Search Results (601)

Background and Objective: Radiologically isolated syndrome (RIS) is characterized by magnetic resonance imaging (MRI) findings suggestive of multiple sclerosis (MS) in individuals without a history of clinical demyelinating events. Increasing evidence indicates that structural brain abnormalities may be present in RIS before the development of overt neurological symptoms. However, most previous studies have employed cross-sectional designs, limiting the ability to characterize the temporal evolution of neurodegenerative changes. This study aimed to investigate longitudinal changes in global, regional, and lobar brain volumes in individuals with RIS using serial MRI examinations obtained at least six months apart. Methods: Patients with RIS who had undergone two 3 Tesla (3T) brain MRI examinations separated by an interval of at least six months were retrospectively identified. Three-dimensional (3D) T1-weighted MRI scans obtained at both time points were analyzed using the volBrain pipeline of the volBrain platform to quantify global, regional, and lobar brain volumes. Longitudinal volumetric changes were expressed as annualized percentage volume changes. The number of T2 lesions and total T2 lesion volume were additionally assessed, and their associations with longitudinal brain volume changes were investigated. Results: A total of 28 patients with RIS were included. After correction for multiple comparisons using the Benjamini–Hochberg false discovery rate (FDR) procedure, significant annual volume loss was observed in total brain volume (p = 0.043), total cerebrum volume (p = 0.033), right cerebrum volume (p = 0.033), left cerebrum volume (p = 0.044), total thalamic volume (p = 0.033), right thalamic volume (p = 0.047), and left thalamic volume (p = 0.043). No significant associations were observed between annualized brain volume changes and follow-up duration, total or regional T2 lesion counts, or total T2 lesion volume. Similarly, annualized brain volume changes did not differ significantly between subgroups defined according to MRI progression, the presence of gadolinium-enhancing lesions, or the presence of spinal cord lesions. Conclusions: Longitudinal volumetric analysis demonstrated progressive brain volume loss involving both global and regional structures in patients with RIS. These findings provide further evidence of measurable longitudinal structural brain changes in RIS before the development of clinically overt demyelinating disease. Larger longitudinal studies incorporating appropriate control groups are warranted to further characterize the temporal trajectory of volumetric changes in RIS. Full article

Background and Objectives: Sensory anomalies are a distinctive feature of Autism Spectrum Disorder (ASD) individuals and appear to differ in intensity, frequency, and subtype between male and female subjects. According to the diagnostic framework of the DSM-5-TR, these sensory patterns are key clinical indicators. The objectives of this study were to investigate sensoriality in ASD, to compare sensory profiles in ASD subjects of both sexes and evaluate potential correlations with clinical profiles. Materials and Methods: A total of 94 ASD participants were enrolled at the Children and Adolescents Neuropsychiatry Department of the University of Naples Federico II. The population was assessed through psychometric (cognitive and adaptive levels, and intensity of autism symptoms) and sensory characterization (using the Short Sensory Profile questionnaire). Subsequently, a Mann–Whitney U test was performed to evaluate differences in sensory profiles between males and females. Spearman’s correlation was used to assess significant associations between the sensory profile and cognitive level, adaptive level, and ASD symptom intensity. Subsequently, for the correlations that emerged as significant, an analysis was performed using a General Linear Model (GLM), including age and Intelligence Quotient (IQ) as covariates in the model. Results: No statistically significant differences in the sensory profile emerged between male and female subjects. Sensory anomalies do not appear to be correlated with cognitive level. Although some statistically significant correlations emerged between the sensory profile, the AQ, and the ADOS-2 comparison score, these results were not confirmed after a GLM analysis was performed using the participants’ age and IQ as covariates. Conclusions: The observed results appear partially in line with the existing literature. Following the GLM analysis, it was further observed that variables such as age and IQ play a crucial role in interpreting the functional profile of individuals with ASD. At present, the study has several limitations (the exclusive use of parent-report instruments, an observational design, the lack of a control group) which could affect the robustness of the observed findings. Therefore, further studies are deemed necessary to better define the sex-specific sensory characteristics of ASD individuals. Full article

Background and Objectives: The pathophysiology of medication overuse headache (MOH) remains incompletely understood, and advanced neuroimaging methods such as Diffusion Tensor Imaging (DTI) may help clarify the structural white matter (WM) changes associated with chronic analgesic overuse. The objective of this study was to identify WM microstructural alterations in patients with MOH, both before and after discontinuation of the overused medication, compared with healthy controls (HC), utilizing whole-brain and region-of-interest (ROI)-restricted tract-based spatial statistics (TBSS). Materials and Methods: Twenty-three patients with MOH, diagnosed according to ICHD (3rd edition) criteria, and 23 demographically matched HC underwent 3-Tesla DTI. Whole-brain and ROI-restricted TBSS analyses of fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD) were performed to assess global and tract-specific white matter microstructural alterations. In the MOH group, DTI was repeated at follow-up after withdrawal of the overused medication, initiation of alternative treatment, and clinical improvement (MOH-DW). Sixteen patients and 16 controls were included in the final analysis after exclusions for pregnancy, loss to follow-up, or technical issues. Results: Whole-brain TBSS revealed no statistically significant group differences. ROI-restricted analysis revealed a marked increase in fractional anisotropy (FA) and axial diffusivity (AD) in the MOH group relative to the HC group within the left anterior limb of the internal capsule, the body of the corpus callosum, and the right superior corona radiata. Concurrently, higher mean diffusivity (MD) was observed in the left anterior limb of the internal capsule. At the follow-up assessment, FA and AD remained significantly higher than in healthy controls in the anterior limb of the internal capsule and superior corona radiata, whereas the group difference in the corpus callosum was no longer statistically significant. As the direct within-subject comparison between pre- and post-withdrawal measurements did not reach significance in any region, this may reflect the loss of a detectable group difference rather than confirmed within-subject reversibility. Conclusions: MOH may be associated with WM microstructural changes characterized predominantly by increased, rather than decreased, diffusion anisotropy and axial diffusivity in tracts relevant to pain processing. The disappearance of the significant group difference in the corpus callosum at follow-up raises the hypothesis that this may be compatible with a dynamic and potentially reversible microstructural process; however, because medication withdrawal occurred concurrently with the introduction of alternative treatment, this finding cannot be attributed specifically to withdrawal. Given the modest sample size and the absence of correction across the 27 ROI analyses tested, these exploratory findings are preliminary and warrant confirmation in larger, independent longitudinal cohorts. Full article

Background: Peripheral nerve injury initiates a series of degenerative, inflammatory, and reparative responses. Piracetam and hyperbaric oxygen (HBO) have been proposed as potential therapeutic interventions; however, their effects during the early phase following sciatic nerve injury require further investigation. This study evaluated early histopathological and circulating biochemical responses to piracetam and HBO in a rat model of sciatic nerve injury. Methods: Forty male Wistar Albino rats were randomly allocated to four groups following experimental sciatic nerve injury: an untreated injury control group (Group K), a hyperbaric oxygen therapy group (Group HBO), an intraperitoneal piracetam group (Group P), and a combined hyperbaric oxygen plus piracetam group (Group HBO + P). After 14 days, the rats were euthanised, and sciatic nerve tissues and blood samples were collected for histopathological and biochemical analyses. Results: No statistically significant differences were observed among the four groups with respect to axonal continuity, capillary formation, or myelin sheath regeneration. Fibroblast density was increased in Group P compared with Group K (p = 0.025), while no significant differences were detected among the remaining groups. Inflammatory cell counts were higher in Group P than in Group K (p = 0.037) and elevated in Group HBO + P compared with Group K (p = 0.014). Hypoxia-inducible factor-1 alpha (HIF-1α) expression was highest in Group K. Additionally, neuron-specific enolase levels were significantly increased in Group P compared with Group K (p = 0.006). Conclusions: Under the conditions of this 14-day experimental study, piracetam and HBO were associated with differences in selected circulating biochemical parameters but did not produce statistically significant improvements in the assessed histopathological indices. The findings were interpreted as early responses to treatment, and longer follow-up studies are needed to determine whether these changes translate into sustained axonal regeneration or functional recovery. Full article

Background and Objectives: Traumatic intracranial vascular lesions are rare but severe complications of traumatic brain injury (TBI) and include arterial and venous injuries such as arterial dissections, pseudoaneurysms, arterial occlusions, venous sinus thrombosis, arteriovenous fistulas, and carotid–cavernous fistulas. Despite their clinical significance, the available literature remains limited and heterogeneous. This systematic review and meta-analysis aimed to evaluate the diagnostic yield of vascular imaging, spectrum, and imaging modalities of traumatic intracranial vascular lesions in adults with TBI. Materials and Methods: A systematic literature search was conducted from database inception to 31 August 2026 in PubMed, Web of Science Core Collection, Scopus, and the Cochrane Library (CENTRAL) according to the PRISMA 2020 guidelines. Cohorts of patients who underwent vascular imaging after TBI were eligible. When the full text was available, the denominator was the number of patients imaged with a modality able to detect the lesion in question and the numerator was reported at patient level for intracranial lesions. The primary analyses were restricted to cohorts with an explicit adult age criterion or a separately reported adult subgroup; cohorts with a pediatric fraction that could not be separated entered a sensitivity analysis only. Data extraction and quality assessment using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist for prevalence studies were performed independently by two reviewers. Proportions were pooled with a logit-transformed random-effects model with restricted maximum-likelihood estimation and prediction intervals, with Freeman–Tukey and generalized linear mixed models as sensitivity analyses. Results: Nineteen studies with 3542 imaged patients were included, eight of them adult cohorts with 2021 patients. In adult cohorts, the pooled diagnostic yield was 11.0% (95% CI, 2.3–39.8%; four cohorts) for dural venous sinus thrombosis, 4.8% (95% CI, 1.1–18.4%; three cohorts) for pseudoaneurysm, 1.1% (95% CI, 0.0–20.8%; two cohorts) for arteriovenous fistula, and 0.7% (95% CI, 0.2–3.1%; three cohorts) for carotid–cavernous fistula, with I² between 74.7% and 96.2% and prediction intervals spanning most of the possible range; arterial dissection (7.0%) and arterial occlusion (5.8%) were reported by a single adult cohort and were not pooled. The proportion of patients with any lesion was not pooled, because the seven cohorts that imaged every patient differed in whether and how the venous compartment was assessed; it ranged from 1.5% to 56.9% by cohort. Adding the eleven adult-dominant cohorts gave 17.5% for sinus thrombosis and 4.5% for pseudoaneurysm. In exploratory univariable meta-regressions for sinus thrombosis, trauma mechanism, imaging modality, and study design were each associated with part of the heterogeneity and were confounded with one another in these cohorts. Conclusions: Every estimate describes the yield of vascular imaging in adults selected for it, rests on two-to-four small cohorts, and carries very low certainty; the prediction intervals show that a new cohort may fall far from the pooled value, and none of the estimates can be read as the frequency of these lesions in TBI in general. Full article

Background and Objectives: Persistent pain in rheumatoid arthritis (RA) may reflect mechanisms not fully captured by systemic inflammatory markers. This study estimated the frequency of elevated Central Sensitization Inventory (CSI) scores in women with RA and examined associations with pain, fatigue, depressive symptoms, function, inflammatory markers, and disease activity. Materials and Methods: This prospective single-center observational cohort included 97 female inpatients who completed a standardized three-week rehabilitation program. The CSI was used as a symptom-based screening instrument. Pain, function, fatigue, and depressive symptoms were assessed with the Visual Analog Scale (VAS), Health Assessment Questionnaire (HAQ), FACIT-Fatigue scale, and Beck Depression Inventory-II (BDI-II), respectively. Results: Fifty-seven participants (58.8%) had CSI scores ≥ 40. Higher CSI scores were associated with greater pain, more depressive symptoms, more fatigue, and higher DAS28-CRP scores, but not with ESR, CRP, IL-6, or disease duration. In adjusted baseline models, the association with VAS pain was statistically significant but modest (unstandardized beta = 0.024 per CSI point; standardized beta = 0.273). Across the three-week follow-up, VAS pain decreased by 2.53 points; mean FACIT-Fatigue and HAQ changes were smaller than commonly cited clinically important thresholds, and CSI changed only modestly. In adjusted multivariable models, higher CSI scores remained independently associated with VAS pain, FACIT-Fatigue, and BDI-II scores, whereas no significant association was found with HAQ. CSI was not associated with CRP, IL-6, or disease duration. Conclusions: In this cohort of women with RA, elevated CSI scores identified a greater self-reported symptom burden and were independently associated with pain, fatigue, and depressive symptoms after adjustment, though the pain association remained modest in magnitude. No meaningful association was found with functional disability. The uncontrolled, single-arm design and restricted inflammatory-marker range preclude causal conclusions or proof that symptoms were independent of inflammation. Full article

Background and Objectives: Patients with chronic stroke aged 65 years or older and who are more than 6 months post-onset are generally considered to have reached a rehabilitation plateau, beyond which further functional improvement is difficult to achieve. This study aimed to evaluate changes in gait function before and after integrative Korean–Western medicine treatment in older adults with chronic stroke. Materials and Methods: In this single-center, retrospective, single-group pre–post observational study, we analyzed the medical records of 15 patients with chronic stroke aged ≥65 years who received integrative Korean–Western medicine treatment five times per week for 4 weeks. The primary outcome was the step length ratio, reflecting gait symmetry. Secondary outcomes included walking velocity, lateral symmetry, center of pressure (COP)-related parameters, manual muscle test (MMT) scores, and Fugl-Meyer Assessment (FMA) scores. Results: The step length ratio increased significantly from 0.61 [0.50–0.70] before treatment to 0.86 [0.62–0.94] after treatment (p = 0.009, r = 0.675). Walking velocity (p = 0.006, r = 0.715) and mean COP velocity (p = 0.007, d = −0.822) also improved significantly. In contrast, no significant changes were observed in MMT or FMA scores, and no treatment-related adverse events were recorded. Conclusions: In this retrospective, uncontrolled, single-group study, significant improvements in gait symmetry, walking velocity, and postural control were observed following integrative Korean–Western medicine treatment in older adults with chronic stroke. The improvement in gait function without a corresponding change in FMA-based motor function—although both MMT and FMA scores were relatively high at baseline, potentially limiting sensitivity to detect further motor improvement—raises the hypothesis that other mechanisms, potentially including enhanced sensorimotor integration, may have contributed to these changes; however, this mechanistic interpretation remains speculative and was not directly tested. Randomized controlled trials with appropriate control groups are warranted to further verify these findings. Full article

Background and Objectives: Visual evoked potentials (VEPs) are established tools for detecting optic pathway involvement in multiple sclerosis (MS); however, the distinct clinical significance of longitudinal changes in latency and amplitude remains unclear. This exploratory study aimed to evaluate the clinical utility of serial VEP assessments in patients with relapsing–remitting MS (RRMS) by examining the associations between temporal changes in latency and amplitude and concurrent markers of disease activity and disability. Materials and Methods: We retrospectively analyzed 83 patients with RRMS from three centers who underwent at least two pattern-reversal VEP assessments ≥ 1 year apart. Patients with recent optic neuritis were excluded. Longitudinal changes in VEP latency and amplitude were evaluated in relation to relapse activity during the same inter-assessment interval, baseline MRI and CSF findings, and disability assessed by the Expanded Disability Status Scale (EDSS). Sensitivity analyses were stratified and adjusted for disease-modifying therapy (DMT) efficacy tier, and progression independent of relapse activity (PIRA) was examined using a formal definition. Results: Over a median follow-up of 2 years, 43.4% of patients developed P100 latency prolongation, which was independently associated with a higher annualized relapse rate during the same interval (odds ratio [OR] 2.91, p = 0.005; area under the curve (AUC) 0.72 for concurrent on-study relapse activity), an association that persisted after adjustment for DMT efficacy tier, but not with disability worsening. In contrast, 56.6% of patients exhibited amplitude reduction, which was associated with greater disability accumulation at the group level, with higher EDSS scores at follow-up despite similar baseline values (p < 0.05); the corresponding inverse correlation between amplitude decline and EDSS change was only nominally significant (ρ = −0.231, p = 0.036), did not survive correction for multiple comparisons, and was attenuated after adjustment for baseline EDSS. Formally defined PIRA events were rare (n = 3), precluding inference. Baseline magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) findings differed in the latency group, with fewer MRI lesions and a lower immunoglobulin G (IgG) index, whereas no corresponding differences were observed in the amplitude group. Conclusions: In this exploratory cohort, longitudinal prolongation of VEP latency was associated with concurrent relapse activity, whereas amplitude decline showed a weaker, group-level association with disability. These findings are consistent with, but do not demonstrate, distinct inflammatory and neurodegenerative substrates, and warrant prospective validation before serial VEP monitoring can inform individualized management in MS. Full article

Background and Objectives: Stroke, a neurological disorder caused by damage to the central nervous system, is commonly accompanied by impairments in motor and sensory function and muscle strength. We compared the effects of progressive squat exercises performed under varying support-surface stability conditions on quadriceps femoris muscle thickness in patients 6 months to less than 1 year after stroke, using rehabilitative ultrasound imaging. Materials and Methods: This randomized, open-label, parallel-group controlled trial assessed 36 patients with stroke for eligibility. Four individuals were excluded before randomization; the remaining 32 participants were randomly assigned in a 1:1 ratio to either the unstable-support-surface squat exercise group (n = 16) or the stable-support-surface squat exercise group (n = 16). Both groups performed progressive squat exercises five times per week for 4 weeks. Quadriceps femoris muscle thickness was measured before and after the intervention using rehabilitative ultrasound imaging. Results: Between-group comparisons of changes from baseline showed significantly greater increases in rectus femoris and vastus medialis muscle thickness in the unstable support-surface squat exercise group than in the stable support-surface squat exercise group (p < 0.05). No significant between-group differences were observed in vastus intermedius or vastus lateralis muscle thickness (p > 0.05). Conclusions: Progressive squat exercise performed on an unstable support surface resulted in greater increases in rectus femoris and vastus medialis muscle thickness than the same exercise performed on a stable support surface. However, these findings are limited to muscle thickness and should not be interpreted as evidence of improved muscle strength or functional performance. Full article

Background and Objectives: This trial examined whether two task-complexity gait training protocols differentially affect EEG spectral activity, cognitive–motor interference, and gait performance in chronic stroke. Materials and Methods: Forty-four participants were randomly allocated to Progressive Task-Complexity Gait Training (PTCGT; n = 22) or Constant Task-Complexity Gait Training (CTCGT; n = 22). Both groups trained for 4 weeks using the same auditory-feedback walker. PTCGT progressed from obstacle avoidance to rhythmic auditory cueing plus obstacle avoidance, followed by a verbal fluency dual-task. CTCGT maintained rhythmic auditory cueing plus obstacle avoidance. Outcomes included EEG theta, SMR, mid-beta, Concentration Index, SEF-50, DTC%, and GAITRite gait parameters. Results: Significant group-by-time interactions were observed for EEG and gait measures. DTC showed a significant interaction in repeated-measures ANOVA (p = 0.041), but not in mixed-effects sensitivity analysis (p = 0.088). PTCGT showed greater pre–post changes in EEG and gait outcomes, whereas the DTC difference was less robust. Conclusions: PTCGT was associated with greater changes in EEG spectral characteristics and gait performance than CTCGT. However, these differences cannot be attributed specifically to the progressive task-complexity protocol because PTCGT also involved additional cognitive-task exposure and greater task complexity. In addition, because cognitive-task performance was not quantitatively assessed, improvements in dual-task ability or cognitive–motor integration cannot be established. Full article

Background and Objectives: Prognostic assessment in metastatic epidural spinal cord compression (MESCC) requires estimation of survival, systemic condition, and the likelihood of early functional improvement. We evaluated whether posterior paraspinal fatty infiltration and an exploratory routine-imaging axial muscle phenotype derived from preoperative L3 CT/MRI were associated with overall survival and early neurological improvement after surgery for MESCC. Materials and Methods: Consecutive adults who underwent surgery for MESCC (Bilsky grade 1C–3) between June 2020 and November 2025 were retrospectively analyzed. Psoas quantity was measured on preoperative L3 computed tomography using the psoas-to-vertebral-body ratio (PVR) and psoas muscle index. Posterior paraspinal muscle quality was graded on axial T2-weighted L3 magnetic resonance imaging using a Goutallier-style scale in the multifidus/erector spinae compartment. The primary exposure was high-grade posterior paraspinal fatty infiltration, defined as patient-level maximum Goutallier grade 3–4. An exploratory secondary phenotype combined lower PVR by sex-specific cohort median with Goutallier grade 3–4. Results: Among 133 eligible patients, PVR measurements were available in 119, Goutallier grading in 112, and complete combined phenotyping in 109. Median survival was 383 days for Goutallier 0–2 and 144.5 days for Goutallier 3–4. In the primary clinical/Katagiri-adjusted Cox model, Goutallier 3–4 was associated with worse overall survival (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.06–3.07; p = 0.029). The exploratory both-abnormalities subgroup comprised 21 patients, with median survival of 73 days, and among patients with a preoperative Frankel deficit, early Frankel improvement occurred in 2/15 (13.3%); the adjusted overall-survival HR was 2.64 (95% CI 1.15–6.03; p = 0.021), whereas binary-outcome estimates were imprecise. Conclusions: High-grade posterior paraspinal fatty infiltration was associated with inferior survival and lower early neurological improvement after surgery for MESCC. The combined phenotype identified a small high-risk subgroup but should be regarded as hypothesis-generating. These routine-imaging markers require external validation and should not be used as stand-alone surgical selection criteria. Full article

Background and Objectives: In this study, we investigate the relationship between the state of consciousness and the whole white matter integrity at the chronic stage in diffuse axonal injury (DAI) patients, using tract-based spatial statistics (TBSS). Materials and Methods: Twenty-seven chronic DAI patients and 22 healthy controls were enrolled. Patients were divided into a disorder of consciousness (DOC) group (n = 11, Coma Recovery Scale-Revised [CRS-R] score < 23) and a non-DOC group (n = 16, CRS-R score = 23). Fractional anisotropy (FA) values across 48 subcortical white matter regions of interest (ROIs), defined by the Johns Hopkins University atlas, were analyzed using TBSS to evaluate group differences. Results: The groups significantly differed on FA values of 48 ROIs (Pillai’s trace = 1.000, p < 0.05). The Tukey’s HSD test revealed that the FA values of 44 ROIs (except for the column and body of fornix, right corticospinal tract, left retrolenticular part of internal capsule, and left uncinate fasciculus) among the 48 ROIs of the DOC group were significantly lower than those of the non-DOC group, whereas the FA values of all 48ROIs of the DOC group were significantly lower than those of the control group (p < 0.05). On the other hand, except for the bilateral corticospinal tract, the FA values of 46 ROIs among the 48 ROIs of the non-DOC group were significantly lower than those of the control group (p < 0.05). Conclusions: In DAI patients, the state of consciousness was related to injury severity in most subcortical neural structures. Full article

Background and Objectives: Chronic spontaneous lumbar epidural hematoma (CSLEH) is a rare condition that may mimic a lumbar synovial cyst clinically and radiologically, making accurate preoperative diagnosis challenging. This study aimed to compare the clinical and magnetic resonance imaging (MRI) characteristics of CSLEHs and lumbar synovial cysts and to identify features that may facilitate their preoperative differentiation. Materials and Methods: This retrospective single-center study included 16 adult patients who underwent surgical decompression for symptomatic extradural lesions located between T12 and S1 and were ultimately diagnosed with either CSLEH or lumbar synovial cyst. Based on definitive intraoperative findings with histopathological confirmation when applicable, patients were classified into a CSLEH group (n = 6) or a lumbar synovial cyst group (n = 10). Demographic characteristics, clinical presentation, MRI findings, lesion localization, neurological deficits, pain severity assessed using the Visual Analog Scale (VAS), and postoperative outcomes were compared between the groups. Results: Patients with CSLEHs had a significantly shorter symptom duration (p = 0.001), more frequent anticoagulant use (p = 0.008), and a higher prevalence of motor weakness (p < 0.001) and sensory deficits (p = 0.001) than those with lumbar synovial cysts. Preoperative pain severity was significantly greater in the CSLEH group (p < 0.001). No significant differences were observed in MRI signal characteristics or lesion distribution between the groups. Surgical decompression was associated with marked postoperative pain improvement in both groups, with a greater reduction in VAS scores (ΔVAS) in the CSLEH group (p = 0.007). No postoperative complications were observed. Conclusions: CSLEH should be considered in the differential diagnosis of lumbar synovial cyst, particularly in patients with a relatively short symptom duration, anticoagulant use, and progressive neurological deficits. Although conventional MRI remains essential for preoperative evaluation, substantial overlap in MRI characteristics may limit reliable differentiation between these entities. Integration of clinical and radiological findings may improve preoperative diagnostic suspicion, while surgical exploration can provide both definitive diagnosis and effective neural decompression. Full article

Background and Objectives: Biological correlates of baseline clinical responsiveness remain incompletely characterized in older adults with acute ischemic stroke treated with intravenous thrombolysis. We evaluated associations between admission Glasgow Coma Scale (GCS) and pre-thrombolysis hematologic, inflammatory, iron-status, and micronutrient parameters. Materials and Methods: This retrospective single-center cohort included 95 unique patients aged ≥65 years, all treated with intravenous alteplase between 2020 and 2024. Admission GCS ranged from 11 to 14. Spearman correlations used original GCS scores. Principal proportional odds models used ordered GCS categories of 11–12, 13, and 14, and were adjusted for age, sex, and admission National Institutes of Health Stroke Scale (NIHSS), with false discovery rate corrections. Sensitivity analyses additionally considered clinician-documented aphasia, congestive heart failure, atrial fibrillation, and reperfusion status for 24 h GCS change. Results: Admission GCS correlated most strongly with RDW-CV (rho = −0.843; 95% bootstrap CI, −0.892 to −0.774) and MCV (rho = 0.779; 95% CI, 0.668 to 0.866). Principal adjusted odds ratios per one-SD increase were 5.68 for hemoglobin, 3.01 for log-transformed ferritin, 4.71 for serum iron, 4.71 for log-transformed vitamin B12, 0.20 for C-reactive protein, and 0.019 for RDW-CV (all FDR-adjusted p < 0.001). Association directions remained consistent in sensitivity analyses. MCV showed an exploratory nonlinear association. No biomarker was associated with the direction of 24 h GCS change after FDR correction, including reperfusion-adjusted models. Conclusions: Pre-thrombolysis biological parameters were concurrently associated with baseline GCS within this single-center cohort and restricted GCS range. These associations do not establish causality, independence from unmeasured lesion location or infarct volume, predictive utility, or early neurological recovery. Prospective external validation is required. Full article

Background and Objectives: Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized as a lifespan neurodevelopmental condition with far-reaching consequences for functioning and health that extend well beyond its core signs and symptoms. This narrative review synthesizes evidence on the real-world impact of ADHD across the lifespan, with a focus on academic and occupational outcomes, interpersonal and family functioning, risk-taking and behavioral outcomes, accidental and sport-related injuries, physical and medical health burdens, substance use disorders, sexual health risks, and mortality. Materials and Methods: A structured search of PubMed, Scopus, and Web of Science supplemented by reference-list screening was conducted to identify relevant clinical studies, epidemiological studies, longitudinal investigations, systematic reviews, and meta-analyses published between 2000 and 2025. Evidence was synthesized narratively, with greater interpretive weight given to systematic reviews and meta-analyses, large epidemiological datasets, longitudinal studies, and investigations accounting for important potential confounding factors. Results: Findings indicate that ADHD is associated with substantial impairments across functional, behavioral, and health domains. However, the strength and magnitude of these associations vary and may be influenced by symptom presentation, neurocognitive characteristics, psychiatric comorbidities, lifestyle behaviors, and broader clinical and contextual factors, with evidence of bidirectional relationships for some outcomes. These findings caution against uniformly interpreting adverse outcomes as direct causal consequences of ADHD and support interconnected neurocognitive, reward/motivational, emotional, and environmental pathways linking ADHD features with downstream impairment. Clinically, the evidence underscores the importance of assessing functional impairment alongside ADHD signs and symptoms. Conclusions: Overall, ADHD is associated with substantial and heterogeneous burdens across the lifespan, highlighting the need for multidimensional assessment, further longitudinal and mechanistic research, and timely access to evidence-based interventions. Full article