Current Journal of Neurology

Histogram analysis of diffusion weighted magnetic resonance imaging for predicting isocitrate dehydrogenase 1 mutation status in brain gliomas

2025-11-30T08:32:40+00:00

Background: Gliomas are a major type of central nervous system (CNS) tumor. Accurate diagnosis of glioma grade and molecular subtype such as isocitrate dehydrogenase 1 (IDH1) mutation status remains a challenge as required invasive biopsy, which is limited by sampling bias and procedural risks. Quantitative analysis of functional magnetic resonance imaging (MRI), particularly apparent diffusion coefficient (ADC) maps, can serve as a non-invasive diagnostic tool for gliomas. However, using ADC values from different tumor regions may not accurately reflect the tumors’ heterogeneous nature. This study aims to investigate the diagnostic accuracy of histogram features of ADC maps across the entire tumor volume in differentiating between low-grade gliomas (LGGs) and high-grade gliomas (HGGs), as well as IDH1-wildtype from IDH1-mutated tumors.

Methods: This cross-sectional study included 30 patients with glioma who were assessed prior to undergoing surgical resectionmean, minimum, median, maximum, 10^th, 25^th, 75^th, and 90^th percentiles, mode, standard deviation (SD), kurtosis, inhomogeneity, skewness, and entropy, were obtained from the ADC maps. Statistical analysis was conducted to clarify associations between ADC histogram parameters, grade, and IDH1 mutation status. The sensitivity was determined to evaluate the performance of each parameter.

Results: The analysis revealed that 10^th percentile ADC (ADC10^th) had the highest sensitivity (87.5%, P = 0.0423) for discriminating between glioma grades and IDH1 mutation status, respectively.

Conclusion: The whole-tumor ADC histogram-profiling indicates potential value for predicting glioma grades and IDH1 molecular subtypes. However, further validation is required before clinical adoption.

The relationship between HbA1c and the functional outcome of acute ischemic stroke: A prospective cohort study

2025-11-30T08:32:39+00:00

Background: High fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and random glucose levels have been associated with poor neurological outcomes in patients with acute ischemic stroke (AIS). This study aimed to determine the prognostic value of HbA1c in predicting stroke’s functional outcome.

Methods: In this prospective cohort study, one-hundred patients with AIS who were admitted to the Imam Khomeini Hospital Complex, Tehran, Iran, from March 2019 to February 2020, within 72 hours of symptom onset were included. A 3-month modified Rankin Scale (mRS) was used to assess the functional outcome. Patients were divided into 3 groups based on the HbA1c levels: low HbA1c level (≤ 5.6%), moderate HbA1c level (5.7%-6.4%), and high HbA1c level
(≥ 6.5%). Using chi-square test, t-test, analysis of variance (ANOVA), multiple logistic regression, and receiver operating characteristic (ROC) analysis, we studied the association and prognostic value of HbA1c levels and 3-month mRS as an outcome. The significance level was considered as P < 0.05.

Results: We included 100 patients (53 men) with a mean age of 71.55 ± 11.94 years. The mean
HbA1c, National Institutes of Health Stroke Scale (NIHSS), and mRS scores at admission were
6.98 ± 2.34, 8.27 ± 4.40, and 3.01 ± 1.47, respectively. Three-month mRS scores were significantly higher in patients with high HbA1c levels (3.43 ± 1.88) compared with low HbA1c levels (0.43 ± 0.61) and moderate HbA1c levels (1.72 ± 1.45) (P < 0.001).0.897, and a serum HbA1c level at admission threshold of 6.15% had a sensitivity of 95.2% and a specificity of 77.6% to predict the poor outcome [95% confidence interval (CI): 0.837-0.957].

Conclusion: Our findings indicated that serum HbA1c levels at admission could be a valuable predictor of the functional outcome of patients with AIS.

Translation and psychometric validation of the Persian version of amyotrophic lateral sclerosis cognitive behavioral screen (ALS-CBS) and revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R)

2025-11-30T08:32:38+00:00

Background: The Amyotrophic Lateral Sclerosis Cognitive Behavioral Screen (ALS-CBS) and the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) are widely recognized tools for evaluating cognitive, behavioral, and functional changes in patients with amyotrophic lateral sclerosis (ALS). Given the increasing number of ALS cases in Persian-speaking communities, there is a critical need for culturally and linguistically adapted versions of these instruments. The objective of this study was to translate the ALS-CBS and ALSFRS-R into Persian and evaluate their validity and reliability to ensure their applicability in clinical practice and research.

Methods: The Persian versions of the ALS-CBS and ALSFRS-R questionnaires were developed using the translation-back translation method. The translated questionnaires were administered to 36 individuals diagnosed with ALS. To assess content validity, neuromuscular specialists evaluated each item based on relevance, clarity, simplicity, necessity, and comprehensiveness, using content validity ratio (CVR) and content validity index (CVI) measures. Internal consistency reliability was assessed using Cronbach's alpha coefficient. Test-retest reliability was evaluated using the intra-class correlation coefficient (ICC). Statistical analysis was conducted using SPSS software.

Results: All questionnaire items demonstrated satisfactory face validity after expert-guided revisions. The minimum acceptable values for CVI (≥ 0.78) and CVR (≥ 0.62) were achieved by correcting items that initially scored below the threshold. Reliability analysis revealed ICC values of 0.969 and 0.816 for the cognitive and behavioral sections of the ALS-CBS, respectively, and 0.909 for the ALSFRS-R. Cronbach’s alpha coefficients were 0.791 for the ALS-CBS behavioral section and 0.825 for the ALSFRS-R, indicating acceptable internal consistency.

Conclusion: The Persian versions of the ALS-CBS and ALSFRS-R have been shown to be both valid and reliable. These adapted tools provide valuable resources for assessing the cognitive, behavioral, and functional status of patients with ALS in Persian-speaking populations, ultimately supporting more accurate diagnosis, monitoring, and disease management.

Pregnancy outcome in patients with multiple sclerosis: A retrospective study from single center in Benghazi, Libya

2025-11-30T08:32:37+00:00

Background: Misconceptions about multiple sclerosis (MS), pregnancy, and disease-modifying therapies (DMTs) are common, often driven by fears that DMTs pose risks to the fetus or that pregnancy will exacerbate the disease. This study aimed to evaluate and document local clinical practices and decision-making processes in the management of women with MS regarding DMT use during pregnancy.

Methods: A retrospective review was conducted at the MS Clinic of Benghazi Medical Center, Benghazi, Libya, from January 1, 2016 to December 31, 2019. Medical records of women meeting the 2017 McDonald’s criteria for MS diagnosis were analyzed. Data collected included demographic and clinical variables, pregnancy outcomes, DMT use, and postpartum care. Statistical analysis was performed using SPSS software.

Results: Thirty-six women (61 pregnancies) were included. The median age was 36 years (range: 24-56). Unplanned pregnancies occurred in 24/36 women, 32/61 pregnancies (52%). Only five women continued DMTs during pregnancy. Uncomplicated pregnancies occurred in 30/36 women (83%), while postpartum relapses were reported in 12 women (33%), 11 with unplanned pregnancies. The median time to DMT resumption postpartum was 4 months. Breastfeeding was practiced for a median duration of 4 months. Preconception magnetic resonance imaging (MRI) was performed in 6 women (16.6%).

Conclusion: This study provides valuable insights into the management of MS during pregnancy in Libya. While the sample size is small, the findings underscore the importance of standardized guidelines for DMT use, pregnancy planning, and postpartum care. Future studies with larger cohorts and broader DMT options are needed.

Evaluation of the antinociceptive effects of syringic acid in male mice: Using formalin, writhing, and hot plate pain models

2025-11-30T08:32:35+00:00

Background: Syringic acid (SA) is a natural phenolic compound with antioxidant and anti-inflammatory properties. Due to limited studies on the analgesic effect of SA, we decided to comprehensively investigate this effect. Thus, the analgesic activity of SA was assessed for the first time using the formalin and writhing models, in addition to the hot plate (HP) test, involving its action on opioid, GABAergic, nitric oxide (NO)/cGMP, and ATP-sensitive K⁺ channel pathways. Furthermore, we examined exploratory and locomotor behaviors post SA administration.

Methods: A total of 231 mice were randomly assigned to groups of 7. SA was administered at doses of 25, 50, and 100 mg/kg. To investigate the possible pathways, naloxone, flumazenil, L-NAME/methylene blue, and glibenclamide were administered before SA injection. Behavioral tests were performed using the open-field (OF) apparatus. Statistical analysis was performed using one-way (or two-way) analysis of variance (ANOVA) with Tukey, least significant difference (LSD), and Bonferroni post hoc tests. All the results were evaluated under blind conditions.

Results: SA showed significant analgesic effects in the acute (P < 0.050) and chronic (P < 0.001) phases of formalin (P < 0.050) and writhing tests (P < 0.001) but not in the HP test. Furthermore, SA decreased exploratory behavior. Opioid receptor blockade reduced the number of writhes (P < 0.050). Moreover, using L-NAME increased the pain reaction time in the HP test (P < 0.010).

Conclusion: SA exhibited analgesic effects in the formalin and writhing models, but not in the HP test Blocking opioid receptors in the writhing test reduced the analgesic effect of SA. Exploratory behavior increased when flumazenil, naloxone, and L-NAME were injected before SA administration.

Applications of deep learning in intracranial aneurysm imaging: A scoping review of detection, risk prediction, and emerging prognostic models

2025-11-30T08:32:34+00:00

Background: Intracranial aneurysms (IAs) pose a significant risk of rupture and subarachnoid hemorrhage, necessitating early, accurate detection and risk stratification. With advances in artificial intelligence, deep learning (DL) has emerged as a transformative tool in neurovascular imaging. However, the clinical translation of DL applications remains constrained by variability in model design, data sources, and validation strategies. The aim of the present study was to systematically map and evaluate the landscape of DL applications in the detection, segmentation, risk prediction, and outcome assessment of IAs, with attention to methodological rigor, clinical utility, and translational limitations.

Methods: We conducted a scoping review of studies indexed in PubMed, Scopus, and Web of Science up to August 2023, following PRISMA-ScR guidelines. Eligible studies employed DL algorithms for IA-related diagnostic or prognostic tasks using radiological imaging. Data extraction included model architecture, imaging modality, validation strategy, performance metrics, and thematic focus. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools.

Results: Forty-two studies met the inclusion criteria, encompassing over 10,000 patients across diverse imaging platforms and DL architectures. Convolutional neural networks (CNNs) were the most commonly used models, with reported sensitivities ranging from 73% to 99% and AUCs frequently exceeding 0.85. Despite promising results in IA detection and rupture risk prediction, only a minority of studies conducted external validation or addressed post-treatment outcomes. Major gaps include a lack of benchmarking across models, limited explainability, and regulatory or ethical frameworks.

Conclusion: DL algorithms demonstrate strong diagnostic and predictive performance in IA imaging but face critical barriers to clinical integration, including interpretability challenges, dataset heterogeneity, and limited generalizability. Future research should prioritize multicenter validation, explainable AI techniques, and outcome-focused modeling to advance safe and effective deployment in neurosurgical care.

Migraine with or without metabolic syndrome: Is there any difference?

2025-11-30T08:32:33+00:00

Background: Migraine is a common neurological disorder that affects 12-15 percent of the general population. There are few studies in the literature comparing various characteristics of patients with migraine with and without metabolic syndrome with variable results. This study identifies distinct patterns in migraine frequency, severity, or triggers associated with patients with migraine with and without metabolic syndrome.

Methods: This was a cross-sectional study and patients fulfilling the International Classification of Headache Disorders-3^rd edition (ICHD-3) for defining migraine were included in the study. National Cholesterol Education Program (NCEP)-Third Report was used to define metabolic syndrome. Headache severity [visual analog scale (VAS) scoring] and disability grading [Migraine Disability Assessment (MIDAS) scoring] were noted. We compared various clinical parameters in patients with migraine with and without metabolic syndrome.

Results: A total of 204 patients with migraine were recruited. We found that the majority of migraineurs were women (female to male ratio = 4.2:1), with a mean age of 28 years (12-58). A total of 25 patients with migraine (12.25%) had metabolic syndrome. In migraineurs with metabolic syndrome, the mean age at onset, female preponderance, and mean duration of illness were significantly higher than migraineurs without metabolic syndrome. Those with and without metabolic syndrome did not significantly differ from one another in terms of migraine triggers, frequency, severity of headache, or disability severity.

Conclusion: This study showed that metabolic syndrome was present in about 12% of patients with migraine. Individuals with metabolic syndrome had longer mean durations of illness and female preponderance and were older at initial presentation compared to migraineurs without metabolic syndrome.

Globus pallidotomy for the management of post-stroke hemichorea: A case report

2025-11-30T08:32:32+00:00

The Article Abstract is not available.

Wall-eyed bilateral internuclear ophthalmoplegia syndrome from a brainstem haemorrhage

2025-11-30T08:32:31+00:00

The Article Abstract is not available.

Scientometric insights into neurology publications in Iran

2025-11-30T08:32:30+00:00

Background: Undoubtedly, medical science has been born since the beginning of human creation. One of its important branches is neurology. Neurosciences in Iran, with a little delay from the first world, with the efforts of researchers, opened the way for the diagnosis and treatment of neurological diseases, and we reached the place where we are.

Methods: In this bibliometric and scientometric study, we have evaluated the process of neurological science in Iran. By referring to the reliable indexes, we checked Web of Science (WoS), PubMed, and Scopus from 1963 onwards. We showed the published activities of Iranians in the form of charts and tables.

Results: This study indicates the increasing growth of scientific studies in the field of neurology. In the field of neuroscience, the researchers are mostly aimed at the education and training of specialists and PhD students, and depending on the research facilities, as well as acquaintances and connections for the publication of articles. Diseases that have afflicted a large number of people causing them to suffer and limiting their activities, such as multiple sclerosis (MS), Alzheimer's, epilepsy, Parkinson's, and brain strokes have been the focus of researchers.

Conclusion: Neurological studies have an increasing trend and can be divided into two basic sections, which are mainly done by neuroscientists and are based on the educational needs and training of specialists, but neurology studies and scientific publications are mainly done by neurologists and based on feeling the need and diseases in this field have been done.