Citations

This article highlights herpes zoster radiculitis, a condition that predominantly affects elderly patients and classically presents with progressive limb weakness, pain, and vesicular rash. Neuroimaging with MRI may demonstrate nerve root enlargement with T2-hyperintensity and gadolinium enhancement. Diagnosis can be confirmed with varicella zoster virus PCR in CSF. Effective treatment includes IV acyclovir and neuropathic pain agents such as gabapentin, which together can lead to symptomatic improvement. Early diagnosis and comprehensive treatment are crucial to prevent complications. Patients with zoster-associated plexopathy have a higher incidence of postherpetic neuralgia compared to those with herpes zoster rash alone. Thus, multimodal treatment involving antivirals, rehabilitation, and pain management is essential for recovery.

High-grade gliomas, like glioblastoma multiforme (GBM), are the most common malignant brain tumors in adults and are treated with the chemotherapy drug temozolomide (TMZ). In humans, a retrospective analysis of patients’ overall survival suggests that morning dosing may confer a benefit over evening dosing. Circadian variation in O6-methylguanine-DNA methyltransferase (MGMT) gene expression and promoter methylation has been implicated in increased tumor cell sensitivity to TMZ in the morning. Although patient compliance with timed oral administration of TMZ was high in a prospective trial, it is not known whether differences in daily sleep patterns of patients impact the biological time of drug administration or overall survival. Using wrist actigraphy collected from 10 high-grade glioma patients, we quantified the moment of oral TMZ delivery in terms of wall clock time and internal biological time during the months after surgical tumor resection. We found that variation of daily rhythms within and between individuals caused dosing times to vary more in their internal biological time than wall clock time so that, for example, some doses taken by patients assigned for the evening (2000 h) were closer to the patient’s internal biological morning. We conclude that wrist actigraphy provides a reliable and non-invasive estimate of personal circadian time that could improve efficacy and precision of TMZ delivery. These findings may inform personalized circadian medicine and optimized times for TMZ delivery in the clinic.

Background Headache is a common symptom following mild traumatic brain injury (mTBI). Post-traumatic headache (PTH), a secondary headache disorder that develops after mTBI, often persists for months or years. To identify potential recovery mechanisms and prognostic biomarkers, the present study investigated whether longitudinal changes in pain-induced brain activation differ between healthy controls (HC) and PTH participants showing headache improvement and those without improvement. Methods Thirty-three participants who met International Classification of Headache Disorders, 3rd edition, criteria for acute PTH within 59 days post-mTBI and 33 HC participants were included with no significant differences in demographics. All participants underwent functional magnetic resonance imaging scans at baseline, four weeks, and 16 weeks post-enrollment using a thermal stimulation paradigm with noxious and non-painful heat stimuli. ‘Painful vs. Non-Painful Heat’ contrasts were generated using SPM12. PTH improvement was assessed at three months post-enrollment via electronic headache diaries. Two-sample t -tests compared the brain activation between HC and PTH at baseline. Linear mixed-effects models examined longitudinal changes for HC, PTH improvement and non-improvement groups across visits. Generalized linear models compared these groups within visits. Results Baseline analysis revealed several regions with significantly higher activation in acute PTH compared to HC, including bilateral postcentral gyrus, right superior temporal gyrus, right middle temporal gyrus, left inferior parietal gyrus, right superior parietal gyrus, left ventral striatum, left olfactory cortex, left gyrus rectus, and left middle occipital gyrus. Over time, the PTH improvement group demonstrated progressive normalization across all identified brain regions, whereas the non-improvement group showed only partial normalization in left ventral striatum, left olfactory cortex, and left gyrus rectus. Sustained elevated activation in specific regions distinguished PTH participants without headache improvement from those with headache improvement, suggesting potential biomarkers for persistent PTH. Conclusions Our findings demonstrate significantly altered pain-induced brain activations in participants with acute PTH compared to HC. Longitudinal analysis revealed distinct recovery trajectories: progressive normalization in the improvement group versus persistent alterations in the non-improvement group. These neuroimaging patterns may serve as biomarkers for identifying individuals at risk for persistent PTH, with implications for early intervention and personalized treatment approaches.

BACKGROUND AND IMPORTANCE: Basilar artery fenestration aneurysms (BAFAs) present significant clinical challenges because of their high rupture risk and complex anatomy. Comprehensive management strategies are required, including thorough vascular assessment and post-treatment surveillance. Integration of complementary analyses such as computational fluid dynamics (CFD) holds promise in facilitating preoperative planning for these intricate lesions. CLINICAL PRESENTATION: A 60-year-old female was diagnosed with a BAFA during evaluation for headaches. Digital subtraction angiography revealed the aneurysm projecting posteriorly with a neck predominantly based on the right limb of the fenestration. After initial treatment with a pipeline embolization device, the aneurysm remained patent, requiring further treatment. A secondary approach with stent-assisted loose-packing coil embolization was then performed, resulting in complete occlusion of the aneurysm. Analysis of pretreatment 3-dimensional rotational angiogram images with CFD provided critical hemodynamic insights. It identified that 38.89% of the aneurysm area was exposed to low wall shear stress (WSS) and 11.5% was exposed to high WSS, indicating a high rupture risk profile with significant areas of both low and high WSS. In addition, low WSS was observed in regions corresponding to daughter sacs, suggesting a higher rupture risk. Streamline analysis indicated increased inflow through the right vertebral artery and the right limb of the fenestration, supporting the initial angiographic impression and guiding the choice of therapeutic strategy. CONCLUSION: This is the first study to analyze the morphology and pretreatment hemodynamics of a BAFA using CFD, illustrating the potential for future development of individualized therapeutic approach–based CFD in complex aneurysms.

Summary: Background: Peripheral arterial disease (PAD) increases cardiovascular (CV) morbidity and mortality, but remains underdiagnosed and undertreated. Several trials support low-dose direct oral anticoagulant (DOAC) use in PAD treatment, although this has yet to be widely adopted in clinical practice. Patients and methods: We conducted a retrospective study of patients who underwent ankle-brachial index testing (ABI) from 1996 – 2020 at Mayo Clinic. We included patients with PAD defined by abnormal ABI (<1.0 or >/=1.4). Primary outcomes evaluated were myocardial infarcts (MI), ischemic strokes (IS), critical limb ischemia (CLI)/amputation, bleeding events and all-cause mortality. DOAC and warfarin use were each compared to no anticoagulant use for the outcomes using univariate analysis and multivariate analysis. Results: 22,162 patients had abnormal ABI readings; 1,266 were on warfarin and 269 were on DOAC for any indication. Both the DOAC and warfarin groups showed significant a decrease in all-cause mortality. The DOAC group showed superior mortality outcomes with HR 0.50 [95% CI 0.40–0.63], p-value <0.001 compared to warfarin with HR 0.88 [95% CI 0.81–0.96], p-value <0.004. There appeared to be a similar trend for MI and CLI/amputation however this was not statistically significant. IS was similar with only warfarin being statistically significant. The DOAC group had improved bleeding outcomes compared to the warfarin group, HR 0.53 (95% CI 0.24–0.85), p-value 0.007. Notably, the addition of ASA for both AC groups resulted in significant HR >1. Conclusions: Our study shows that anticoagulation use, particularly DOACs, is associated with decreased all-cause mortality in patients with PAD. There appears to be a favorable trend for DOACs in MI, IS and CLI/amputation. Lastly, DOACs were found to have superior outcomes with bleeding events.

Introductory paragraph The extracellular Calcium-sensing receptor (CaSR) regulates cellular responsiveness to physiological changes in ionized calcium (Ca 2+ ) concentrations. The CaSR is expressed in the brain, including in hypothalamic growth hormone stimulating GHRH and anorectic POMC neurons that control growth and energy homeostasis. We embryonically deleted the Casr gene in neurons to create Neuron CaSR -/- mice to delineate the role of this receptor in regulating growth, skeletal development, and energy metabolism. Neuron CaSR -/- mice had reduced size, weight and bone mass compared to littermate controls, with a dysregulated growth hormone axis. They also showed increased adiposity and circulating leptin levels, leptin resistance, and decreased glucose tolerance, along with reduced expression of the anorectic precursor peptide POMC and secondary increases in the expression of the anorectic peptide AgRP in the hypothalamus of Neuron CaSR -/- mice. Knockdown of CaSR in adult mice specifically in the hypothalamic arcuate nucleus, where GHRH, POMC and AgRP neurons reside, also resulted in increased body weight, adiposity, leptin resistance, and glucose intolerance, and reduced bone mass. Together these data suggest that neuronal CaSR critically regulates energy and skeletal metabolism and body growth by modulating hypothalamic function, representing a new paradigm for central integration of calcaemic activities with body function.

Purpose To evaluate the differences in clinical outcomes and complication rates between open and arthroscopic iliopsoas (IP) tenotomy between 1998 and 2023 at our institution. Methods Patients who underwent arthroscopic iliopsoas fractional lengthening (IPFL) or open tenotomy for IP tendinitis following total hip arthroplasty (THA) between 1988 and 2023 were identified. Patients were excluded if they underwent revision IP tendon release, had additional concomitant procedures, or had less than a 24‐month postoperative follow‐up. Patient records were reviewed, and patient‐reported outcomes were collected via electronic survey. Results Fifty‐two patients (36 arthroscopic, 16 open) were followed for an average of 68.7 (24.0‐203.7) months. Overall surgery satisfaction was 7.9 (scale 0‐10) following arthroscopic IPFL and 6.0 following open tenotomy ( P = .178). Eighty‐six percent of patients reported improvement in their anterior groin pain following arthroscopic IPFL, compared to 45% following open tenotomy ( P = .065). In the arthroscopic cohort, 64% reported improved hip flexion strength, compared to 36% in the open cohort ( P = .158). Visual analog scale for pain at rest was lower following arthroscopic IPFL (1.1 ± 2.2 vs 3.3 ± 3.2, P = .0092), while pain with use did not differ between cohorts (3.1 ± 1.3 vs 2.6 ± 1.1, P = .786). There were no differences in postoperative Tegner (3.1 ± 1.3 vs 2.6 ± 1.1, P = .302), modified Harris Hip Score (77.0 ± 19.0 vs 69.2 ± 26.9, P = .073), or Single Assessment Numeric Evaluation (70.9 ± 28.7 vs 66.7 ± 31.8, P = .571) scores between arthroscopic and open cohorts. Revision THA rates did not differ following arthroscopic or open procedures (8.3% vs 25%, P = .104). Conclusions Patients have improved pain at rest following arthroscopic IPFL when compared to open tenotomy for IP tendinitis following THA. Overall complication and reoperation rates were low for both techniques. Level of Evidence Level III, retrospective cohort study.