Neurology International

11 pages, 263 KiB

Open AccessArticle

Neurophysiological Markers of Adaptation and Compensation Following Lower Limb Amputation: An Analysis of EEG Oscillations and Clinical Predictors from the DEFINE Cohort Study

by Guilherme J. M. Lacerda, Valton Costa, Lucas Camargo, Linamara R. Battistella, Marta Imamura and Felipe Fregni

Neurol. Int. 2025, 17(2), 21; https://doi.org/10.3390/neurolint17020021 - 28 Jan 2025

Abstract

Background: Neuroplasticity, involving cortical and subcortical reorganization, plays a critical role in the adaptation and compensation process post-amputation. However, underlying neurophysiological changes remain unclear, particularly in brain oscillations. Methods: This is a cross-sectional analysis that includes baseline data from 48 individuals with lower [...] Read more.

Background: Neuroplasticity, involving cortical and subcortical reorganization, plays a critical role in the adaptation and compensation process post-amputation. However, underlying neurophysiological changes remain unclear, particularly in brain oscillations. Methods: This is a cross-sectional analysis that includes baseline data from 48 individuals with lower limb amputation from our DEFINE Cohort Study project. EEG data were collected using a 64-channel system during a 5-min resting-state period. Preprocessed data were analyzed for delta and alpha oscillations across frontal, central, and parietal regions. Logistic regression models examined associations between EEG oscillations and clinical variables, including cognition (MoCA), functional independence (FIM), and phantom limb sensations (PLS). Results: The multivariate logistic regression analysis revealed distinct patterns of association between EEG oscillations and clinical variables. Delta oscillations were inversely associated with cognitive scores (OR: 0.69; p = 0.048), while higher delta power was related to the absence of PLS (OR: 58.55; p < 0.01). Frontal alpha power was positively linked to cognitive function (OR: 1.55; p = 0.02) but negatively associated with functional independence (OR: 0.75; p = 0.04). Conclusions: These findings suggest that lower frequencies, such as delta oscillations, play a role as potential compensatory brain rhythms. In contrast, alpha oscillations may reflect a more adapted pattern of brain reorganization after amputation. Full article

22 pages, 1781 KiB

Open AccessReview

The Interplay Between Sleep Apnea and Postpartum Depression

by Antonino Maniaci, Luigi La Via, Mario Lentini, Basilio Pecorino, Benito Chiofalo, Giuseppe Scibilia, Salvatore Lavalle, Antonina Luca and Paolo Scollo

Neurol. Int. 2025, 17(2), 20; https://doi.org/10.3390/neurolint17020020 - 28 Jan 2025

Abstract

The complicated association between sleep apnea and postpartum depression (PPD), two diseases that can have a major influence on a mother’s health and well-being, is examined in this thorough review. An increasing number of people are realizing that sleep apnea, which is defined [...] Read more.

The complicated association between sleep apnea and postpartum depression (PPD), two diseases that can have a major influence on a mother’s health and well-being, is examined in this thorough review. An increasing number of people are realizing that sleep apnea, which is defined by repeated bouts of upper airway obstruction during sleep, may be a risk factor for PPD. The literature currently available on the frequency, common risk factors, and possible processes relating these two disorders is summarized in this study. We investigate the potential roles that sleep apnea-related hormone fluctuations, intermittent hypoxia, and fragmented sleep may play in the onset or aggravation of PPD. We also talk about the difficulties in identifying sleep apnea in the postpartum phase and how it can affect childcare and mother–infant attachment. The evaluation assesses the effectiveness of existing screening techniques, available treatments, and how well they manage both illnesses at the same time. Lastly, we identify research gaps and suggest future lines of inquiry to enhance maternal health outcomes. Full article

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16 pages, 1529 KiB

Open AccessReview

The Role of Somatic Mutations in Ischemic Stroke: CHIP’s Impact on Vascular Health

by Aiman Kinzhebay and Amankeldi A. Salybekov

Neurol. Int. 2025, 17(2), 19; https://doi.org/10.3390/neurolint17020019 - 27 Jan 2025

Abstract

Clonal hematopoiesis of indeterminate potential (CHIP) is increasingly recognized as a significant contributor to ischemic stroke and other cardiovascular diseases due to its association with somatic mutations in hematopoietic cells. These mutations, notably in genes like DNMT3A, TET2, and JAK2, [...] Read more.

Clonal hematopoiesis of indeterminate potential (CHIP) is increasingly recognized as a significant contributor to ischemic stroke and other cardiovascular diseases due to its association with somatic mutations in hematopoietic cells. These mutations, notably in genes like DNMT3A, TET2, and JAK2, induce pro-inflammatory and pro-atherosclerotic processes, promoting vascular damage and stroke risk. With the prevalence of CHIP rising with age, its presence correlates with higher mortality and morbidity rates in ischemic stroke patients. This article explores the mechanisms through which CHIP influences vascular aging and stroke, emphasizing its potential as a biomarker for early risk stratification and a target for therapeutic intervention. The findings highlight the necessity of integrating CHIP status in clinical evaluations to better predict outcomes and personalize treatment strategies in stroke management. Full article

(This article belongs to the Special Issue Treatment Strategy and Mechanism of Acute Ischemic Stroke)

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11 pages, 531 KiB

Open AccessArticle

Albuminocytologic Dissociation and the Impact of Age-Adjusted Cerebrospinal Fluid Protein Levels in Guillain–Barré Syndrome

by Nithisha Thatikonda, Alexandru Lerint, Chaitra Takle, Xiang Fang and Chilvana Patel

Neurol. Int. 2025, 17(2), 18; https://doi.org/10.3390/neurolint17020018 - 24 Jan 2025

Abstract

Background: This study examined the impact of age-adjusted cerebrospinal fluid (CSF) protein levels on clinical characteristics, disease severity, and outcomes in Guillain–Barré Syndrome (GBS) patients. Methods: This retrospective study included 71 GBS patients at UTMB Galveston. Albuminocytologic dissociation (ACD) was defined as CSF–total [...] Read more.

Background: This study examined the impact of age-adjusted cerebrospinal fluid (CSF) protein levels on clinical characteristics, disease severity, and outcomes in Guillain–Barré Syndrome (GBS) patients. Methods: This retrospective study included 71 GBS patients at UTMB Galveston. Albuminocytologic dissociation (ACD) was defined as CSF–total protein (CSF-TP) >0.45 g/L with a cell count of <50 cells/L. Patients were grouped using the conventional cutoff (>0.45 g/L) and age-adjusted upper limits (URLs) for CSF-TP levels, comparing clinical, CSF, and electrophysiological characteristics across groups. Results: The mean age was 50 years (SD = 14.5). The mean age of patients with a CSF-TP > 45 g/L was higher (53 vs. 39 years, p = 0.000), whereas no such difference was noted using age-dependent URLs. Using age-adjusted CSF-TP URLs reduced the sensitivity for detecting ACD by 20%. CSF-TP > age-adjusted URLs were associated with lower MRC sum scores (39 vs. 47.43, p = 0.000), higher ICU admission rates (34% vs. 20%, p = 0.003), and the need for second-line treatment (41% vs. 17%, p = 0.049), and the trends were not observed with the conventional cutoff of 0.45 g/L. CSF-TP was an independent predictor of lower MRC sum scores (p = 0.009, 95% CI −0.058, −0.009) and higher GBS disability scores (p = 0.015, 95% CI 0.000, 0.004). Conclusions: ACD is a common finding in GBS, but normal protein levels do not exclude the diagnosis. Using age-adjusted URLs might improve specificity but reduce sensitivity for ACD detection, potentially increasing false negatives. CSF-TP levels exceeding age-adjusted URLs were more strongly associated with greater disease severity and poorer outcomes compared to the conventional cutoff of 0.45 g/L. Full article

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16 pages, 2336 KiB

Open AccessSystematic Review

Proprioceptive Neuromuscular Facilitation and/or Electrical Stimulation in Patients with Peripheral Facial Paralysis: A Systematic Review

by Nerea Dominguez-Defez, Juan Lopez-Barreiro, Pablo Hernandez-Lucas and Ana González-Castro

Neurol. Int. 2025, 17(2), 17; https://doi.org/10.3390/neurolint17020017 - 23 Jan 2025

Abstract

Background: Peripheral facial paralysis (PFP) affects the facial nerve, the seventh cranial nerve. It has an incidence rate of 20–30 cases per 100,000 habitants. The diagnosis is clinical, though imaging tests may be required in some cases. The treatment protocol includes medication, physiotherapy, [...] Read more.

Background: Peripheral facial paralysis (PFP) affects the facial nerve, the seventh cranial nerve. It has an incidence rate of 20–30 cases per 100,000 habitants. The diagnosis is clinical, though imaging tests may be required in some cases. The treatment protocol includes medication, physiotherapy, and, in certain cases, surgery. Proprioceptive neuromuscular facilitation (PNF) techniques and electrical stimulation have been shown to be significant for recovery. Although PFP has a high recovery rate, up to 40% of patients may experience permanent sequelae. Objective: to assess the efficacy of treatment based on electrical stimulation and/or PNF in patients affected by PFP. Methods: A systematic search was conducted across six databases (PubMed, Medline, SportDiscus, CINAHL, Scopus, and Web of Science) in November 2024. Randomized controlled trials were included. Results: Fourteen articles were analyzed, applying PNF and/or electrical stimulation methods, pharmacological treatment, low-level laser treatment, subcutaneous collagen injections, and physiotherapy protocols involving facial expression exercises, yielding evidence for the variables assessed. Conclusions: PNF and/or electrical stimulation treatment in patients with PFP can be effective when employed early with appropriate parameters, showing promising results in improving quality of life, facial movement quality, and CMAP and reducing both the incidence and degree of synkinesis. Full article

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16 pages, 4854 KiB

Open AccessCase Report

Pituitary Spindle Cell Oncocytoma: More than a Grade 1 Tumor?

by Jonathan Hammond, Zacharie Gagne, Bojana Mitrovic and Stefano M. Priola

Neurol. Int. 2025, 17(2), 16; https://doi.org/10.3390/neurolint17020016 - 22 Jan 2025

Abstract

Background/Objectives: Spindle cell oncocytomas (SCOs) of the pituitary gland are rare tumors often misdiagnosed for nonfunctioning pituitary macroadenomas. Although classified as grade 1, they are often challenging in terms of diagnosis and treatment. Pituitary SCOs harbor peculiar features such as hypervascularity and stronger [...] Read more.

Background/Objectives: Spindle cell oncocytomas (SCOs) of the pituitary gland are rare tumors often misdiagnosed for nonfunctioning pituitary macroadenomas. Although classified as grade 1, they are often challenging in terms of diagnosis and treatment. Pituitary SCOs harbor peculiar features such as hypervascularity and stronger adherence to surrounding structures, with increased risk of hemorrhage, partial resection, and significantly higher recurrence rate. Almost 100 cases have been reported so far. The role of surgery is still crucial for the decompression of the optic chiasm as well as for achieving diagnosis. However, given the higher tendency of recurrence, the role of postoperative radiotherapy has been investigated over the last few years. Case presentation: Here, we reported a case of a 48-year-old female with a pituitary SCO treated at our institution, in which we focused on diagnosis, treatment, and follow-up. Conclusions: This type of tumor presents a challenge related to its higher vascularity and strong adherence to the surrounding structures. Adjuvant radiotherapy is something that should be considered, especially when gross total resection is not achieved, and finally, SCOs require diligent follow-up to monitor for any signs of disease recurrence or progression. Full article

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18 pages, 1856 KiB

Open AccessReview

fMRI Insights into Visual Cortex Dysfunction as a Biomarker for Migraine with Aura

by Damian Pikor, Natalia Banaszek-Hurla, Alicja Drelichowska, Mikołaj Hurla, Jolanta Dorszewska, Tomasz Wolak and Wojciech Kozubski

Neurol. Int. 2025, 17(2), 15; https://doi.org/10.3390/neurolint17020015 - 21 Jan 2025

Abstract

Migraine with aura (MwA) is a common and severely disabling neurological disorder, characterised by transient yet recurrent visual disturbances, including scintillating scotomas, flickering photopsias, and complex geometric patterns. These episodic visual phenomena significantly compromise daily functioning, productivity, and overall quality of life. Despite [...] Read more.

Migraine with aura (MwA) is a common and severely disabling neurological disorder, characterised by transient yet recurrent visual disturbances, including scintillating scotomas, flickering photopsias, and complex geometric patterns. These episodic visual phenomena significantly compromise daily functioning, productivity, and overall quality of life. Despite extensive research, the underlying pathophysiological mechanisms remain only partially understood. Cortical spreading depression (CSD), a propagating wave of neuronal and glial depolarisation, has been identified as a central process in MwA. This phenomenon is triggered by ion channel dysfunction, leading to elevated intracellular calcium levels and excessive glutamate release, which contribute to widespread cortical hyperexcitability. Genetic studies, particularly involving the CACNA gene family, further implicate dysregulation of calcium channels in the pathogenesis of MwA. Recent advances in neuroimaging, particularly functional magnetic resonance imaging (fMRI), have provided critical insights into the neurophysiology of MwA. These results support the central role of CSD as a basic mechanism behind MwA and imply that cortical dysfunction endures beyond brief episodes, possibly due to chronic neuronal dysregulation or hyperexcitability. The visual cortex of MwA patients exhibits activation patterns in comparison to other neuroimaging studies, supporting the possibility that it is a disease-specific biomarker. Its distinctive sensory and cognitive characteristics are influenced by a complex interplay of cortical, vascular, and genetic factors, demonstrating the multifactorial nature of MwA. We now know much more about the pathophysiology of MwA thanks to the combination of molecular and genetic research with sophisticated neuroimaging techniques like arterial spin labelling (ASL) and fMRI. This review aims to synthesize current knowledge and analyse molecular and neurophysiological targets, providing a foundation for developing targeted therapies to modulate cortical excitability, restore neural network stability, and alleviate the burden of migraine with aura. The most important and impactful research in our field has been the focus of this review, which highlights important developments and their contributions to the knowledge and treatment of migraine with aura. Full article

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8 pages, 1907 KiB

Open AccessCase Report

Electroencephalographic and Epilepsy Findings in ZNF711 Variants: A Case Series of Two Siblings

by Michele Minerva, Lorenzo Perilli, Samanta Carbone, Margherita Maria Rossi, Federica Lotti, Luisa Lonoce, Maria Rosaria Curcio and Salvatore Grosso

Neurol. Int. 2025, 17(1), 14; https://doi.org/10.3390/neurolint17010014 - 20 Jan 2025

Abstract

Background/Objectives: ZNF711(Zinc finger protein 711) encodes a zinc finger protein of currently undefined function, located on the X chromosome. Current knowledge includes a limited number of case reports where this gene has been exclusively associated with X-linked intellectual disability (XLID). As far as [...] Read more.

Background/Objectives: ZNF711(Zinc finger protein 711) encodes a zinc finger protein of currently undefined function, located on the X chromosome. Current knowledge includes a limited number of case reports where this gene has been exclusively associated with X-linked intellectual disability (XLID). As far as we are aware, we report the first cases of epilepsy associated with this particular variant. Our aim is to further delineate the phenotypic spectrum of ZNF711 gene pathogenic variants, adding clinical features to this rare condition, following a genotype-first approach. Case presentation: We describe the familiar case of two male siblings presenting with moderate intellectual disability (ID), language delay, and motor stereotypies. Additionally, they experienced generalized tonic–clonic seizures (GTCSs) and myoclonic seizures with interictal electroencephalographic abnormalities. Both children underwent various genetic testing and counselling, including an extended next-generation sequencing (NGS) panel, revealing a hemizygous c.657C > G pathogenic variant in the ZNF711 gene from maternal inheritance. Conclusions: This case expands the clinical range of ZNF711 variants by highlighting epilepsy as a potential comorbidity and suggesting other possible causal candidates for generalized epilepsy. Moreover, it emphasizes the need for further research into the phenotypic spectrum associated with this variant. Full article

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13 pages, 674 KiB

Open AccessReview

Optical Coherence Tomography in Huntington's Disease—A Potential Future Biomarker for Neurodegeneration?

by Clancy Cerejo, Nicolas De Cleene, Elias Mandler, Katarina Schwarzová, Samuel Labrecque, Philipp Mahlknecht, Florian Krismer, Atbin Djamshidian, Klaus Seppi and Beatrice Heim

Neurol. Int. 2025, 17(1), 13; https://doi.org/10.3390/neurolint17010013 - 20 Jan 2025

Abstract

Huntington's disease (HD) is a progressive neurodegenerative disorder for which, until now, only symptomatic treatment has been available. Lately, there have been multiple ongoing clinical trials targeting therapeutic agents for preventing disease onset or slowing disease progression in HD. These studies are in [...] Read more.

Huntington's disease (HD) is a progressive neurodegenerative disorder for which, until now, only symptomatic treatment has been available. Lately, there have been multiple ongoing clinical trials targeting therapeutic agents for preventing disease onset or slowing disease progression in HD. These studies are in constant need of reliable biomarkers for neurodegeneration in HD. In recent years, retinal biomarkers have attracted significant attention in neurodegenerative disorders. Likewise, optical coherence tomography (OCT) is being evaluated as a potential biomarker in HD. In this article, we review the existing literature on OCT as a biomarker for neurodegeneration in HD. Full article

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14 pages, 2570 KiB

Open AccessArticle

Analysis of Upper Facial Weakness in Central Facial Palsy Following Acute Ischemic Stroke

by Monton Wongwandee and Kantham Hongdusit

Neurol. Int. 2025, 17(1), 12; https://doi.org/10.3390/neurolint17010012 - 19 Jan 2025

Abstract

Background: Central facial palsy (CFP), resulting from upper motor neuron lesions in the corticofacial pathway, is traditionally characterized by the sparing of the upper facial muscles. However, reports of upper facial weakness in CFP due to acute ischemic stroke have challenged this long-held [...] Read more.

Background: Central facial palsy (CFP), resulting from upper motor neuron lesions in the corticofacial pathway, is traditionally characterized by the sparing of the upper facial muscles. However, reports of upper facial weakness in CFP due to acute ischemic stroke have challenged this long-held assumption. This study aimed to determine the prevalence of upper facial weakness in CFP and identify its associated clinical factors. Methods: In this cross-sectional study, we evaluated consecutive patients with acute ischemic stroke admitted to a university hospital in Thailand from January 2022 to June 2023. Full-face video recordings were analyzed using the Sunnybrook Facial Grading System. Upper facial weakness was defined as asymmetry in at least one upper facial expression. Multivariable logistic regression was performed to identify factors associated with upper facial weakness. Results: Of 108 patients with acute ischemic stroke, 92 had CFP, and among these, 70 (76%) demonstrated upper facial weakness. Tight eye closure (force and wrinkle formation, both 42%) was the most sensitive indicator for detecting upper facial weakness. Greater stroke severity, as reflected by higher NIHSS scores (adjusted odds ratio [aOR], 1.42; 95% CI 1.07–1.88) and the presence of lower facial weakness (aOR, 6.56; 95% CI 1.85–23.29) were significantly associated with upper facial involvement. Although upper facial weakness was generally milder than lower facial weakness, its severity correlated with increasing lower facial asymmetry during movement. Conclusions: Contrary to traditional teaching, upper facial weakness is common in CFP due to acute ischemic stroke. The severity of stroke and the presence of lower facial weakness are key predictors of upper facial involvement. These findings underscore the need for clinicians to reconsider the diagnostic paradigm, recognizing that upper facial weakness can occur in CFP. Enhanced awareness may improve diagnostic accuracy, inform treatment decisions, and ultimately lead to better patient outcomes. Full article

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11 pages, 670 KiB

Open AccessReview

Early Polytherapy for Probably Benzodiazepine Refractory Naïve Status Epilepticus (Stage 1 Plus)

by Giuseppe Magro

Neurol. Int. 2025, 17(1), 11; https://doi.org/10.3390/neurolint17010011 - 19 Jan 2025

Abstract

Stage 1 Plus is defined here as a naïve, previously untreated, status epilepticus (SE) that is probably refractory to Benzodiazepines (BDZ). These cases include not only prolonged SE as previously proposed by the author (SE lasting > 10 min) but also other cases [...] Read more.

Stage 1 Plus is defined here as a naïve, previously untreated, status epilepticus (SE) that is probably refractory to Benzodiazepines (BDZ). These cases include not only prolonged SE as previously proposed by the author (SE lasting > 10 min) but also other cases notoriously associated with BDZ refractoriness such as the absence of prominent motor phenomena and acute etiology (especially primary central nervous system etiology). Interestingly, the absence of prominent motor phenomena as is the case of non convulsive SE might implicitly fall in the category of prolonged SE due to the delay in recognition and treatment. Future studies should help identify other factors associated with BDZ refractoriness, therefore widening the definition of Stage 1 Plus. The appropriate timing for defining prolonged SE may also differ depending on different etiology. Consequently, in future tailored models of SE, the definition of prolonged SE could be enhanced by defining it for a longer duration than Tx, a time point that changes based on different etiologies (x), Tx being much shorter than 10 min in acute etiologies. These cases of naïve probably BDZ refractory SE (Stage 1 Plus) might require a different approach: combined polytherapy from the start. The objective of this review is to provide pathophysiological and pre-clinical evidence, mostly from animal studies, for the different approach of combined polytherapy from the start for those cases of SE falling in the definition of Stage 1 Plus. Full article

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10 pages, 272 KiB

Open AccessArticle

Initial Contact with Forefoot or Rearfoot in Spastic Patients After Stroke—Three-Dimensional Gait Analysis

by Inês Mendes-Andrade, Miguel Reis e Silva and Jorge Jacinto

Neurol. Int. 2025, 17(1), 10; https://doi.org/10.3390/neurolint17010010 - 18 Jan 2025

Abstract

Background/Objectives: Post-stroke hemiparetic gait often presents with asymmetric patterns to compensate for stability deficits. This study examines gait differences in chronic stroke patients with spastic hemiparesis based on initial foot contact type—forefoot versus rearfoot. Methods: Thirty-four independently walking spastic hemiparetic patients were retrospectively [...] Read more.

Background/Objectives: Post-stroke hemiparetic gait often presents with asymmetric patterns to compensate for stability deficits. This study examines gait differences in chronic stroke patients with spastic hemiparesis based on initial foot contact type—forefoot versus rearfoot. Methods: Thirty-four independently walking spastic hemiparetic patients were retrospectively analyzed. Using 3D gait analysis, patients were categorized by initial contact type. Spatiotemporal descriptors, joint kinematics, kinetics, and EMG patterns were compared across groups. Results: Patients with rearfoot initial contact (G1) showed higher cadence, longer single-limb support time and shorter stride times than those with forefoot contact (G0). G1 patients also demonstrated greater knee flexion during stance, enhancing stability. Additionally, G1 patients with abnormal lateral gastrocnemius activation in the swing phase showed increased ankle power at the end of the stance phase. Conclusions: In post-stroke spastic hemiparetic patients, the type of initial foot contact—forefoot or rearfoot—appears to influence gait characteristics, with rearfoot contact associated with a trend toward improved gait parameters, such as increased cadence and longer single-limb support. Full article

30 pages, 6503 KiB

Open AccessReview

Non-Thrombotic Filling Defects in Cerebral Veins and Sinuses: When Normal Structures Mimic a Disease

by Marialuisa Zedde and Rosario Pascarella

Neurol. Int. 2025, 17(1), 9; https://doi.org/10.3390/neurolint17010009 - 17 Jan 2025

Abstract

Cerebral venous thrombosis (CVT) is a rare and potentially critical cerebrovascular disease involving intracranial dural sinuses and veins. The diagnosis is a stepwise pathway starting from clinical suspicion and employing several neuroradiological techniques, mainly Computed Tomography (CT)-based and Magnetic Resonance Imaging (MRI)-based modalities. [...] Read more.

Cerebral venous thrombosis (CVT) is a rare and potentially critical cerebrovascular disease involving intracranial dural sinuses and veins. The diagnosis is a stepwise pathway starting from clinical suspicion and employing several neuroradiological techniques, mainly Computed Tomography (CT)-based and Magnetic Resonance Imaging (MRI)-based modalities. The neuroradiological findings, both in the diagnostic phase and in the follow-up phase, may provide some results at risk for misdiagnosis. Non-thrombotic filling defects of intracranial dural sinuses are among them, and the potential sources are artefactual and or anatomical (venous septa and arachnoid granulations). The misdiagnosis of these findings as CVT is potentially linked to dangerous consequences. A potential strategy to avoid this is to increase the knowledge about technical and anatomical reasons for non-thrombotic filling defects of intracranial dural sinuses and their imaging features. The main aim of this review is to address these issues, including the variability of the intracranial venous pathways, providing the solutions for overcoming the above-cited potential misdiagnosis of non-thrombotic filling defects as CVT. Full article

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10 pages, 426 KiB

Open AccessPerspective

An “Engram-Centric” Approach to Transient Global Amnesia (TGA) and Other Acute-Onset Amnesias

by Andrew J. Larner

Neurol. Int. 2025, 17(1), 8; https://doi.org/10.3390/neurolint17010008 - 15 Jan 2025

Abstract

The differential diagnosis of acute-onset amnesia includes transient global amnesia (TGA), transient epileptic amnesia (TEA), and functional (or psychogenic) amnesia. The most common of these, TGA, is a rare but well-described condition characterised by a self-limited episode of dense anterograde amnesia with variable [...] Read more.

The differential diagnosis of acute-onset amnesia includes transient global amnesia (TGA), transient epileptic amnesia (TEA), and functional (or psychogenic) amnesia. The most common of these, TGA, is a rare but well-described condition characterised by a self-limited episode of dense anterograde amnesia with variable retrograde amnesia. Although the clinical phenomenology of TGA is well described, its pathogenesis is not currently understood, thus preventing the development of evidence-based therapeutic recommendations. Here, TGA, TEA, and functional amnesia are considered in light of the historical engram conception of memory, now informed by recent experimental research, as disturbances in distributed ensembles of engram neurones active during memory formation and recall. This analysis affords therapeutic implications for these conditions, should interventions to reactivate latent or silent engrams become available. Full article

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8 pages, 441 KiB

Open AccessArticle

Clinical Outcome After Surgical Treatment of Traumatic Peroneal Nerve Injury: An Analysis of Risk Factors After Different Surgical Approaches

by Daniel N. Werkmann, Ute M. Bäzner, Martin Petkov, Lena Minzenmay, Gregor Durner, Gregor Antoniadis, Christian R. Wirtz, Maria T. Pedro, Andreas Knoll and Andrej Pala

Neurol. Int. 2025, 17(1), 7; https://doi.org/10.3390/neurolint17010007 - 13 Jan 2025

Abstract

Background: This study aims to analyze potential risk factors that may influence the clinical outcomes following surgical treatment of traumatic peroneal nerve lesions. Methods: We conducted a retrospective analysis of patients with traumatic peroneal nerve injuries treated with decompression, split repair, or nerve [...] Read more.

Background: This study aims to analyze potential risk factors that may influence the clinical outcomes following surgical treatment of traumatic peroneal nerve lesions. Methods: We conducted a retrospective analysis of patients with traumatic peroneal nerve injuries treated with decompression, split repair, or nerve grafting between 2010 and 2020. Motor function and potential risk factors were evaluated. Results: Out of 93 patients, 42 (45%) underwent decompression, 15 (16%) received split repair, and 36 (39%) required autologous nerve grafting. Up to one year after surgery, weakness of the anterior tibial muscle improved from a median of M0 to M3. After one year following nerve decompression, functional recovery was observed in 28 (65%) cases, in 9 (21%) cases after split repair, and in 7 (16%) cases following autologous nerve grafting. A defect greater than 8 cm was associated with significantly poorer improvement of extensor hallucis longus (p = 0.037, HR 0.109). We found no significant associations between age, diabetes mellitus, arterial hypertension, obesity, and postoperative outcomes. Conclusions: According to the present data, a significant number of patients achieved functional improvement following surgical treatment, indicating that this procedure should be considered an important treatment option in selected cases. Full article

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25 pages, 717 KiB

Open AccessReview

The Rise of Pluripotent Stem Cell-Derived Glia Models of Neuroinflammation

by Srishti Kala, Andrew G. Strutz and Moriah E. Katt

Neurol. Int. 2025, 17(1), 6; https://doi.org/10.3390/neurolint17010006 - 13 Jan 2025

Abstract

Neuroinflammation is a blanket term that describes the body’s complex inflammatory response in the central nervous system (CNS). It encompasses a phenotype shift to a proinflammatory state, the release of cytokines, the recruitment of peripheral immune cells, and a wide variety of other [...] Read more.

Neuroinflammation is a blanket term that describes the body’s complex inflammatory response in the central nervous system (CNS). It encompasses a phenotype shift to a proinflammatory state, the release of cytokines, the recruitment of peripheral immune cells, and a wide variety of other processes. Neuroinflammation has been implicated in nearly every major CNS disease ranging from Alzheimer’s disease to brain cancer. Understanding and modeling neuroinflammation is critical for the identification of novel therapeutic targets in the treatment of CNS diseases. Unfortunately, the translation of findings from non-human models has left much to be desired. This review systematically discusses the role of human pluripotent stem cell (hPSC)-derived glia and supporting cells within the CNS, including astrocytes, microglia, oligodendrocyte precursor cells, pericytes, and endothelial cells, to describe the state of the field and hope for future discoveries. hPSC-derived cells offer an expanded potential to study the pathobiology of neuroinflammation and immunomodulatory cascades that impact disease progression. While much progress has been made in the development of models, there is much left to explore in the application of these models to understand the complex inflammatory response in the CNS. Full article

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12 pages, 1566 KiB

Open AccessArticle

Endocrine Outcome and Quality of Life After Transsphenoidal Resection of Pituitary Adenoma—A Prospective Randomized Single-Blinded Study Comparing Endoscopic Versus Microscopic Resection

by Andrej Pala, Nadja Grübel, Benjamin Mayer, Ralf Becker, Fabian Sommer, Bernd Schmitz, Gwendolin Etzrodt-Walter, Christian Rainer Wirtz and Michal Hlavac

Neurol. Int. 2025, 17(1), 5; https://doi.org/10.3390/neurolint17010005 - 10 Jan 2025

Abstract

Background: Endoscopic pituitary surgery might yield better endocrine outcomes compared to microscopic resection. We conducted a prospective, randomized, single-blinded study to compare the endocrine outcome and quality of life (QoL) of patients with newly diagnosed pituitary adenoma who underwent either endoscopic or microscopic [...] Read more.

Background: Endoscopic pituitary surgery might yield better endocrine outcomes compared to microscopic resection. We conducted a prospective, randomized, single-blinded study to compare the endocrine outcome and quality of life (QoL) of patients with newly diagnosed pituitary adenoma who underwent either endoscopic or microscopic transsphenoidal surgery (NCT03515603). Methods: Due to slow recruitment, this study had to be stopped prematurely. Out of 170 transsphenoidal pituitary surgeries performed during the study period, 36 patients were enrolled in this study. The primary endpoint was based on the development of a new hypopituitarism. Secondary endpoints included the extent of resection, complications, and QoL. Results: Endoscopic surgery was performed in 47.2% (n = 17). A new hypopituitarism was found in 8.3% (n = 3). All these cases underwent microscopic resection. Arginine vasopressin deficiency was found in 2.7% (n = 1) after microscopic resection. Gross total resection was achieved in 94.4% (n = 34). No surgical complications or new neurological deficits were observed. QoL improved significantly after the surgery, as measured by EQ-VAS (p = 0.003). According to EQ-5D3L, QoL improved or remained unchanged in almost all patients. No significant difference was found in QoL between the endoscopic and microscopic groups. Conclusion: The endoscopic technique appears to offer benefits in the treatment of pituitary adenomas, particularly in terms of achieving a favorable endocrine outcome. Full article

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1 pages, 166 KiB

Open AccessCorrection

Correction: AlTawari et al. Nusinersen Treatment for Spinal Muscular Atrophy: Retrospective Multicenter Study of Pediatric and Adult Patients in Kuwait. Neurol. Int. 2024, 16, 631–642

by Asma AlTawari, Mohammad Zakaria, Walaa A. Kamel, Nayera Shaalan, Gamal Ahmed Ismail Elghazawi, Mohamed Esmat Anwar Ali, Dalia Salota, Amr Attia, Ehab Elsayed Ali Elanany, Osama Shalaby, Fatema Alqallaf, Vesna Mitic and Laila Bastaki

Neurol. Int. 2025, 17(1), 4; https://doi.org/10.3390/neurolint17010004 - 2 Jan 2025

Abstract

In the published publication [...] Full article

10 pages, 2672 KiB

Open AccessCase Report

Subsequent Acute Ischemic Stroke in a Patient with Monocular Vision Loss Associated with Isolated Internal Carotid Artery Occlusion: A Case Report

by Jessica Seetge, Balázs Cséke, Zsófia Nozomi Karádi, Eszter Szalai, Valéria Gaál and László Szapáry

Neurol. Int. 2025, 17(1), 3; https://doi.org/10.3390/neurolint17010003 - 26 Dec 2024

Abstract

Background/Objectives: Acute retinal ischemia, including central retinal artery occlusion (CRAO), is recognized as a stroke equivalent by the American Heart Association/American Stroke Association (AHA/ASA), necessitating immediate multidisciplinary evaluation and management. However, referral patterns among ophthalmologists remain inconsistent, and evidence-based therapeutic interventions to improve [...] Read more.

Background/Objectives: Acute retinal ischemia, including central retinal artery occlusion (CRAO), is recognized as a stroke equivalent by the American Heart Association/American Stroke Association (AHA/ASA), necessitating immediate multidisciplinary evaluation and management. However, referral patterns among ophthalmologists remain inconsistent, and evidence-based therapeutic interventions to improve visual outcomes are currently lacking. CRAO is associated with a significantly elevated risk of subsequent acute ischemic stroke (AIS), particularly within the first week following diagnosis, yet the role of intravenous thrombolysis (IVT) in this setting remains controversial. This case report presents a unique case of CRAO with concurrent internal carotid artery (ICA) occlusion, followed by an AIS affecting the middle cerebral artery (MCA). Case presentation: An 83-year-old woman presented with acute, painless monocular vision loss to the emergency department. IVT was administered within 4.5 h of admission for suspected CRAO associated with ICA occlusion (ICAO) identified on CT-angiography (CTA). One hour post-thrombolysis, CT-perfusion (CTP) confirmed MCA occlusion (MCAO), necessitating mechanical thrombectomy (MT). Successful recanalization was achieved without complications, and the patient demonstrated no functional impairments at discharge. Conclusions: This case underscores the importance of maintaining a vigilant approach to stroke management in CRAO patients. It highlights the diagnostic challenges encountered in clinical practice and advocates for further research into the role of IVT in CRAO cases with ICAO, emphasizing the need for consensus in treatment. Full article

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