RATIONALE AND OBJECTIVES:Inflammation plays a crucial role in the pathophysiology of intracranial aneurysms (IAs). Our previous research demonstrated that blood inflammatory indices can serve as predictors of aneurysmal wall enhancement (AWE), which signifies the presence of inflammation within the aneurysmal wall and functions as an imaging biomarker for IA instability. Here, we aimed to further examine the relationship between blood inflammatory indices, AWE, and long-term clinical outcomes in patients with intracranial fusiform aneurysms (IFAs). MATERIALS AND METHODS:We reviewed patients with IFAs who underwent high-resolution magnetic resonance imaging and blood laboratory tests, as recorded in our maintained database. Initially, a cross-sectional study was conducted to identify potential blood inflammatory indices that could predict the average value of aneurysmal wall enhancement in three dimensions (3D-AWEavg). Subsequently, a follow-up study was performed to further elucidate the potential predictors associated with overall poor outcomes (CAO) in the same cohort. RESULTS:A total of 92 patients were included in the cross-sectional study. Both the systemic inflammation response index (SIRI), the systemic immune-inflammation index (SII), and the neutrophil-to-lymphocyte ratio (NLR) were associated with 3D-AWEavg in univariate analysis; however, only SIRI was found to independently predict 3D-AWEavg (P = 1.1 × 10-5). In the follow-up study, 64 patients were included, with a mean follow-up period of 29.27 months. SIRI (13.725 [2.467-76.349], P = .003) and 3D-AWEavg (5.387 [1.320-21.988], P = .019) were identified as the predictors of CAO in patients with IFAs. Furthermore, patients with a high SIRI value (≥0.725 × 109/L, log-rank = 0.002) or a 3D-AWEavg ≥ 0.604 (log-rank = 3 × 10-5) had significantly higher risk of CAO. CONCLUSION:SIRI predicts both aneurysmal wall enhancement and long-term adverse outcomes in patients with IFAs, supporting its potential role as a novel biomarker for risk stratification and clinical decision-making in this population.

ABSTRACT Background and Purpose Although stroke survivors are known to have an increased risk of chronic balance dysfunction and falls, prospective studies focusing on long‐term fall risk in mild stroke patients—especially those with acute vestibular symptoms—remain limited. This prospective study aimed to longitudinally characterize vestibular symptom resolution patterns within 1 year in minor stroke patients and identify predictors of the long‐term risk of falls or fear of falling (FoF). Methods This prospective observational study recruited 242 patients with acute minor stroke presenting vestibular symptoms between September 2021 and December 2022. Vestibular symptom progression was systematically assessed at discharge, 3, 6, and 12 months poststroke. Functional outcomes were quantified using the modified Rankin Scale (mRS), while balance confidence and psychological status were evaluated with standardized instruments at each follow‐up. Longitudinal analysis tracked vestibular symptom evolution over 12 months. Multivariable logistic regression identified independent predictors of falls and FoF. Results Among 242 minor stroke patients with acute vestibular symptoms, symptom persistence rates progressively declined from 56.20% at discharge to 30.99% at 3 months, 26.45% at 6 months, and 16.12% at 1‐year follow‐up. Multivariable regression revealed that a total small vessel disease (SVD) score ≥ 2 (odds ratios [OR] = 5.106, 95% confidence intervals [CI]: 1.747–14.921, p = 0.003) independently predicted 1‐year fall risk. Notably, both persistent vestibular symptomsnd the presence of anxiety/depression poststroke were significantly associated with increased risks of falls and FoF. Conclusion Vestibular symptoms resolution in minor stroke follows a biphasic trajectory, with rapid early improvement and slower late recovery. Importantly, temporal lobe involvement, SVD score ≥ 2, persistent vestibular symptoms, and anxiety/depression are independent predictors of long‐term fall risk. The findings highlight the clinical value of early SVD marker identification and regular monitoring of both vestibular function and emotional status.

ObjectiveTo explore the incidence, risk factors, and comorbidities of persistent postural-perceptual dizziness (PPPD) after stroke.MethodsPatients with acute stroke and vestibular symptoms were enrolled prospectively and continuously. Baseline information, risk factors, imaging materials, and diagnosis were collected. PPPD, anxiety, depression, and quality of life were followed up in 6 months after stroke. Binary logistic regression was used to identify the risk factors of PPPD.ResultsIn this study, 284 patients (82.0% of males) were enrolled, with a mean age of 56.33 ± 11.87 years. Thirty-five patients (12.3%) had PPPD in 6-month follow-up. Patients with PPPD had a higher proportion of clinically significant anxiety and clinically significant depression and a lower three-level five-dimension EuroQol (EQ-5D-3L) index. Binary logistic regression analysis identified medulla oblongata stroke (OR, 5.549; p < .001), cerebellar stroke in posterior inferior cerebellar artery (PICA) territory (OR, 2.449; p = .026), and clinically significant anxiety at discharge (OR, 5.030; p < .001) were significant predictors for PPPD.ConclusionsAbout 12.3% of stroke patients with vestibular symptoms developed PPPD at 6 months after stroke, with a higher prevalence of psychological comorbidities and decreased quality of life. Medulla oblongata lesion, cerebellar (PICA territory) lesion, and clinically significant anxiety at discharge were independent risk factors for PPPD.

Background: Posterior circulation infarction (PCI) is the most common manifestation of vertebrobasilar dolichoectasia (VBD). Vessel wall enhancement (VWE) in high-resolution magnetic resonance imaging (HR-MRI) is associated with ischemic stroke. Objectives: This study aims to evaluate different quantitative VWE parameters in identifying PCI in VBD patients by comparing the sensitivity of each VWE parameter. The associated factors of PCI and VWE were also identified. Methods: Patients with VBD who received HR-MRI were retrospectively analyzed and divided into PCI and non-PCI groups. Morphological parameters of VBD were measured using magnetic resonance angiography. VWE parameters, including arterial-to-pituitary stalk contrast ratio (CRstalk), arterial enhancement index, and arterial enhancement ratio, were extracted and calculated. The receiver-operating characteristic curve was used to compare the sensitivity of VWE parameters in discriminating PCI. The independent factors associated with PCI and VWE were investigated. Results: A total of 140 patients with VBD were included. Forty patients (28.6 %) had PCI. CRstalk with the average signal intensity (CRstalk-avg) had the highest sensitivity in identifying PCI with an area under curve value of 0.783 and a cut-off value of 0.47. CRstalk-avg (OR = 2.908, p < 0.001) and basilar artery tortuosity index (BATI) (OR = 1.391, p = 0.033) were independently associated with PCI. The independent associated factors of VWE were BA diameter (OR = 4.273, p < 0.001), BATI (OR = 1.040, p = 0.032), and hyperlipidemia (OR = 3.040, p = 0.018). Conclusion: CRstalk-avg may be the most sensitive parameter for quantifying VWE to identify PCI in patients with VBD, and it is also independently associated with PCI. BA diameter, BATI, and hyperlipidemia are independently associated with VWE.

ABSTRACTBackground and PurposeBasilar artery (BA) tortuosity is closely associated with posterior circulation infarction (PCI) and dizziness/unsteadiness. This study aims to determine the relationship between BA tortuosity and the outcome of dizziness and unsteadiness in PCI patients.MethodThis study prospectively recruited PCI patients presenting with dizziness and unsteadiness. BA tortuosity was diagnosed based on Smoker's criteria. The BA tortuosity index (BATI) was measured from magnetic resonance angiography (MRA) images. Posterior circulation was divided into proximal (medulla oblongata and posterior inferior cerebellar), middle, and distal territories. Symptoms, risk of falls, and quality of life were followed up in 3 months after stroke. Logistic regression was used to identify possible factors associated with the persistence of dizziness and unsteadiness.ResultsAmong 182 PCI patients presenting with dizziness and unsteadiness, 97 (53.3%) had BA tortuosity, including 19 (10.4%) with moderate‐to‐severe BA tortuosity. At the 3‐month follow‐up, 58 (31.9%) patients continued to experience dizziness and unsteadiness, with significantly decreased quality of life and a high risk of falls. Binary logistic regression analysis identified moderate‐to‐severe BA tortuosity (OR, 4.474; 95% CI, 1.591–12.579; p = 0.004) and lesions involving the proximal posterior circulation territory (OR, 2.146; 95% CI, 1.097–4.199; p = 0.026) as risk factors for persistent dizziness and unsteadiness after PCI, while thrombolysis (OR, 0.280; 95% CI, 0.079–0.992; p = 0.049) as a protective factor. BATI (OR, 1.072; 95% CI, 1.028–1.119; p = 0.001) was also independently associated with dizziness and unsteadiness after PCI.ConclusionProminent BA tortuosity increases the risk of persistent dizziness and unsteadiness after PCI, leading to a high risk of falls and decreased quality of life. This warrants more attention in clinical practice.

This study aims to develop a reliable predictive model for assessing intracranial aneurysm (IA) instability by utilizing four-dimensional flow magnetic resonance imaging (4D-Flow MRI) and high-resolution MRI (HR-MRI). Initially, we curated a prospective dataset, dubbed the primary cohort, by aggregating patient data that was consecutively enrolled across two centers from November 2018 to November 2021. Unstable aneurysms were defined as those with symptoms, morphological change or ruptured during follow-up periods. We introduce a specialized ensemble learning framework, termed the Hybrid Model, which synergistically combines two heterogeneous base learning algorithms: 4D-Flow logistic regression (4D-Flow-LR) and Multi-crop Attention Branch Network (MicroAB-Net). The ability of the hybrid model to predict aneurysm instability was compared with baseline models: PHASES (population, hypertension, age, size, earlier rupture, and site) LR, ELAPSS (earlier subarachnoid hemorrhage, location, age, population, size, and shape) LR, aneurysm wall enhancement (AWE) LR, and Radiomics using the area under the curve (AUC) with Delong's test. Finally, the Hybrid Model was further validated in the validation cohort (patients enrolled between December 2021 to May 2022). In the primary cohort, 189 patients (144 women [76.2 ​%]; aged 58.90 years ​± ​10.32) with 213 IAs were included. In the validation cohort, 48 patients (35 women [72.9 ​%]; aged 55.0 years ​± ​10.77) with 53 IAs were included. The Hybrid Model achieved the highest performance both in the primary cohort (AUC ​= ​0.854) and the validation cohort (AUC ​= ​0.876). The Hybrid model provided a promising prediction of aneurysm instability.

目的 探索性研究伴前庭症状的急性轻型卒中患者卒中后6个月焦虑抑郁状态的危险因素及神经功能恢复情况.方法 前瞻性连续收集2020年9月—2022年9月首都医科大学附属北京天坛医院神经内科住院患者中伴发前庭症状的急性轻型卒中患者的人口学信息、卒中危险因素、发病前mRS评分、入院时NIHSS评分、卒中类型和部位.评估住院期间及卒中后6个月HAMA和HAMD评分.根据卒中后6个月HAMA和HAMD评估结果将患者分为焦虑抑郁组和非焦虑抑郁组,采用二元logistic回归分析影响患者卒中后6个月焦虑抑郁状态的危险因素,同时随访mRS以评估神经功能恢复情况.结果 共纳入患者230例,平均年龄(56.2±11.9)岁,全部患者发病6个月均预后良好(mRS评分<2分).卒中后6个月时30例患者(13.0％)存在焦虑和(或)抑郁状态.二元logistic回归分析结果显示,住院期存在焦虑和(或)抑郁状态(OR 3.734,95％CI 1.659～8.400,P=0.001)是卒中后6个月存在焦虑和(或)抑郁状态的危险因素.结论 伴前庭症状的急性轻型卒中患者整体神经功能预后良好,住院期间存在焦虑和(或)抑郁状态的患者更易在卒中后6个月继发焦虑和(或)抑郁状态.

目的 探讨急性轻型卒中患者出现卒中相关前庭症状的临床特征、演变规律,分析其持续存在的危险因素.方法 前瞻性连续纳入2020年9月-2021年9月首都医科大学附属北京天坛医院神经病学中心发病7?d内,存在前庭症状的急性轻型(NIHSS<6分)卒中(包括缺血性卒中和脑出血)住院患者,收集基线人口学信息、症状、既往史、影像学信息、入院NIHSS、最终诊断等资料.入院时采用汉密尔顿焦虑量表和汉密尔顿抑郁量表评估患者有无焦虑和(或)抑郁状态.在住院期间不同时间点和发病后3个月连续随访患者的前庭症状演变情况,采用二元logistic回归分析卒中后3个月前庭症状持续存在的危险因素.结果 最终纳入完成3个月随访的153例患者,平均年龄55.3±11.6岁,男性占85.0％(130/153).发病时前庭症状以头晕最常见(137/153,89.5％),其次为姿势性症状(107/153,69.9％)和眩晕(67/153,43.8％),前庭-视觉症状最少见(15/153,9.8％),74.5％(114/153)合并有2种或以上前庭症状.卒中后2周50.3％(77/153)的患者前庭症状缓解.卒中后3个月随访时,43例(28.1％)仍存在前庭症状,110例(71.9％)前庭症状已缓解.有前庭症状的患者仍以头晕(38/43,88.4％)和姿势性症状(29/43,67.4％)为主,仅4.6％(2/43)的患者存在眩晕,所有患者均无前庭-视觉症状.单因素分析显示,卒中后3个月前庭症状持续组后循环近段卒中比例高于无前庭症状组(58.1％?vs.?32.7％,P=0.004).二元logistic回归分析显示后循环近段卒中(OR?3.75,95％CI?1.71～8.25,P=0.001)和入院时NIHSS高(OR?1.35,95％CI?1.06～1.73,P=0.017)是患者发病后3个月前庭症状持续存在的独立危险因素.结论 急性轻型卒中患者存在的卒中相关前庭症状以头晕和姿势性症状为主,常为多种症状共存.前庭症状短期恢复情况较好,后循环近段卒中和入院时NIHSS高是卒中后3个月前庭症状持续存在的独立危险因素.

头晕和眩晕等前庭症状是社区人群和急诊科患者就诊的常见主诉,卒中是引起前庭症状的重要原因,而前庭症状的持续存在可能延缓或加重卒中患者其他功能的恢复.此外,患者既往长期存在的或卒中前新发的前庭症状可能影响患者卒中后的神经功能恢复.目前卒中相关前庭症状的临床特点、演变形式和发生机制尚不完全明了,患者的预后,尤其是卒中后持续存在的前庭症状与情绪情感障碍的关系还有待进一步研究.本文首次提出"卒中相关前庭症状"这一概念,围绕卒中事件发生前、中、后三个时期,对其临床特点、演变规律和相应的辅助检查方法的研究现状和进展进行综述.

持续性姿势-知觉性头晕是常见的慢性功能性头晕,既往被冠以多种名称,包括恐惧性姿势性眩晕、空间运动不适、视觉性眩晕和慢性主观性头晕,这代表了神经科、耳鼻喉科和精神科对其在不同阶段的认识.这些疾病既有共同特点,也各有独特之处,目前它们的发病机制尚不明确.近年来,神经影像学技术的发展为进一步探索持续性姿势-知觉性头晕及其相关疾病患者的神经影像学表现和相关的病理生理学机制提供了帮助,有利于这些疾病的早期诊断和治疗.本文将对持续性姿势-知觉性头晕及其相关疾病的脑部结构和功能影像学特点进行综述.