The escalating burden of antimicrobial resistance poses formidable challenges to anti-infective therapy for central nervous system infections. The presence of the blood-brain barrier and blood-cerebrospinal fluid barrier restricts the cerebrospinal fluid penetration of most antimicrobial agents, while conventional empirical treatment regimens are increasingly inadequate to contend with evolving and complex resistance mechanisms. This article provides a systematic review of recent advances in the management of drug-resistant central nervous system infections, encompassing rapid diagnostic approaches, resistance mechanism-guided targeted therapy, emerging clinical evidence on novel antimicrobial agents, and pharmacokinetic/pharmacodynamic (PK/PD)-oriented individualized treatment strategies.
Intracranial infection is an important cause of secondary post-infectious hydrocephalus (PIH). Its pathological process is complex, involving multiple aspects such as inflammatory response, changes in cerebrospinal fluid circulation dynamics, and brain parenchymal damage, which seriously affects patient prognosis. This review aims to systematically elaborate on the epidemiological characteristics, core pathophysiological mechanisms, diagnostic evaluation, as well as current therapeutic strategies and emerging interventions for intracranial infection and PIH, in order to provide a theoretical basis for optimizing clinical diagnosis and treatment.
Central nervous system infections present clinical features of high disability and high mortality in the field of neurosurgery. The expansion of neurosurgical centers, the increase in surgical volume and the use of prosthetic materials and implants, have made nosocomial and iatrogenic intracranial infections coexist, the pathogen spectrum has shifted from Gram-positive cocci toward multidrug-resistant Gram-negative bacilli, and the coverage window of conventional empirical antimicrobial regimens has been compressed. In terms of diagnosis, the positivity of cerebrospinal fluid (CSF) culture is low after empirical antibiotic exposure; CSF heparin-binding protein, procalcitonin, lactate and metagenomic next-generation sequencing (mNGS) are becoming key methods for early postoperative stratified differentiation. In terms of treatment, the clinical positioning of intraventricular/intrathecal administration and new-generation antimicrobials (cefiderocol, contezolid, etc.) are becoming increasingly clear; long-term external drainage (LED) and continuous lumbar drainage (CLD) as approaches for refractory ventriculitis and complex postoperative infection, have become routine strategies that can be tested by multicenter prospective studies. In the future, the key issues for this disease are the routine management of antimicrobial resistance (AMR), multi-marker combined diagnosis and a national neuro-infection registry. This article presents a clinical perspective from the standpoints of current epidemiology, diagnostic stratification, treatment pathways and future directions.
Objective To investigate causal relationship between gut microbiota (GM) and Parkinson's disease (PD) by Mendelian randomization (MR) analysis. Methods The GM Genome-Wide Association Study (GWAS) data from the MiBioGen Consortium (including 18340 participants in 24 cohorts from 11 countries) and PD GWAS data from the IEU Open GWAS database [including 33674 PD patients and 449056 health controls with 17891936 single nucleotide polymorphism (SNP)]. According to the preset threshold (SNP F>10), independent genetic variation sites significantly correlated with the relative abundance of intestinal flora were extracted as instrumental variables. Inverse variance weighting method was used to examine the causal relationship between GM and PD; for instrumental variables, sensitivity analysis was performed with leave-one-out method, heterogeneity test was performed with Cochran Q test, and horizontal pleiotropy test was performed with MR-Egger regression to verify the stability and reliability of the results. The outliers were tested by MR-Pleiotropy RESidual Sum and Outlier (PRESSO) global analysis. The funnel plot was drawn to determine whether there was potential bias in the data. Results According to MR, there was a causal relationship between GM of 2 species and PD: Candidatus soleaferrea (OR=1.192, 95%CI: 1.041-1.366; P=0.011) and Clostridiumsensustrictol (OR=1.356, 95%CI: 1.089-1.690; P=0.007) were risk factors for PD. Sensitivity analysis showed that the result was stable, heterogeneity test showed that there was no instrumental variable that had a strong influence on the result (P>0.05, for all), horizontal pleotropy showed no horizontal pleotropy (P>0.05, for all), and MR-PRESSO global analysis showed no outlier value (P>0.05, for all). Funnel plot showed no potential bias. Therefore, the effects of heterogeneity and horizontal pleiotropy on causal effect can be eliminated. Conclusions The GM of Candidatus soleaferrea and Clostridiumsensustrictol are risk factors for PD. The specific mechanism of action remains to be further explored.
Dysarthria is a common motor speech disorder following stroke, which has a severe adverse impact on patients' rehabilitation prognosis and quality of life. Currently, research and understanding of post-stroke dysarthria remain insufficient, and the multiple adverse effects it brings to patients have not received sufficient attention. With increasing attention to functional recovery and long-term quality of life in stroke patients, the scientific assessment and rehabilitation of dysarthria have become important focuses in neurorehabilitation. This article reviews the research progress in its pathophysiological mechanisms, clinical classification, assessment methods, and rehabilitation therapy. This study found that current research in this field mainly has problems such as strong subjectivity in assessment methods, lack of high-level evidence-based medical evidence support for treatment plans, and insufficient individualization. Therefore, on the basis of sorting out the current situation, this article discusses the possible future directions of developing objective assessment tools and precise treatment plans, in order to provide new insights for improving the rehabilitation effect of post-stroke dysarthria.
Objective To evaluate the clinical value of temporal horn-abdominal subcutaneous tunnelled external drainage for the management of post-infectious trapped temporal horn(TTH).Methods A retrospective analysis was performed on 26 patients who developed TTH after intracranial infection and underwent temporal horn-abdominal subcutaneous tunnelled external drainage in the Plastic Surgery Hospital,Chinese Academy of Medical Sciences from August 2022 to August 2024.Preoperative and postoperative clinical and imaging data were collected.The reduction rate of the maximum cross-sectional area of the temporal horn,the volume of temporal horn,and improvement rate of clinical symptoms were statistically analysed.Results Among the 26 patients,21 underwent direct temporal horn-abdominal subcutaneous tunnelled drainage surgery;5 cases of temporal horn abscess were treated with temporal horn external drainage first,after no pus was discharged and the bacterial culture of cerebrospinal fluid(CSF)was negative,temporal horn-abdominal subcutaneous tunnelled external drainage was performed.Among them,12 cases had simple temporal horn exteral drainage surgery,12 cases had temporal horn exteral drainage surgery combined with lateral ventricle external drainage,2 cases had temporal horn exteral drainage surgery combined with trapped fourth ventricle exteral drainage.One case had the drain removed because of persistent absence of CSF outflow,2 cases died,and 23 cases underwent modified ventriculo-peritoneal shunt(VPS)at the second stage.A≥50%reduction in the maximum cross-sectional area of the temporal horn was achieved in 88.46%(23/26)of the patients.The postoperative volume of temporal horn was significantly smaller than the preoperative volume(Z=-5.626,P=0.000).Headache(χ2=17.053,P=0.000),cerebral herniation(χ2=6.125,P=0.008),consciousness disorders(χ2=7.111,P=0.004),increased muscle tone(χ2=5.143,P=0.016),elevated blood pressure(χ2=16.056,P=0.000),and tachycardia(χ2=21.043,P=0.000)had all improved compared to preoperative levels.Conclusions Temporal horn-abdominal subcutaneous tunnelled external drainage for post-infectious TTH can effectively control infection and clear CSF while continuously relieving intracranial hypertension,creating safe conditions for second-stage VPS,and thereby helping to increase the shunt success rate and shorten the overall treatment period.
Objective To investigate the application value of cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) in determining the timing of ventriculo-peritoneal shunt (VPS) in patients with post-infectious hydrocephalus (PIH). Methods A retrospective analysis was conducted on clinical data from 15 patients with PIH admitted to Huanhu Hospital Affiliated to Tianjin Medical University from January 2021 to December 2025. All patients underwent CSF mNGS and routine CSF analysis after clinical control of infection and before planned VPS. The time intervals from infection control to shunt surgery and the rate of postoperative reinfection were recorded. Neurological outcome was assessed using the modified Rankin Scale (mRS) and consciousness status using the Glasgow Coma Scale (GCS) before surgery, at discharge, and 3 months after discharge. Results The pathogen detection rate of mNGS was 15/15, compared to 11/15 for conventional CSF culture, with no statistically significant difference between the two methods (χ2=2.250, P=0.125). There was statistically significant difference in distribution of infection types between CSF mNGS and conventional CSF culture (χ2=6.250, P=0.018). Although CSF white blood cell count (Z=3.242, P=0.001), protein (t=2.750, P=0.015), and lactate (Z=3.417, P=0.000) levels were significantly above normal ranges before VPS, all CSF mNGS results were negative, indicating a sterile CSF state. The median time from clinical cure of infection to shunt surgery was 12 (6, 20) d, and the postoperative reinfection rate was 0. Statistically significant differences were observed in mRS (χ2=27.111, P=0.000) and GCS (χ2=19.143, P=0.000) scores before surgery, at discharge, and 3 months after discharge. Pairwise comparison revealed that mRS score 3 months after discharge was lower than that before surgery (Z=4.930, P=0.000) and at discharge (Z=3.739, P=0.019); and 3 months after discharge GCS score was higher than that before surgery (Z=-3.925, P=0.000). Conclusions Early VPS guided by negative CSF mNGS results appears safe and feasible, effectively shortening preoperative waiting time, reducing the risk of infection recurrence, and improving outcomes of PIH patients. This method provides a novel reference for determining the optimal timing of shunt surgery in PIH patients.
Objective To compare the clinical characteristics, therapeutic responses and complications of intrathecal polymyxin B treatment for intracranial infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP), screen risk factors for secondary multiloculated hydrocephalus, and evaluate the predictive efficiency of relevant indicators, so as to provide evidence for stratified clinical management of intracranial infection induced by drug-resistant bacteria. Methods A total of 27 patients receiving standardized intrathecal polymyxin B treatment for intracranial infection were prospectively enrolled, including 13 patients in the CRAB group and 14 patients in the CRKP group according to pathogenic bacteria. Univariate and multivariate Logistic regression analyses were applied to screen risk factors of multiloculated hydrocephalus, and receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of each indicator. Results Except for the intergroup difference in the proportion of male patients (P=0.006), there were no statistical differences between 2 groups in other clinical characteristics and incidence of various complications (P>0.05, for all). Logistic regression analysis showed that new intracranial hemorrhage (OR=8.190, 95%CI: 1.269-52.862; P=0.027) and ventricular catheter obstruction (OR=12.190, 95%CI: 1.045-142.156; P=0.046) were risk factors for multiloculated hydrocephalus. ROC analysis revealed that area under the curve (AUC) of new intracranial hemorrhage was 0.775 (95%CI: 0.583-0.967, P=0.005), sensitivity was 75%, specificity was 72.70%, optimal cutoff value was 0.500. The AUC of ventricular catheter obstruction was 0.763 (95%CI: 0.574-0.951, P=0.006), sensitivity was 62.50%, specificity was 90.90%, optimal cutoff value was 0.500. The AUC of the two-indicator combined prediction model reached 0.841 (95%CI: 0.678-1.004, P=0.000), sensitivity was 87.50%, specificity was 72.70%, optimal cutoff value was 0.418. Delong test revealed no statistically significant difference in predictive performance between the combined model and single indicator (P>0.05, for all). Conclusions Under the standardized intrathecal polymyxin B regimen, patients with CRAB and CRKP intracranial infection present the similar short-term inflammatory control efficacy and complication risks. New intracranial hemorrhage and ventricular catheter obstruction are high-risk factors for multiloculated hydrocephalus. The combined prediction model integrating the two indicators can improve the ability of early risk identification, which is more suitable for clinical screening of high-risk populations and individualized intervention.
Objective To report the clinical diagnosis and treatment of a case of sporadic Creutzfeldt-Jakob disease (sCJD), Heidenhain variant, presenting initially with Balint syndrome following severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection, and to review relevant literature to summarize the clinical characteristics of this disease. Methods and Results An 81-year-old male patient was admitted to The Second Affiliated Hospital of Soochow University on August 19, 2023, with clinical manifestations of gait instability, simultanagnosia, optic ataxia, and oculomotor apraxia (Balint syndrome). The condition progressively worsened, with the development of dementia, features of cerebellar involvement, and myoclonus. Cerebrospinal fluid tested positive for 14-3-3γ protein. DWI showed cortical hyperintensities in the bilateral parieto-occipito- temporal lobes, displaying the "cortical ribbon sign". EEG revealed frequent medium-to-high amplitude slow waves predominantly in the fronto-temporal region. The final diagnosis was sCJD, Heidenhain variant, presenting initially with Balint syndrome. Treatment aimed at improving cognition and controlling myoclonus yielded a poor response. Twenty days after discharge, the patient developed akinetic mutism and dyspnea, ultimately succumbing to respiratory failure. Conclusions Balint syndrome is a rare initial clinical manifestation of sCJD, warranting early recognition. SARS-CoV-2 infection may potentially trigger or accelerate the progression of sCJD.
Objective To identify the risk factors for intracranial infection after extra ventricular drainage (EVD) and Ommaya reservoir implantation in children. Methods Clinical data of 170 children who underwent EVD or Ommaya reservoir implantation in Fujian Children's Hospital from December 2021 to January 2026 were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were performed to screen for risk factors of postoperative intracranial infection. Results The overall incidence of postoperative intracranial infection was 17.65% (30/170). According to whether intracranial infection occurred postoperatively, patients were divided into infection group (n=30) and non-infection group (n=140). Logistic regression analysis showed that age<3 years (OR=4.445, 95%CI: 1.747-11.309; P=0.002), lower preoperative albumin level (OR=0.934, 95%CI: 0.884-0.988; P=0.017), lower preoperative hemoglobin level (OR=0.965, 95%CI: 0.941-0.990; P=0.006) and postoperative cerebrospinal fluid leakage (OR=4.802, 95%CI: 1.704-13.529; P=0.003) were risk factors for postoperative intracranial infection. Conclusions Age<3 years, lower preoperative albumin and hemoglobin level and postoperative cerebrospinal fluid leakage are risk factors for intracranial infection after EVD and Ommaya reservoir implantation in children. Perioperative infection prevention and control measures should be intensified for the above high risk factors in clinical practice.
Objective To evaluate the value of nasal normal saline irrigation and bacteriological testing of the surgical pathway in the prevention and treatment of intraoperative intracranial infection after endoscopic endonasal skull base surgery. Methods A retrospective analysis was conducted on the clinical data of 307 patients who underwent endoscopic endonasal skull base surgery in Tianjin Huanhu Hospital between September 2018 and December 2024. Patients were divided into 2 groups based on the nasal disinfection method: the povidone-iodine disinfection group (n=171) and the normal saline irrigation group (n=136). Intraoperative bacterial culture was performed 3 times in 80 patients in the normal saline irrigation group. Primary outcome measures were results of bacterial culture from the surgical pathway and the incidence of postoperative intracranial infection. Results Postoperative intracranial infection occurred in 6 patients (3.51%) in the povidone-iodine disinfection group and 2 patients (1.47%) in the normal saline irrigation group, with no statistically significant difference between the 2 groups (Fisher's exact probability: P=0.308). Among 80 patients of the normal saline irrigation group who underwent bacteriological testing, nasal colonizing bacteria were cultured in 49 cases before nasal irrigation and 41 cases after irrigation. The top 3 most common bacteria were Staphylococcus epidermidis, Klebsiella pneumoniae, and Streptococcus viridans in both periods. Colonizing bacteria were detected in sphenoid sinus of 29 cases, with the top 3 being Klebsiella pneumoniae, Staphylococcus epidermidis, and Streptococcus viridans; additionally, 4 bacterial species not detected in the nasal cavity were identified, namely Klebsiella oxytoca, Granulicatella adiacens, Enterococcus faecium, and Enterobacter cloacae. Intracranial infection occurred in 1 out of 80 patients who underwent bacteriological testing, and the bacterial strain isolated from the cerebrospinal fluid was consistent with the colonizing bacteria in the nasal cavity and paranasal sinuses. Conclusions Normal saline irrigation of the surgical pathway can reduce the incidence of intracranial infection, and nasal disinfection with povidone-iodine is an unnecessary measure. The pathogenic bacteria of postoperative intracranial infection in endoscopic endonasal skull base surgery patients originate from nasal colonizing bacteria. Intraoperative pathogenic bacteria detection is helpful for guiding the treatment of postoperative intracranial infection.
Background Previous studies identified 65 ml as the threshold of CT perfusion imaging (CTP) hypoperfusion lesion volume for predicting poor outcomes in medically managed patients with mild anterior circulation ischemic stroke. However, whether this threshold remains applicable to patients undergoing endovascular therapy (EVT) and those with posterior circulation ischemic stroke remains uncertain. Based on the updated and expanded cohort from the International Stroke Perfusion Imaging Registry (INSPIRE), this study included patients with EVT and posterior circulation large vessel occlusion (LVO) stroke, recalibrated the optimal CTP hypoperfusion lesion volume cutoff for predicting the early neurologic deterioration (END) and the long-term poor outcome, and explored the efficacy and safety of EVT in patients with high hypoperfusion-volume burden. Methods A total of 193 minor stroke patients with LVO from the updated INSPIRE cohort were included. Among them, 72 patients (37.31%) received EVT and 41 patients (21.24%) had posterior circulation LVO stroke. All patients underwent CTP and received either medical therapy or EVT. The clinical outcomes were END and severe disability or death at 90 d, defined as a modified Rankin Scale (mRS) score of 5-6. Univariate and multivariate Logistic regression analyses were used to identify factors associated with clinical outcomes. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff value of CTP hypoperfusion lesion volume for predicting END and long-term poor outcome. Stratified analyses were further performed to compare clinical outcomes between medical therapy and EVT in patients with different hypoperfusion-volume burdens. Results END occurred in 28 (14.51%) of 193 patients, and severe disability or death at 90 d occurred in 19 (10.38%) of 183 patients. Logistic regression analysis showed that larger hypoperfusion lesion volume at admission was a risk factor for END (OR=1.010, 95%CI: 1.000-1.020; P=0.010). Hypoperfusion lesion volume≥75 ml was a common risk factor for END (OR=4.890, 95%CI: 1.890-12.610; P=0.001) and severe disability or death at 90 d (OR=7.740, 95%CI: 2.290-26.200; P=0.001). ROC curve showed that the area under the curve (AUC) of hypoperfusion lesion volume at admission for predicting END and severe disability or death at 90 d were 0.71 (95%CI: 0.610-0.820, P=0.000) and 0.72 (95%CI: 0.600-0.850, P=0.000), respectively. The optimal cutoff value was 75 ml for both outcomes. Using 75 ml as the threshold, patients were divided into a low hypoperfusion-volume burden group (<75 ml, n=122) and a high hypoperfusion-volume burden group (≥75 ml, n=71). The risk of END in the high hypoperfusion-volume burden group was 4.89 times than that of the low hypoperfusion-volume burden group [28.17% (20/71) vs. 6.56% (8/122), P=0.000], and the risk of severe disability or death at 90 d in the high hypoperfusion-volume burden group was 7.74 times than that of the low hypoperfusion-volume burden group [22.54% (16/71) vs. 2.46% (3/122), P=0.000]. There was no significant difference in the risk of symptomatic intracranial hemorrhage (sICH) in 2 groups (P=0.062). Stratified analysis showed that, regardless of low (<75 ml) or high (≥75 ml) hypoperfusion-volume burden, there were no significant differences between the medical therapy subgroup and the EVT subgroup in the incidence of END, favorable functional outcome at 90 d (mRS score 0-2), or sICH (P>0.05, for all). Conclusions In this expanded cohort including patients undergoing EVT and those with posterior circulation LVO stroke, hypoperfusion lesion volume at admission remained an important predictor of END and long-term poor outcome, defined as severe disability or death at 90 d. The optimal cutoff value was recalibrated to 75 ml. For patients with high hypoperfusion-volume burden (≥75 ml), the benefit-risk balance of EVT should be carefully evaluated. Clinical decision-making should not rely solely on the National Institutes of Health Stroke Scale (NIHSS) score, but should also incorporate CTP hypoperfusion lesion volume for refined risk stratification and avoidance of unnecessary intervention in high-risk patients.
Objective To explore the effect of intensive blood pressure control on the prognosis in patients with acute severe ischemic stroke after revascularization therapy. Methods Total 128 patients with acute severe ischemic stroke treated in North China University of Science and Technology Affiliated Hospital from March 2024 to May 2025 were enrolled. After revascularization therapy, they were randomly divided into 2 groups: 63 patients received intensive blood pressure control with systolic blood pressure (SBP) maintained at 120-139 mmHg, and 65 patients received standard blood pressure control with SBP of 140-180 mmHg. The National Institutes of Health Stroke Scale (NIHSS) was adopted to assess neurological deficit at admission and 1, 7 and 30 d after blood pressure control treatment. The modified Rankin Scale (mRS) was used to evaluate neurological prognosis at 90 d. Meanwhile, the incidence of adverse events within 14 d and 90-day mortality were recorded. Results Intensive blood pressure control group presented lower NIHSS score than standard blood pressure control group (F=10.924, P=0.001). Both groups exhibited prominent changes in NIHSS score before and after intervention (F=4945.477, P=0.000). Compared with baseline level, NIHSS score declined at 1 d (t=9.115, P=0.000; t=6.984, P=0.000), 7 d (t=13.012, P=0.000; t=11.855, P=0.001), and 30 d (t=22.906, P=0.000; t=22.720, P=0.001) in 2 groups. The NIHSS score at 7 d (t=3.577, P=0.000; t=3.413, P=0.001) and 30 d (t=18.149, P=0.000; t=14.893, P=0.000) were lower than those at 1 d in 2 groups. Moreover, the NIHSS score 30 d were significantly lower than those at 7 d in both groups (t=14.700, P=0.000; t=14.338, P=0.001). A higher proportion of patients achieved favorable prognosis with mRS score of 0-2 in intensive blood pressure control group relative to standard blood pressure control group [50.79% (32/63) vs. 32.31% (21/65); χ2=4.506, P=0.034]. No remarkable differences were observed regarding the incidence of adverse events within 14 d and 90-day mortality in 2 groups. Conclusions Controlling SBP at 120-139 mmHg after revascularization therapy in patients with acute severe ischemic stroke contributes to better neurological recovery and clinical prognosis. The incidence of adverse events and mortality were comparable between intensive blood pressure control and standard blood pressure control strategies.
患者 男性,55岁,因头痛、视物模糊2月余,于2017年 7月 12日收入首都医科大学宣武医院急诊科.患者入院前2月余无明显诱因出现头部持续性胀痛,偶有恶心、呕吐,呕吐物为非喷射性少量胃内容物,右眼视物模糊,无复视,伴有睡眠增多,于2017年 6月 8日至我院眼科门诊就诊,眼底照相检查显示视盘水肿(图 1),光学相干断层扫描术(OCT)显示盘周各象限视网膜神经纤维层(RNFL)增厚(表1),荧光素眼底血管造影(FFA)显示动脉早期视盘充盈延迟,晚期荧光渗漏(图2),建议进一步完善相关检查.
Objective To explore the predictive value of preoperative fibrinogen to albumin ratio (FAR) for futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion. Methods Total 226 patients with acute large vessel occlusion who underwent successful mechanical thrombectomy in the Affiliated Hospital of Yangzhou University from January 2020 to October 2023 were enrolled. According to the modified Rankin Scale (mRS) 90d after surgery, they were divided into effective recanalization group (mRS≤2, n=118) and futile recanalization group (mRS≥3, n=108). Univariate and multivariate Logistic regression analyses were used to screen the risk factors for futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of preoperative FAR and its combined index for futile recanalization. Results Logistic regression analysis showed that high admission National Institutes of Health Stroke Scale (NIHSS) score (OR=1.111, 95%CI: 1.030-1.198; P=0.007), high preoperative FAR (OR=1.539, 95%CI: 1.221-1.941; P=0.000), extended Thrombolysis in Cerebral Infarction (eTICI) grade 2b (OR=12.208, 95%CI: 3.363-44.317; P=0.000) and postoperative hemorrhagic transformation (OR=4.286, 95%CI: 1.641-11.197; P=0.003) were risk factors for futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion, while high admission Alberta Stroke Program Early CT Score (ASPECTS; b=-1.243, OR=0.288, 95%CI: 0.157-0.529, P = 0.000) and one stent retriever pass (b=-1.280, OR=0.278, 95%CI: 0.103-0.749; P=0.011) were protective factors for effective recanalization. The ROC curve showed that the area under the curve (AUC) of preoperative FAR was 0.67 (95%CI: 0.590-0.738, P=0.000), with sensitivity was 62.96% and specificity was 66.10%. The AUC of preoperative FAR combined with admission NIHSS and admission ASPECTS was 0.86 (95%CI: 0.804-0.899, P=0.000), with sensitivity was 85.19% and specificity was 72.88%. The combination of the three factors had the highest predictive efficacy for futile recanalization (P=0.000, 0.001, 0.000). Conclusions High preoperative FAR can be used as a predictor of futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion. Patients with preoperative FAR>7.10 should be given more attention. Preoperative FAR combined with admission NIHSS and admission ASPECTS has a high preoperative predictive value for futile recanalization.
Objective To investigate the preliminary experience of a modified neuroendoscopic dual burr-hole sequential approach for third ventriculostomy combined with pineal region tumor biopsy in the treatment of tumor marker-negative pediatric pineal region tumor with obstructive hydrocephalus. Methods and Results The clinical data of 9 children with pineal region tumor and obstructive hydrocephalus admitted to Beijing Tiantan Hospital, Capital Medical University from June 2023 to November 2025 were analyzed. Among them, 4 cases underwent the conventional single burr-hole endoscopic third ventriculostomy (ETV) combined with pineal region tumor biopsy (single burr-hole group), and 5 cases received the modified neuroendoscopic dual burr-hole sequential approach for third ventriculostomy combined with pineal region tumor biopsy (dual burr-hole group). Postoperative evaluation showed: in the single burr-hole group, the mean operative time was 2.79 h, and the pathological diagnostic success rate was 3/4. In the dual burr-hole group, the mean operative time was 2.37h, and the pathological diagnostic success rate was 5/5. Obstructive hydrocephalus was effectively relieved in all patients in both groups. In the single burr-hole group, one case had intraoperative blood loss>100 ml, 3 cases experienced mild forniceal contusion, one case had septum pellucidum vein injury, and one case developed transient postoperative memory decline. No safety events occurred in the dual burr-hole group. Conclusions The modified neuroendoscopic dual burr-hole sequential approach, with its precise anatomical design and excellent visualization, provides a safe, efficient and integrated solution for the treatment of pediatric pineal region tumor with obstructive hydrocephalus. It holds promise as one of the standard surgical approaches for such cases.
Migraine is a common neurological disorder with higher prevalence and recurrence rates. As research into its mechanism progresses, processes such as neurogenic inflammation, cortical spreading depression (CSD), and trigeminovascular system activation were extensively investigated, these mechanisms involve complex interactions among various neurotransmitters and vasoactive substances. However, current studies mainly centered on the quantitative changes in biomarkers within peripheral plasma or specific signaling pathways of circulating factors in migraine patients, while the cerebrospinal fluid microenvironment adjacent to the pathogenic loci remains scarcely explored. A large number of studies have shown that abnormal changes in components in the cerebrospinal fluid microenvironment, such as inorganic ions, proteins, and various signaling molecules like inflammatory factors and neurotransmitters, may trigger migraines. This review aims to systematically delineate the role of cerebrospinal fluid components in migraine, integrating perspectives on ionic homeostasis, signaling mediators, metabolic substrates, and the glymphatic system, it clarifies the association between cerebrospinal fluid alterations and the onset and progression of migraine attacks.
Migraine is a primary headache disorder with pronounced rhythmic characteristics, in which attacks exhibit non-random temporal patterns across circadian, weekly, monthly, and seasonal time scales. These temporal distributions are closely associated with sleep-wake rhythms, neuroendocrine fluctuations, and environmental light exposure, highlighting a critical role of biological rhythms in modulating migraine susceptibility. The suprachiasmatic nucleus (SCN), as the central circadian clock, may play a pivotal role in the dynamic modulation of migraine threshold through its rhythmic regulation of sleep, neuroendocrine, and immune-inflammatory processes via the hypothalamic network. From a chronobiological perspective, this review systematically summarizes the rythum patterns of the migraine attacks, temporal distribution variations across different populations, and the underlying neurobiological mechanisms. We focuse on the roles of sleep-wake rhythms, neuroendocrine rhythms, neurovascular and neuroimmune rhythm in lowering migraine attack thresholds. Furthermore, we summarise the research advances and clinical prospects of time-based therapy strategies optimized according to circadian rhythm in migraine management.
Objective To explore the changes in white matter fiber bundles in patients with ischemic stroke after endovascular treatment and their correlation with the degree of neurological dysfunction. Methods A total of 188 patients with cerebrovascular diseases who underwent endovascular treatment at Cangzhou People's Hospital in Hebei Province from January 2020 to February 2023 were included. Two weeks after the operation, the National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of neurological deficit. Diffusion tensor tractography (DTT) was used to obtain the fractional anisotropy (FA) values and the number of white matter fiber bundles in the region of interest (ROI; inferior frontooccipital fasciculus, corticospinal tract, frontopontine tract, cingulum tract and uncinate fasciculus). Pearson and partial correlation analyses were conducted to explore the correlation between the FA values of the white matter fiber tracts in ROI and the degree of neurological deficit and the number of white matter fiber bundles. A generalized linear mixed model was constructed to analyze the relationship between the FA values of the lesion side ROI and the severe neurological deficit and restricted cubic spline model was constructed to analyze the dose-response relationship. Results The patients were divided into a group without neurological deficit (≤1 points, n=83) and a group with neurological deficit (>1 points, n=105). According to the degree of neurological deficit, patients were further divided into mild group (2-4 points, n=41), moderate group (5-15 points, n=34), and severe group (>15 points, n=30). 1) The FA values of the inferior frontooccipital fasciculus, corticospinal tract, frontopontine tract, cingulum tract, and uncinate fasciculus on the lesion side were lower in the neurofunctional deficit group than in the group without neurofunctional deficit. Correlation analysis showed that the FA values on the lesion side of the inferior fasciculus frontooccipital, corticospinal tract, frontopontine tract, cingulum tract, and uncinate fasciculus were all negatively correlated with the NIHSS score (P=0.000, for all). 2) There were statistically significant differences in the FA values of the inferior frontooccipital fasciculus, corticospinal tract, frontopontine tract, cingulum tract, and uncinate fasciculus on the lesion side among the mild group, moderate group, and severe group (P=0.000, for all). There were also statistically significant differences in the number of white matter fiber bundles of the inferior frontooccipital fasciculus, corticospinal tract, and frontopontine tract between the moderate group and severe group (P=0.000, for all). Among them, the FA values of the inferior frontooccitital fasciculus (P=0.005, 0.000), corticospinal tract (P=0.000, 0.000), frontopontine tract (P=0.023, 0.000), cingulum tract (P=0.016, 0.000), and uncinate fasciculus (P=0.000, 0.000) on the lesion side were lower in the severe group than in the mild group. The FA values of the inferior frontooccipital fasciculus (P=0.002), corticospinal tract (P=0.050), and cingulum tract (P=0.029) on the lesion side were also lower in the severe group than in the moderate group. Correlation analysis showed that inferior frontooccipital fasciculus, corticospinal tract, frontopontine tract, cingulum tract, uncinate fasciculus was positively correlated with the number of nerve fibers (P=0.000, for all). 3) The generalized linear mixed model indicated that the FA values on the lesion side of inferior frontooccipital fasciculus (OR=1.172, 95%CI: 1.081-1.228; P=0.034), corticospinal tract (OR=1.116, 95%CI: 1.021-1.854; P=0.006), and uncinate fasciculus (OR=1.308, 95%CI: 1.138-1.468; P=0.007) were risk factors for severe neurological deficit. The restricted cubic spline model revealed that for patients with severe neurological deficit, the FA values on the lesion side of the inferior frontooccipital fasciculus, corticospinal tract, frontopontine tract, the cingulum tract, and uncinate fasciculus showed a non-linear negative correlation with the risk of severe neurological deficit (P=0.000, for all). The risk of severe neurological deficit increased as the FA values decreased. Conclusions Patients with cerebrovascular diseases have structural changes in the white matter fiber bundles on the lesion side, including the inferior frontooccipital fasciculus, corticospinal tract, frontopontine fasciculus, cingulum tract and uncinate fasciculus. These changes are related to the severity of neurological dysfunction. The FA values and the number of nerve fibers may become early predictive indicators for neurological dysfunction in patients with ischemic stroke.
Migraine is a common and highly disabling primary headache, imposing a heavy disease and economic burden worldwide. Although various traditional oral prophylactic medications exist, their limited efficacy and frequent adverse reactions lead to poor patient adherence, resulting in a large unmet clinical need. Calcitonin gene-related peptide (CGRP) plays a core role in the initiation and development of migraine, and monoclonal antibodies targeting the CGRP pathway offer a novel option for migraine prophylaxis. This review aims to systematically summarize the latest research advances of anti-CGRP and anti-CGRP receptor monoclonal antibodies in the preventive treatment of migraine, covering their mechanisms of action, key clinical trial evidence, real-world applications, safety profiles, and health economic value, so as to provide clinicians and related professionals with a comprehensive, up-to-date evidence-based reference.
