Neurology International

11 pages, 569 KiB

Open AccessEditor’s ChoiceReview

Obstructive Sleep Apnea in Pregnancy: A Comprehensive Review of Maternal and Fetal Implications

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

Neurol. Int. 2024, 16(3), 522-532; https://doi.org/10.3390/neurolint16030039 - 7 May 2024

Viewed by 1184

Abstract

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition in pregnancy, associated with various maternal and fetal complications. This review synthesizes the current evidence on the epidemiology, pathophysiology, and neurological consequences of OSA in pregnancy, along with the potential management strategies. Articles [...] Read more.

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition in pregnancy, associated with various maternal and fetal complications. This review synthesizes the current evidence on the epidemiology, pathophysiology, and neurological consequences of OSA in pregnancy, along with the potential management strategies. Articles were sourced from the PubMed, EMBASE, and Cochrane databases until 2023. Our comprehensive review highlights that the incidence of OSA increases during pregnancy due to physiological changes such as weight gain and hormonal fluctuations. OSA in pregnancy is linked with gestational hypertension, pre-eclampsia, gestational diabetes, and potential adverse fetal outcomes such as intrauterine growth restriction and preterm birth. Continuous positive airway pressure (CPAP) therapy remains the most effective management strategy for pregnant women with OSA. However, adherence to CPAP therapy is often suboptimal. This comprehensive review underscores the importance of the early recognition, timely diagnosis, and effective management of OSA in pregnancy to improve both maternal and fetal outcomes. Future research should focus on enhancing screening strategies and improving adherence to CPAP therapy in this population. Full article

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16 pages, 2738 KiB

Open AccessEditor’s ChoiceReview

Oxidative Stress and Neurodegeneration: Insights and Therapeutic Strategies for Parkinson’s Disease

by Erjola Bej, Patrizia Cesare, Anna Rita Volpe, Michele d’Angelo and Vanessa Castelli

Neurol. Int. 2024, 16(3), 502-517; https://doi.org/10.3390/neurolint16030037 - 29 Apr 2024

Viewed by 1286

Abstract

Parkinson’s disease (PD) is a progressive neurodegenerative condition marked by the gradual deterioration of dopaminergic neurons in the substantia nigra. Oxidative stress has been identified as a key player in the development of PD in recent studies. In the first part, we [...] Read more.

Parkinson’s disease (PD) is a progressive neurodegenerative condition marked by the gradual deterioration of dopaminergic neurons in the substantia nigra. Oxidative stress has been identified as a key player in the development of PD in recent studies. In the first part, we discuss the sources of oxidative stress in PD, including mitochondrial dysfunction, dopamine metabolism, and neuroinflammation. This paper delves into the possibility of mitigating oxidative stress as a potential treatment approach for PD. In addition, we examine the hurdles and potential of antioxidant therapy, including the challenge of delivering antioxidants to the brain and the requirement for biomarkers to track oxidative stress in PD patients. However, even if antioxidant therapy holds promise, further investigation is needed to determine its efficacy and safety in PD treatment. Full article

(This article belongs to the Collection Advances in Neurodegenerative Diseases)

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9 pages, 1941 KiB

Open AccessEditor’s ChoiceBrief Report

Thecaloscopy Reduces the Risk of Recurrent Perineural (Tarlov) Cysts after Microsurgical Resection

by Michael Luchtmann, Angelika Klammer, Mircea-Alin Iova, André Roth, Vijay Kumar Chanamolu, Christian Mawrin and Jan-Peter Warnke

Neurol. Int. 2024, 16(2), 450-458; https://doi.org/10.3390/neurolint16020033 - 17 Apr 2024

Viewed by 1160

Abstract

Sacral Tarlov cysts (TCs), often asymptomatic, can cause significant pain and severe neurological dysfunction. Conventional treatments are generally associated with high recurrence and complication rates. Specifically, the substantial recurrence rates, which can reach as high as 50%, significantly impact long-term outcomes. Recent evidence [...] Read more.

Sacral Tarlov cysts (TCs), often asymptomatic, can cause significant pain and severe neurological dysfunction. Conventional treatments are generally associated with high recurrence and complication rates. Specifically, the substantial recurrence rates, which can reach as high as 50%, significantly impact long-term outcomes. Recent evidence increasingly supports the hypothesis that the formation of Tarlov cysts (TCs) may be associated with inflammatory processes within the nerve root sheath, further exacerbated by elevated cerebrospinal fluid (CSF) pressure. This retrospective study explores thecaloscopy, combined with surgical techniques, as a more effective alternative. We observed a total of 78 patients, 48 of whom underwent endoscopic fenestration of the arachnoid sheath in addition to microsurgical resection of the TC. We found that the fenestration of the arachnoid sheath at the level of lumbosacral spinal nerve root entry led to a significantly decreased risk of developing recurrent TCs (5/48 vs. 9/30). Only one of the patients suffered from a persistent new bladder dysfunction after microsurgical resection. This presented technique provides a promising treatment path for the future management of TCs, offering a safe and more effective treatment option compared to previous methods. Additionally, the advantages of the thecaloscopy provide pathophysiological implications regarding the development of perineural cysts. Full article

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13 pages, 4881 KiB

Open AccessEditor’s ChoiceArticle

[¹²⁵I]IPC-Lecanemab: Synthesis and Evaluation of Aβ-Plaque-Binding Antibody and Comparison with Small-Molecule [¹⁸F]Flotaza and [¹²⁵I]IBETA in Postmortem Human Alzheimer’s Disease

by Christopher Liang, Cayz G. Paclibar, Noresa L. Gonzaga, Stephanie A. Sison, Harman S. Bath, Agnes P. Biju and Jogeshwar Mukherjee

Neurol. Int. 2024, 16(2), 419-431; https://doi.org/10.3390/neurolint16020031 - 8 Apr 2024

Viewed by 1283

Abstract

Therapeutic antibodies for reducing Aβ plaque load in Alzheimer’s disease (AD) is currently making rapid progress. The diagnostic imaging of Aβ plaque load in AD has been underway and is now used in clinical studies. Here, we report our preliminary findings on imaging [...] Read more.

Therapeutic antibodies for reducing Aβ plaque load in Alzheimer’s disease (AD) is currently making rapid progress. The diagnostic imaging of Aβ plaque load in AD has been underway and is now used in clinical studies. Here, we report our preliminary findings on imaging a therapeutic antibody, Lecanemab, in a postmortem AD brain anterior cingulate. [¹²⁵I]5-iodo-3-pyridinecarboxamido-Lecanemab ([¹²⁵I]IPC-Lecanemab) was prepared by coupling N-succinimidyl-5-([¹²⁵I]iodo)-3-pyridinecarboxylate with Lecanemab in modest yields. The distinct binding of [¹²⁵I]IPC-Lecanemab to Aβ-rich regions in postmortem human AD brains was higher in grey matter (GM) containing Aβ plaques compared to white matter (WM) (GM/WM was 1.6). Anti-Aβ immunostaining was correlated with [¹²⁵I]IPC-Lecanemab regional binding in the postmortem AD human brains. [¹²⁵I]IPC-Lecanemab binding was consistent with the binding of Aβ small molecules, [¹⁸F]flotaza and [¹²⁵I]IBETA, in the same subjects. [¹⁸F]Flotaza and [¹²⁵I]IBETA, however, exhibited significantly higher GM/WM ratios (>20) compared to [¹²⁵I]IPC-Lecanemab. Our results suggest that radiolabeled [¹²⁵I]IPC-Lecanemab retains the ability to bind to Aβ in human AD and may therefore be useful as a PET imaging radiotracer when labeled as [¹²⁴I]IPC-Lecanemab. The ability to directly visualize in vivo a promising therapeutic antibody for AD may be useful in treatment planning and dosing and could be complimentary to small-molecule diagnostic imaging to assess outcomes of therapeutic interventions. Full article

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13 pages, 905 KiB

Open AccessEditor’s ChoiceReview

Mortality Predictors for Adult Patients with Mild-to-Moderate Traumatic Brain Injury: A Literature Review

by Ansam Eghzawi, Alameen Alsabbah, Shatha Gharaibeh, Iktimal Alwan, Abeer Gharaibeh and Anita V. Goyal

Neurol. Int. 2024, 16(2), 406-418; https://doi.org/10.3390/neurolint16020030 - 5 Apr 2024

Viewed by 1163

Abstract

Traumatic brain injuries (TBIs) represent a significant public health concern, with mild-to-moderate cases comprising a substantial portion of incidents. Understanding the predictors of mortality among adult patients with mild-to-moderate TBIs is crucial for optimizing clinical management and improving outcomes. This literature review examines [...] Read more.

Traumatic brain injuries (TBIs) represent a significant public health concern, with mild-to-moderate cases comprising a substantial portion of incidents. Understanding the predictors of mortality among adult patients with mild-to-moderate TBIs is crucial for optimizing clinical management and improving outcomes. This literature review examines the existing research to identify and analyze the mortality predictors in this patient population. Through a comprehensive review of peer-reviewed articles and clinical studies, key prognostic factors, such as age, Glasgow Coma Scale (GCS) score, the presence of intracranial hemorrhage, pupillary reactivity, and coexisting medical conditions, are explored. Additionally, this review investigates the role of advanced imaging modalities, biomarkers, and scoring systems in predicting mortality following a mild-to-moderate TBI. By synthesizing the findings from diverse studies, this review aims to provide clinicians and researchers with valuable insights into the factors influencing mortality outcomes in adult patients with a mild-to-moderate TBI, thus facilitating more informed decision making and targeted interventions in clinical practice. Full article

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14 pages, 969 KiB

Open AccessEditor’s ChoiceReview

Decoding Post-Viral Fatigue: The Basal Ganglia’s Complex Role in Long-COVID

by Thorsten Rudroff

Neurol. Int. 2024, 16(2), 380-393; https://doi.org/10.3390/neurolint16020028 - 28 Mar 2024

Viewed by 1654

Abstract

Long-COVID afflicts millions with relentless fatigue, disrupting daily life. The objective of this narrative review is to synthesize current evidence on the role of the basal ganglia in long-COVID fatigue, discuss potential mechanisms, and highlight promising therapeutic interventions. A comprehensive literature search was [...] Read more.

Long-COVID afflicts millions with relentless fatigue, disrupting daily life. The objective of this narrative review is to synthesize current evidence on the role of the basal ganglia in long-COVID fatigue, discuss potential mechanisms, and highlight promising therapeutic interventions. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases. Mounting evidence from PET, MRI, and functional connectivity data reveals basal ganglia disturbances in long-COVID exhaustion, including inflammation, metabolic disruption, volume changes, and network alterations focused on striatal dopamine circuitry regulating motivation. Theories suggest inflammation-induced signaling disturbances could impede effort/reward valuation, disrupt cortical–subcortical motivational pathways, or diminish excitatory input to arousal centers, attenuating drive initiation. Recent therapeutic pilots targeting basal ganglia abnormalities show provisional efficacy. However, heterogeneous outcomes, inconsistent metrics, and perceived versus objective fatigue discrepancies temper insights. Despite the growing research, gaps remain in understanding the precise pathways linking basal ganglia dysfunction to fatigue and validating treatment efficacy. Further research is needed to advance understanding of the basal ganglia’s contribution to long-COVID neurological sequelae and offer hope for improving function across the expanding affected population. Full article

(This article belongs to the Special Issue COVID-19, Neuroinflammation and Therapeutics, 2nd Edition)

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23 pages, 858 KiB

Open AccessEditor’s ChoiceSystematic Review

Pulmonary Function Tests Post-Stroke. Correlation between Lung Function, Severity of Stroke, and Improvement after Respiratory Muscle Training

by Fotios Drakopanagiotakis, Konstantinos Bonelis, Paschalis Steiropoulos, Dimitrios Tsiptsios, Anastasia Sousanidou, Foteini Christidi, Aimilios Gkantzios, Aspasia Serdari, Styliani Voutidou, Chrysoula-Maria Takou, Christos Kokkotis, Nikolaos Aggelousis and Konstantinos Vadikolias

Neurol. Int. 2024, 16(1), 139-161; https://doi.org/10.3390/neurolint16010009 - 11 Jan 2024

Viewed by 1523

Abstract

Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs [...] Read more.

Stroke is a significant cause of mortality and chronic morbidity caused by cardiovascular disease. Respiratory muscles can be affected in stroke survivors, leading to stroke complications, such as respiratory infections. Respiratory function can be assessed using pulmonary function tests (PFTs). Data regarding PFTs in stroke survivors are limited. We reviewed the correlation between PFTs and stroke severity or degree of disability. Furthermore, we reviewed the PFT change in stroke patients undergoing a respiratory muscle training program. We searched PubMed until September 2023 using inclusion and exclusion criteria in order to identify studies reporting PFTs post-stroke and their change after a respiratory muscle training program. Outcomes included lung function parameters (FEV₁, FVC, PEF, MIP and MEP) were measured in acute or chronic stroke survivors. We identified 22 studies of stroke patients, who had undergone PFTs and 24 randomised controlled trials in stroke patients having PFTs after respiratory muscle training. The number of patients included was limited and studies were characterised by great heterogeneity regarding the studied population and the applied intervention. In general, PFTs were significantly reduced compared to healthy controls and predicted normal values and associated with stroke severity. Furthermore, we found that respiratory muscle training was associated with significant improvement in various PFT parameters and functional stroke parameters. PFTs are associated with stroke severity and are improved after respiratory muscle training. Full article

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

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13 pages, 2306 KiB

Open AccessEditor’s ChoiceArticle

Variability of the Cervical Branch Depending on the Facial Nerve Branching Pattern and Anthropometric Type of the Head

by Angela Babuci, Victor Palarie, Ilia Catereniuc, Zinovia Zorina, Sergiu Visnevschi, Diana Heimes, Sofia Lehtman and Peer W. Kämmerer

Neurol. Int. 2024, 16(1), 113-125; https://doi.org/10.3390/neurolint16010007 - 4 Jan 2024

Cited by 1 | Viewed by 2108

Abstract

(1) Background: Considering that the specialty literature supplies only general data about the variability of the cervical branch of the facial nerve, this study aimed to determine this branch’s variation and individual peculiarities depending on the nerve branching pattern and anthropometric type of [...] Read more.

(1) Background: Considering that the specialty literature supplies only general data about the variability of the cervical branch of the facial nerve, this study aimed to determine this branch’s variation and individual peculiarities depending on the nerve branching pattern and anthropometric type of the head. (2) Methods: The study was conducted on 75 hemifaces of adult formalized cadavers. Ahead of anatomical dissection, each head was measured to establish the anthropometric type, according to Franco and colleagues. The branching patterns were then distributed according to the Davis classification. (3) Results: The number of cervical branches (CB) of the facial nerve varied from one to five branches, with the following rate: 1 CB (61.3%), 2 CB (28%), 3 CB (6.7%), 4 CB (2.7%), and 5 CB (1.3%). Seven branching patterns of the facial nerve were revealed: Type I in 18.7%, Type II in 14.7%, Type III in 20%, Type IV in 14.6%, Type V in 5.3%, Type VI in 18.7%, and Type NI in 8% (bizarre types). According to the branching pattern, the mean numbers of the cervical branches were as follows: Type I—1.6 ± 1.02; Type II—1.4 ± 0.50; Type III—1.4 ± 0.50; Type IV—1.4 ± 0.67; Type V—2.0 ± 1.41; Type VI—1.8 ± 1.12; and Type-NI—1.8 ± 0.75; p = 0.599. According to the anthropometric type of the head, the mean number of CB in the mesocephalic type (MCT) was 1.5 ± 0.82, in the dolichocephalic type (DCT), 1.7 ± 0.87, and in the brachycephalic type, (BCT) 1.8 ± 1.04; p = 0.668. (4) Conclusions: The cervical branch of the facial nerve varies depending on the facial nerve branching pattern and the anthropometric type of the head. The highest degree of variation was characteristic of BCT and Type V and the lowest, of MCT and Types II, III, and IV. Full article

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18 pages, 3063 KiB

Open AccessEditor’s ChoiceReview

Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment

by Roy A. Poblete, Charlotte Zhong, Anish Patel, Grace Kuo, Philip Y. Sun, Jiayu Xiao, Zhaoyang Fan, Nerses Sanossian, Amytis Towfighi and Patrick D. Lyden

Neurol. Int. 2024, 16(1), 95-112; https://doi.org/10.3390/neurolint16010006 - 4 Jan 2024

Viewed by 2541

Abstract

Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this [...] Read more.

Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this population, post-traumatic cerebral infarction (PTCI) acutely after TBI is an important but under-recognized complication that is associated with negative functional outcomes. In this comprehensive review, we describe the incidence and pathophysiology of PTCI. We then discuss the diagnostic and treatment approaches for the most common etiologies of isolated PTCI, including brain herniation syndromes, cervical artery dissection, venous thrombosis, and post-traumatic vasospasm. In addition to these mechanisms, hypercoagulability and microcirculatory failure can also exacerbate ischemia. We aim to highlight the importance of this condition and future clinical research needs with the goal of improving patient outcomes after TBI. Full article

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21 pages, 3362 KiB

Open AccessEditor’s ChoiceReview

The Management of Intracranial Aneurysms: Current Trends and Future Directions

by Aviraj S. Deshmukh, Stefano M. Priola, Aris H. Katsanos, Gianluca Scalia, Aderaldo Costa Alves, Abhilekh Srivastava and Christine Hawkes

Neurol. Int. 2024, 16(1), 74-94; https://doi.org/10.3390/neurolint16010005 - 3 Jan 2024

Cited by 3 | Viewed by 1972

Abstract

Intracranial aneurysms represent a major global health burden. Rupture of an intracranial aneurysm is a catastrophic event. Without access to treatment, the fatality rate is 50% in the first 30 days. Over the last three decades, treatment approaches for intracranial aneurysms have changed [...] Read more.

Intracranial aneurysms represent a major global health burden. Rupture of an intracranial aneurysm is a catastrophic event. Without access to treatment, the fatality rate is 50% in the first 30 days. Over the last three decades, treatment approaches for intracranial aneurysms have changed dramatically. There have been improvements in the medical management of aneurysmal subarachnoid haemorrhage, and there has been an evolution of treatment strategies. Endovascular therapy is now the mainstay of the treatment of ruptured intracranial aneurysms based on robust randomised controlled trial data. There is now an expansion of treatment indications for unruptured intracranial aneurysms to prevent rupture with both microsurgical clipping and endovascular treatment. Both microsurgical and endovascular treatment modalities have evolved, in particular with the introduction of innovative endovascular treatment options including flow diversion and intra-saccular flow disruption. These novel therapies allow clinicians to treat more complex and previously untreatable aneurysms. We aim to review the evolution of treatment strategies for intracranial aneurysms over time, and discuss emerging technologies that could further improve treatment safety and functional outcomes for patients with an intracranial aneurysm. Full article

(This article belongs to the Special Issue Global Burden of Neurological Disorder)

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13 pages, 1131 KiB

Open AccessEditor’s ChoiceSystematic Review

Phantosmia in Parkinson’s Disease: A Systematic Review of the Phenomenology of Olfactory Hallucinations

by Tommaso Ercoli, Caterina Francesca Bagella, Claudia Frau, Elisa Ruiu, Sabrine Othmani, Giansalvo Gusinu, Carla Masala, Leonardo Antonio Sechi, Paolo Solla and Giovanni Defazio

Neurol. Int. 2024, 16(1), 20-32; https://doi.org/10.3390/neurolint16010002 - 22 Dec 2023

Cited by 1 | Viewed by 1635

Abstract

Olfactory dysfunction is a prevalent non-motor symptom in Parkinson’s disease (PD), affecting approximately 65–90% of subjects. PD patients may also report odor perception in the absence of any external source, often referred to as olfactory hallucinations (OHs) or phantosmia. This study aims to [...] Read more.

Olfactory dysfunction is a prevalent non-motor symptom in Parkinson’s disease (PD), affecting approximately 65–90% of subjects. PD patients may also report odor perception in the absence of any external source, often referred to as olfactory hallucinations (OHs) or phantosmia. This study aims to explore the current understanding of OHs in PD and offer a comprehensive overview of their prevalence and characteristics. We conducted a systematic search of the literature published on PubMed from inception to July 2023 regarding OHs in PD, following PRISMA guidelines. From the 2875 studies identified through database searching, 29 studies fulfilled the necessary criteria and underwent data extraction. The frequency of OHs in PD patients varies widely, ranging from 0.5% to 18.2%, with female prevalence ranging from 36% to 75% of the patients. Olfactory experiences may vary widely, ranging from pleasant scents to unpleasant odors. Several studies have indicated the concurrent presence of other types of hallucinations alongside phantosmia, especially visual and auditory hallucinations. OHs in PD are a type of hallucination that has been largely overlooked. To gain a deeper understanding of OHs in PD patients, the next crucial step should involve the development and validation of a dedicated questionnaire. Full article

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9 pages, 288 KiB

Open AccessEditor’s ChoiceArticle

Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting?

by Dalibor Sila, Francisco Luis Casnati, Mária Vojtková, Philipp Kirsch, Stefan Rath and František Charvát

Neurol. Int. 2023, 15(4), 1480-1488; https://doi.org/10.3390/neurolint15040096 - 6 Dec 2023

Cited by 3 | Viewed by 1255

Abstract

Background: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment modality. Methods: [...] Read more.

Background: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment modality. Methods: We retrospectively reviewed 142 cases conducted internally; 78 were treated surgically and 64 were treated using MMA embolization. We analyzed the treatment failure rate and complications, and using a binary logistic regression model, we identified treatment failure risk factors. Results: We found a comparable treatment failure rate of 23.1% for the surgery group and 21.9% for the MMA embolization group. However, in the MMA embolization group, 11 cases showed treatment failure due to early neurological worsening with a need for concomitant surgery. We also found a recurrence of hematoma in 15.4% of cases in the surgery group and 6.3% of cases in the MMA embolization group. Conclusion: Both modalities have their advantages; however, correct identification is crucial for treatment success. According to our findings, hematomas with a maximal width of <18 mm, a midline shift of <5 mm, and no acute or subacute (hyperdense) hematoma could be treated with MMA embolization. Hematomas with a maximal width of >18 mm, a midline shift of >5 mm, and no membranous segmentation could have better outcomes after surgical treatment. Full article

12 pages, 3663 KiB

Open AccessEditor’s ChoiceArticle

Analysis of Post-COVID-19 Guillain–Barré Syndrome over a Period of One Year in the University Hospital of Split (Croatia)

by Niko Dunkić, Marija Nazlić, Valerija Dunkić and Ivica Bilić

Neurol. Int. 2023, 15(4), 1359-1370; https://doi.org/10.3390/neurolint15040086 - 6 Nov 2023

Cited by 1 | Viewed by 1629

Abstract

The virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is capable of attacking the nervous system in several ways and leading to neurological diseases such as GBS (Guillain–Barré syndrome) through the resulting neurotropism and immune response. The aim of this study is to [...] Read more.

The virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is capable of attacking the nervous system in several ways and leading to neurological diseases such as GBS (Guillain–Barré syndrome) through the resulting neurotropism and immune response. The aim of this study is to show the relationship between Coronavirus disease (COVID-19) and GBS and to better understand the clinical symptoms to prevent poor outcomes. Data from 15 patients were extracted from the Department of Neurology, University Hospital of Split, Croatia, for the year 2021. The age of the patients ranged from 26 to 89 years, of whom 27% were women. Sixty seven percent of all GBS patients recovered from COVID-19 infection, whereas post-vaccinal polyradiculoneuritis was detected in 6%. Forty four percent of the patients who developed GBS had a severe form of COVID-19 infection. Forty percent of patients were treated with intravenous immunoglobulins (IVIG), followed by therapeutic plasma exchange (PLEX) in 27%. After the therapy, improvement was observed in 13 patients, while two patients died. The results suggest that SARS-CoV-2 triggers GBS because it follows a similar pattern of infection as the other viral and bacterial agents that contribute to the onset of GBS. There is no evidence that prior infection with COVID-19 worsens the clinical presentation of GBS. Full article

(This article belongs to the Special Issue Global Burden of Neurological Disorder)

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7 pages, 1571 KiB

Open AccessEditor’s ChoiceCase Report

A Case Series of Four Patients with Artery of Percheron Occlusion over a Three-Month Period

by Matej Perovnik, Janja Pretnar Oblak and Senta Frol

Neurol. Int. 2023, 15(4), 1352-1358; https://doi.org/10.3390/neurolint15040085 - 2 Nov 2023

Viewed by 2420

Abstract

Here, we present a case series of four patients diagnosed with acute ischaemic stroke due to occlusion of the artery of Percheron (AOP), a rare stroke variant, observed in a single emergency centre within a three-month period. AOP occlusion is characterized by bilateral [...] Read more.

Here, we present a case series of four patients diagnosed with acute ischaemic stroke due to occlusion of the artery of Percheron (AOP), a rare stroke variant, observed in a single emergency centre within a three-month period. AOP occlusion is characterized by bilateral thalamic infarction with or without involvement of the mesencephalon. The presenting symptoms are diverse and not specific, but commonly include disturbance of consciousness, memory impairment, and vertical gaze palsy. In addition, due to the location of the infarction, imaging recognition is challenging and AOP occlusion often remains undiagnosed. This paper emphasizes the necessity of early recognition and appropriate management of AOP occlusion to significantly impact patient outcomes. Moreover, we argue that the condition might be more common than previously thought and that misdiagnosis or delay in diagnosis may lead to inappropriate treatment and potential failure to apply thrombolysis within the required timeframe. Full article

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0 pages, 687 KiB

Open AccessEditor’s ChoiceArticle

Headache and NOTCH3 Gene Variants in Patients with CADASIL

by Oliwia Szymanowicz, Izabela Korczowska-Łącka, Bartosz Słowikowski, Małgorzata Wiszniewska, Ada Piotrowska, Ulyana Goutor, Paweł P. Jagodziński, Wojciech Kozubski and Jolanta Dorszewska

Neurol. Int. 2023, 15(4), 1238-1252; https://doi.org/10.3390/neurolint15040078 - 9 Oct 2023

Cited by 2 | Viewed by 2050

Abstract

Autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited vascular disease characterized by recurrent strokes, cognitive impairment, psychiatric symptoms, apathy, and migraine. Approximately 40% of patients with CADASIL experience migraine with aura (MA). In addition to MA, CADASIL patients [...] Read more.

Autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited vascular disease characterized by recurrent strokes, cognitive impairment, psychiatric symptoms, apathy, and migraine. Approximately 40% of patients with CADASIL experience migraine with aura (MA). In addition to MA, CADASIL patients are described in the literature as having migraine without aura (MO) and other types of headaches. Mutations in the NOTCH3 gene cause CADASIL. This study investigated NOTCH3 genetic variants in CADASIL patients and their potential association with headache types. Genetic tests were performed on 30 patients with CADASIL (20 women aged 43.6 ± 11.5 and 10 men aged 39.6 ± 15.8). PCR-HRM and sequencing methods were used in the genetic study. We described three variants as pathogenic/likely pathogenic (p.Tyr189Cys, p.Arg153Cys, p.Cys144Arg) and two benign variants (p.Ala202=, p.Thr101=) in the NOTCH3 gene and also presented the NOTCH3 gene variant (chr19:15192257 T>G). Clinical features including headache associated with NOTCH3 (chr19:15192257 T>G) are described for the first time. Patients with pathogenic/likely pathogenic variants had similar headache courses. People with benign variants showed a more diverse clinical picture. It seems that different NOTCH3 variants may contribute to the differential presentation of a CADASIL headache, highlighting the diagnostic and prognostic value of headache characteristics in this disease. Full article

(This article belongs to the Special Issue Migraines and Beyond: Advances in the Pathogenesis and Treatment of Chronic Headache Disorders)

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54 pages, 3017 KiB

Open AccessEditor’s ChoiceReview

Migraine: Advances in the Pathogenesis and Treatment

by Horia Pleș, Ioan-Alexandru Florian, Teodora-Larisa Timis, Razvan-Adrian Covache-Busuioc, Luca-Andrei Glavan, David-Ioan Dumitrascu, Andrei Adrian Popa, Andrei Bordeianu and Alexandru Vlad Ciurea

Neurol. Int. 2023, 15(3), 1052-1105; https://doi.org/10.3390/neurolint15030067 - 31 Aug 2023

Cited by 6 | Viewed by 8891

Abstract

This article presents a comprehensive review on migraine, a prevalent neurological disorder characterized by chronic headaches, by focusing on their pathogenesis and treatment advances. By examining molecular markers and leveraging imaging techniques, the research identifies key mechanisms and triggers in migraine pathology, thereby [...] Read more.

This article presents a comprehensive review on migraine, a prevalent neurological disorder characterized by chronic headaches, by focusing on their pathogenesis and treatment advances. By examining molecular markers and leveraging imaging techniques, the research identifies key mechanisms and triggers in migraine pathology, thereby improving our understanding of its pathophysiology. Special emphasis is given to the role of calcitonin gene-related peptide (CGRP) in migraine development. CGRP not only contributes to symptoms but also represents a promising therapeutic target, with inhibitors showing effectiveness in migraine management. The article further explores traditional medical treatments, scrutinizing the mechanisms, benefits, and limitations of commonly prescribed medications. This provides a segue into an analysis of emerging therapeutic strategies and their potential to enhance migraine management. Finally, the paper delves into neuromodulation as an innovative treatment modality. Clinical studies indicating its effectiveness in migraine management are reviewed, and the advantages and limitations of this technique are discussed. In summary, the article aims to enhance the understanding of migraine pathogenesis and present novel therapeutic possibilities that could revolutionize patient care. Full article

(This article belongs to the Special Issue Migraines and Beyond: Advances in the Pathogenesis and Treatment of Chronic Headache Disorders)

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21 pages, 1052 KiB

Open AccessEditor’s ChoiceReview

Long COVID, the Brain, Nerves, and Cognitive Function

by Allison B. Reiss, Caitriona Greene, Christopher Dayaramani, Steven H. Rauchman, Mark M. Stecker, Joshua De Leon and Aaron Pinkhasov

Neurol. Int. 2023, 15(3), 821-841; https://doi.org/10.3390/neurolint15030052 - 6 Jul 2023

Cited by 15 | Viewed by 6146

Abstract

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). Long-term complications are an increasing issue in patients who have been infected with COVID-19 and may be a result of viral-associated systemic and central nervous system inflammation or may [...] Read more.

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). Long-term complications are an increasing issue in patients who have been infected with COVID-19 and may be a result of viral-associated systemic and central nervous system inflammation or may arise from a virus-induced hypercoagulable state. COVID-19 may incite changes in brain function with a wide range of lingering symptoms. Patients often experience fatigue and may note brain fog, sensorimotor symptoms, and sleep disturbances. Prolonged neurological and neuropsychiatric symptoms are prevalent and can interfere substantially in everyday life, leading to a massive public health concern. The mechanistic pathways by which SARS-CoV-2 infection causes neurological sequelae are an important subject of ongoing research. Inflammation- induced blood-brain barrier permeability or viral neuro-invasion and direct nerve damage may be involved. Though the mechanisms are uncertain, the resulting symptoms have been documented from numerous patient reports and studies. This review examines the constellation and spectrum of nervous system symptoms seen in long COVID and incorporates information on the prevalence of these symptoms, contributing factors, and typical course. Although treatment options are generally lacking, potential therapeutic approaches for alleviating symptoms and improving quality of life are explored. Full article

(This article belongs to the Special Issue COVID-19, Neuroinflammation and Therapeutics)

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17 pages, 701 KiB

Open AccessEditor’s ChoiceReview

The Effects of Physical Activity in Children and Adolescents with Developmental Coordination Disorder

by Harilaos Zaragas, Olga Fragkomichelaki, Marina Geitona, Maria Sofologi, Georgia Papantoniou, Dimitrios Sarris, Vassiliki Pliogou, Christos Charmpatsis and Panagoula Papadimitropoulou

Neurol. Int. 2023, 15(3), 804-820; https://doi.org/10.3390/neurolint15030051 - 29 Jun 2023

Cited by 3 | Viewed by 3802

Abstract

The purpose of this literature review was to detect and study the effectiveness of therapeutic intervention programs, such as physical activities and sports, on children and adolescents with Developmental Motor Coordination Disorder (DCD) to improve their motor skills. The sample for this study [...] Read more.

The purpose of this literature review was to detect and study the effectiveness of therapeutic intervention programs, such as physical activities and sports, on children and adolescents with Developmental Motor Coordination Disorder (DCD) to improve their motor skills. The sample for this study consisted of 48 (100%) papers, specifically, 40 (83.5%) articles, 3 (6.2%) doctoral theses, 2 (4.1%) master’s theses and 3 (6.2%) papers from conference proceedings from the year 2014 to 2022. To search the sample, the following terms were used: DCD or dyspraxia, physical activity programs, intervention, physical intervention, physical education, etc. The results for the existence of statistically significant results and internal validity of intervention programs using physical activities and sports in children and adolescents with DCD showed that a large number of intervention programs improved the children’s motor skills as well as their daily functionality. In contrast, other interventions failed to improve dynamic and static balance. The negative result could be due either to the short duration of the interventions or to the improper suboptimal design—organization of the methodology of these programs—such as the heterogeneous intervention samples and the use of inappropriate and reliable assessment tools. Full article

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18 pages, 3053 KiB

Open AccessEditor’s ChoiceReview

Scientific Rationale for the Treatment of Cognitive Deficits from Long COVID

by Arman Fesharaki Zadeh, Amy F. T. Arnsten and Min Wang

Neurol. Int. 2023, 15(2), 725-742; https://doi.org/10.3390/neurolint15020045 - 31 May 2023

Cited by 7 | Viewed by 7381

Abstract

Sustained cognitive deficits are a common and debilitating feature of “long COVID”, but currently there are no FDA-approved treatments. The cognitive functions of the dorsolateral prefrontal cortex (dlPFC) are the most consistently afflicted by long COVID, including deficits in working memory, motivation, and [...] Read more.

Sustained cognitive deficits are a common and debilitating feature of “long COVID”, but currently there are no FDA-approved treatments. The cognitive functions of the dorsolateral prefrontal cortex (dlPFC) are the most consistently afflicted by long COVID, including deficits in working memory, motivation, and executive functioning. COVID-19 infection greatly increases kynurenic acid (KYNA) and glutamate carboxypeptidase II (GCPII) in brain, both of which can be particularly deleterious to PFC function. KYNA blocks both NMDA and nicotinic-alpha-7 receptors, the two receptors required for dlPFC neurotransmission, and GCPII reduces mGluR3 regulation of cAMP-calcium-potassium channel signaling, which weakens dlPFC network connectivity and reduces dlPFC neuronal firing. Two agents approved for other indications may be helpful in restoring dlPFC physiology: the antioxidant N-acetyl cysteine inhibits the production of KYNA, and the α2A-adrenoceptor agonist guanfacine regulates cAMP-calcium-potassium channel signaling in dlPFC and is also anti-inflammatory. Thus, these agents may be helpful in treating the cognitive symptoms of long COVID. Full article

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11 pages, 291 KiB

Open AccessEditor’s ChoiceReview

The Role of Alpha-2 Agonists for Attention Deficit Hyperactivity Disorder in Children: A Review

by Elisa E. Neuchat, Brooke E. Bocklud, Kali Kingsley, William T. Barham, Patrick M. Luther, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett and Alan D. Kaye

Neurol. Int. 2023, 15(2), 697-707; https://doi.org/10.3390/neurolint15020043 - 22 May 2023

Cited by 3 | Viewed by 8097

Abstract

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is marked by symptoms such as inappropriate levels of inattention, hyperactivity, and impulsivity that can [...] Read more.

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is marked by symptoms such as inappropriate levels of inattention, hyperactivity, and impulsivity that can affect academic, social, and personal functioning in children and adolescents. This review summarizes clinical trials demonstrating the effectiveness of Alpha-2 agonists in reducing symptoms of inattention, hyperactivity, and impulsivity in children with ADHD. Studies were identified through a systematic search of PubMed and Cochrane databases. However, these medications’ long-term safety and efficacy remain uncertain, with a lack of data on their effects on growth, cardiovascular function, and other adverse events. Further studies are required to determine these medications’ optimal dose and treatment duration. Methods: Medications that target the noradrenergic system, such as Alpha-2 agonists, have been increasingly used as a treatment option for ADHD, with guanfacine and clonidine being two of the most commonly used medications. They function by selectively targeting Alpha-2 adrenergic receptors in the brain leading to improved attention and reduced hyperactivity and impulsivity symptoms in children with ADHD. Results: Clinical trials have demonstrated the effectiveness of Alpha-2 agonists in treating ADHD in children by reducing symptoms of inattention, hyperactivity, and impulsivity. However, these medications’ long-term safety and efficacy still need to be completely understood. Due to a lack of information on the effects of Alpha-2 agonists on growth, cardiovascular function, and other long-term adverse events, more studies must investigate the optimal dose and treatment duration for these medications. Conclusions: Despite these concerns, Alpha-2 agonists remain a valuable treatment option for ADHD in children, especially those unable to tolerate stimulant medications or who have coexisting conditions such as tic disorders. Future research should continue to explore the safety and efficacy of Alpha-2 agonists in the long term. In conclusion, Alpha-2 agonists show promise as a treatment for ADHD in children; however, the safety and efficacy of these drugs in the long term are not yet completely understood. Additional studies are required to investigate the optimal dose and treatment duration for these medications in their use as a treatment for this debilitating disease. Full article

16 pages, 3130 KiB

Open AccessEditor’s ChoiceArticle

Semi-Automated Recording of Facial Sensitivity in Rat Demonstrates Antinociceptive Effects of the Anti-CGRP Antibody Fremanezumab

by Nicola Benedicter, Karl Messlinger, Birgit Vogler, Kimberly D. Mackenzie, Jennifer Stratton, Nadine Friedrich and Mária Dux

Neurol. Int. 2023, 15(2), 622-637; https://doi.org/10.3390/neurolint15020039 - 29 Apr 2023

Cited by 4 | Viewed by 2006

Abstract

Migraine pain is frequently accompanied by cranial hyperalgesia and allodynia. Calcitonin gene-related peptide (CGRP) is implicated in migraine pathophysiology but its role in facial hypersensitivity is not entirely clear. In this study, we investigated if the anti-CGRP monoclonal antibody fremanezumab, which is therapeutically [...] Read more.

Migraine pain is frequently accompanied by cranial hyperalgesia and allodynia. Calcitonin gene-related peptide (CGRP) is implicated in migraine pathophysiology but its role in facial hypersensitivity is not entirely clear. In this study, we investigated if the anti-CGRP monoclonal antibody fremanezumab, which is therapeutically used in chronic and episodic migraines, can modify facial sensitivity recorded by a semi-automatic system. Rats of both sexes primed to drink from a sweet source had to pass a noxious mechanical or heat barrier to reach the source. Under these experimental conditions, animals of all groups tended to drink longer and more when they had received a subcutaneous injection of 30 mg/kg fremanezumab compared to control animals injected with an isotype control antibody 12–13 days prior to testing, but this was significant only for females. In conclusion, anti-CGRP antibody, fremanezumab, reduces facial sensitivity to noxious mechanical and thermal stimulation for more than one week, especially in female rats. Anti-CGRP antibodies may reduce not only headache but also cranial sensitivity in migraineurs. Full article

(This article belongs to the Special Issue Migraines and Beyond: Advances in the Pathogenesis and Treatment of Chronic Headache Disorders)

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14 pages, 1173 KiB

Open AccessEditor’s ChoiceReview

Macrophages in Recurrent Glioblastoma as a Prognostic Factor in the Synergistic System of the Tumor Microenvironment

by Nicola Montemurro, Bhavya Pahwa, Anish Tayal, Anushruti Shukla, Manuel De Jesus Encarnacion, Issael Ramirez, Renat Nurmukhametov, Vishal Chavda and Antonella De Carlo

Neurol. Int. 2023, 15(2), 595-608; https://doi.org/10.3390/neurolint15020037 - 23 Apr 2023

Cited by 22 | Viewed by 3100

Abstract

Glioblastoma (GBM) is a common and highly malignant primary tumor of the central nervous system in adults. Ever more recent papers are focusing on understanding the role of the tumor microenvironment (TME) in affecting tumorigenesis and the subsequent prognosis. We assessed the impact [...] Read more.

Glioblastoma (GBM) is a common and highly malignant primary tumor of the central nervous system in adults. Ever more recent papers are focusing on understanding the role of the tumor microenvironment (TME) in affecting tumorigenesis and the subsequent prognosis. We assessed the impact of macrophages in the TME on the prognosis in patients with recurrent GBM. A PubMed, MEDLINE and Scopus review was conducted to identify all studies dealing with macrophages in the GBM microenvironment from January 2016 to December 2022. Glioma-associated macrophages (GAMs) act critically in enhancing tumor progression and can alter drug resistance, promoting resistance to radiotherapy and establishing an immunosuppressive environment. M1 macrophages are characterized by increased secretion of proinflammatory cytokines, such as IL-1ß, tumor necrosis factor (TNF), IL-27, matrix metalloproteinase (MMPs), CCL2, and VEGF (vascular endothelial growth factor), IGF1, that can lead to the destruction of the tissue. In contrast, M2 is supposed to participate in immunosuppression and tumor progression, which is formed after being exposed to the macrophage M-CSF, IL-10, IL-35 and the transforming growth factor-ß (TGF-β). Because there is currently no standard of care in recurrent GBM, novel identified targeted therapies based on the complex signaling and interactions between the glioma stem cells (GSCs) and the TME, especially resident microglia and bone-marrow-derived macrophages, may be helpful in improving the overall survival of these patients in the near future. Full article

(This article belongs to the Special Issue Glioblastoma: Mechanics of Development, Progression and New Surgical and Clinical Management)

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15 pages, 3210 KiB

Open AccessEditor’s ChoiceArticle

Sensory Motor Function Disturbances in Mice Prenatally Exposed to Low Dose of Ethanol: A Neurobehavioral Study in Postnatal and Adult Stages

by Kamal Smimih, Bilal El-Mansoury, Fatima Ez-Zahraa Saad, Manal Khanouchi, Souad El Amine, Abdelmohcine Aimrane, Nadia Zouhairi, Abdessalam Ferssiwi, Abdelali Bitar, Mohamed Merzouki and Omar El Hiba

Neurol. Int. 2023, 15(2), 580-594; https://doi.org/10.3390/neurolint15020036 - 19 Apr 2023

Viewed by 2030

Abstract

Prenatal alcohol exposure (PAE) refers to fetal exposure to alcohol during pregnancy through placental barrier transfer from maternal blood. The postnatal outcomes of PAE differ among exposed individuals and range from overt (serious) alcohol-related behavioral and neurophysiological impairments to covert (silenced) symptoms. The [...] Read more.

Prenatal alcohol exposure (PAE) refers to fetal exposure to alcohol during pregnancy through placental barrier transfer from maternal blood. The postnatal outcomes of PAE differ among exposed individuals and range from overt (serious) alcohol-related behavioral and neurophysiological impairments to covert (silenced) symptoms. The aims of the present investigation were to assess the postnatal neurobehavioral disturbances, particularly, motor coordination and sensory-motor function in mice with PAE. Female mice with positive vaginal plugs were divided into three groups: group 1: Et + Pyr: received two i.p injections of ethanol (1 g/kg) followed by pyrazole (100 mg/kg). Group 2: Pyr: received an i.p injection of pyrazole (100 mg/kg). Group 3: C: of saline controls received, in equal volume, saline solution (NaCl 0.9%). After birth, mice pups were weighed and subjected to behavioral tests for motor function screening using the motor ambulation test, cliff aversion, surface righting, and negative geotaxis, while at the adult stage, mice were subjected to the open field, rotarod, parallel bars, and static rods tests. Our data show an obvious decrement of body weight from the first post-natal day (P1) and continues over the adult stage. This was accompanied by an obvious impaired sensory-motor function which was maintained even at the adult stage with alteration of the locomotor and coordination abilities. The current data demonstrate the powerful neurotoxic effect of prenatal ethanol exposure on the sensory-motor and coordination functions, leading to suppose possible structural and/or functional neuronal disturbances, particularly the locomotor network. Full article

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13 pages, 805 KiB

Open AccessEditor’s ChoiceReview

The Role of Human Microbiota in Myasthenia Gravis: A Narrative Review

by Giuseppe Schirò, Salvatore Iacono and Carmela Rita Balistreri

Neurol. Int. 2023, 15(1), 392-404; https://doi.org/10.3390/neurolint15010026 - 10 Mar 2023

Cited by 2 | Viewed by 3836

Abstract

Myasthenia gravis (MG) is an autoimmune neuromuscular disease characterized by fluctuating weakness of the skeletal muscles. Although antibodies against the neuromuscular junction components are recognized, the MG pathogenesis remains unclear, even if with a well-known multifactorial character. However, the perturbations of human microbiota [...] Read more.

Myasthenia gravis (MG) is an autoimmune neuromuscular disease characterized by fluctuating weakness of the skeletal muscles. Although antibodies against the neuromuscular junction components are recognized, the MG pathogenesis remains unclear, even if with a well-known multifactorial character. However, the perturbations of human microbiota have been recently suggested to contribute to MG pathogenesis and clinical course. Accordingly, some products derived from commensal flora have been demonstrated to have anti-inflammatory effects, while other have been shown to possess pro-inflammatory properties. In addition, patients with MG when compared with age-matched controls showed a distinctive composition in the oral and gut microbiota, with a typical increase in Streptococcus and Bacteroides and a reduction in Clostridia as well as short-chain fatty acid reduction. Moreover, restoring the gut microbiota perturbation has been evidenced after the administration of probiotics followed by an improvement of symptoms in MG cases. To highlight the role of the oral and gut microbiota in MG pathogenesis and clinical course, here, the current evidence has been summarized and reviewed. Full article

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10 pages, 287 KiB

Open AccessEditor’s ChoiceReview

Ketamine Evolving Clinical Roles and Potential Effects with Cognitive, Motor and Driving Ability

by Amber N. Edinoff, Saveen Sall, Colby B. Koontz, Ajah K. Williams, DeMarcus Drumgo, Aya Mouhaffel, Elyse M. Cornett, Kevin S. Murnane and Alan D. Kaye

Neurol. Int. 2023, 15(1), 352-361; https://doi.org/10.3390/neurolint15010023 - 3 Mar 2023

Viewed by 2155

Abstract

While driving under the influence of drugs, drivers are more likely to be involved in and cause more accidents than drivers who do not drive under the influence. Ketamine is derived from phencyclidine and acts as a noncompetitive antagonist and allosteric modulator of [...] Read more.

While driving under the influence of drugs, drivers are more likely to be involved in and cause more accidents than drivers who do not drive under the influence. Ketamine is derived from phencyclidine and acts as a noncompetitive antagonist and allosteric modulator of N-methyl-D-aspartate receptors. Ketamine has been used to treat a variety of psychiatric disorders, with the most notable being treatment-resistant depression. With the rise of at-home ketamine treatment companies, the safety of unsupervised administration remains under evaluation. A study with ketamine and a ketamine-like medication, rapasitnel, showed that those who were given ketamine experienced more sleepiness and had decreased self-reported motivation and confidence in their driving abilities. Moreover, there seem to be significant differences in the acute versus persistent effects of ketamine, as well as the anesthetic versus subanesthetic doses, both in terms of effects and outcomes. These divergent effects complicate the clinical uses of ketamine, specifically involving driving, drowsiness, and cognitive abilities. This review aims to describe not only the various clinical uses of ketamine but also the potentially detrimental effects of driving under the influence, which should be understood to help with counseling the patients who use these substances, both for their well-being and to protect public safety. Full article

(This article belongs to the Collection Advances in Neurodegenerative Diseases)

13 pages, 602 KiB

Open AccessEditor’s ChoiceArticle

Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

by Burak B. Ozkara, Mert Karabacak, Apoorva Kotha, Alperen Aslan, Omar Hamam, Namratha Edpuganti, Meisam Hoseinyazdi, Richard Wang, Brian C. Cristiano and Vivek S. Yedavalli

Neurol. Int. 2023, 15(1), 225-237; https://doi.org/10.3390/neurolint15010015 - 3 Feb 2023

Cited by 1 | Viewed by 2375

Abstract

Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify [...] Read more.

Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify potential predictive clinical, lab, and radiographic biomarkers in patients who present with severe AIS due to large vessel occlusion and have been successfully treated with mechanical thrombectomy. This single-center, retrospective study included patients who experienced AIS secondary to large vessel occlusion with an initial NIHSS score ≥ 21 and were recanalized successfully with mechanical thrombectomy. Retrospectively, demographic, clinical, and radiologic data from electronic medical records were extracted, and laboratory baseline parameters were obtained from emergency department records. The clinical outcome was defined as the modified Rankin Scale (mRS) score at 90 days, which was dichotomized into favorable functional outcome (mRS 0–3) or unfavorable functional outcome (mRS 4–6). Multivariate logistic regression was used to build predictive models. A total of 53 patients were included. There were 26 patients in the favorable outcome group and 27 in the unfavorable outcome group. Age and platelet count (PC) were found to be predictors of unfavorable outcomes in the multivariate logistic regression analysis. The areas under the receiver operating characteristic (ROC) curve of models 1 (age only model), 2 (PC only model), and 3 (age and PC model) were 0.71, 0.68, and 0.79, respectively. This is the first study to reveal that elevated PC is an independent predictor of unfavorable outcomes in this specialized group. Full article

(This article belongs to the Collection Biomarkers in Stroke Prognosis)

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37 pages, 642 KiB

Open AccessEditor’s ChoiceSystematic Review

Exploring the Impact of Cerebral Microbleeds on Stroke Management

by Anastasia Sousanidou, Dimitrios Tsiptsios, Foteini Christidi, Stella Karatzetzou, Christos Kokkotis, Aimilios Gkantzios, Chrisostomos Bairaktaris, Vaia Karapepera, Paschalina Bebeletsi, Ioanna Karagiannakidou, Marinos Marinidis, Nikolaos Aggelousis and Konstantinos Vadikolias

Neurol. Int. 2023, 15(1), 188-224; https://doi.org/10.3390/neurolint15010014 - 1 Feb 2023

Cited by 6 | Viewed by 2215

Abstract

Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute [...] Read more.

Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute markers of blood leakage from pathologically fragile small vessels. In the present review, we evaluated whether CMBs affect ischemic and hemorrhagic stroke outcomes and explored the fundamental question of whether CMBs may shift the risk–benefit balance away from reperfusion therapy or antithrombotic use in acute ischemic stroke patients. A literature review of two databases (MEDLINE and Scopus) was conducted to identify all the relevant studies published between 1 January 2012 and 9 November 2022. Only full-text articles published in the English language were included. Forty-one articles were traced and included in the present review. Our findings highlight the utility of CMB assessments, not only in the prognostication of hemorrhagic complications of reperfusion therapy, but also in forecasting hemorrhagic and ischemic stroke patients’ functional outcomes, thus indicating that a biomarker-based approach may aid in the provision of counseling for patients and families, improve the selection of more appropriate medical therapies, and contribute to a more accurate choice of patients for reperfusion therapy. Full article

(This article belongs to the Collection Biomarkers in Stroke Prognosis)

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21 pages, 5956 KiB

Open AccessEditor’s ChoiceArticle

Inflammation and Treatment-Resistant Depression from Clinical to Animal Study: A Possible Link?

by Lara F. Almutabagani, Raghad A. Almanqour, Jawza F. Alsabhan, Abdulaziz M. Alhossan, Maha A. Alamin, Haya M. Alrajeh, Asma S. Alonazi, Ahmed M. El-Malky and Nouf M. Alrasheed

Neurol. Int. 2023, 15(1), 100-120; https://doi.org/10.3390/neurolint15010009 - 16 Jan 2023

Cited by 10 | Viewed by 2483

Abstract

The aim of this study was to investigate the relationship between treatment-resistant depression (TRD) and inflammation in humans and experimental models. For the human study, a retrospective cohort study was conducted with 206 participants; half were on antidepressants for major depressive disorder. The [...] Read more.

The aim of this study was to investigate the relationship between treatment-resistant depression (TRD) and inflammation in humans and experimental models. For the human study, a retrospective cohort study was conducted with 206 participants; half were on antidepressants for major depressive disorder. The patients were divided into healthy and depressed groups. Inflammation was assessed based on the values of the main inflammatory biomarkers (CRP, WBC and ESR). For the animal experiments, 35 adult male Wistar rats were assigned to stressed and non-stressed groups. Inflammation and stress were induced using lipopolysaccharide and chronic unpredictable mild stress. A 10 mg/kg intraperitoneal injection of fluoxetine (FLX), a known antidepressant, was simultaneously administered daily for 4 weeks. Behavioral tests were performed. The plasma levels of inflammatory and stress biomarkers were measured and were significantly higher in the stressed and non-responsive groups in both studies. This study provides evidence of the link between inflammation and TRD. We further observed a possible link via the Phosphorylated Janus Kinase 2 and Phosphorylated Signal Transducer and Activator of Transcription 3 (P-JAK2/P-STAT3) signaling pathway and found that chronic stress and high inflammation hinder the antidepressant effects of FLX. Thus, non-response to antidepressants could be mitigated by treating inflammation to improve the antidepressant effect in patients with TRD. Full article

(This article belongs to the Collection Advances in Neurodegenerative Diseases)

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9 pages, 924 KiB

Open AccessEditor’s ChoiceArticle

Post-Stroke Pneumonia in Real-World Practice: Background, Microbiological Examination, and Treatment

by Takayoshi Akimoto, Makoto Hara, Masaki Ishihara, Katsuhiko Ogawa and Hideto Nakajima

Neurol. Int. 2023, 15(1), 69-77; https://doi.org/10.3390/neurolint15010006 - 9 Jan 2023

Cited by 2 | Viewed by 2004

Abstract

Post-stroke pneumonia (PSP) has an impact on acute ischemic stroke (AIS). Although predictive scores for PSP have been developed, it is occasionally difficult to predict. Clarifying how PSP was treated after its onset in clinical practice is important. Admitted patients with AIS over [...] Read more.

Post-stroke pneumonia (PSP) has an impact on acute ischemic stroke (AIS). Although predictive scores for PSP have been developed, it is occasionally difficult to predict. Clarifying how PSP was treated after its onset in clinical practice is important. Admitted patients with AIS over a 2-year period were retrospectively reviewed. Of 281 patients with AIS, 24 (8.5%) developed PSP. The integer-based pneumonia risk score was higher in patients with PSP. The onset of PSP was frequently seen up to the 4th day of hospitalization. Of patients with PSP, sputum examination yielded Geckler 4 or 5 in only 8.3%. Angiotensin-converting enzyme inhibitor (ACE-I) was more frequently administered to patients with PSP; however, all these cases were started with ACE-I following PSP onset. Nasogastric tubes (NGTs) were inserted in 16 of the patients with PSP, of whom 11 were inserted following PSP onset. Multivariate analysis showed that PSP onset was a poor prognostic factor independent of the female sex, urinary tract infection, and National Institutes of Health Stroke Scale. PSP treatment would benefit from the administration of antimicrobials and ACE-I, as well as NGT insertion. To select effective agents for PSP and evaluate the indications for NGT insertion, further case studies are needed. Full article

(This article belongs to the Special Issue Stroke: From Pathophysiology to Therapy)

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14 pages, 3204 KiB

Open AccessEditor’s ChoiceArticle

Magnetic Resonance Imaging (MRI) Findings in COVID-19 Associated Encephalitis

by Manoj Tanwar, Aparna Singhal, Mohammadreza Alizadeh and Houman Sotoudeh

Neurol. Int. 2023, 15(1), 55-68; https://doi.org/10.3390/neurolint15010005 - 5 Jan 2023

Viewed by 2719

Abstract

We conducted this study to investigate the scope of the MRI neuroimaging manifestations in COVID-19-associated encephalitis. From January 2020 to September 2021, patients with clinical diagnosis of COVID-19-associated encephalitis, as well as concomitant abnormal imaging findings on brain MRI, were included. Two board-certified [...] Read more.

We conducted this study to investigate the scope of the MRI neuroimaging manifestations in COVID-19-associated encephalitis. From January 2020 to September 2021, patients with clinical diagnosis of COVID-19-associated encephalitis, as well as concomitant abnormal imaging findings on brain MRI, were included. Two board-certified neuro-radiologists reviewed these selected brain MR images, and further discerned the abnormal imaging findings. 39 patients with the clinical diagnosis of encephalitis as well as abnormal MRI findings were included. Most (87%) of these patients were managed in ICU, and 79% had to be intubated-ventilated. 15 (38%) patients died from the disease, while the rest were discharged from the hospital. On MRI, FLAIR hyperintensities in the insular cortex were the most common finding, seen in 38% of the patients. Micro-hemorrhages on the SWI images were equally common, also seen in 38% patients. FLAIR hyperintensities in the medial temporal lobes were seen in 30%, while FLAIR hyperintensities in the posterior fossa were evident in 20%. FLAIR hyperintensities in basal ganglia and thalami were seen in 15%. Confluent FLAIR hyperintensities in deep and periventricular white matter, not explained by microvascular angiopathy, were detected in 7% of cases. Cortical-based FLAIR hyperintensities in 7%, and FLAIR hyperintensity in the splenium of the corpus callosum in 7% of patients. Finally, isolated FLAIR hyperintensity around the third ventricle was noted in 2% of patients. Full article

(This article belongs to the Special Issue COVID-19, Neuroinflammation and Therapeutics)

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11 pages, 286 KiB

Open AccessEditor’s ChoiceArticle

ME/CFS and Post-Exertional Malaise among Patients with Long COVID

by Leonard A. Jason and Joseph A. Dorri

Neurol. Int. 2023, 15(1), 1-11; https://doi.org/10.3390/neurolint15010001 - 20 Dec 2022

Cited by 44 | Viewed by 15633

Abstract

This study sought to ascertain the prevalence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) among a sample of 465 patients with Long COVID. The participants completed three questionnaires: (1) a new questionnaire measuring both the frequency and severity of 38 common symptoms of COVID [...] Read more.

This study sought to ascertain the prevalence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) among a sample of 465 patients with Long COVID. The participants completed three questionnaires: (1) a new questionnaire measuring both the frequency and severity of 38 common symptoms of COVID and Long COVID, (2) a validated short form questionnaire assessing ME/CFS, and (3) a validated questionnaire measuring post-exertional malaise. The population was predominantly white, female, and living in North America. The mean duration since the onset of COVID-19 symptoms was 70.5 weeks. Among the 465 participants, 58% met a ME/CFS case definition. Of respondents who reported that they had ME/CFS only 71% met criteria for ME/CFS and of those who did not report they had ME/CFS, 40% nevertheless did meet criteria for the disease: both over-diagnosis and under-diagnosis were evident on self-report. This study supports prior findings that ME/CFS occurs with high prevalence among those who have persistent COVID-19 symptoms. Full article

20 pages, 685 KiB

Open AccessEditor’s ChoiceReview

Stroke and Emerging Blood Biomarkers: A Clinical Prospective

by Aimilios Gkantzios, Dimitrios Tsiptsios, Stella Karatzetzou, Sofia Kitmeridou, Vaia Karapepera, Erasmia Giannakou, Penelope Vlotinou, Nikolaos Aggelousis and Konstantinos Vadikolias

Neurol. Int. 2022, 14(4), 784-803; https://doi.org/10.3390/neurolint14040065 - 22 Sep 2022

Cited by 22 | Viewed by 4724

Abstract

Stroke constitutes the primary source of adult functional disability, exhibiting a paramount socioeconomic burden. Thus, it is of great importance that the prediction of stroke outcome be both prompt and accurate. Although modern neuroimaging and neurophysiological techniques are accessible, easily available blood biomarkers [...] Read more.

Stroke constitutes the primary source of adult functional disability, exhibiting a paramount socioeconomic burden. Thus, it is of great importance that the prediction of stroke outcome be both prompt and accurate. Although modern neuroimaging and neurophysiological techniques are accessible, easily available blood biomarkers reflecting underlying stroke-related pathophysiological processes, including glial and/or neuronal death, neuroendocrine responses, inflammation, increased oxidative stress, blood–brain barrier disruption, endothelial dysfunction, and hemostasis, are required in order to facilitate stroke prognosis. A literature search of two databases (MEDLINE and Science Direct) was conducted in order to trace all relevant studies published between 1 January 2010 and 31 December 2021 that focused on the clinical utility of brain natriuretic peptide, glial fibrillary acidic protein, the red cell distribution width, the neutrophil-to-lymphocyte ratio, matrix metalloproteinase-9, and aquaporin-4 as prognostic tools in stroke survivors. Only full-text articles published in English were included. Twenty-eight articles were identified and are included in this review. All studied blood-derived biomarkers proved to be valuable prognostic tools poststroke, the clinical implementation of which may accurately predict the survivors’ functional outcomes, thus significantly enhancing the rehabilitation efficiency of stroke patients. Along with already utilized clinical, neurophysiological, and neuroimaging biomarkers, a blood-derived multi-biomarker panel is proposed as a reasonable approach to enhance the predictive power of stroke prognostic models. Full article

(This article belongs to the Special Issue Stroke: From Pathophysiology to Therapy)

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30 pages, 4525 KiB

Open AccessEditor’s ChoiceSystematic Review

Brain Structural and Functional Alterations in Multiple Sclerosis-Related Fatigue: A Systematic Review

by Chiara Barbi, Francesca Benedetta Pizzini, Stefano Tamburin, Alice Martini, Anna Pedrinolla, Fabio Giuseppe Laginestra, Gaia Giuriato, Camilla Martignon, Federico Schena and Massimo Venturelli

Neurol. Int. 2022, 14(2), 506-535; https://doi.org/10.3390/neurolint14020042 - 8 Jun 2022

Cited by 14 | Viewed by 3957

Abstract

Fatigue is one of the most disabling symptoms of multiple sclerosis (MS); it influences patients’ quality of life. The etiology of fatigue is complex, and its pathogenesis is still unclear and debated. The objective of this review was to describe potential brain structural [...] Read more.

Fatigue is one of the most disabling symptoms of multiple sclerosis (MS); it influences patients’ quality of life. The etiology of fatigue is complex, and its pathogenesis is still unclear and debated. The objective of this review was to describe potential brain structural and functional dysfunctions underlying fatigue symptoms in patients with MS. To reach this purpose, a systematic review was conducted of published studies comparing functional brain activation and structural brain in MS patients with and without fatigue. Electronic databases were searched until 24 February 2021. The structural and functional outcomes were extracted from eligible studies and tabulated. Fifty studies were included: 32 reported structural brain differences between patients with and without fatigue; 14 studies described functional alterations in patients with fatigue compared to patients without it; and four studies showed structural and functional brain alterations in patients. The results revealed structural and functional abnormalities that could correlate to the symptom of fatigue in patients with MS. Several studies reported the differences between patients with fatigue and patients without fatigue in terms of conventional magnetic resonance imaging (MRI) outcomes and brain atrophy, specifically in the thalamus. Functional studies showed abnormal activation in the thalamus and in some regions of the sensorimotor network in patients with fatigue compared to patients without it. Patients with fatigue present more structural and functional alterations compared to patients without fatigue. Specifically, abnormal activation and atrophy of the thalamus and some regions of the sensorimotor network seem linked to fatigue. Full article

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17 pages, 2553 KiB

Open AccessEditor’s ChoiceArticle

Hesperetin, a Citrus Flavonoid, Ameliorates Inflammatory Cytokine-Mediated Inhibition of Oligodendroglial Cell Morphological Differentiation

by Satoshi Nishino, Yoko Fujiki, Takanari Sato, Yukino Kato, Remina Shirai, Hiroaki Oizumi, Masahiro Yamamoto, Katsuya Ohbuchi, Yuki Miyamoto, Kazushige Mizoguchi and Junji Yamauchi

Neurol. Int. 2022, 14(2), 471-487; https://doi.org/10.3390/neurolint14020039 - 31 May 2022

Cited by 8 | Viewed by 3493

Abstract

Oligodendrocytes (oligodendroglial cells) are glial cells that wrap neuronal axons with their differentiated plasma membranes called myelin membranes. In the pathogenesis of inflammatory cytokine-related oligodendroglial cell and myelin diseases such as multiple sclerosis (MS), typical inflammatory cytokines tumor necrosis factor α (TNFα) and [...] Read more.

Oligodendrocytes (oligodendroglial cells) are glial cells that wrap neuronal axons with their differentiated plasma membranes called myelin membranes. In the pathogenesis of inflammatory cytokine-related oligodendroglial cell and myelin diseases such as multiple sclerosis (MS), typical inflammatory cytokines tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) are thought to contribute to the degeneration and/or progression of the degeneration of oligodendroglial cells and, in turn, the degeneration of naked neuronal cells in the central nervous system (CNS) tissues. Despite the known involvement of these inflammatory cytokines in disease progression, it has remained unclear whether and how TNFα or IL-6 affects the oligodendroglial cells themselves or indirectly. Here we show that TNFα or IL-6 directly inhibits morphological differentiation in FBD-102b cells, which are differentiation models of oligodendroglial cells. Their phenotype changes were supported by the decreased expression levels of oligodendroglial cell differentiation and myelin marker proteins. In addition, TNFα or IL-6 decreased phosphorylation levels of Akt kinase, whose upregulation has been associated with promoting oligodendroglial cell differentiation. Hesperetin, a flavonoid mainly contained in citrus fruit, is known to have neuroprotective effects. Hesperetin might also be able to resolve pre-illness conditions, including the irregulated secretion of cytokines, through diet. Notably, the addition of hesperetin into cells recovered TNFα- or IL-6-induced inhibition of differentiation, as supported by increased levels of marker protein expression and phosphorylation of Akt kinase. These results suggest that TNFα or IL-6 itself contributes to the inhibitory effects on the morphological differentiation of oligodendroglial cells, possibly providing information not only on their underlying pathological effects but also on flavonoids with potential therapeutic effects at the molecular and cellular levels. Full article

(This article belongs to the Special Issue Fourth Brainstorming Research Assembly for Young Neuroscientists (BraYn))

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18 pages, 930 KiB

Open AccessEditor’s ChoiceReview

Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System

by Steven H. Rauchman, Jacqueline Albert, Aaron Pinkhasov and Allison B. Reiss

Neurol. Int. 2022, 14(2), 453-470; https://doi.org/10.3390/neurolint14020038 - 30 May 2022

Cited by 14 | Viewed by 11915

Abstract

Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common [...] Read more.

Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community. Full article

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11 pages, 859 KiB

Open AccessEditor’s ChoiceArticle

Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort

by Antonino Lupica, Vincenzo Di Stefano, Salvatore Iacono, Antonia Pignolo, Martina Quartana, Andrea Gagliardo, Brigida Fierro and Filippo Brighina

Neurol. Int. 2022, 14(2), 406-416; https://doi.org/10.3390/neurolint14020033 - 27 Apr 2022

Cited by 33 | Viewed by 3765

Abstract

Background and aims. Patients with Myasthenia gravis (MG) are considered vulnerable as they may present with respiratory muscle weakness and because they are on immunosuppressive treatment; thereby, COVID-19 may have a detrimental effect on these patients. Vaccines against COVID-19 are currently available and [...] Read more.

Background and aims. Patients with Myasthenia gravis (MG) are considered vulnerable as they may present with respiratory muscle weakness and because they are on immunosuppressive treatment; thereby, COVID-19 may have a detrimental effect on these patients. Vaccines against COVID-19 are currently available and it has been shown as they can prevent severe COVID-19 in vulnerable patients. Notwithstanding their efficacy, vaccine hesitancy has not been completely dispelled in the general population. Unfortunately, there is limited data about the safety of these vaccines in MG patients. The aims of this study are to evaluate the impact of COVID-19 in a MG cohort, the adherence to COVID-19 vaccination in Italy and vaccine safety in MG patients. Methods. A retrospective cohort study of MG patients attending the Neuromuscular Clinic of the University Hospital “Paolo Giaccone” of Palermo, Italy, was performed. Patients underwent telephone interviews with a dedicated questionnaire on SARS-CoV-2 vaccination and infection. Vaccine safety was assessed though the evaluation of vaccine-related adverse events (AEs) and comparisons of MG-ADL scores before and after vaccination. Patient worsening was defined as two or more point increases in MG-ADL scores. Results. From a total of 90 participants, 75 answered the questionnaire and 70.5% of them (n = 53) received the vaccine; ten patients did not receive vaccination and 3 patients were partially vaccinated. Among the vaccinated patients, about 45% (n = 24) experienced at least one AE, with a complete resolution within one week. No serious AEs and life-threatening conditions were observed. Globally, MG-ADL scores did not worsen after vaccination. Nine unvaccinated patients experienced SARS-CoV2 infection and four of them (44%) died—one patient required respiratory support, whereas three patients were asymptomatic. Conclusions. COVID-19 significantly impacted MG patients with an increase in mortality due to respiratory sequelae. Vaccines against SARS-CoV-2 showed good short-term safety in MG patients, who may take advantage of vaccination to avoiding life-threatening complications such as COVID-19 pneumonia. Full article

(This article belongs to the Special Issue Neurological Aspects of COVID-19: What We Knew Then, What We Know Now, & What We Need to Prepare for in the Future)

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15 pages, 3790 KiB

Open AccessEditor’s ChoiceReview

Ischemic Stroke and SARS-CoV-2 Infection: The Bidirectional Pathology and Risk Morbidities

by Vishal Chavda, Bipin Chaurasia, Alessandro Fiorindi, Giuseppe E. Umana, Bingwei Lu and Nicola Montemurro

Neurol. Int. 2022, 14(2), 391-405; https://doi.org/10.3390/neurolint14020032 - 24 Apr 2022

Cited by 27 | Viewed by 4813

Abstract

Stroke is a fatal morbidity that needs emergency medical admission and immediate medical attention. COVID-19 ischemic brain damage is closely associated with common neurological symptoms, which are extremely difficult to treat medically, and risk factors. We performed literature research about COVID-19 and ischemia [...] Read more.

Stroke is a fatal morbidity that needs emergency medical admission and immediate medical attention. COVID-19 ischemic brain damage is closely associated with common neurological symptoms, which are extremely difficult to treat medically, and risk factors. We performed literature research about COVID-19 and ischemia in PubMed, MEDLINE, and Scopus for this current narrative review. We discovered parallel manifestations of SARS-CoV-19 infection and brain ischemia risk factors. In published papers, we discovered a similar but complex pathophysiology of SARS-CoV-2 infection and stroke pathology. A patient with other systemic co-morbidities, such as diabetes, hypertension, or any respiratory disease, has a fatal combination in intensive care management when infected with SARS-CoV-19. Furthermore, due to their shared risk factors, COVID-19 and stroke are a lethal combination for medical management to treat. In this review, we discuss shared pathophysiology, adjuvant risk factors, challenges, and advancements in stroke-associated COVID-19 therapeutics. Full article

(This article belongs to the Special Issue Neurological Aspects of COVID-19: What We Knew Then, What We Know Now, & What We Need to Prepare for in the Future)

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9 pages, 250 KiB

Open AccessEditor’s ChoiceArticle

Financial Incapacity of Patients with Mild Alzheimer’s Disease: What Neurologists Need to Know about Where the Impairment Lies

by Vaitsa Giannouli and Magda Tsolaki

Neurol. Int. 2022, 14(1), 90-98; https://doi.org/10.3390/neurolint14010008 - 11 Jan 2022

Cited by 11 | Viewed by 2872

Abstract

Research in the last decade has focused on assessing financial capacity and incapacity mainly in old age, but new research has turned to address the question of how financial incapacity can be predicted by cognitive factors. The aim of this study was to [...] Read more.

Research in the last decade has focused on assessing financial capacity and incapacity mainly in old age, but new research has turned to address the question of how financial incapacity can be predicted by cognitive factors. The aim of this study was to identify which cognitive domains predict financial capacity and the relevant cognitive skills of patients with mild Alzheimer’s disease (AD) in order to assist neurologists in functional assessment and further patient referral. In this study, 109 patients diagnosed with mild AD were examined with a number of neuropsychological tests: Mini-Mental State Examination (MMSE), Functional Rating Scale for Symptoms of Dementia (FRSSD), Functional Cognitive Assessment Scale (FUCAS), Trail Making Test (TMT)-Part B, Rey-Osterrieth Complex Figure Test (ROCFT)-copy condition and delayed recall condition, Rey Auditory Verbal Learning Test (RAVLT), Boston Naming Test, Rivermead Behavioural Memory Test (RBMT), digit span forward and backward, WAIS-R digit symbol substitution test, Neuropsychiatric Inventory (NPI), Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). LCPLTAS total score and relevant subdomains were best predicted only by the score of one item coming from MMSE: subtraction of serial sevens. This is the only measure of arithmetic testing in use for the Greek geriatric population. Financial capacity is severely impaired in the group of mild AD patients. In order to prevent financial exploitation cases, neurologists, neuropsychologists, psychiatrists, and geriatrists should pay close attention to the information from the relevant arithmetic question of MMSE, as it is one of the most widely administered screening tests in clinical settings. Full article

(This article belongs to the Collection Brain Health Initiative: Advocacy in Global Neurology)

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