Neuroprognostication after cardiac arrest (CA) is critical for guiding treatment decisions. However, concerns about self-fulfilling prophecy related to withdrawal of life-sustaining therapy (WLST) complicate outcome prediction. This study evaluated the accuracy of guideline-recommended prognostic markers within 14 days after CA for predicting poor 12-month outcomes in patients without WLST during the first four weeks after CA. This prospective multicenter observational study enrolled adults who remained comatose 72 h after CA across eight German hospitals between 2014 and 2017. Patients with WLST during the first four weeks, stroke, pre-existing disorders of consciousness, or terminal malignancy were excluded, leaving 101 patients for analysis. Prognostic markers assessed included pupillary light and corneal reflexes (PLR + CR), EEG, somatosensory evoked potentials (SEP), neuron-specific enolase (NSE) concentration, and the best Coma Recovery Scale–Revised (CRS-R) score. Poor outcome was defined as a modified Rankin Scale score of 4–6 at 12 months. Poor outcomes occurred in 67.3

Die Beurteilung des Affekts erfolgt bei erhaltener Kommunikationsfähigkeit durch psychometrische Testverfahren bzw. im Rahmen einer strukturierten Anamnese, jedoch kann eine Objektivierung je nach Krankheitsbild eingeschränkt sein. In unserer Studie sollten daher Affekte mit Elektroenzephalografie (EEG) und KI (Künstliche Intelligenz)-gestützter Auswertung untersucht werden. 14 gesunde Probanden wurden nach Ableitung eines Ruhe-EEGs akustischen emotionalen Stimuli ausgesetzt und währenddessen ein EEG aufgezeichnet. Anschließend erfolgte eine emotionale Selbstauskunft mithilfe einer 5-stufigen Likert-Skala. Als emotionale Stimuli wurden jeweils drei Audioclips verwendet mit bis zu vier Valenzkategorien. Nachfolgend wurden die Veränderungen in den neurologischen EEG-Signalen in Zusammenhang mit der Selbstauskunft mithilfe von künstlichen, neuronalen Netzwerken bzw. hybriden neuronalen Netzwerken klassifiziert und mit einer Vorhersagewahrscheinlichkeit (Accuracy) bestätigt. Durch die Verwendung eines aktuellen, am Stand der Technik orientierten, CNN-Netzwerks konnten Affekte mit bis zu 90% Accuracy im EEG suffizient detektiert werden. Angesichts der hohen Erkennungsrate durch Auswertung künstlicher neuronaler Netzwerke und des einfachen Versuchsaufbaus eröffnet sich großes Potenzial für zukünftige klinische Anwendungen, die eine individuelle Analyse und Beurteilung des Affekts anhand von EEG-Daten bei Patienten ermöglichen.

Background:Non-ischemic cerebral enhancing (NICE) lesions are a rare complication following endovascular therapy (EVT) for cerebral aneurysms. Although first described in 2008, data on long-term outcome and treatment response remain limited. Objectives:In this study, we investigated the long-term follow-up of patients with NICE lesions, including magnetic resonance imaging (MRI) findings, clinical course, and treatment. Design:For this single-center ambispective observational study, we enrolled nine patients with NICE lesions after EVT for cerebral aneurysms. Methods:We analyzed patients diagnosed with NICE lesions following EVT between 2008 and 2024 at the University Hospital of Augsburg. Data collection included patients' and procedural characteristics, clinical course, MRI findings, and response to immunotherapies. Results:We present the long-term follow-up of five patients already published and four additional cases. Nine female patients (mean age at diagnosis 50.67 ± 11.82 (± standard deviation, SD) years) were identified and analyzed with a mean follow-up of 1659.44 ± 1426.87 (SD) days, ranging from 328 to 5223 days (cumulative follow-up of 40.92 patient-years). In total, 112 MRIs were available for evaluation. Eight patients developed symptoms at a mean of 11 ± 13.41 (SD) days post-EVT, one patient remained asymptomatic. New NICE lesions during follow-up were detected in six patients, five patients developed new or increasing symptoms. All patients received glucocorticosteroids with variable duration, six patients required additional immunotherapies. At final follow-up, all patients had a favorable outcome (modified Rankin Scale 0-1), though residual symptoms persisted in four of them. Conclusion:Hitherto, this study presents the longest follow-up period of patients developing NICE lesions after EVT. NICE lesions may have a highly variable course regarding radiological and clinical characteristics, with potential for both clinical and radiological recurrence years after initial presentation. While immunosuppressive therapy appears effective, optimal treatment regimens and duration have yet to be determined. Our findings underline the importance of regular clinical and MRI controls for individual patient care in this rare condition.

Global cerebral ischemia (GCI) following cardiac arrest (CA) is often associated with a poor prognosis and longterm disorders of consciousness. Bilateral absence of cortical responses of the median nerve somatosensory evoked potentials (SSEP) is believed to predict poor outcome with almost 100 % specificity [1–4]. We report a case of a patient with good outcome despite repeatedly absent cortical SSEP responses and without hypothermia. A 16-year-old student suffered CA while playing soccer. Cardiopulmonary resuscitation began within 3 min. Initial rhythm analysis showed ventricular fibrillation (VF, Fig. 1a). Both pupils were dilated and unresponsive to light. After 25 min of resuscitation, stable cardiac output was reestablished and he was admitted to an intensive care unit. Despite the lack of sedative drugs, he was comatose. The GCS motor score was three and pupils were reactive to light. Because of aspiration pneumonia, the patient was ventilated and sedation was started with propofol, midazolam, and fentanyl for 48 h. Hypothermia was not induced, because this was only optional for children according to the 2005 European resuscitation council guidelines [5]. Neurological assessment after 72 h (with no sedation for the last 24) revealed a GCS of 5 (E1V1M3). At this time, median nerve SSEP were conducted in a specialized neurophysiology lab ([3000 recordings/year). N20 cortical responses were bilaterally absent (Fig. 1b). The EEG showed severe encephalopathy. Serum markers for neuronal damage were not examined. A brain CT scan after 96 h showed slight brain edema and obscuration of the caudate nucleus head (Fig. 1c). Based on the lack of arousal and the unfavourable SSEP results, the parents were informed about the diagnosis of severe GCI and the nearly inevitable poor prognosis. Because of a myoclonic status of the diaphragm, he was treated with repeated single doses of barbiturates and muscle relaxants on days 4–7. Sedation was discontinued on day 7, but again the patient failed to recover consciousness. On day 9, SSEP were repeated and again showed no signs of cortical N20 responses. He was extubated on day 12. On day 27, he was transferred to a specialized neurorehabilitation center in the minimally conscious state. He remained in inpatient rehabilitation for 7 months with constant improvement of neurological function. He was able to leave the rehabilitation facility on foot together with his mother (Fig. 1d). 3 years after cardiac arrest, the patient now lives at home with his parents (Barthel index 90/100 points). He rates his quality of life as 65 % (EuroQol, ranging from 0 to 100 %). Dysarthria and fine motor control problems are his biggest limitations on participation in life. A mutation in the SCN5A-gene was A. Bender (&) K. Howell M. Frey Department of Neurology, Therapiezentrum Burgau, Dr.-Friedl-Str. 1, 89331 Burgau, Germany e-mail: andreas.bender@med.uni-muenchen.de

Lewis-Sumner syndrome (LSS, synonymous multifocal acquired demyelinating sensory and motor neuropathy, MADSAM) is a dysimmune peripheral neuropathy responding to corticosteroids and intravenous immunoglobulins (IVIG) in the majority of patients. We report on the long term treatment (37 and 46months respectively) of two LSS patients, who had initially responded to IVIG, with subcutaneous immunoglobulins (SCIg). Both were switched to SCIg since stabilization by IVIG could only be achieved with short treatment intervals, and one of them also suffered from recurrent transient ischemic attacks (TIAs) following IVIG related increased blood viscosity. Long-term use of SCIg was safe and well tolerated. Both patients were clinically stable with only mild to moderate fluctuations requiring SCIg dosage adaptions. No further ischemic events occurred, when the patient was switched to SCIg.