Background This study aimed to develop an automated algorithm to noninvasively distinguish gliomas from other intracranial pathologies, preventing misdiagnosis and ensuring accurate analysis before further glioma assessment.Methods A cohort of 1280 patients with a variety of intracranial pathologies was included. It comprised 218 gliomas (mean age 54.76 +/- 13.74 years; 136 males, 82 females), 514 patients with brain metastases (mean age 59.28 +/- 12.36 years; 228 males, 286 females), 366 patients with inflammatory lesions (mean age 41.94 +/- 14.57 years; 142 males, 224 females), 99 intracerebral hemorrhages (mean age 62.68 +/- 16.64 years; 56 males, 43 females), and 83 meningiomas (mean age 63.99 +/- 13.31 years; 25 males, 58 females). Radiomic features were extracted from fluid-attenuated inversion recovery (FLAIR), contrast-enhanced, and noncontrast T1-weighted MR sequences. Subcohorts, with 80% for training and 20% for testing, were established for model validation. Machine learning models, primarily XGBoost, were trained to distinguish gliomas from other pathologies.Results The study demonstrated promising results in distinguishing gliomas from various intracranial pathologies. The best-performing model consistently achieved high area-under-the-curve (AUC) values, indicating strong discriminatory power across multiple distinctions, including gliomas versus metastases (AUC = 0.96), gliomas versus inflammatory lesions (AUC = 1.0), gliomas versus intracerebral hemorrhages (AUC = 0.99), gliomas versus meningiomas (AUC = 0.98). Additionally, across all these entities, gliomas had an AUC of 0.94.Conclusions The study presents an automated approach that effectively distinguishes gliomas from common intracranial pathologies. This can serve as a quality control upstream to further artificial-intelligence-based genetic analysis of cerebral gliomas.

BACKGROUND:The neuroinflammatory response to aneurysmal subarachnoid hemorrhage (SAH) might have a crucial impact on the burden of disease. We aimed to analyze the behavior of interleukin-6 (IL-6) in cerebrospinal fluid (CSF) during SAH and its relation to complications and outcomes. METHODS:We included consecutive SAH patients with regular CSF IL-6 measurements treated between January 2005 and June 2016 (n = 420). IL-6 levels were recorded every 72 hours (from day 1-3 [d1-3] until day 19-21 [d19-21]). Study endpoints were delayed cerebral infarction (DC-infarction), in-hospital mortality, and unfavorable outcome at 6 months after SAH (modified Rankin scale >3). RESULTS:There was an initial increase of IL-6 on d4-6 (median: 3121 vs. 1467 pg/mL on d1-3), with a gradual decrease over the remaining time. The IL-6 value on d1-3 showed associations with in-hospital mortality and unfavorable outcomes, whereas IL-6 on d4-6 was related to the risk of DC-infarction and in-hospital mortality. According to receiver operating characteristic curves, clinically relevant cutoffs were defined for IL-6 on d1-3 (>2000 pg/mL) and d4-6 (>2500 pg/mL). In multivariate analysis, IL-6 >2000 pg/mL on d1-3 was independently associated with in-hospital mortality (adjusted odds ratio [aOR = 2.67; P = 0.009) and unfavorable outcome (aOR=2.30; P = 0.006). In turn, IL-6 >2500 pg/mL on d4-6 was independently associated with in-hospital mortality (aOR = 2.28; P = 0.017) and DC-infarction (aOR = 1.64; P = 0.044). SAH individuals with angiographic vasospasm showed marked elevation of IL-6 from d1-3 to d4-6 compared to their counterparts without vasospasm (+1770.5 vs. -21 pg/mL; P = 0.02). CONCLUSIONS:Our data confirm the substantial impact of neuroinflammation on SAH. CSF IL-6 values measured during the first week after SAH occurrence present the most valuable outcome predictors.

INTRODUCTION:Understanding sex differences in the clinical presentation of patients with suspected stroke is important to reduce sex-related disparities and improve care. We aimed to characterize presenting symptoms in women and men with suspected stroke evaluated at our comprehensive stroke center. METHODS:This was a retrospective analysis of consecutive patients with suspected stroke treated at the University Hospital Essen between January 2017 and December 2021. Patient characteristics, signs and symptoms as well as final diagnoses in women and men were compared. Logistic regression analysis was performed to assess the association of individual symptoms with a diagnosis of cerebrovascular disease. RESULTS:We included 6,069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2,576/3,022) of women and 88.0% (2,681/3,047) of men (p = 0.002). Aphasia (31.4% vs. 27.7%, p = 0.002), neglect (15.5% vs. 12.8%, p = 0.003), gaze deviation (21.0% vs. 18.8%, p = 0.034), as well as nonfocal symptoms including impairments in consciousness (17.0% vs 14.6%, p = 0.012), orientation (42.5 vs. 36.4%, p < 0.001), and completion of tasks (31.2% vs. 26.0%, p < 0.001) were more common among women. Limb ataxia (8.1% vs. 11.2%, p < 0.001) and dysarthria (44.0% vs. 46.8%, p = 0.030) were less frequent in women. Neglect and gaze deviation were independent positive predictors of cerebrovascular disease in women but not in men. CONCLUSION:Although clinical presentation was similar in both sexes, cortical and nonfocal symptoms were more common among women with suspected stroke. Awareness of sex differences and acknowledgment of the full clinical picture are important to ensure optimal management for women and men with suspected stroke. Our findings might serve as a target for educational programs in order to improve preclinical stroke detection in patients with predominantly nonfocal or subtle symptoms.

Poor-grade aneurysmal subarachnoid hemorrhage (PGASAH) is associated with high mortality and morbidity despite advanced treatments. Accurate prediction of prognosis remains a clinical challenge. This study aimed to identify independent risk factors and develop a predictive nomogram for unfavorable outcomes in PGASAH patients. This retrospective study included 348 PGASAH patients treated between 2003 and 2016. Univariate and multivariate logistic regression analyses were performed to evaluate the association of premorbid conditions, admission aSAH clinical parameters, admission laboratory parameters, and clinical complications with unfavorable outcomes, defined as mRS > 2 at 6 months. Independent predictors were identified, and a nomogram was constructed to assess predictive accuracy and clinical utility. The median age of PGASAH patients was 55.1 years, 64.9% were females. Independent predictors of unfavorable outcomes (mRS > 2) at 6 months included age > 55 years (aOR = 2.44), cardiac valve disease (aOR = 6.50), dilated pupils at admission (aOR = 2.64), early infarction (aOR = 5.56), and delayed cerebral ischemia (aOR = 5.09). The nomogram demonstrated good predictive performance with an AUC of 0.807. Decision curve analysis affirmed its clinical applicability. The intuitive nomogram helps physicians predict PGASAH prognosis at discharge, improving long-term management, optimizing resource allocation, and enhancing patient and family awareness and psychological preparedness. External validation is required for broader clinical use.

ObjectiveThis study aimed to investigate the effects of computer-assisted cognitive training (CACT) on cognitive function and activities of daily living in patients with post-stroke cognitive impairment. Additionally, it aimed to explore the changes in specific cognitive domains before and after treatment.DesignThe study was a double-blind, randomized, controlled trial.SettingIt took place in rehabilitation wards or outpatient clinics.ParticipantsSixty patients with post-stroke cognitive impairment took part in the study.InterventionsParticipants were randomly assigned to either the control (n = 30) or the intervention group (n = 30). Both groups received conventional rehabilitation and cognitive training, and the intervention group additionally received CACT.Main outcome measuresThe primary outcome measures included the Mini-Mental State Examination (MMSE) and event-related potential (ERP) P300 for cognitive function, as well as the modified Barthel Index (MBI) for activities of daily living. Secondary outcomes were the Trail Making Test (TMT), the Symbol-Digit Modalities Test (SDMT), the Auditory Verb Learning Test-Huashan version (AVLT-H), the Boston Naming Test (BNT), and the Clock Drawing Test (CDT), which assessed cognitive function across specific domains.ResultsBoth groups showed significant improvements in MMSE, MBI, amplitude of P300, and latency of P300, with the intervention group demonstrating more pronounced improvements compared to the control group. In terms of specific cognitive domains, the intervention group exhibited greater improvements than the control group in TMT-A, TMT-B, and AVLT-H. Both groups showed improvements in SDMT and BNT, but the differences between the groups were not statistically significant. Additionally, there was no significant improvement in the CDT for either group before and after treatment.ConclusionCACT was found to improve patients’ cognitive function, especially in areas of attention, executive function, and memory. It also effectively improved activities of daily living.

Einleitung Bei lymphatischen und gemischt venös-lymphatischen Malformationen handelt es sich um angeborene Malformationen des Gefäßsystems (nach ISSVA). Die Ätiologie der Malformationen ist aktuell noch unklar. Bei engen anatomischen Nachbarschaften zu funktionell wichtigen Strukturen oder kosmetischen Einschränkungen kann eine Therapie notwendig sein.

There is a growing body of research that suggests conditions during the period of pregnancy and birth can affect how autism spectrum disorder (ASD) presents itself. This study aimed to investigate the incidence of oxygen deprivation during this period known as prenatal and perinatal hypoxic risk (HR) conditions in ASD compared with neurotypical control (NTC) youth. We also examined ventricular morphology variations associated with HR exposure, and to evaluate associations with clinical symptoms. Results from a cohort of 104 youth revealed a higher incidence of exposure to prenatal hypoxic conditions in the ASD group. Additionally, ASD individuals with prenatal hypoxic exposure (ASD + HR) demonstrated larger third ventricle volumes compared with both ASD and NTC individuals without such exposure (ASD-HR and NTC-HR, respectively). Furthermore, associations were identified between prenatal hypoxic exposure, third ventricle volume, sensory dysfunction, and severity of sleep disturbances. These findings suggest exposure to prenatal hypoxic risk conditions may exacerbate or modify the neurodevelopmental trajectory and symptom severity in ASD, emphasizing the need for better prenatal care and specific interventions to reduce these risks.

OBJECTIVE:Despite recent advances in neuro-intensive care, there is still considerable mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). In this long-term monocentric observational cohort study, we aimed to analyze the rates, timing, and predictors of mortality after SAH. METHODS:All consecutive SAH cases treated between January 2003 and June 2016 were included. Patients' demographic characteristics, previous medical history, SAH-related parameters, and available post-treatment follow-up data were collected and evaluated as potential mortality predictors in univariate and multivariate analyses. RESULTS:Of 992 patients, 179 died during the initial treatment and 33 during the follow-up time reaching an overall mortality rate of 21.4 %. Of over 119 tested variables, we identified the following independent predictors in the final multivariate Cox regression analysis: age >55 years (p<0.0001); World Federation of Neurosurgical Societies (WFNS) admission grade IV or V (p=0.025); Hijdra sum score ≥15 points (p=0.003); intracranial pressure (ICP) increase (p<0.0001); and delayed cerebral ischemia (DCI) (p<0.0001). Being exposed to all five risk factors resulted in the case fatality rate of 75 % within a median survival of 14 days, compared to 2.5 % within a median of 1525 days when none of these features were present. CONCLUSIONS:The initial impact of aneurysmal bleeding is amongst the major mortality causes after SAH. Of potentially preventable adverse events, ICP increase and DCI occurring during initial treatment also present eminent clinical relevance for patients' survival in the long-term follow-up. Further ICP and DCI management optimization might help to decrease the mortality rate after SAH.

Background and Objectives: Development of acute coronary syndrome (ACS) after aneurysmal subarachnoid hemorrhage (aSAH) strongly affects further neuro-intensive care management. We aimed to analyze the incidence, risk factors and clinical impact of ACS in aSAH patients. Materials and Methods: This retrospective analysis included 855 aSAH cases treated between 01/2003 and 06/2016. The occurrence of ACS during 3 weeks of aSAH was documented. Patients’ demographic, clinical, radiographic and laboratory characteristics at admission were collected as potential ACS predictors. The association between ACS and the aSAH outcome was analyzed as the occurrence of cerebral infarcts in the computed tomography scans and unfavorable outcome (modified Rankin scale > 3) at 6 months after aSAH. Univariable and multivariable analyses were performed. Results: ACS was documented in 28 cases (3.3%) in the final cohort (mean age: 54.9 years; 67.8% females). In the multivariable analysis, there was a significant association between ACS, an unfavorable outcome (adjusted odds ratio [aOR] = 3.43, p = 0.027) and a borderline significance with cerebral infarcts (aOR = 2.5, p = 0.066). The final prediction model for ACS occurrence included five independent predictors (age > 55 years [1 point], serum sodium < 142 mmol/L [3 points], blood sugar ≥ 170 mg/dL [2 points], serum creatine kinase ≥ 255 U/L [3 points] and gamma-glutamyl transferase ≥ 36 U/L [1 point]) and showed high diagnostic accuracy for ACS prediction (AUC = 0.879). Depending on the cumulative score value, the risk of ACS in the cohort varied between 0% (0 points) and 66.7% (10 points). Conclusions: ACS is a rare, but clinically very relevant, complication of aSAH. The development of ACS can reliably be predicted by the presented prediction model, which enables the early identification of aSAH individuals at high risk for ACS. External validation of the prediction model is mandatory.

OBJECTIVES:To understand the status of screen exposure in children with epilepsy and analyze the influencing factors for screen exposure time, providing a scientific basis for managing screen exposure in these children. METHODS:A convenience sampling method was used to select 275 children with epilepsy from outpatient clinics or those undergoing 24-hour electroencephalogram monitoring at two tertiary hospitals in Jinan from March to June 2023. Their parents (fathers or mothers) completed a questionnaire to collect data on screen exposure, parental screen regulation behaviors, and related information about the children and their families. The Wilcoxon rank-sum test or the Kruskal-Wallis H test was used to conduct a univariate analysis of the average screen exposure time of children on school days and weekends, as well as the daily average screen exposure time. A multivariate logistic regression analysis was used to identify the risk factors for children whose screen exposure time exceeded the recommended guidelines (average screen exposure time on school days >1 hour or average on weekends >2 hours). RESULTS:The median screen exposure duration on school days was 40 minutes, while on weekends it was 120 minutes. Among the children studied, 23.1% (63/273) had average screen exposure time exceeding 1 hour on school days, and 42.5% (117/275) had average screen exposure time exceeding 2 hours on weekends. Four children experienced seizures while using screen devices. Multivariate logistic regression analysis indicated that using screen devices shortly before sleep, lower educational levels of parents, caregivers discussing screen content with children, and longer seizure durations in children were risk factors for exceeding recommended guidelines (P<0.05). CONCLUSIONS:Some children with epilepsy have a screen exposure time exceeding the recommended guidelines. A longer seizure duration, lower parental education levels, and permissive digital parenting are closely associated with children's screen exposure time exceeding the recommended guidelines. Families and children exhibiting these characteristics should be prioritized for attention and health education.

ObjectivesTo establish accurate and objective dermoscopic diagnostic criteria and grading standards for males and females with androgenetic alopecia (AGA).MethodsTwenty patients each with AGA, diffuse alopecia areata, telogen effluvium, and healthy controls were enrolled in the current study. In addition, 60 patients with grades F1/V1, F2/V2, and F3/V3 AGA (20 cases each) were enrolled. The patients underwent dermoscopic examinations. The sensitivity and specificity of the diagnostic criteria were based on the 60 AGA and 60 non-AGA. In addition, 150 patients diagnosed with AGA clinically and by dermoscopy were enrolled to calculate the accuracy of the grading criteria.ResultsThe diagnostic criteria included primary, secondary, and exclusion criteria. The grading criteria included three indices, which divided the severity of AGA into grades 1, 2, and 3. The sensitivity and specificity of the diagnostic criteria were 98.3% and 96.7% respectively. The accuracy of grade 1, 2, and 3 dermoscopic grading criteria were 96%, 92%, and 100% respectively, with a total accuracy of 96%.LimitationsTo test the diagnostic and grading criteria, more patients need to be collected.ConclusionsThe dermoscopic diagnostic and grading criteria are objective with good accuracy, which could provide a reasonable basis for the early diagnosis, grading treatment, and improved prognosis for AGA.

Although previous studies have demonstrated that transcranial focused ultrasound stimulation protects the ischemic brain,clear criteria for the stimulation time window and intensity are lacking.Electrical impedance tomography enables real-time monitoring of changes in cerebral blood perfusion within the ischemic brain,but investigating the feasibility of using this method to assess post-stroke rehabilitation in vivo remains critical.In this study,ischemic stroke was induced in rats through middle cerebral artery occlusion surgery.Transcranial focused ultrasound stimulation was used to treat the rat model of ischemia,and electrical impedance tomography was used to measure impedance during both the acute stage of ischemia and the rehabilitation stage following the stimulation.Electrical impedance tomography results indicated that cere bral impedance increased after the onset of ischemia and decreased following transcranial focused ultrasound stimulation.Furthermore,the stimulation promoted motor function recovery,reduced cerebral infarction volume in the rat model of ischemic stroke,and induced the expression of brain-derived neurotrophic factor in the ischemic brain.Our results also revealed a significant correlation between the impedance of the ischemic brain post-intervention and improvements in behavioral scores and infarct volume.This study shows that daily administration of transcranial focused ultrasound stimulation for 20 minutes to the ischemic hemisphere 24 hours after cerebral ischemia enhanced motor recovery in a rat model of ischemia.Additionally,our findings indicate that electrical impedance tomography can serve as a valuable tool for quantitatively evaluating rehabilitation after ischemic stroke in vivo.These findings suggest the feasibility of using impedance data collected via electrical impedance tomography to clinically assess the effects of rehabilitatory interventions for patients with ischemic stroke.

ABSTRACT Objective The size of unruptured intracranial aneurysms (UIA) remains the most crucial risk factor for treatment decisions. On the other side, there is a non‐negligible portion of small ruptured IA and large stable UIA. This study aimed to identify the patients' characteristics related to IA size in the context of IA rupture status. Methods A total of 2152 patients, with 1002 being hospitalized for an acute aneurysmal subarachnoid hemorrhage (SAH), were included from our institutional IA database. Different demographic and clinical characteristics of patients and IA were collected. IA size was the study endpoint, assessed as continuous variable in univariate and multivariable linear regression analysis, separately for ruptured (R) IA and UIA. Results The mean IA size was 8.3 and 7.3 mm in the UIA and RIA subpopulations, respectively. Higher age (p = 0.003) and baseline blood urea level (p < 0.001) were independently associated with increasing UIA size. In contrast, location at the posterior circulation (p < 0.001), familiar intracranial aneurysms (p < 0.001), serum potassium (p = 0.006), and total serum protein (p = 0.019) were related to smaller UIA size in the multivariate analysis. For RIA, a statistically significant and independent association was detected for location (p = 0.019), history of gastrointestinal diseases (p = 0.042), and levothyroxine intake (p = 0.002). Conclusions Identification of clinical characteristics related to the size of ruptured and unruptured IA allows a more differentiated view on the genesis of RIA and UIA and the value of sack size as a basis for therapeutic decision‐making. More research is needed to verify the identified risk factors.

Objective: This study aims to facilitate the translation of innovative closed-loop deep brain stimulation (DBS) strategies from theory to practice by establishing a research platform. The platform addresses the challenges of real-time stimulation artifact removal, low-latency feedback stimulation, and rapid translation from animal to clinical experiments. Materials and Methods: The platform comprises hardware for neural sensing and stimulation, a closed-loop software framework for real-time data streaming and computation, and an algorithm library for implementing closed-loop DBS strategies. The platform integrates hardware for both animal and clinical research. The closed-loop software framework handles the entire closed-loop stimulation, including data streaming, stimulation artifact removal, preprocessing, a closed-loop stimulation strategy, and stimulation control. It provides a unified programming interface for both C/C++ and Python, enabling secondary development to integrate new closed-loop stimulation strategies. Additionally, the platform includes an algorithm library with signal processing and machine learning methods to facilitate the development of new closed-loop DBS strategies. Results: The platform can achieve low-latency feedback stimulation control with response times of 6.23 +/- 0.85 ms and 6.95 +/- 1.11 ms for animal and clinical experiments, respectively. It effectively removed stimulation artifacts and demonstrated flexibility in implementing new closed-loop DBS algorithms. The platform has integrated several typical closed-loop protocols, including threshold-adaptive DBS, amplitude-modulation DBS, dual-threshold DBS and neural state-dependent DBS. Conclusions: This work provides a research tool for rapidly deploying innovative closed-loop strategies for translational research in both animal and clinical studies. The platform's capabilities in real-time data processing and low-latency control represent a significant advancement in translational DBS research, with potential implications for the development of more effective therapeutic interventions.

Objective:Recurrent intracerebral hemorrhage (ICH) poses a high risk for patients with cerebral cavernous malformations (CCMs). This study aimed to assess the influence of medication intake on hemorrhage risk in sporadic CCMs. Methods:From a database of 1,409 consecutive patients with CCM (2003-2021), subjects with sporadic CCMs and complete magnetic resonance imaging data were included. We evaluated the presence of ICH as a mode of presentation, the occurrence of ICH during follow-up, and medication intake, including beta blockers, statins, antithrombotic therapy, and thyroid hormones. The impact of medication intake on ICH at presentation was calculated using univariate and multivariate logistic regression with age and sex adjustment. The longitudinal cumulative 5-year risk for (re-)hemorrhage was analyzed using the Kaplan-Meier curves and the Cox regression analysis. Results:A total of 1116 patients with CCM were included. Logistic regression analysis showed a significant correlation (OR: 0.520, 95% CI: 0.284-0.951, p = 0.034) between antithrombotic therapy and ICH as a mode of presentation. Cox regression analysis revealed no significant correlation between medication intake and occurrence of (re-)hemorrhage (hazard ratios: betablockers 1.270 [95% CI: 0.703-2.293], statins 0.543 [95% CI: 0.194-1.526], antithrombotic therapy 0.507 [95% CI: 0.182-1.410], and thyroid hormones 0.834 [95% CI: 0.378-1.839]). Conclusion:In this observational study, antithrombotic treatment was associated with the tendency to a lower rate of ICH as a mode of presentation in a large cohort of patients with sporadic CCM. Intake of beta blockers, statins, and thyroid hormones had no effect on hemorrhage as a mode of presentation. During the 5-year follow-up period, none of the drugs affected the further risk of (re-)hemorrhage.