Neurology

2024 McDonald Criteria: Earlier, More Frequent MS Diagnoses With Lower Specificity

In 347 suspected MS referrals, 274 remained after excluding 73 patients with alternative diagnoses. Applying 2024 versus 2017 McDonald criteria during initial workup increased MS diagnoses (220 vs 172) and halved median time to diagnosis (40 vs 84 days). By follow-up, more patients still met 2024 than 2017 criteria (237 vs 204), with fewer labeled clinically or radiologically isolated syndromes. Initial 2024 criteria showed high sensitivity (92.6%) but only moderate specificity (57.8%) versus 2017-based final MS diagnosis, implying more false positives. Performance was similar in children and adults over 50, though advanced imaging and CSF markers were often unavailable. 1

EVT Improves Outcomes in Basilar Occlusion With NIHSS ≤10

This nationwide Chinese registry included 106 basilar artery occlusion patients with NIHSS ≤10; 78 received EVT and 28 standard medical treatment. EVT was associated with a favorable 90-day mRS shift compared with medical therapy (adjusted OR 6.22; 95% CI 2.31–16.73). Ninety-day mortality was lower with EVT (adjusted OR 0.23; 95% CI 0.06–0.88) without increased symptomatic intracerebral hemorrhage within 48 hours. Functional advantages of EVT persisted at one year, although higher baseline NIHSS still predicted worse outcomes in both groups. 2

Hyperacute BP Lowering Before EVT Linked to Worse Outcomes

Among 492 anterior circulation large-vessel occlusion patients undergoing EVT, 53 (10.8%) received intravenous antihypertensives in the ED before thrombectomy. After propensity matching, active BP lowering was associated with worse 3‑month mRS distribution (adjusted OR 0.38; 95% CI 0.18–0.80). Pre-EVT BP reduction was also linked to greater infarct volume growth without decreasing symptomatic intracerebral hemorrhage. These data argue against routine aggressive BP lowering in hyperacute EVT candidates absent other compelling indications. 3

Blood p‑tau217 Testing Reclassifies Cognitive Diagnoses and Increases Confidence

Two hundred new patients with cognitive symptoms across general neurology and a memory unit underwent blood p‑tau217 testing. Diagnostic category changed in 25.5% after p‑tau217 results, indicating substantial real-world impact on etiologic labeling. Clinician diagnostic confidence increased from 6.90 to 8.49 on a 10‑point scale after receiving biomarker data. Agreement with final diagnosis improved from 75.5% pre-biomarker (kappa 0.576) to 94.5% post-biomarker (kappa 0.906). Effects were consistent across referral settings and across subjective complaints, MCI, and dementia stages, supporting routine implementation. 4