.4%; p = 0.018). This difference was particularly notable in patients with mild MG symptoms (MGFA class II and III). Conclusion: Median nerve RNS showed higher sensitivity and greater decrement magnitude than ulnar nerve RNS, particularly in mild generalized MG cases. These findings suggest that median nerve RNS is a valuable complementary diagnostic tool in MG, especially during early disease stages.
