Neurology

CSF profile helps stratify early relapse risk in biopsy-proven primary CNS vasculitis

This cohort of biopsy-confirmed primary CNS vasculitis quantified relapse incidence in a systematically followed population. Investigators tested whether baseline cerebrospinal fluid characteristics were associated with early disease recurrence after initial therapy. Findings support using CSF profiles to stratify relapse risk and tailor surveillance and maintenance immunosuppression intensity. Clinicians can consider closer early follow-up in patients with higher-risk CSF patterns, pending validation and therapy-specific analyses. 1

IsCHEMiA: an imaging-based risk score for poststroke epilepsy that surpasses SeLECT

IsCHEMiA predicts poststroke epilepsy after first-ever ischemic stroke using infarct size, cortical involvement, hemorrhagic transformation, early seizures, MCA involvement, and age. In 1,436 derivation and 2,534 international validation patients, discrimination was high, with c-statistics between 0.826 and 0.870. IsCHEMiA outperformed SeLECT, with better overall c-statistic and calibration at 1 and 3 years across cohorts. Risk gradients were clinically meaningful, with low risk at scores around 3 and very high risk at scores ≥8. The score can guide counseling, EEG or clinic follow-up intensity, and selection for antiepileptogenesis trials in high-risk patients. 2

Autoregulation-guided blood pressure control after thrombectomy links to secondary injury and outcome

In 199 endovascular thrombectomy patients, individualized autoregulation limits were derived from continuous arterial pressure and near-infrared spectroscopy monitoring. Greater percentage of time outside these limits independently predicted early neurologic deterioration and worse 90-day modified Rankin Scale scores. Time above the upper limit was associated with hemorrhagic transformation, symptomatic intracranial hemorrhage, and increased cerebral edema. In nonrecanalized patients, each additional hour below the lower limit correlated with substantial infarct volume progression. These data support autoregulation-based BP targets after thrombectomy rather than uniform systolic or MAP thresholds alone. 3

Capillary dried plasma p-tau217 detects Alzheimer’s pathology with good accuracy and scalability

The DROP-AD study evaluated dried plasma and blood spot biomarkers from capillary blood in 337 participants across seven centers. Dried plasma p-tau217 correlated strongly with venous plasma p-tau217 and increased with Alzheimer’s disease severity. It predicted CSF biomarker positivity with good accuracy, supporting its use as a surrogate for Alzheimer’s pathology status. Glial fibrillary acidic protein and neurofilament light were also measurable, including in individuals with Down syndrome. High concordance between supervised and self-collected samples suggests feasibility for community or at-home Alzheimer’s biomarker workflows, pending further protocol refinement. 4