《神经病学年鉴》发表了对神经病学具有广泛兴趣的文章，尤其是那些对理解人类神经系统疾病的机制和治疗有重大影响的文章。尽管 ANNALS 使用多种临床和基本神经科学方法发表论文，但我们最感兴趣的是学术神经学家普遍感兴趣的那些手稿，包括临床试验和其他为医学实践提供信息的大规模研究。纯粹的基础研究，没有很强的临床或转化潜力，不太可能有足够的优先发表权。

The Annals of Neurology publishes articles on a wide range of topics relevant to neurology, particularly those that have a significant impact on understanding the mechanisms and treatments of human neurological diseases. While the Annals employs various clinical and basic neuroscience methods for publication, we are particularly interested in manuscripts that are of general interest to academic neurologists, including clinical trials and large-scale studies that provide valuable information for medical practice. Purely basic research, lacking strong clinical or translational potential, is less likely to receive priority for publication.

《Annals of Neurology》发表了与神经病学相关的广泛主题文章，特别是那些对理解人类神经系统疾病的机制和治疗具有重要影响的研究。虽然《Annals of Neurology》采用多种临床和基础神经科学方法来发表论文，但我们特别关注那些学术神经学家普遍感兴趣的稿件，包括临床试验和其他为医学实践提供重要信息的大规模研究。纯粹的基础研究，若缺乏明显的临床或转化潜力，通常不具备优先发表的条件。

Annals of Neurology

Objective To examine the association of the plasma neuroaxonal injury markers neurofilament light (NfL), total tau, glial fibrillary acid protein, and ubiquitin carboxyl‐terminal hydrolase L1 with delirium, delirium severity, and cognitive performance. Methods Delirium case–no delirium control (n = 108) pairs were matched by age, sex, surgery type, cognition, and vascular comorbidities. Biomarkers were measured in plasma collected preoperatively (PREOP), and 2 days (POD2) and 30 days postoperatively (PO1MO) using Simoa technology (Quanterix, Lexington, MA). The Confusion Assessment Method (CAM) and CAM‐S (Severity) were used to measure delirium and delirium severity, respectively. Cognitive function was measured with General Cognitive Performance (GCP) scores. Results Delirium cases had higher NfL on POD2 and PO1MO (median matched pair difference = 16.2pg/ml and 13.6pg/ml, respectively; p &lt; 0.05). Patients with PREOP and POD2 NfL in the highest quartile (Q4) had increased risk for incident delirium (adjusted odds ratio [OR] = 3.7 [95% confidence interval (CI) = 1.1–12.6] and 4.6 [95% CI = 1.2–18.2], respectively) and experienced more severe delirium, with sum CAM‐S scores 7.8 points (95% CI = 1.6–14.0) and 9.3 points higher (95% CI = 3.2–15.5). At PO1MO, delirium cases had continued high NfL (adjusted OR = 9.7, 95% CI = 2.3–41.4), and those with Q4 NfL values showed a −2.3 point decline in GCP score (−2.3 points, 95% CI = −4.7 to −0.9). Interpretation Patients with the highest PREOP or POD2 NfL levels were more likely to develop delirium. Elevated NfL at PO1MO was associated with delirium and greater cognitive decline. These findings suggest NfL may be useful as a predictive biomarker for delirium risk and long‐term cognitive decline, and once confirmed would provide pathophysiological evidence for neuroaxonal injury following delirium. ANN NEUROL 2020;88:984–994

Tamara G. Fong

Sarinnapha M. Vasunilashorn

Long Ngo

Towia A. Libermann

Simon T. Dillon

Eva M. Schmitt

Alvaro Pascual‐Leone

Steven E. Arnold

Richard N. Jones

Edward R. Marcantonio

Sharon K. Inouye

Ann Neurol

Association of Plasma Neurofilament Light with Postoperative Delirium

血浆神经丝轻链与术后谵妄的关联

Annals of NeurologyVolume 27, Issue 3 p. 327-327 Editorial Traumatic brain injury: A silent epidemic Murray Goldstein DO, MPH, Murray Goldstein DO, MPH Chairman Interagency Head Injury Task Force, National Institute of Neurological Disorders and Stroke, Bethesda, MDSearch for more papers by this author Murray Goldstein DO, MPH, Murray Goldstein DO, MPH Chairman Interagency Head Injury Task Force, National Institute of Neurological Disorders and Stroke, Bethesda, MDSearch for more papers by this author First published: March 1990 https://doi.org/10.1002/ana.410270315Citations: 145AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume27, Issue3March 1990Pages 327-327 RelatedInformation

Murray Goldstein

Traumatic brain injury: A silent epidemic

创伤性脑损伤：一种无声的流行病

Objective This study was undertaken to examine the comparative safety of antiseizure medication (ASM) monotherapy in pregnancy with respect to risk of major congenital malformations (MCMs), overall and by MCM subtype. Methods We conducted a population‐based cohort study using national health register data from Denmark, Finland, Iceland, Norway, and Sweden (1996–2020). We compared pregnancies with first trimester exposure to lamotrigine monotherapy to ASM‐unexposed, carbamazepine, valproate, oxcarbazepine, levetiracetam, and topiramate to lamotrigine monotherapy, and stratified monotherapy groups by dose. The outcome was nongenetic MCM and specific subtypes. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) with log‐binomial regression and propensity score weights. Results There was a higher crude risk of any MCM in pregnancies exposed to lamotrigine monotherapy (n = 8,339) compared to ASM‐unexposed pregnancies (n = 4,866,362), but not after confounder adjustment (aRR = 0.97, 95% CI = 0.87–1.08). Compared to lamotrigine, there was an increased risk of malformations associated with valproate (n = 2,031, aRR = 2.05, 95% CI = 1.70–2.46) and topiramate (n = 509, aRR = 1.81, 95% CI = 1.26–2.60), which increased in a dose‐dependent manner. We found no differences in malformation risk for carbamazepine (n = 2,674, aRR = 0.91, 95% CI = 0.72–1.15), oxcarbazepine (n = 1,313, aRR = 1.09, 95% CI = 0.83–1.44), or levetiracetam (n = 1,040, aRR = 0.78, 95% CI = 0.53–1.13). Valproate was associated with several malformation subtypes, including nervous system, cardiac, oral clefts, clubfoot, and hypospadias, whereas lamotrigine and carbamazepine were not. Interpretation Topiramate is associated with an increased risk of MCM similar to that associated with valproate, but lower doses may mitigate the risks for both drugs. Conversely, we found no increased risks for lamotrigine, carbamazepine, oxcarbazepine, or levetiracetam, which is reassuring. ANN NEUROL 2023;93:551–562

Jacqueline M. Cohen

Silje Alvestad

Carolyn E. Cesta

Marte‐Helene Bjørk

Maarit K. Leinonen

Mette Nørgaard

Kristjana Einarsdóttir

Anders Engeland

Mika Gissler

Øystein Karlstad

Kari Klungsøyr

Ingvild Odsbu

Johan Reutfors

Randi M. Selmer

Torbjörn Tomson

Sinna Pilgaard Ulrichsen

Helga Zoega

Kari Furu

Comparative Safety of Antiseizure Medication Monotherapy for Major Malformations

抗癫痫药物单药治疗对重大畸形的安全性比较

The glymphatic system cleans amyloid and tau proteins from the brain in animal studies of Alzheimer disease (AD). However, there is no direct evidence showing this in humans.
Participants (n = 50, 62.6 ± 5.4 years old, 36 women) with AD and normal controls underwent amyloid positron emission tomography (PET), tau PET, structural T1‐weighted magnetic resonance imaging, and neuropsychological evaluation. Whole‐brain glymphatic activity was measured by diffusion tensor image analysis along the perivascular space (DTI‐ALPS).
ALPS‐indexes showed negative correlations with deposition of amyloid and tau on PET images and positive correlations with cognitive scores even after adjusting for age, sex, years of education, andAPOE4genotype covariates in multiple AD‐related brain regions (allp< 0.05). Mediation analysis showed that ALPS‐index acted as a significant mediator between regional standardized uptake value ratios of amyloid and tau images and cognitive dysfunction even after correcting for multiple covariates in AD‐related brain regions. These regions are responsible for attention, memory, and executive function, which are vulnerable to sleep deprivation.
Glymphatic system activity may act as a significant mediator in AD‐related cognitive dysfunction even after adjusting for multiple covariates and gray matter volumes. ALPS‐index may provide useful disease progression or treatment biomarkers for patients with AD as an indicator of modulation of glymphatic activity. ANN NEUROL 2023;93:164–174

Jung‐Lung Hsu

Yi‐Chia Wei

Cheng Hong Toh

Ing‐Tsung Hsiao

Kun‐Ju Lin

Tzu‐Chen Yen

Ming‐Feng Liao

Long‐Sun Ro

<scp>Magnetic Resonance</scp>Images Implicate That Glymphatic Alterations Mediate Cognitive Dysfunction in<scp>Alzheimer Disease</scp>

磁共振图像表明，脑脊液循环改变介导了阿尔茨海默病中的认知功能障碍

Glutamate levels were determined in the fasting plasma of 22 patients with early-stage primary amyotrophic lateral sclerosis (ALS) and compared to those of healthy and diseased controls. There was a significant increase (by approximately 100%, p less than 0.0005) in the plasma glutamate of the ALS patients as compared with the controls. Oral glutamate loading (60 mg of monosodium glutamate per kilogram of body weight, taken orally after overnight fasting) resulted in significantly greater elevations in the plasma glutamate and aspartate levels in the ALS patients than in the controls. Glutamate, a potentially neuroexcitotoxic compound, is thought to be the transmitter of the corticospinal tracts and certain spinal cord interneurons. A systemic defect in the metabolism of this amino acid may underlie primary ALS.

Andreas Plaitakis

James T. Caroscio

Abnormal glutamate metabolism in amyotrophic lateral sclerosis

肌萎缩侧索硬化症中的谷氨酸代谢异常

Objective Despite treatments which reduce relapses in multiple sclerosis (MS), many patients continue to experience progressive disability accumulation. MS is associated with metabolic disruptions and cerebral metabolic stress predisposes to tissue injury and possibly impaired remyelination. Additionally, myelin homeostasis is metabolically expensive and reliant on glycolysis. We investigated cerebral metabolic changes in MS and when in the disease course they occurred, and assessed their relationship with microstructural changes. Methods This study used combined fluorodeoxyglucose (FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI) to measure cerebral metabolic rate of glucose and oxygen, thereby quantifying glycolysis. Twelve healthy controls, 20 patients with relapsing MS, and 13 patients with non‐relapsing MS were studied. Relapsing patients with MS were treatment naïve and scanned pre‐ and post‐initiation of high efficacy disease modifying therapy. Results In normal appearing white matter, we observed increased glucose utilization and reduced oxygen utilization in newly diagnosed MS, consistent with increased glycolysis. Increased glycolysis was greater in patients with a longer disease duration course and higher disability. Among newly diagnosed patients, different treatments had differential impacts on glucose utilization. Last, whereas hypermetabolism within lesions was clearly associated with inflammation, no such relationship was found within normal appearing white matter. Interpretation Increased white matter glycolysis is a prominent feature of cerebral metabolism in MS. It begins early in the disease course, increases with disease duration and is independent of microstructural evidence of inflammation in normal appearing white matter. Optimization of the metabolic environment may be an important component of therapies designed to reduce progressive disability. ANN NEUROL 2024

Matthew R Brier

Bradley Judge

Chunwei Ying

Amber Salter

Hongyu An

Aakash Patel

Qing Wang

Yong Wang

Anne H Cross

Robert T Naismith

Tammie LS Benzinger

Manu S Goyal

Increased White Matter Aerobic Glycolysis in Multiple Sclerosis

多发性硬化症中白质有氧糖酵解增加

A 49-year-old man presented with episodic headache lasting 30 to 60 minutes and relieved by resting. He is a chronic smoker with an unremarkable past medical history. The physical exam was normal. Computed tomography angiogram (CTA) found suspected aneurysmal dilation (white arrow) at the A1 segment of the right anterior cerebral artery (ACA), the left A2 segment of the left ACA supplied by the right ACA through the anterior communicating artery, and the A1 segment of left ACA absent (Fig 1A). Diagnostic cerebral angiography was performed for further evaluation. Right carotid angiography showed small outpouching at the right A1 segment, corresponding to the CTA finding. A three-dimensional rotational angiography showed that the small outpouching was the left accessory middle cerebral artery (MCA) infundibulum instead of a genuine aneurysm. A small branch from its apex crossed the middle line, ran laterally to the left Sylvian fissure, and terminated at the prefrontal area of the left hemisphere, suggestive of a left accessory MCA (white arrowheads) (Fig 1B, Video S1). After supportive medical treatment, the patient's headache subsided. The accessory MCA is an uncommon anomaly of the MCA that arises from the ACA and passes into the Sylvian fissure along the MCA.1 The incidence of accessory MCA in angiographic and anatomical studies is reported to be 0.3 to 4.0%, and that of duplicated MCA is 0.2 to 2.9%.2 A previous study by Komiyama et al2 reported a consistent cortical supply by the accessory MCA to the anterior frontal lobe. Previous literature reported that the accessory MCA arises from the ipsilateral ACA. Infundibular dilation is funnel-shaped widening at the origin of a cerebral artery. A small perforator or cortical artery arising from its apex is crucial to differentiate from the aneurysm. This case showed an infundibulum over a rare anatomical variant of the accessory MCA, originating from the contralateral A1 segment of ACA. Such anatomical variant was not reported in previous literature. This case illustrated the importance of identifying vascular anomalies with operative or endovascular management implications. We thank the patient for providing permission to share his information. W.L. and N.M. contributed to the study concept and design; W.L., N.M., and X.T. contributed to data acquisition and analysis: W.L., N.M., B.Y. contributed to drafting the manuscript and preparing the figure and video. Nothing to report. Obtained. The data that supports the findings of this study are available in the supplementary material of this article. Video S1. On three-dimensional rotational angiography, a small outpouching was detected at the A1 segment of the right anterior cerebral artery. A small branch from its apex crossed the middle line, ran laterally to the left Sylvian fissure, and terminated at the prefrontal area of the left hemisphere, suggestive of a left accessory middle cerebral artery. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Wai Ting Lui

Tao Xiong

Bo Yang

Ning Ma

Infundibulum of an Aberrant Accessory <scp>MCA</scp> Mimics Aneurysm

异常副大脑中动脉漏斗部模拟动脉瘤

A 48-year-old woman presented with intermittent headaches for 3 years. Cerebral computed tomography angiography showed irregular vessels resembling a moyamoya pattern involving the left middle cerebral artery (MCA), and found an aneurysm in the ophthalmic segment of the right internal carotid artery (Fig 1A). Digital subtraction angiography showed the absence of the normal left M1 segment, replaced by a serpentine vascular tangle that connects the carotid termination to the normal distal M1 segment, consistent with twig-like MCA (T-MCA; Fig 1B). This structure differs from the moyamoya pattern, and may be related to the persistence of the fetal arterial network that ultimately developed into the main trunk of the MCA. Cinematic rendering of computed tomography angiography provides a clear depiction of T-MCA anatomy, facilitating communication between the doctor and the patient, and adding value to existing medical images in preoperative planning (Fig 1C, Video S1). In general, aneurysms associated with T-MCA should be prioritized for targeted therapy, especially ruptured aneurysms. In T-MCA with recurrent stroke, bypass intervention may be a last resort. T-MCA can be found incidentally, or it can present with hemorrhagic or ischemic stroke, but most patients with T-MCA in previous studies have had hemorrhagic stroke. Hemorrhagic stroke in T-MCA may be related to rupture of aneurysms, the twig-like network, or other abnormal collateral vessels. Ischemic stroke in T-MCA may be mainly caused by hemodynamic compromise, artery-to-artery embolism, or a combination of both. Although aneurysm formation, hemorrhage, and ischemia are known clinical consequences, many cases of T-MCAs may remain clinically and radiologically stable for at least several years.1 Therefore, given the absence of hemorrhagic or severe ischemic complications, the patient in the present study was treated conservatively and underwent regular imaging monitoring. T-MCA is a rare vascular anomaly characterized by a plexiform network of small vessels replacing the M1 segment of the MCA.1 The incidence of T-MCA has been widely assessed in Asian populations, ranging from 0.11% to 1.17% in angiographic studies.2 However, due to the similarity of the imaging manifestations of T-MCA and moyamoya disease, up to 69% of patients with T-MCA are initially diagnosed with moyamoya disease.3 Moyamoya is a progressive, predominantly bilateral steno-occlusive disorder that typically involves the internal carotid artery termini with involvement of the proximal anterior cerebral artery and MCA. However, T-MCA does not involve the distal internal carotid artery. Although typical moyamoya disease is angiographically bilateral and symmetric, T-MCA is a unilateral anomaly. Additionally, in T-MCAs, there are no transdural collateral vessels, as are seen in most cases of moyamoya disease. In moyamoya disease, distal MCA vessels have the appearance of a "puff of smoke." However, in T-MCA, the caliber of the distal MCA and flow are maintained. This is the most important difference from moyamoya disease.4 Cinematic rendering techniques have significantly improved the ability to generate photorealistic 3D images from computed tomography data, providing a remarkable level of realism that better shows the imaging characteristics of T-MCA, thereby reducing misdiagnosis rates, and avoiding unnecessary evaluation and treatment. Both authors contributed to the conception and design of the study; the acquisition and analysis of data; and drafting the text and preparing the figure. We thank Siemens Healthineers engineer, Dr X. Zhao, for his support in rendering film technology. Nothing to report. Video S1. Cinematic rendering from CT angiography in a 48-year-old woman with a twig-like left middle cerebral artery. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Linggen Dong

Ming Lv

Cinematic Rendering of Twig‐Like Middle Cerebral Artery

大脑中动脉分支的影视化渲染

Objective Parkinson's disease (PD) resting tremor is thought to be initiated in the basal ganglia and amplified in the cerebello‐thalamo‐cortical circuit. Because stress worsens tremor, the noradrenergic system may play a role in amplifying tremor. We tested if and how propranolol, a non‐selective beta‐adrenergic receptor antagonist, reduces PD tremor and whether or not this effect is specific to stressful conditions. Methods In a cross‐over, double‐blind intervention study, participants with PD resting tremor received propranolol (40 mg, single dose) or placebo (counter‐balanced) on 2 different days. During both days, we assessed tremor severity (with accelerometry) and tremor‐related brain activity (with functional magnetic resonance imaging), as well as heart rate and pupil diameter, while subjects performed a stressful cognitive load task that has been linked to the noradrenergic system. We tested for effects of drug (propranolol vs placebo) and stress (cognitive load vs rest) on tremor power and tremor‐related brain activity. Results We included 27 PD patients with prominent resting tremor. Tremor power significantly increased during cognitive load versus rest ( F [1,19] = 13.8; p = 0.001; = 0.42) and decreased by propranolol versus placebo ( F [1,19] = 6.4; p = 0.02; = 0.25), but there was no interaction. We observed task‐related brain activity in a stress‐sensitive cognitive control network and tremor power‐related activity in the cerebello‐thalamo‐cortical circuit. Propranolol significantly reduced tremor‐related activity in the motor cortex compared to placebo ( F [1,21] = 5.3; p = 0.03; = 0.20), irrespective of cognitive load. Interpretation Our findings indicate that propranolol has a general, context‐independent, tremor‐reducing effect that may be implemented at the level of the primary motor cortex. ANN NEUROL 2024

Anouk van der Heide

Maaike Wessel

Danae Papadopetraki

Dirk E.M. Geurts

Teije H. van Prooije

Frank Gommans

Bastiaan R. Bloem

Michiel F. Dirkx

Rick C. Helmich

Propranolol Reduces Parkinson's Tremor and Inhibits Tremor‐Related Activity in the Motor Cortex: A Placebo‐Controlled Crossover Trial

普萘洛尔减轻帕金森震颤并抑制运动皮层中与震颤相关的活动：一项安慰剂对照交叉试验

Kenneth L Tyler

Annual Report from the Editor‐in‐Chief (2024)

主编年度报告（2024）

Abbreviation	Ann Neurol.
Journal Impact	8.07
Quartiles(Global)	NEUROSCIENCES(Q1)

ISSN	0364-5134, 1531-8249
h-index	331
Top Journals	Yes

Publication Information	Publisher: John Wiley & Sons Inc.，Publishing cycle: Monthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1977，Proportion of original research papers: 98.05%，Self Citation Rate:1.20%， Gold OA Rate: 43.62%
Average review cycle	网友分享经验：一般,3-8周
Average recruitment ratio	网友分享经验：很难

Annals of Neurology

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