BACKGROUND AND OBJECTIVES Growing evidence suggests that the APOE ε4 allele, a genetic risk factor for Alzheimer disease (AD), influences the clinical-pathologic features of Parkinson disease (PD). APOE ε4 promotes brain amyloid accumulation, indicating a PD subtype more susceptible to late copathology. However, the early correlates of APOE ε4 carriers in PD are not known. In this study, we used a

BACKGROUND AND OBJECTIVES Cognitive impairment in older adults is influenced by coexisting β-amyloid (Aβ), tau, and cerebral small vessel disease (CSVD). Cerebral microbleeds (CMBs) are associated with Aβ and CSVD, but their role on tau-related neurodegeneration remains unclear. We investigated whether the CMBs modify tau-related disease progression. METHODS A longitudinal, prospective cohort

Regression discontinuity design (RDD) offers a rigorous approach for estimating causal effects using observational data where randomized clinical trials are not feasible by leveraging cutoff-based treatment rules, effectively accounting for confounding when certain assumptions hold true. RDD remains underused in neurologic research, with most existing applications in neurology emerging only in the

A 50-year-old man presented with acute-onset numbness and tingling in his extremities, which progressively worsened, leading to severe gait instability and near-inability to walk. Two weeks earlier, he had experienced an upper respiratory tract infection. Neurologic examination revealed bilateral ptosis, truncal and gait ataxia, and impaired sensory function, with preserved motor strength. The differential

BACKGROUND AND OBJECTIVES Impaired kidney function has been linked to altered concentrations of blood biomarkers of Alzheimer disease (AD), but the underlying mechanisms and its potential role in dementia development remain poorly understood. We explored the associations between estimated glomerular filtration rate (eGFR), blood-based biomarkers of AD, and dementia development. METHODS Data were

We present a case of a 5-year-old, who developed refractory, multifocal myoclonus, which progressed over several weeks, leading to a profound functional decline. The diagnostic workup was complicated by a compelling genetic finding that suggested a possible primary epileptic encephalopathy. However, meticulous history-taking uncovered key details inconsistent with a purely genetic disorder, raising

BACKGROUND AND OBJECTIVES Engagement in physical and cognitive activities is associated with a decreased risk of mild cognitive impairment (MCI) and dementia, but the association with Alzheimer disease (AD) neuroimaging biomarkers is less clear. We thus examined associations of physical and cognitive activities with longitudinal trajectories of AD neuroimaging biomarkers among older adults free of

BACKGROUND AND OBJECTIVES Driving integrates multiple cognitive, sensory, and motor systems and may serve as a real-world indicator of functional decline in aging. Older adults with mild cognitive impairment (MCI) often experience subtle driving changes before formal dementia diagnosis, but longitudinal, real-world evidence is limited. This study examined whether naturalistic driving data can differentiate

BACKGROUND AND OBJECTIVES Progressive supranuclear palsy (PSP) is characterized by progressive atrophy of brainstem, subcortical, and frontal regions. It is unknown whether longitudinal atrophy patterns differ between PSP-Richardson syndrome (PSP-RS) and cortical and subcortical clinical variants of PSP and whether atrophy rates could be useful outcome measures for treatment trials. We aimed to determine

BACKGROUND AND OBJECTIVES Kappa-free light chain (κ-FLC) is a quantitative biomarker of intrathecal immunoglobulin synthesis, with diagnostic accuracy comparable to oligoclonal bands in patients with multiple sclerosis (pwMS). However, their association with longitudinal brain MRI parameters remains unclear. We investigated associations between κ-FLC and MRI metrics in pwMS. METHODS In this retrospective

In this article, we highlight a relatively underaddressed topic in the field of neurology-periprocedural brain health. After reviewing the scope of the problem, we call upon neurologists to join multidisciplinary efforts to realize the goal of reducing the rate of periprocedural stroke, cognitive impairment, and mortality and outline a roadmap of the work that lies ahead to achieve optimal periprocedural

Ophthalmoplegia with ptosis represents a heterogeneous group of disorders that pose significant diagnostic challenges. We report the case of a 16-year-old adolescent boy presenting with ophthalmoplegia and unilateral ptosis. This case underscores the critical role of comprehensive clinical evaluation and standardized therapeutic protocols in the diagnosis and management of this disorder. Readers will

It is well recognized that many pandemic viruses are associated with neurologic complications, most recently with COVID-19. After the outbreak of the COVID-19 pandemic, neurologic surveillance platforms were implemented to characterize the complications of COVID-19. Surveillance platforms are invaluable in providing timely data, informing clinical practice, and directing future research. Lessons learned

BACKGROUND AND OBJECTIVES Patients with multiple sclerosis (MS) exhibit variability in disability progression and response to disease-modifying therapies (DMTs). Identifying those at greatest risk of disability worsening and most likely to benefit from high-efficacy DMTs remains challenging. We aimed to identify distinct disability worsening phenotypes, explore their mechanisms, and evaluate DMT impact

BACKGROUND AND OBJECTIVES In comatose patients after cardiac arrest (CA), only "highly malignant" or "benign" EEG patterns are recognized as robust markers of poor and good outcomes, respectively, whereas many patients with "malignant" EEG remain in prognostic uncertainty. We aimed to assess the prognostic value of combined malignant EEG criteria for poor neurologic outcome in this clinical setting

BACKGROUND AND OBJECTIVES A significant proportion of patients with ischemic stroke treated with endovascular therapy (EVT) do not achieve favorable clinical outcomes despite successful recanalization. Identifying patients who may benefit from adjunctive therapies is a priority. We hypothesized that incomplete reperfusion is associated with evolution of imaging markers on early post-EVT MRI and clinical

BACKGROUND AND OBJECTIVES The choroid plexus (ChP) plays a crucial role in maintaining brain health. Alzheimer disease (AD) pathologies may damage the ChP and accelerate neurodegeneration. Previous imaging studies have found overall increased ChP volume in patients with AD. In this study, we aim to investigate AD-related ChP morphological features and their associations with cognitive decline.

A 30-year-old woman with relapsing-remitting multiple sclerosis on ocrelizumab presented with subacute diplopia, dysarthria, spastic upper extremity diplegia, nausea, and vomiting. She was 4 months postpartum at the time of presentation and had resumed ocrelizumab infusions within 1 month after delivery. MRI demonstrated T2 hyperintensities involving the bilateral anterior medulla, substantia nigra

BACKGROUND AND OBJECTIVES Patients with myasthenia gravis (MG) exhibit significant heterogeneity based on age at disease onset. However, existing retrospective studies in China remain confined to single-center settings with limitations in sample size adequacy. The aim of this study was to compare clinical characteristics, treatment responsiveness, and long-term postintervention status of patients

Artificial intelligence (AI) is rapidly reshaping neurology, offering opportunities to improve efficiency, expand access to care, and enhance clinical decision making. Yet, without deliberate safeguards, AI can perpetuate or exacerbate existing health disparities, especially for systemically marginalized populations. This article examines the dual potential of AI, as both a driver of innovation and

BACKGROUND AND OBJECTIVES Mood symptoms are recognized short-term sequelae of traumatic brain injury (TBI). Research regarding depressive symptoms among older, community-based individuals with TBI is limited. Previous studies have largely focused on short-term and intermediate-term follow-up. METHODS The Atherosclerosis Risk in Communities study is an ongoing prospective cohort study of community-dwelling

In the etiologic assessment of ischemic stroke, conventional imaging techniques may underestimate the clinical significance of high-risk plaques that do not exhibit significant luminal stenosis. Here, we report the case of a 66-year-old male patient who experienced 3 recurrent strokes. Carotid ultrasound and digital subtraction angiography showed no apparent carotid stenosis. However, high-resolution

BACKGROUND AND OBJECTIVES Head CT is an essential element of emergency department (ED) diagnosis and treatment of numerous neurologic emergencies. However, it is costly in aggregate, exposes patients to ionizing radiation, and can contribute to increased ED delays and length of stay. The objective of this study was to characterize head CT use in a nationwide sample of EDs between 2007 and 2022.

This poetic reflection highlights how routine bedside tests become opportunities for multifaceted learning for trainees. The "finger-to-nose" test used in neurologic examinations not only provides insight into neurologic signs but also teaches about clear communication, patience, and connecting with the patient's way of thinking. Drawing on real-life, day-to-day clinical encounters, the piece explores

BACKGROUND AND OBJECTIVES The benefit of IV thrombolysis (IVT) before endovascular therapy (EVT) in acute ischemic stroke patients with basilar artery occlusion (BAO) remains unclear. Most existing studies have focused on patients directly admitted to comprehensive stroke centers (CSCs), where EVT is readily available. Our objective was to evaluate the effectiveness and safety of IVT initiated before

BACKGROUND AND OBJECTIVES The role of IV thrombolysis before endovascular thrombectomy (bridging thrombectomy, BT) in posterior circulation large-vessel occlusion stroke remains uncertain. This study evaluated the effectiveness and safety of BT compared with direct thrombectomy (DT) using data from 2 nationwide registries and an updated meta-analysis. METHODS Patients from collaborative registries

We report a case of an 83-year-old female patient who presented with binocular diplopia associated with left periorbital pain. She was diagnosed with a left pupil-involving third nerve palsy initially believed to be either microvascular or aneurysmal. However, negative vascular neuroimaging and further serologic workup suggested the possibility of neurosyphilis. Her clinical course was significant

From all-female residency classes to all-female leadership programs, the unique environment of these settings emphasizes the role we share in women supporting each other to succeed.

BACKGROUND AND OBJECTIVES Neuropathologic burden explains part of the clinical expression of dementia. Frailty and sex have been involved in the individual vulnerability to cognitive impairment, yet it remains unclear how they jointly modify the relationship between neuropathology and cognition. This study investigated whether frailty and sex modify the associations of neurodegenerative and cerebrovascular

BACKGROUND AND OBJECTIVES α-Synuclein (αSyn) seed amplification assays (SAAs) accurately detect αSyn pathology in dementia with Lewy bodies (DLB). Alzheimer disease (AD) copathology occurs in ∼70% of patients with DLB at autopsy. The association of different αSyn-SAA and AD biomarker profiles with clinical outcomes in DLB can aid prognostication and inform clinical trial design. METHODS This is

BACKGROUND AND OBJECTIVES Dravet syndrome (DS) is an intractable developmental and epileptic encephalopathy caused primarily by pathogenic variants in the voltage-gated sodium channel α subunit 1 (SCN1A) gene. Patients with DS experience refractory seizures and significant cognitive and behavioral deficits. Longitudinal studies using standardized assessments are needed to systematically document patient

BACKGROUND AND OBJECTIVES Treatment decisions for patients with epileptic seizures due to cerebral cavernous malformations (CCMs) are challenging because of a paucity of studies. We aimed to assess the rates and risk factors of CCM-related seizures during long-term follow-up without CCM intervention. METHODS This population-based study included people aged 16 years or older in Scotland who were

Endovascular therapy (EVT) has proven benefit for patients with anterior circulation large vessel occlusion (LVO) strokes with moderate-to-severe deficits, but its value in patients presenting 6-24 hours after onset with mild symptoms (NIH Stroke Scale score ≤5) remains unclear. This journal club article examines a retrospective analysis of CLEAR registry data comparing EVT with medical management

Vanishing white matter (VWM) is a rare disorder, characterized by degeneration of CNS white matter, clinically often exacerbated by stressors such as fever and minor head trauma. VWM is caused by biallelic pathogenic variants in the EIF2B1-5 genes, causing reduced activity of eukaryotic initiation of translation factor 2B, resulting in dysregulation of the integrated stress response (ISR). New scientific

BACKGROUND AND OBJECTIVES Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by 3 core symptom complexes: parkinsonism, cerebellar syndrome, and dysautonomia. Recent Movement Disorder Society (MDS) criteria allow for the clinical diagnosis of MSA based solely on motor symptoms, without requiring dysautonomia. This study aimed to evaluate the frequency and disease trajectory

BACKGROUND AND OBJECTIVES Temporal lobe epilepsy (TLE) is a highly prevalent neurologic disorder, with 30%-50% of patients developing drug-resistant epilepsy. Pharmacoresistant seizures remodel critical arousal and respiratory networks, impairing autonomic function and chemoreception and putting patients at increased risk of adverse respiratory events and sudden unexpected death (SUDEP). Given that

BACKGROUND AND OBJECTIVES Sorbitol dehydrogenase (SORD) deficiency, due to biallelic loss-of-function variants in the SORD gene, is a recently recognized cause of autosomal recessive hereditary neuropathy. Specific diagnosis is difficult on clinical grounds alone, and molecular genetic testing of SORD is complicated by the presence of a pseudogene. Biochemical testing of serum sorbitol is suggested

OBJECTIVES To determine population attributable fractions (PAFs) of modifiable dementia risk factors by income, and independent and interactive associations of race-ethnicity and income with each risk factor and cumulative number of midlife risk factors. METHODS This nationally representative cross-sectional study of the 1999-2008, 2011-2014, and primarily the 2015-2018 National Health and Nutrition

BACKGROUND AND OBJECTIVES Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease (cSVD) characterized by β-amyloid deposition in cortical and leptomeningeal vessels. Free water (FW) and peak width of skeletonized mean diffusivity (PSMD) are diffusion-weighted MRI biomarkers of cSVD. Although PSMD has been associated with CAA, it is unknown whether FW reflects CAA-related tissue injury

BACKGROUND AND OBJECTIVE Executive dysfunction (ExD) is a common comorbidity of focal epilepsy. Focal cortical dysplasia (FCD) is the most common lesional cause of epilepsy in children. We aimed to investigate clinical, etiologic (pathology), and anatomic vs functional network associations with ExD in FCD-related epilepsy. FCD lesion-network interactions may underlie ExD. The primary analysis was

BACKGROUND AND OBJECTIVES Anticoagulation in patients with intracerebral hemorrhage (ICH) and atrial fibrillation reduces the risk of ischemic stroke (IS), but also potentially causes an excess risk of recurrent ICH. In this context, we assessed the role of neuroimaging in identifying patients with particular susceptibility to IS or ICH, potentially allowing for individualized risk stratification

BACKGROUND AND OBJECTIVES Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in older patients and an important contributor to cognitive decline and recurrent hemorrhagic stroke. Diagnosis of CAA is commonly based on MRI findings interpreted according to established criteria. Recently, the simplified Edinburgh criteria were proposed as a CT-based alternative

BACKGROUND AND OBJECTIVES Heavy alcohol use (HAU) is a modifiable risk factor that may influence intracerebral hemorrhage (ICH) severity and cerebral small vessel disease (cSVD), but its role remains insufficiently understood. We aimed to investigate how HAU is associated with acute ICH characteristics and cSVD burden. METHODS In this cross-sectional study, we analyzed prospectively collected