Anti-SEZ6L2 antibody-associated autoimmune encephalitis is a rare immune-mediated disorder characterized predominantly by progressive cerebellar ataxia. Due to its rarity and variable presentation, it remains under-recognized and is frequently misdiagnosed as cerebrovascular or neurodegenerative disease. We report a 53-year-old female who developed subacute dysarthria and progressive gait ataxia over several weeks in December 2024. Despite the absence of acute infarction on initial imaging, the presence of a patent foramen ovale (PFO) led to a presumptive diagnosis of embolic cerebral infarction at a local hospital. She received antiplatelet therapy and underwent PFO closure without clinical benefit. Upon transfer to our hospital, neurological examination revealed scanning speech, bilateral limb ataxia, mild left central facial weakness, positive bilateral Hoffmann signs, and a positive Romberg sign. Neurophysiology demonstrated brainstem and somatosensory pathway dysfunction. Serum and CSF anti-SEZ6L2 antibodies were positive (1:1000 and 1:100, respectively). The patient had a history of cervical carcinoma treated with surgery and chemoradiotherapy 11 years earlier, with no evidence of recurrence. She was treated with double-filtration plasmapheresis, mycophenolate mofetil, and rituximab, with stabilization of symptoms but residual deficits. We also conducted a narrative literature review and summarized the clinical features of 24 previously reported cases. This case illustrates that anti-SEZ6L2 antibody-associated encephalitis can be misdiagnosed as cerebral infarction, particularly when PFO is present. A careful history of symptom progression, absence of acute infarction on MRI, and lack of response to stroke therapy should prompt early autoimmune antibody testing. Diagnosis requires integration of clinical phenotype, antibody testing, and exclusion of alternative causes. Further studies are needed to establish standardized treatment protocols.
Ultrasonography is a practical, non-invasive method for assessing skeletal muscle morphology after stroke. Reliable measurement of finger flexor muscle thickness is essential for monitoring structural muscle changes associated with chronic spastic paresis and rehabilitation. This study investigated the intra-rater reliability, measurement error, and agreement of ultrasonographic measurements of the flexor digitorum superficialis and flexor digitorum profundus in individuals with chronic ischemic stroke. Twenty-four individuals with chronic ischemic stroke underwent two ultrasound examinations of finger flexor muscles performed by the same examiner 24 h apart. Intra-rater reliability was assessed using the two-way mixed-effects, single-measure intraclass correlation coefficient (2,1) with 95
Multiple sclerosis (MS) is the most common inflammatory neurological disease among young and middle-aged adults. Although there is no cure, disease-modifying therapies (DMT) have been shown to reduce the number and severity of exacerbations, slow disease progression and improve quality of life. However, the benefits of DMT are hampered due to poor adherence. Thus, this systematic review aims to examine the effects of psychological interventions intended to improve adherence in adults with MS. We searched CENTRAL, MEDLINE, Embase, PsycINFO and other databases and trials registers, screened reference lists to identify studies (last search July 2026). We included randomized controlled trials (RCTs) of interventions based on psychological theories and practice that aimed to improve adherence in people with MS versus usual care, no intervention, placebo treatment or another intervention. Interventions could focus on DMT initiation, re-initiation or improving ongoing adherence. We evaluated the overall certainty of evidence using the GRADE approach. We included five parallel RCTs (529 participants with MS; mean age 45.4 years; 481 female). We found some evidence that, in the short term, motivational interventions may reduce DMT discontinuation in those taking DMT and may increase reinititation of DMT in those who have stopped taking DMT. However, these findings were based on low certainty evidence so must be interpreted with caution. There was low certainty evidence that at 10-week post-treatment a motivational-interviewing CBT intervention may increase decisions to re-initiate DMT. It was unclear whether a brief MI counseling intervention improved adherence (fewer missed doses) relative to usual care. The main finding of this review is that motivational interventions may reduce, in the short term, DMT discontinuation and may increase reinititation of DMT. Evidence for the efficacy of other psychological approaches on adherence to DMT is uncertain. This conclusion is based on low-certainty evidence and should be interpreted cautiously. In addition, all five included studies were conducted in the USA and in settings that limit their generalizability. Key limitations of the review include the lack of some outcome data in included studies, and no meta-analysis due to the lack of overlap between studies in any of the outcome measures. This review highlights the dearth of studies in this area limiting scope for evidence-based recommendation for practice. There is a need for additional high-quality research to improve confidence in estimates of effect and to evaluate long-term outcomes.
The etiology of ischemic stroke in young adults is complex and requires dynamic reassessment as the disease course evolves. We report an 18-year-old woman with migraine with aura. She initially presented with multiple posterior circulation infarctions and was found to have a patent foramen ovale (PFO) with a moderate right-to-left shunt. The infarctions recurred the day after cervical and cranial manipulation. Within 12 weeks, the condition progressed to severe stenosis and partial occlusion of the V3-V4 segments of the left vertebral artery, the basilar artery, and both posterior cerebral arteries. High-resolution vessel wall imaging (HR-VWI; 3D-VISTA sequence) showed eccentric wall thickening and intramural hematoma, supporting vertebrobasilar artery dissection. After individualized antithrombotic and conservative treatment, wall thickening and luminal stenosis partially improved during 11 months of follow-up, with no new infarction. This case suggests that vascular imaging should be repeated when the clinical course of stroke in a young patient is inconsistent with the initial assessment, with HR-VWI performed when necessary. A single case cannot establish a causal relationship between cervical manipulation and arterial dissection or the efficacy of any specific treatment.
Current classifications of Guillain-Barré syndrome (GBS) cannot adequately predict the prognosis and response to immunotherapy of patients, leading to treatment uncertainty and suboptimal outcomes. This study aimed to establish a novel, data-driven classification to identify clinically distinct GBS subtypes and improve outcome prediction. Clinical, laboratory, and electrodiagnostic data from 155 patients with GBS who underwent plasmapheresis were retrospectively analyzed. A clustering algorithm, mixture model, was applied to identify distinct patient subgroups. Subsequently, a streamlined, interpretable decision tree model was developed using the most crucial features. Three distinct clusters were identified. Cluster 1 (n = 39) represented the most severe presentation, with a median admission GBS disability scale of 5 and the lowest rate of post-treatment independent ambulation at 30 days after symptom onset (12.8
