Neurology Asia

Prevalence of atrial cardiopathy in subtypes of acute ischemic stroke

shishir pandey — 2025-10-06

Background & Objective: Atrial cardiopathy, an abnormal and permanent structural change in atrial tissue, can occur due to inherited factors, exposure to toxins, or cardio-thoracic surgery. Histologically, it may involve myocyte hypertrophy and atrial fibrosis. Atrial electrical remodeling, a consequence of atrial cavity enlargement, leads to irreversible alterations in the density of ion channels, ion currents, and action potential duration. Our study conducted at a single center over 1.5 years examined the prevalence of atrial cardiopathy in different subtypes of acute ischemic stroke.

Methods: We did a prospective observational single-center study over 1.5 years on 110 acute ischemic stroke patients above 18 year who presented to our hospital with first ever ischemic stroke. These patients underwent assessments for vascular risk factors, routine hematological and biochemical parameters, and neuro- radiological analysis necessary for diagnosing the stroke and determining its underlying causes. The stroke subtype of each patient was defined based on the TOAST classification, utilizing clinical data, radiological images, and investigation findings. Atrial cardiopathy was identified by the presence of any of the following criteria: PTFV1 > 5000 μV-ms, NT-proBNP level > 250 pg/ml, or severe left atrial enlargement (≥ 5.2 cm in men or ≥ 4.7 cm in women). The distribution of atrial cardiopathy within each subgroup was analyzed, and conclusions were drawn concerning the study’s aims and objectives. Results &

Conclusion: The indicators of atrial cardiopathy, including atrial diameter, NT-pro BNP level, and PTFV1>5000, were notably higher in the groups with cardio-embolic and undetermined causes compared to the other groups.

Association between erythrocyte and platelet related parameters with the initial severity of acute ischemic stroke

Chen Chen — 2025-10-06

Background & Objective: The purpose of the present study was to evaluate the association between erythrocyte and platelet related parameters with the initial severity of acute ischemic stroke (AIS).

Methods: This observational study included 113 patients with AIS in the 4th Department of Internal Medicine, Xiong’an New District Rongcheng People’s Hospital. Erythrocyte and platelet related parameters including red blood cell distribution width (RDW), hematocrit value (HCT), platelet volume distribution width (PDW), and plateletcrit (PCT) were measured for all patients. In addition, modified Rankin Scale (mRS) was performed to assess the initial severity of AIS for all patients. Ordinal logistic regression analysis was used to investigate the association between the erythrocyte and platelet related parameters with mRS.

Results: RDW was positively and significantly associated with mRS (Estimate = 0.532, P = 0.025, 95% CI: 0.067, 0.997) in patients with AIS.

Conclusion: RDW is associated with the initial severity of AIS.

Blood lipid levels and acute ischemic stroke: A meta-analysis

Yaping Huang — 2025-10-06

Objective: This meta-analysis aims to evaluate the association between lipid profiles and the risk of symptomatic intracerebral hemorrhage (sICH) when using thrombolysis to treat acute ischemic stroke (AIS).

Methods: We included 11 studies from various geographic regions, focusing on patients treated with intravenous thrombolysis. Lipid parameters such as high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides were examined.

Results: While no discernible correlation was found between total cholesterol levels and sICH risk, two studies reported significantly lower LDL levels in patients with sICH. Additionally, lower HDL levels and elevated triglycerides correlated with increased sICH risk in specific studies.

Conclusion: These findings highlight the complex role of lipid profiles in stroke management, particularly in the context of thrombolytic therapy. Sensitivity analyses validated the robustness of the findings, suggesting that lipid management strategies should be individualized for AIS patients to balance ischemic and hemorrhagic risks. Future large-scale randomized trials are warranted to validate these findings.

Different clinical classifications of ischemic stroke may lead to different conclusions

Xin-Lei Mao — 2025-10-06

Objectives: To compare the differences in three ischemic stroke classification systems and their impact on the conclusions of gene polymorphism.

Methods: Prospective analysis of inpatient data of acute ischemic stroke at Wenzhou Central Hospital from May 2022 to December 2022. Patients were classified using the Trial of Org 10172 in acute stroke treatment (TOAST) classification, Korean modified TOAST (KM TOAST) classification, and Chinese ischemic stroke subclassification (CISS). The PAI-1 4G/5G, eNOS G894T, ACE gene I/D and MTHFR Gene C677T loci were detected.

Results: A total of 305 patients were included in this study. In TOAST, KM TOAST, and CISS systems, large- artery atherosclerosis (LAA) subtype accounted for 34.4%, 59.4% and 41.9% correspondingly, small- artery occlusion (SAO) subtype accounted for 37.4%, 21.3% and 26.2% respectively. And the lowest proportion was other definite cause (ODC) (1.3%, 1.3%, 1.3%). There were significant differences among the etiology subtypes of LAA, SAO, and Stroke of undetermined cause (UND). In the four gene loci detected, the genotype distribution of the PAI-1 4G/5G locus was different among the three etiological classification systems.

Conclusions: There are differences in the distribution of subtypes in the three ischemic stroke classification systems. The different etiological classification may have an impact on the conclusion of gene polymorphisms.

Non-Traditional Chinese and non-Ayurvedic complementary and alternative medicine in Southeast Asian post-stroke care: A systematic review

Trishan Manav Sri Ram — 2025-10-06

Background and Purpose: Stroke has a particularly high incidence and mortality in the Association of Southeast Asian Nations (ASEAN) region. Complementary and alternative medicine (CAM) usage is widespread in this region, including Traditional Chinese Medicine (TCM) and Ayurvedic medicine, but also other forms of traditional medicine. This study aims to systematically review the prevalence, type and effectiveness of non-TCM non-Ayurvedic CAM in post-stroke patients in the ASEAN region.

Methods: PubMed, Embase and Scopus databases were searched from inception to 27 July 2024. Studies with patients from the ASEAN region who were diagnosed with stroke and used any CAM that was not TCM or Ayurvedic medicine were included. Two independent authors screened through relevant articles, extracted data and assessed risk of bias.

Results: Sixteen studies from four countries were included. The use of massages, herbs, spiritual and energy healing methods were widely adopted for post-stroke patients in the ASEAN region. Evidence for CAM improving neurological and physical stroke outcomes were limited. Despite this, studies have been largely unanimous in reporting improved psychological and quality of life outcomes following CAM use.

Conclusions: There is a severe paucity of published literature on non-TCM and non-Ayurvedic CAM use in stroke patients in the ASEAN region despite likely widespread use. There is some evidence of potential benefit but these are limited to subjective patient-reported outcomes. More research is needed to understand its impact and how best to complement conventional stroke care without compromising outcomes.

Temporal muscle thickness and clinical outcomes after thrombectomy for internal carotid artery occlusion

Yao-Chung Yang — 2025-10-06

Objectives: Although endovascular thrombectomy (EVT) can help achieve enhanced functional recovery following anterior circulation large-vessel occlusion (ACLVO) stroke, some patients exhibit poor functional outcomes. We assessed the influence of temporal muscle thickness (TMT) on the functional status after 3 months in individuals with ACLVO stroke treated with EVT.

Methods: This retrospective study analysed adult patients with ACLVO stroke who had undergone EVT between August 2017 and July 2023. We collected clinical, radiological, and laboratory data. The primary functional outcome was the modified Rankin scale (mRS) score 3 months after EVT, and the patients were categorised accordingly into unfavorable (mRS 3–6) and favorable (mRS 0–2) outcome groups.

Results: Overall, 96 patients (mean age: 69.5 years; 58% men; admission NIHSS: 18.3±5.5) were enrolled. At 3-month follow-up, 74 (77.1%) patients experienced unfavorable functional outcomes. The mean TMT was significantly lower in the unfavorable outcome group compared to the favorable outcome group (5.32 ± 1.90 mm vs. 6.66 ± 1.51 mm, P = .003). In multivariate analysis, thinner TMT and higher NIHSS at 24-36 h post-EVT were independently associated with unfavorable 3-month functional outcomes. Subgroup analyses revealed that TMT was significantly associated with unfavorable outcomes in elderly patients (age ≥70 years, P = .044), those with Internal Carotid Artery (ICA) occlusion (P = .005), particularly in ICA occlusion patients achieving successful recanalization (P = .034).

Conclusions: Thinner TMT was independently associated with unfavorable 3-month functional outcomes in patients with acute ICA occlusion who had undergone EVT, suggesting its potential value as a prognostic marker.

A prediction model for the risk of gastrointestinal bleeding associated with antiplatelet therapy in patients with ischemic stroke

Ziqiang Yu — 2025-10-06

Objective: Patients with ischemic stroke (IS) undergoing antiplatelet therapy are at risk of gastrointestinal bleeding (GIB). This study aims to develop and validate a multivariable integrated risk prediction model for GIB, to optimize clinical decision-making.

Methods: A retrospective cohort of IS patients who received antiplatelet therapy from 2020 to 2024 was included. Demographic characteristics and laboratory parameters (including complete blood count, coagulation profile, liver and kidney function tests, and stool occult blood) were collected. Predictive factors were selected using LASSO regression and logistic regression, and a nomogram model was constructed. Evaluation metrics included area under the curve (AUC), calibration curve (mean absolute error, MAE), and decision curve analysis (DCA).

Results: Six independent risk factors were identified: C-reactive protein (CRP) (p = 0.003), hemoglobin (HGB) (p < 0.001), D-Dimer (p = 0.039), albumin/globulin ratio (ALB/GLB, p = 0.021), age (p = 0.01), and fibrinogen (FIB, p = 0.037), which collectively drive the risk of GIB. The predictive model demonstrated an AUC of 0.79 in both the training and validation cohorts, with MAE values ranging from 0.018 to 0.04, and a Hosmer-Lemeshow test result of p > 0.05. The model exhibited good fit, strong discrimination capability for GIB, and stable diagnostic performance. Decision curve analysis revealed significant net benefits within the risk threshold range of 0.2-1.

Conclusion: The developed nomogram model effectively predicts the risk of GIB in IS patients undergoing antiplatelet therapy, providing a basis for individualized treatment strategies.

The correlation between inflammatory biomarkers and vascular cognitive impairment in patients with cerebral small vessel disease

chun-ying ou — 2025-10-06

Objective: To investigate the correlation between plasma inflammatory biomarkers MMP-9, Lp-PLA2, IL-6, TNF-α and vascular cognitive impairment in patients with cerebral small vessel disease (CSVD), and to provide theoretical evidence for the early diagnosis and treatment of cognitive impairment in patients with cerebral small vessel disease.

Methods: A total of 400 patients admitted to the Department of Neurology, Xuzhou Central Hospital, for treatment of CSVD from January 2019 to June 2023 were randomly selected. The cognitive function of the patients was assessed using the Montreal Cognitive Assessment (MoCA) scale. Based on the scores, the patients with CSVD were divided into a normal cognition group (n=196) and a cognitive impairment group (n=204). According to the severity of cognitive impairment, the cognitive impairment group was further divided into mild cognitive impairment group (n=100), moderate cognitive impairment group (n=59),and severe cognitive impairment group (n=45). A healthy control group of 100 individuals who underwent physical examinations during the same period was included. The correlation between plasma inflammatory biomarkers MMP-9, Lp-PLA2, IL- 6, TNF-α and vascular cognitive impairment was studied.

Results: Compared with the healthy control group, the levels of smoking, homocysteine (HCY), carotid artery plaque formation, MMP-9, Lp-PLA2, IL-6, TNF-α in the normal cognition group and cognitive impairment group of patients with CSVD were significantly increased, with statistical significance (P<0.05). Moreover, the levels of smoking, HCY, carotid artery plaque formation, MMP-9, Lp-PLA2, IL-6, TNF-α in the cognitive impairment group were higher than those in the normal cognition group, with statistical significance (P<0.05). Multivariate logistic regression analysis showed that after controlling for confounding factors such as smoking, HCY, and carotid artery plaque formation, MMP-9, Lp-PLA2, IL-6, and TNF-α in patients with CSVD were still positively correlated with vascular cognitive impairment (P<0.05) and were independent risk factors. Compared with the mild cognitive impairment group, the levels of plasma MMP-9, Lp-PLA2, IL-6, and TNF-α in patients with moderate and severe cognitive impairment were significantly increased, with statistical significance (P<0.05); compared with the moderate cognitive impairment group, the levels of plasma MMP-9, Lp-PLA2, IL-6, and TNF-α in patients with severe cognitive impairment were significantly increased, with statistical significance (P<0.05). There was a negative linear relationship between plasma inflammatory biomarkers MMP-9, Lp-PLA2, IL-6, and TNF-α levels and cognitive function scores (P<0.05).

Conclusion: Plasma MMP-9, Lp-PLA2, IL-6, and TNF-α are independent risk factors for vascular cognitive impairment in patients with CSVD. Plasma MMP-9, Lp-PLA2, IL-6, and TNF-α levels in patients with CSVD are positively correlated with the severity of vascular cognitive impairment.

Study on the changes in blood biochemical indicators of patients with Cerebral venous sinus thrombosis and their correlation with imaging examination results

Li Zhao — 2025-10-06

Objective: This study investigates the implications of combining blood biochemical indicators with imaging for Cerebral venous sinus thrombosis (CVST) diagnosis, aiming to enhance diagnostic precision and speed.

Methods: We retrospectivity analyzed data from 120 CVST patients between August 1, 2016, and July 31, 2023, examining clinical, laboratory, and cranial MRI and MRV imaging data. Statistical methods assessed the diagnostic significance of various blood indicators and their correlation with CVST.

Results: Headache was the most common symptom, followed by changes in vision, epileptic seizures, and neurological deficits. D-dimer levels, fibrinogen, plateletcrit, mean corpuscular volume (MCV) and platelet distribution width were higher in CVST patients compared to controls. Subgroup analysis revealed that gender and age might influence certain blood test indicators. Notably, a significant difference in D-dimer levels between patient groups with and without complications was observed, suggesting its potential as a biomarker for complication risk. Logistic regression model analysis further confirmed the significant positive correlation between elevated D-dimer levels and CVST risk, also noting that increases in plateletcrit and platelet distribution width were positively correlated with CVST risk. Moreover, through correlation analysis using point biserial correlation coefficient and Spearman’s correlation coefficient, significant correlations were found among blood test indicators, and between these indicators and CVST status. MRI and MRV, as key imaging tools for diagnosing CVST, directly display thrombus formation, further enhancing diagnostic accuracy.

Conclusion: Blood biochemical markers and imaging (MRI and MRV) are vital in diagnosing CVST, aiding in faster, accurate clinical decision-making and better patient outcomes.

Therapeutic potential of N-acetylcysteine in epilepsy: A systematic review

sonika sharma — 2025-10-06

Background: Epilepsy is a long-term neurological disorder that is defined by repeated seizures, often resistant to standard anti-seizure medications. Oxidative stress, mitochondrial impairment, and neuroinflammation are central to epileptogenesis. N-acetylcysteine (NAC), an antioxidant and glutathione precursor, was shown to possess potential neuroprotective properties in model systems, and therefore systematic assessment was indicated.

Methods: This systematic review was conducted in accordance with PRISMA 2020. The databases accessed were PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, and the Cochrane Library up to December 2024. The inclusion criteria were controlled experimental animal studies reporting the measurement of NAC in epilepsy models. Extraction of data on seizure frequency reduction, oxidative stress modulation, mitochondrial integrity, behavioral scoring, and histopathological changes was emphasized. Bias was assessed with the SYRCLE tool.

Results: Eight studies were identified to be included. NAC doses ranged from 0.1 mg/L (immersion in water) to 600 mg/kg (intraperitoneal) with treatment durations from a single acute administration to 40-day chronic treatment. Statistically significant reduction of frequency and severity of seizures was noted in 75% of studies with a reduction in percentages of EEG spikes in a dose-dependent manner and an increase in latency of seizures up to 135% being obtained. MDA levels decreased and SOD activity increased in all described models. Chronic treatment increased mitochondrial membrane potential and controlled mTOR and Drp1 expression. Aggravation of seizures was noted at doses higher than 500 mg/kg/day in absence epilepsy models with weight loss and motor impairment at higher chronic doses.

Conclusion: NAC exerted anticonvulsant, antioxidant, and neuroprotective actions in preclinical models of epilepsy in a dose- and duration-dependent manner. Although encouraging, the side effects occurred at high dose levels, stressing dose optimization and additional translational studies to delineate therapeutic windows.

Clinical efficacy of ketogenic diet combined with perampanel in epilepsy treatment: A randomized controlled trial

Wei Wang — 2025-10-06

Objective: This study evaluated the therapeutic effectiveness and safety of combining the ketogenic diet with perampanel, a newly developed antiseizure medication, in individuals with epilepsy.

Methods: A prospective randomized controlled trial enrolled 140 epilepsy patients at the department of neurology in a tertiary general hospital in Beijing, China from January 2022 to November 2024. Patients were randomly assigned to either a control or an observation group (n = 70 in each group). The epilepsy seizure counts and seizure duration, as well as serum biomarkers (BDNF, NSE, S100β), cognitive functions (MMSE, MoCA), clinical efficacy, and adverse reaction events were compared pre- and post- treatment.

Results: Compared to the pre-treatment period, both groups exhibited significant reductions in epilepsy seizure counts and seizure duration, along with decreases in serum BDNF, NSE, and S100β levels (P < 0.05), as well as improvements in MMSE and MoCA scores post-treatment (P < 0.05). In addition, the intervention group displayed fewer epilepsy seizure counts and shorter epilepsy seizure durations, as well as lower levels of BDNF, NSE, and S100β, and higher MMSE and MoCA scores after treatment, compared to the control group (all P < 0.05). The intervention group demonstrated a significantly higher total effective rate and a lower incidence of adverse events compared to the control group (all P < 0.05).

Conclusion: Combining the ketogenic diet with perampanel showed good clinical effectiveness and a favorable adverse event profile in treating epilepsy.

Epilepsy education for future nurses: On knowledge, attitude and first aid approaches

Yasemin Şahin Yıldız — 2025-10-06

Background & Objective: Nursing students will play an important role in providing care to epilepsy patients in the future. Epilepsy education is an important tool in improving knowledge, attitude and seizure first aid approaches. The purpose of this research was to assess the efficacy of the epilepsy training program.

Method: This one-group pretest-posttest quasi-experimental study was conducted with 95 students studying at the Nursing Department of the Faculty of Health Sciences in Turkey between November 2022 and February 2023. The data of the study were collected with the first aid management form, The Epilepsy Knowledge Scale and The Epilepsy Attitude Scale. In this study, which included pretest and posttests, a three-session face-to-face epilepsy education programme based on epilepsy was applied.

Results: In this research, it was shown that the results before and after education were statistically significantly different (p<0.05). The epilepsy knowledge scale score increased from 8.33±3.56 to 13.27±2.19, and the epilepsy attitude scale score increased from 59.70±7.67 to 62.96±6.02 after the training. The attitudes and knowledge of students about epilepsy were significantly correlated positively (r=0.399, p<0.05 before education, r=0.403, p<0.05 after education). The number of students who felt capable of seizure intervention increased significantly after the education (p<0.05).

Conclusion: The research revealed the beneficial effects of epilepsy education intervention applied to nursing students. In the future, awareness should continue to be promoted through epilepsy education programs, and accessibility to such programs should be increased.

Professional attitudes of pre-nursing students to the care of patients with epilepsy in Southeastern Turkey

mensure turan — 2025-10-06

Objective: This study was conducted to demonstrate whether nurse trainees are adequately prepared in terms of professionalism to provide quality care to patients with epilepsy.

Method: The descriptive and cross-sectional study was conducted among first-year (n=104) and fourth-year (n=96) nursing students in a public university in eastern Turkey. Data were collected using the “Student Introduction Form”, “Attitude Scale for Nursing Profession (ASNP)”, “Epilepsy Knowledge Scale (EKS)”, and “Epilepsy Attitude Scale (EAS)”. Number, percentage, mean, standard deviation, minimum, maximum, Chi-square test, Whitney-U test, Kruskal-Wallis test, and Kruskal-Wallis Bonferroni test were used to evaluate the data.

Results: There was no statistically significant difference between the mean scores of ASNP, EKS, and EAS total scores according to the years of the students (p>0.05). In fourth year students, female gender, knowing someone with epilepsy, having a mother/father/sister/sibling with epilepsy or self, and being involved in the treatment and care of a patient with epilepsy were associated with better attitudes towards the nursing profession, their level of knowledge about epilepsy and their attitudes towards individuals with epilepsy. In addition, ASNP total scores of the first-year and fourth- year students had positive and significant effects on the total scores of the EKS (r=0.379, p=0.000; r=0.311, p=0.004, respectively).

Conclusion: It was found that first and fourth-year nursing students in Southeastern Turkey had positive attitudes towards the nursing profession, moderate knowledge about epilepsy, and moderate attitudes towards people with epilepsy. In this context, students should be supported more in theoretical education and clinical practice.

Temporal lobe epilepsy with or without hippocampal sclerosis: Different neuropsychological profiles and associated clinical factors

Thidaporn Manmen — 2025-10-06

Objective: To elucidate the neurocognitive profiles in temporal lobe epilepsy with or without hippocampal sclerosis (TLE-HS vs TLE-noHS) and ascertain clinical factors associated with the different scores of neurocognitive tests.

Methods: TLE patients who underwent neuropsychological tests (NPTs) in our center were recruited. The NPTs included the Wisconsin Card Sorting Test, Stroop Color-Word Test, Trail Making Test, the Wechsler Adult Intelligence Scale - fourth edition and the Wechsler Memory Scale - fourth edition. Student t-test or Mann–Whitney U test was used to assess the difference in scores between groups. Univariate and multivariate linear regression analyses were also used to assess clinical factors associated with statistically significant NPT scores.

Results: Among 109 recruited patients, 81 were TLE-HS, and 28 were TLE-noHS. NPT score results showed that verbal comprehension index (VCI) and auditory memory index (AMI) were significantly lower in TLE-HS. A lower VCI score was associated with earlier onset, longer duration of epilepsy, presence of generalized tonic-clonic seizure, history of febrile seizure, and some antiseizure medication uses. HS was an independent factor associated with lower VCI, whereas, in addition to HS, some clinical factors, i.e., history of status epilepticus, lower highest years of education or psychiatric comorbidities, were also independently associated with lower AMI.

Conclusions: Our findings suggest that TLE-HS had unique clinical characteristics and different NPT scores from TLE-noHS. In clinical practice, we should be aware that NPT scores might be affected by some clinical factors, and only VCI is a promising test that can help differentiate these two conditions.

Utility of prognostic models and early predictors of functional outcome in Guillain-Barré syndrome in an Indian cohort

Rajendra S Jain — 2025-10-06

Objectives: The study aimed to evaluate the prognostic models modified Erasmus Guillain–Barré syndrome(GBS) outcome score (mEGOS) and Erasmus GBS respiratory insufficiency score (EGRIS) and to examine biochemical and hematological predictors of functional outcomes in an Indian GBS cohort.

Methods: An ambispective observational study was conducted in the neurology department of a tertiary care center in northwest India from 2021 to 2024 including 68 patients aged 18 and older, diagnosed with classical GBS per the Brighton criteria.

Results: Among the 68 patients (mean age 39.28 years), 63.2% were male, 95.6% presented within two weeks of illness onset, 25% had prodromal illnesses, and 35.3% had cranial nerve involvement. Nerve conduction studies revealed acute inflammatory demyelinating polyneuropathy, acute motor axonal neuropathy, and acute motor- sensory axonal neuropathy in 27.9%, 42.6%, and 2.9% of patients respectively. Mean(±SD) GBS disability scale (GDS) scores at admission, 1 month, and 6 months were 3.50 (±0.74), 1.79 (±1.26), and 0.84 (±1.00), respectively, mean(±SD) mEGOS and EGRIS scores at admission were 4.68 (±3.10) and 1.86 (±1.46), respectively. In 1.5% of patients, mechanical ventilation was needed, and 88.2% received intravenous immunoglobulin. The mEGOS score correlated significantly with the GDS at admission, 1 month, and 6 months. Significant correlations were found between neutrophil/lymphocyte ratio, lymphocyte percentage, and GDS score at admission. Platelet count correlated with GDS scores at 6 months (p < 0.05).

Conclusion: Prognostic models mEGOS and EGRIS, along with inflammatory biochemical markers, effectively assess disease severity, need for intensive care, and predict functional outcomes in the Indian GBS population.

Sleep profile and its clinical correlates in patients with carpal tunnel syndrome

Jyoti Gautam — 2025-10-06

Background & Objective: Nocturnal pain and paresthesias are common in carpal tunnel syndrome (CTS). However, there is limited literature on the impact of CTS on sleep profile. The aim of this study was to systematically analyse sleep profile in CTS and to correlate with clinical and electrophysiological features.

Methods: Prospective evaluation of 44 patients diagnosed to have CTS was carried out using Visual Analog Scale (VAS), Functional Severity Scale (FSS) and Symptom Severity Scale (SSS) components of Boston Carpal Tunnel Questionnaire (BCTQ), Historic and objective scale (HiOb), and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). Sleep was assessed using Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and overnight polysomnography (PSG).

Results: Cases had significantly higher mean PSQI, ESS, ISI and STOP-BANG scores as compared to controls. PSQI, ESS, and ISI correlated significantly with FSS, SSS and QuickDASH. PSQI and ISI correlated with VAS. No significant correlation was found between sleep questionnaires and electrophysiological severity. PSG, carried out in 16 cases, showed reduced total sleep time and sleep efficacy, reduced duration of N2 and rapid eye movement (REM) sleep, and higher wake after sleep onset (WASO), wake index, and stage shift index (p<0.05). Sleep efficacy, sleep onset latency, WASO and wake percentage were better in those with clinical and electrophysiological severe grades of CTS.

Conclusion: CTS causes poor sleep quality, and fragmented and reduced sleep, which is under- recognised, but causes significant distress to the patients. Longitudinal alterations in sleep profile including the impact of medical/surgical intervention need to be delineated.

Evaluation of tibial nerve stiffness by elastography in distinguishing diabetic polyneuropathy and small fibre neuropathy in patients with type 2 diabetes

ÖMER FARUK BOLATTÜRK — 2025-10-06

Background & Objective: We investigated the comparison of shear wave elastography (SWE) method with electromyography (EMG) in diabetic polyneuropathy (DPN) cases in patients with type 2 diabetes mellitus (T2 DM) and evaluated the diagnosis of small fiber neuropathy (SFN) with SWE, which was normal in EMG.

Methods: Fifty T2 DM patients and 16 healthy controls were included in the study. Patients were divided into 3 groups according to EMG results; i.e., the group respectively with small fiber neuropathy, sensory axonal neuropathy, and sensorimotor neuropathy. Sonographic measurements were made at the poplitial fossa and medial malleolus level in the study groups, and the results were evaluated statistically.

Results: Fifty T2DM patients and 16 control group patients were included in the study. In the tibial nerve measurements from the popliteal fossa level of the patients, a significant difference was observed in the area under the curve between the control group and the SFN on the right side (p=0.044). In the measurements of the patients from the medial malleolus level, a significant difference was observed in the shear wave velocity on the right side between the control and SFN groups, and also between the SFN group and the sensorimotor neuropathy group (p=0.047).

Conclusion: In this study, significant differences were found between DPN patients and healthy controls when evaluated with cross-sectional area. Thus, SWE may be an alternative objective diagnostic method even in cases where DPN cannot be diagnosed with electrophysiological tests.

Correlation between diabetic retinopathy and diabetic neuropathy in patients with diabetes mellitus: A systematic review and meta-analysis

saba imanparvar — 2025-10-06

Background & Objective: The early identification of microvascular complications associated with diabetes plays a crucial role in determining the disease’s prognosis. This systematic review and meta- analysis aimed to investigate the correlation between diabetic retinopathy (DR) and diabetic neuropathy (DN) in patients with diabetes mellitus (DM).

Method: An advanced literature search was carried out until February 18, 2024, and we accessed the relevant articles from databases including Google Scholar, PubMed, and Scopus. Related articles were extracted. Titles, abstracts, and full texts of the articles were screened. The quality of the included articles was assessed, and the data was extracted and analyzed.

Result: We included 6 cohort and cross-sectional studies with a total population of 54,586. The primary outcome of this study was the interactions among the diabetic microvascular complications, including DR and DN. Our findings indicate DN is associated with increased risk of DR twofold (pooled effect: 2.08, 95% confidence interval (CI): 1.53-2.82٫ I²: 81%, p<0.01). DR was related to DN (pooled OR: 2.67, 95% CI: 1.64–2.97, p < 0.01).

Conclusion: This meta-analysis showed that DN is associated with increased risk of DR in patients with type 2 diabetes. Given the high heterogeneity observed in the studies, further large-scale randomized control trials are still required to prove this association.

Ultrasonographic characteristics of peripheral nerves in primary systemic vasculitis: A cross-sectional study

Nan Hu — 2025-10-06

Objective: To explore the ultrasonographic characteristics of peripheral nerves in primary systemic vasculitis (psV).

Methods: Fifteen patients with psV, 36 with secondary systemic vasculitis (ssV) and 109 healthy controls (HC) were consecutively recruited. Nerve ultrasound was conducted to obtain cross-sectional area (CSA) at predetermined peripheral nerve sites and to detect hypervascularization.

Results: Nerve enlargement was detected in all 15 psV patients, mainly distributing in a multifocal pattern. Compared to ssV patients, remarkable nerve enlargement was showed at M2-M5, M8-M10 segment of the median nerve, U2-U4 segment, U8 and U10 point of ulnar nerve, upper trunk, fibular nerve and sciatic nerve (P < 0.05) in psV patients. Hypervascularization was detected in 8 (53.33%) psV and 17 (47.22%) ssV patients, respectively.

Conclusion: Multifocal nerve enlargement was common in patients with psV. Compared to patients with ssV, nerve enlargement in psV patients presented in the more proximal segment with a higher degree, possibly due to the differences in disease duration. Hypervascularization was common in psV patients and might be related to an active inflammatory state of the peripheral nerve.

Impact of environmental and lifestyle factors on progression and survival in a large Chinese amyotrophic lateral sclerosis cohort

Nan Hu — 2025-10-06

Objective: To investigate the impacts of environmental and lifestyle factors on progression and survival in a large Chinese amyotrophic lateral sclerosis (ALS) cohort.

Methods: We investigated a cohort of 1,312 sALS patients prospectively. A questionnaire was designed to collect information on environmental exposure and lifestyle at baseline. Uni- and multivariate analysis were performed to analyze the influence of environmental and lifestyle factors on the onset age, bulbar onset, progression rate and survival time of ALS.

Results: A total of 1,050 questionnaires were finally received from the patients, among which 407 questionnaires were fully filled out. Low educational level and ever smoked were significantly related to late onset in both univariate and multivariate analysis with backward section (p<0.05). Exposure to organophosphorus pesticide was significantly related to bulbar onset (p=0.027) and rapid progression (p=0.007). Ever drinking alcohol was related to longer survival time in Cox regression model (p=0.040) and the mean survival time of non-drinkers was significantly higher than patients with history of drinking alcohol (p=0.023).

Conclusion: In Chinese ALS population, low educational level was an independent indicator of late onset. Exposure to organophosphorus pesticide was the risk factor for bulbar onset and rapid progression. Smoking and drinking alcohol were less common among ALS patients with late onset and long survival time.

Establishing a quantitative evaluation method for the strength of cranial muscle groups and its application in amyotrophic lateral sclerosis (ALS)

Nan Hu — 2025-10-06

Objective: To establish a quantitative method for strength evaluation targeting cranial muscle groups and applied it in amyotrophic lateral sclerosis (ALS) patients.

Methods: Detailed physical examination were conducted on patients with neuromuscular disorders or healthy population for the selection of the actions innervated by cranial nerves. The six-level strength by manual assessment was designed according to the Medical Research Council (MRC) score. ALS patients were consecutively recruited to explore the clinical significance of the quantitative method.

Results: A total of fourteen actions regarding cranial muscle groups were finally involved in our quantitative evaluation method which was named the MRC cranial score, all of which showed satisfied inter-observer and intra-observer consistency. Among 58 ALS patients, 40 (68.97%) showed decrease in the MRC cranial score at baseline, mainly presenting dysfunction in cheek bulging, swallowing, speech and tongue extension. During the 3-month follow up, there was a significantly negative correlation between the baseline MRC cranial score and ALS progression rate (p<0.001). Low MRC cranial score was significantly related to the need of invasive respiratory support (p=0.005) and gastric catheterization (p=0.003).

Conclusion: In the study, we designed the MRC cranial score, which was a easily operating evaluation method of the strength involving 14 actions innervated by cranial nerves. The MRC cranial score could quantify the involvement of cranial nerves in neuromuscular diseases comprehensively, which was negatively related to the progression rate and might be a predictor of the need of gastric tube or respiratory support in ALS patients.

Proposed protocol for fasciculations detection by muscle ultrasound in amyotrophic lateral sclerosis

Nan Hu — 2025-10-06

Objective: To investigate potential diagnostic value of fasciculations among amyotrophic lateral sclerosis (ALS) patients and determine the most optimal protocol based on selection of a combination of muscles with highest yield in clinical practice.

Methods: The cross-sectional study comprised 149 ALS and 54 non-ALS patients, all underwent muscular ultrasound (MUS) on muscle groups in four body regions to find potential indicators for ALS diagnosis. Fasciculations intensity was divided into five grades based on firing frequency and number in the involved muscle groups. The fasciculations diagnostic score was defined according to the indicators with high specificity for ALS.

Results: Detection rate of fasciculations was highest in the lumbosacral (970/1622, 59.8%) and cervical (841/1516, 55.5%) muscle groups, followed by the thoracic muscles (148/548, 34.3%), and bulbar muscle groups (102/652, 15.6%) among ALS patients (p<0.05). The detection of fasciculations in bulbar and thoracic muscle groups and detection of high-grade fasciculations in cervical and lumbosacral muscle groups were highly specific among ALS patients. Through detailed screening, a total of 13 muscle groups were involved in the fasciculations diagnostic score. Receiver operating characteristic (ROC) analysis showed that the area under curve (AUC) was 0.961 (95%CI 0.927-0.996). The optimal cut-off value was 1 point with 95.8% of sensitivity and 88.9% of specificity.

Conclusions: A practical protocol was feasible with optimal diagnostic yield in suspected ALS to help detect fasciculations. This could complement routine clinical evaluation and electrodiagnostic work-up and be performed as a practical bedside test with little patient burden and low cost.

Association of autonomic dysfunction with disease severity in individuals with primary fibromyalgia syndrome: A cross-sectional study

Akash Pathak — 2025-10-06

Fibromyalgia syndrome is a musculoskeletal condition and presents with fatigue, sleep disturbances, cognitive symptoms, and heightened sensitivity to touch. Autonomic dysfunction is an associated symptom observed in fibromyalgia. The present study examines the association between autonomic dysfunction and fibromyalgia severity. The study enrolled 144 individuals based on the American College of Rheumatology diagnostic criteria (2010) for fibromyalgia. Autonomic functions were assessed using heart rate variability and Ewing’s battery of tests. Fibromyalgia Impact Questionnaire-Revised was used to explore fibromyalgiya severity. A varying degree of fibromyalgia severity was observed in the enrolled individuals with associated increases in pain sensitivity and intensity. Autonomic dysfunction was present in 45.8% (66) of individuals and 8.3% (12) individuals had definite autonomic dysfunction. No correlation was found between fibromyalgia severity and level of autonomic dysfunction. Additionally, no difference was observed in the levels of pain or daily functioning among the three categories of cardiac autonomic dysfunction. Different levels of autonomic dysfunction may be associated with varying levels of fibromyalgia severity, but no definite grade of autonomic dysfunction is associated with a particular grade of severity of fibromyalgia.

Conclusion: Autonomic interaction with chronic pain requires further exploration, considering potential confounders that may impact both factors.

The prevalence and clinical significance of trigeminal neuralgia in patients with multiple sclerosis

İpek Güngör Doğan — 2025-10-06

Background & Objective: Trigeminal neuralgia (TN) is a debilitating neuropathic pain disorder characterized by sudden and intense episodes of facial pain, significantly impairing patients’ quality of life. Diagnosing TN is particularly challenging in multiple sclerosis (MS), a chronic autoimmune, demyelinating, and neurodegenerative disease affecting the central nervous system. TN in MS is predominantly caused by demyelination, axonal loss, inflammation, and brainstem lesions. However, the overlapping symptoms of TN and other craniofacial pain disorders often lead to underdiagnosis and treatment delays. This study aimed to determine the prevalence and clinical characteristics of TN in MS patients, in a cohort of Turkish patients, with a focus on diagnostic challenges and treatment patterns.

Methods: A single-center, cross-sectional survey was conducted, systematically assessing headache and facial pain symptoms among MS patients treated at the Sancaktepe Neuroimmunology Clinic, Istanbul, Turkey.

Results: The findings revealed a significant prevalence of TN (39.8%) in MS patients, with a female predominance and a mean diagnostic delay of 14 months. Despite the availability of effective treatments, a substantial proportion of patients remained undiagnosed and untreated.

Conclusion: There is urgent need to integrate routine TN screening into MS patient care to improve timely diagnosis and effective management. The study underscores the importance of a multidisciplinary approach in addressing this overlooked comorbidity, ultimately enhancing the quality of life for MS patients.

Comparison of fluoroscopy-guided and blind techniques in intrathecal nusinersen administration

Savas Sencan — 2025-10-06

Background & Objectives: Intrathecal nusinersen administration is often performed using a blind technique without any imaging guidance. However, many patients with spinal muscular atrophy(SMA) have progressive and severe scoliosis, making intrathecal access challenging. In patients where intrathecal access is difficult, injections can be performed under imaging guidance, such as fluoroscopy. This study aimed to compare blind versus fluoroscopy-guided intrathecal nusinersen injections in patients with SMA, focusing on postprocedural pain and patient satisfaction.

Method: SMA patients who underwent both blind intrathecal nusinersen injections and fluoroscopy-guided intrathecal nusinersen injections between January2022 and June2023 were retrospectively analyzed. Patient satisfaction (5-point Likert scale) and postprocedural pain levels (Numeric Rating Scale, 0–10) were assessed after both the blind and fluoroscopy-guided procedures, and the results were compared.

Results: This study included 79 fluoroscopy-guided intrathecal nusinersen injections administered to 26 patients during the specified period. The satisfaction score for the fluoroscopy-guided technique (FT) was 5, while it was 2.32±1.31 for the blind technique (BT). Post-procedural pain in the FT was 0.73±0.72, compared to 4.77±1.58 in the BT. Satisfaction in the FT was significantly higher than in the BT, while postprocedural pain scores were significantly lower (p<0.001). Success rate was 71.5% with the BT, whereas it was 100% with the FT (p<0.001).

Conclusion: Administering intrathecal nusinersen with fluoroscopy guidance enhances patient satisfaction and minimizes postprocedural pain in SMA. Additionally, performing the injections under fluoroscopic guidance increases the success rate of the procedure and reduces the risk of potential complications. Therefore, in cases where intrathecal access may be challenging, such as in patients with scoliosis, nusinersen administration could be more appropriately performed by experienced practitioners using fluoroscopic guidance rather than a blind technique.

Can immature granulocyte count be a new biomarker for the evaluation of inflammation in patients with obstructive sleep apnea syndrome? A single-centre study

Isıl Yazıcı Gencdal — 2025-10-06

Background & Objective: Obstructive sleep apnea syndrome (OSAS) is the most common sleep-related breathing disorder. The potential use of the immature granulocyte count as an inflammation marker in certain diseases has been investigated. This study aims to investigate the feasibility of using haemogram parameters including immature granulocyte levels as an inflammatory marker in patients with OSAS and the relationship between this parameter and disease severity.

Methods: This retrospective study was conducted using the data of 101 OSAS patients and 114 healthy controls. Demographic and polysomnographic data were recorded in the OSAS group. The OSAS patients were subdivided into three sub-groups according to apnea-hypopnea index. Haemogram parameters, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), haemoglobin (HGB), haematocrit (HCT), lymphocyte count, mean platelet volume (MPV), platelet count (PLT), MPV/PLT ratio, PLT/lymphocyte ratio (PLR), WBC/MPV ratio (WMR), IGc and IG percentage (IG%) values were compared between the OSAS and control groups.

Results: Haemogram parameters WBC, HGB, HCT, IGc and IG%, lymphocyte count and WMR values were found to be statistically significantly higher and PLR value was lower in the OSAS group. In OSAS subgroups, only HGB and HCT values were found to be significantly higher, parallel to disease severity. As a result of the ROC analysis between the control and OSAS groups, it was determined that the HCT, WBC, PLR, IGc and IG%, lymphocyte count and WMR values had a significant value in presenting increased inflammation in OSAS.

Conclusion: IGc may be used as a novel parameter to indicate increased inflammation in OSAS patients.

Evaluation of systemic immune and inflammatory biomarkers in pediatric idiopathic intracranial hypertension patients

Erel İçel — 2025-10-06

Background & Objective: Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure with normal cerebrospinal fluid analysis and neuroimaging findings. The aim of this study is to evaluate the relationship between systemic immune-inflammation index (SII) (neutrophil*platelet/lymphocyte count) and systemic inflammation response index (SIRI) (monocyte*neutrophil/lymphocyte count) as inflammatory markers with IIH in pediatric patients.

Methods: A total of 42 eyes from 21 pediatric patients diagnosed with IIH and 42 eyes from 21 control subjects were included in the study. Macular and peripapillary measurements, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), SII, and SIRI were recorded.

Results: The study included groups matched for age and gender. When comparing inflammatory parameters, significantly higher values were observed in individuals with IIH for NLR (P < 0.001), PLR (P = 0.005), SII (P < 0.001), and SIRI (P < 0.016). In the univariate analysis of inflammatory parameters, NLR, PLR, MLR, SII, and SIRI values were identified as potential markers for IIH (P = 0.001, P < 0.001, P = 0.004, P = 0.004, P = 0.001, respectively). In the multivariate logistic regression analysis, NLR and PLR values were significantly higher (NLR: OR=3.8, 95% confidence interval [CI]: 1.3-11.0, P=0.013; PLR: OR=6.0, 95% CI: 1.7-20.8, P=0.005). Significant differences were found in mean retinal nerve fiber layer thickness (RNFLT) values between the two groups on OCT (p<0.001). Significant differences were also detected in ganglion cell layer thickness values between the two groups (p=0.003).

Conclusion: Multivariate logistic regression analysis suggests that NLR and PLR values could be effectively used in the diagnosis and treatment of the disease. No statistically significant differences were found between groups in SII and SIRI values.

Changes of serum miR-21-5p level in patients with acute spinal cord injury treated with ganglioside and methylprednisolone pulse therapy and its correlation with therapeutic effect

Bo Wang — 2025-10-06

Background: Acute spinal cord injury (ASCI) is a serious central nervous system condition that carries a high rate of disability and mortality, making it a primary focus of clinical research. The commonly used drugs for ASCI are ganglioside (GM-1) and methylprednisolone (MP). There are few studies available on the impact of GM-1 combined with MP pulse therapy on the clinical outcomes of patients with ASCI and the underlying mechanisms involved.

Methods: In a randomized controlled trial, the 100 patients with ASCI who were treated at our hospital from 2021 to 2024 were selected for this study. They were arbitrarily separated into two equal cohorts, a control cohort and an observation cohort, each containing 50 patients. While the control cohort underwent treatment solely with GM-1, the observation cohort additionally received MP pulse therapy, both treatments administered over a span of six months. The general information of patients was recorded. The motor score, acupuncture pain score, light touch score, Barthel Index (BI) for evaluating daily living capabilities, American Spinal Injury Association (ASIA) neurological function score, and visual analogue scale (VAS) score were analyzed between the two groups before and after treatment to evaluate the recovery of neurological function. Additionally, quantitative real-time PCR (qRT-PCR) was used to assess the serum levels of miR-21-5p in both groups. Moreover, the concentrations of serum inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), along with nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), were quantified using ELISA. The Pearson method was employed to evaluate the correlation between miR-21-5p and the levels of CRP, TNF-α, IL-6, NGF, and BDNF. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive ability of serum miR-21-5p regarding treatment effectiveness in patients with ASCI.

Results: Three patients dropped out of the control group, and no patient dropped out of the observation group. There were no significant variations in the baseline data, index scores, or factor levels between the two groups prior to treatment (P > 0.05). After undergoing therapy, the observation group exhibited significantly higher BI index, ASIA motor and sensory scores, as well as increased in serum miR-21-5p levels, BDNF, and NGF compared to the reference group (P < 0.05). Furthermore, the observation group exhibited marked decreases in VAS ratings as well as serum CRP, TNF-α, and IL-6 levels, in stark contrast to the control group (P < 0.05). Furthermore, the level of miR-21-5p exhibited a negative correlation with the levels of CRP, TNF-α, and IL-6 (P < 0.05), while showing a positive correlation with the levels of BDNF and NGF (P < 0.05). The ROC curve analysis indicated that miR-21-5p possesses strong diagnostic potential for assessing ASCI efficacy, with an area under the curve (AUC) of 0.987, a sensitivity rate of 91.49%, and a specificity rate of 100.00%.

Conclusions: The combination of GM-1 and MP pulse therapy can significantly enhance neurological symptoms and facilitate the restoration of neurological function in patients with ASCI. This effect may be ascribed to the increased levels of miR-21-5p, BDNF, and NGF, along with a reduction in serum inflammatory factors.

The incidence and risk factors of facial nerve dysfunction after acoustic neuroma surgery: A systematic review and meta-analysis

guohu Kuai — 2025-10-06

Background: Facial nerve injury is a common complication after acoustic neuroma surgery, and there is currently a lack of clear evidence-based evidence. We conducted this systematic review and meta-analysis to explore the incidence and risk factors of facial nerve dysfunction (FNF) after acoustic neuroma (AN) surgery through meta-analysis, providing evidence-based basis for clinicians to predict and identify high-risk groups of FNF at an early stage.

Methods: We searched multiple databases including PubMed, Web of Science, Cochrane Library, CNKI, and Wan fang electronically for literatures on the incidence and risk factors of FNF after AN surgery from the establishment of the databases to December 2024. The quality of the literatures was evaluated, and statistical analysis was performed using R 4.4.1 software after data extraction.

Results: A total of 2,631 patients from 17 included literatures were analyzed. The results of meta-analysis showed that the incidence of FNF after AN surgery was 16% (95%CI: 0.11, 0.21). Larger tumor diameter [OR = 1.85, 95%CI (1.38 - 2.47), P < 0.0001], cystic tumors [OR = 2.22, 95%CI (1.43 - 3.45), P = 0.0004], a longer disease course [OR = 1.23, 95%CI (1.08 - 1.40), P = 0.0017], severe adhesion between the tumor and the facial nerve [OR = 5.45, 95%CI (3.67 - 81), P < 0.0001], peritumoral edema [OR = 3.22, 95%CI (1.71 - 6.07), P = 0.0003], total tumor resection [OR = 1.32, 95%CI (1.09 - 1.59), P = 0.0044], and preoperative gamma knife treatment [OR = 5.87, 95%CI (1.79 - 19.25), P = 0.0035] were the risk factors for FNF after AN surgery. The response of intraoperative facial nerve electromyography (EMG) to a 0.05 mA stimulation ≥ 100 microvolts [OR = 0.26, 95%CI (0.08 - 0.87), P = 0.0281] was a protective factor for FNF after AN surgery.

Conclusion: The existing evidence indicates that the incidence of FNF after AN surgery is 16%. Larger tumor diameter, cystic tumors, a longer disease course, severe adhesion between the tumor and the facial nerve, peritumoral edema, total tumor resection, and preoperative gamma knife treatment are the risk factors for FNF after AN surgery, while the response of intraoperative facial nerve EMG to a 0.05 mA stimulation ≥ 100 microvolts is a protective factor. Limited by the quantity and quality of the included literatures, the conclusions of this study still need to be confirmed by more high-quality studies.

Late-onset Pompe disease: Experience from Western India over 25 years

Satish V Khadilkar — 2025-10-06

We report clinical and genetic profile of 10 patients with Late-onset Pompe disease (LOPD) from Western India, diagnosed over 26 years from a cohort of 2374 myopathy cases. Diagnostic modalities evolved from muscle biopsy to enzyme assays and genetic sequencing. The predominant phenotype was limb-girdle weakness; rare features included facial weakness and scapular winging. The c.1841C>T (p.T614M) variant was most common, while the globally prevalent c.-32-13T>G variant was reported for the first time in India. A persistent diagnostic delay averaging six years highlights the need for increased clinician awareness to facilitate timely identification and treatment of this treatable disease.

Late-onset central hypoventilation caused by posterior inferior cerebellar arterial infarction

Jong-Gyu Baek — 2025-10-06

Central hypoventilation syndrome (CHS) is a rare condition caused by damage to the brainstem’s respiratory centers, often following stroke. We report a case of a 65-year-old woman with a lateral medullary infarction presenting with dizziness, dysarthria, and dysphagia. Five days after admission, she experienced respiratory failure with apnea and CO2 retention, requiring mechanical ventilation. Timely intervention improved her respiratory condition, and she was discharged with home ventilation care for ongoing management. This case highlights the importance of recognizing CHS in brainstem stroke and the critical role of early ventilatory support in improving outcomes.

Post haemodialysis stroke thrombolysis, to give or not to give?

ADILAH AMINUDDIN — 2025-10-06

With every increment of glomerular filtration rate (GFR) by 10%, there is an elevated risk of stroke by 7%. Stroke death is also 9 times higher in end stage renal failure (ESRF) patients as compared to the general population. Certain studies have described that intravenous thrombolysis in ESRF patients with acute ischaemic stroke has no added benefit with increased risk of bleeding while some still recommend intravenous thrombolysis (IVT) as it improves neurological outcome. We describe two cases of acute ischaemic stroke at 0 hours post haemodialysis (HD) and 3.5 hours post HD. A 62-year- old gentleman with underlying hypertension and ESRF, presented 3.5 hours after haemodialysis with National Institute of Health Stroke Scale (NIHSS) of 7. Computed Tomography Angiography (CTA) showed a right distal M1 non occlusive thrombus and IV Alteplase 40mg was given. NIHSS post IVT at 6hours showed improvement to 3 and 0 upon discharge. Current mRS is 0. Upon undergoing 3hours of haemodialysis, a 66-year-old gentleman with underlying Hepatitis C and ESRF had an acute stroke with NIHSS of 10. CTA showed left M2 occlusion and IV Alteplase 50mg was given. NIHSS 6hours post IVT is 7 and 4 upon discharge. Complications include, oozing over his left BCF and minimal sulcal subarachnoid haemorhage. Current mRS is 1. In conclusion, post dialysis patients who suffer from an acute stroke, may be given intravenous thrombolysis as to improve their clinical outcome. In this study, both patients were given a lower dose of Alteplase (0.6mg/kg) and had favourable outcomes.

Persistent foreign body granuloma developing on the face following embolization agent and stent placement: A rare case report

Guldeniz Cetin Çetin — 2025-10-06

Foreign body granulomas represent a complex defense mechanism developed by the body in response to foreign substances. While some granulomas remain asymptomatic, others may cause pain, swelling, or functional impairment. A 28-year-old male patient presented to our clinic with complaints of dull pain in the right temple and wounds with discharge opening to the skin in the right frontal, right maxillary, and mandibular regions. The patient’s history revealed that an arteriovenous malformation developed following trauma to the right eyelid at the age of 3, which was subsequently treated at age 18 with an embolizing agent and stent placement due to mass effect and ptosis. Within the first postoperative week, swelling, redness, and pain developed in the right eyelid and forehead, which eventually evolved into discharge opening to the skin. In the subsequent period, this discharge spread toward the maxillary and mandibular regions. A biopsy taken from the open wounds, which persisted for approximately 5 years and showed resistance to antibiotic therapy, revealed foreign body material from the stent and giant cell granuloma tissue. These findings were corroborated by digital cerebral angiography. Foreign body resection of the granuloma tissue has been planned. In conclusion, the present case exemplifies a rare and noteworthy instance of long-term complications of foreign body reactions.

Unilateral spastic trismus in brain stem stroke: A hindrance to oral care, mastication, and speech

Muhamad Faizal Zainudin — 2025-10-06

Spastic trismus (ST) is a rare manifestation of stroke-induced spasticity, characterised by sustained contraction of the masticatory muscles, resulting in restricted jaw opening. It can severely impact oral hygiene, feeding, speech, and access to dental procedures, and may complicate emergency airway management. ST is more commonly observed in bilateral cerebral cortical lesions, while isolated unilateral ST following a brainstem stroke is exceedingly rare. We report a case of unilateral ST in a 57-year-old man with a history of diabetes mellitus and dyslipidaemia who suffered a brainstem stroke affecting the pontomedullary junction and medulla. He developed severe limb incoordination, dysphagia, and dependence on nasogastric tube feeding but remained cognitively intact. He was referred to us two years post-stroke, presenting with severe trismus (interincisal distance of 11 mm) and right jaw hypertrophy. Conservative treatments, including warm compresses and stretching exercises, failed. Botulinum toxin injection was offered, but declined. He was started on oral baclofen (10 mg twice daily), which was later reduced due to drowsiness. After two weeks, his interincisal distance improved to 22 mm, facilitating oral hygiene and speech articulation. Baclofen was discontinued after four weeks as no further improvement was observed, but gains were maintained at three, six, and 12 months post-discharge. This case highlights the challenges in managing post-stroke ST, particularly in a unilateral brainstem lesion. While botulinum toxin remains the treatment of choice, oral antispasmodics may serve as viable alternatives when injections are contraindicated or declined. Further research is needed to establish evidence-based rehabilitation strategies to improve long-term outcomes for ST.

Tuberculous spinal leptomeningitis presenting with anterior spinal artery infarct

Chee Yew Yong — 2025-10-06

The association of tuberculous leptomeningitis and anterior spinal artery infarction, although rare, can result in severe neurological sequelae. Recognising tuberculosis as a potential aetiology is vital. Here we describe a case under our care. A 41-year-old man presented with acute back pain with lower limb weakness and paraesthesia. Magnetic resonance imaging (MRI) of the spine revealed a combination of spinal leptomeningitis, anterior spinal cord lesion and intradural tuberculoma. Cerebrospinal fluid (CSF) analysis revealed findings consistent with tuberculosis myelitis. Spinal tuberculosis can present as an anterior spinal artery infarct.

Tracing the roots of paralysis: A Brown-Vialetto-Van Laere syndrome case report

BHAWNA SHARMA — 2025-10-06

Brown-Vialetto-Van Laere Syndrome (BVVLS) is a rare, inherited neurological disorder characterized by cranial nerve dysfunction, progressive neuropathy, and sensorineural hearing loss. Mutations in riboflavin transporter genes, such as SLC52A2 result in impaired riboflavin metabolism, leading to neurodegeneration. We present a case of a 16-year-old male with progressive sensorineural hearing loss, visual impairment, tongue atrophy, and distal muscle weakness of the hands and feet. This case highlights that if a patient presents with multiple cranial nerve involvement accompanied by small muscle atrophy, we should consider the possibility of this rare metabolic disease. Early recognition of BVVLS is crucial, as high-dose riboflavin supplementation (10– 40 mg/kg/day) can halt or even reverse disease progression. Differentiation from conditions like Madras motor neuron disease is essential for accurate diagnosis and management. This case emphasizes the potential for favourable outcomes with timely intervention.

Hemichorea secondary to cerebral border zone infarction with middle cerebral artery stenosis: A case report

Dae-Seop Shin — 2025-10-06

Hemichorea is a rare presentation of stroke. Post-stroke hemichorea is often caused by a lesion affecting the basal ganglia. Herein, we present an unusual case of hemichorea in a patient with border zone infarction and middle cerebral artery stenosis. A 64-year old man visited the emergency department due to acute onset left-sided hemichorea. Brain MRI showed several dot-like multifocal high signal intensities in the right border zone area between the right anterior cerebral artery and the middle cerebral artery. Transfemoral cerebral angiography revealed severe focal stenosis in the right M1 segment. Mechanical thrombectomy was performed and the stenosis partially improved. Computed tomography perfusion showed a delayed mean transit time in the subcortical area around the stroke lesions and no abnormal perfusion defect in the deep structures. Six days after symptom onset, clonazepam was administered, and the chorea ceased. This case highlights that hemichorea can occur in patients with dot-like, scattered stroke lesions in the border zone.

A delicate balance: Managing intracranial hypertension in pregnancy

Nur Attiyyah Jasmi — 2025-10-06

Idiopathic intracranial hypertension (IIH) is a condition marked by increased intracranial pressure with no identifiable cause, most commonly affecting young, obese women. We present the case of a 24-year-old primigravida with a body mass index of 37, ventricular septal defect repair, and type II diabetes mellitus, who presented at 15 weeks of gestation with blurred vision and reduced visual fields in her right eye. On examination, a grade 2 relative afferent pupillary defect was noted in the right eye, alongside bilateral optic disc swelling. Despite normal neuroimaging and cerebrospinal fluid analysis, a high opening pressure of 33.5 cmH2O was documented during lumbar puncture. A multidisciplinary team from neurology, ophthalmology, and obstetrics, initiated treatment with acetazolamide and topiramate, along with a lumbar drain and serial lumbar punctures. The patient successfully delivered a healthy baby girl via emergency caesarean section at 37 weeks of gestation. After delivery, her optic nerve functions remained stable, although some chronic damage was evident. This case underscores the importance of multidisciplinary collaboration and careful treatment planning for IIH during pregnancy to safeguard both maternal and foetal health.

Bilateral isolated sixth cranial nerve palsy after unilateral intravitreal Ranibizumab injection: Case report and review of literature

Cheau Wei Chin — 2025-10-06

Ranibizumab is an anti-vascular endothelial growth factor agent that has revolutionized the treatment of diabetic macular edema. Although the systemic safety profile of ranibizumab is generally favorable, it could rarely cause adverse effect such as microvascular cranial nerve palsy. A 68-year-old man who has right centrally-involved diabetic macular edema presented with binocular diplopia and squint five days after his first dose of intravitreal ranibizumab injection. His pupils were equal and reactive to light with no relative afferent pupillary defect. Hirschberg test revealed bilateral esotropia at primary gaze, while ocular motility exam showed bilateral abduction deficit. Bilateral lateral rectus palsy was further confirmed with Hess test. Other neurological examination was negative. Given the recent intravitreal ranibizumab injection, the bilateral sixth cranial nerve palsy was attributed to ranibizumab injection causing microvascular complication. The lateral rectus function improved at 3-month follow up. This is the first case report of bilateral sixth cranial nerve palsy that developed following intravitreal ranibizumab injection. We propose that the unilateral intravitreal ranibizumab injection has triggered a systemic microvascular disturbance, resulting in bilateral abducens nerve ischemia.

A novel case with CHST14-related musculocontractural Ehlers-Danlos syndrome

Didem Ardicli — 2025-10-06

Musculocontractural Ehlers-Danlos syndrome (mcEDS) is a relatively newly identified and rare subtype of Ehlers-Danlos syndrome. Multiple congenital contractures, characteristic craniofacial features at birth or in early infancy, and typical cutaneous features are the major criteria for mcEDS. The cause is defects in the synthesis of dermatan sulfate and related proteoglycans, due to biallelic mutations in the CHST14 and DSE genes. In addition to symptoms related to connective tissue, patients may have problems involving various organ systems such as the eye, heart, kidney, brain, and spinal cord. Herein, we present a patient of a 4-year-old girl with mcEDS in whom a novel mutation in the CHST14 gene was identified by whole exome sequencing. The patient presented with hypotonia, motor delay, multipl joint deformities, kyphoscoliosis, and dysmorphic facial features. Initially, she was followed-up with a pre-diagnosis of congenital muscular dystrophy or congenital myopathy. Laboratory investigations revealed mildly elevated serum creatine kinase levels, hydrocephalus, tethered cord, and hydroureteronephrosis. mcEDS manifests itself with hypotonia, arthrogryposis, and motor retardation in newborns and young children, and it may be difficult to differentiate it from congenital neuromuscular disorders. The presence of accompanying typical dysmorphic features and multisystemic involvement should be a warning for the diagnosis of mcEDS.

A rare case of proximal dominant hereditary motor and sensory neuropathy with TFG mutation

Betül Özenç — 2025-10-06

Hereditary motor and sensory neuropathy with proximal dominant involvement (HMSN-P) or Okinawa type is a rare neuromuscular disorder characterized by proximal dominant neurogenic atrophy and distal sensory changes with an autosomal dominant pattern of inheritance. The disease is characterized by adult-onset proximal weakness and atrophy, muscle cramps, fasciculations, areflexia, elevated creatine kinase, hyperlipidemia, and diabetes and is similar to Kennedy’s disease, but differs in that the mode of inheritance is autosomal dominant. We present a 53-year-old male patient with symmetrical proximal weakness, fasciculations, absent patellar tendon reflexes, and a positive family history for the same symptoms suggestive of HMSN-P, as well as his clinical, electrophysiological, and genetic features. These findings led to a genetic test that identified a variant in the TFG gene (c. 854C>T (p.Pro 285Leu)) and confirmed the diagnosis of HMSN-P. This case demonstrates the importance of considering this rare differential diagnosis in patients with proximal muscle weakness and distal sensory deficits with progressive muscle cramps.