Neurología

Update on spontaneous intracranial hypotension

2026-09-30T14:29:49Z

Update on spontaneous intracranial hypotension Portes Souza, Marcio Nattan; Uribe, Bernardo; Zavala, Lucía; Lopez, Reydmar; Nagel, Vanesa; Calderaro, Marcelo; Edelmuth, Diogo Guilherme Background Spontaneous intracranial hypotension (SIH) is a secondary headache disorder caused by spontaneous cerebrospinal fluid (CSF) leakage, typically from dural tears, meningeal diverticula, or CSF venous fistulas, in the absence of preceding trauma or procedures. Although increasingly recognized, SIH remains underdiagnosed and frequently mistaken for primary headache syndromes. Methods This narrative review synthesizes current evidence on the epidemiology, pathophysiology, clinical manifestations, neuroimaging features, complications, and management of SIH. Recent literature and expert consensus were analyzed to integrate advances in imaging-based diagnosis and leak type specific therapeutic strategies. Results SIH arises from low CSF volume rather than true hypotension, leading to brain descent, venous engorgement, and the characteristic MRI features summarized by the SEEPS mnemonic: subdural collections, pachymeningeal enhancement, venous engorgement, pituitary enlargement, and brain sagging. Orthostatic headache is the hallmark symptom, though up to 15% of patients lack clear positional features. Associated symptoms include vestibulocochlear disturbances, neck or interscapular pain, cranial nerve palsies, and cognitive or motor dysfunction. Brain and whole spine MRI are first line diagnostic tools. MR myelography distinguishes SLEC positive (types 1 and 2) from SLEC negative (type 3) leaks, guiding targeted myelography with dynamic CT or digital subtraction techniques for leak localization. Treatment should be tailored to leak type and site: epidural blood or fibrin patching for dural and diverticular leaks, and transvenous embolization for CSF venous fistulas. Surgical repair is reserved for refractory or anatomically complex cases. Reported complications include subdural hematoma, cerebral venous thrombosis, superficial siderosis, and bibrachial amyotrophy. Conclusions SIH represents a heterogeneous spinal disorder with intracranial manifestations. Early recognition, standardized imaging algorithms, and multidisciplinary management are crucial to improving outcomes. Ongoing research into imaging biomarkers, predictors of response, and consensus based care pathways will help advance precision medicine in SIH.

ABSTRACT NUMBER: ESOC2026A1514 ADAPTIVE CONTROL ANKLE ROBOTICS INTEGRATED WITH PHYSIOTHERAPY FOR SEVERE HEMIPARESIS IN SUBACUTE STROKE: A CASE REPORT

2026-09-30T17:30:24Z

ABSTRACT NUMBER: ESOC2026A1514 ADAPTIVE CONTROL ANKLE ROBOTICS INTEGRATED WITH PHYSIOTHERAPY FOR SEVERE HEMIPARESIS IN SUBACUTE STROKE: A CASE REPORT Dossi, Daiana Elizabeth; Gianella, Matías Gabriel; Rivas, María Elisa; Mattei, Martín; Best, María Gabriela; Moya, Diego; Crespo, Marcos José; Hernández, Micaela Anahí; MacKo, Richard; MacKo, Charlene; Ameriso, Sebastián Francisco Background and aims: Adaptive control ankle robotics is a promising but underexplored strategy for stroke rehabilitation. AMBLE is a wireless impedance-controlled ankle exoskeleton with foot switches that adapt dorsiflexion across gait sub-events. We describe integrated ankle robotics and physiotherapy during subacute stroke recovery. Methods: A 46-year-old man with subacute ischemic stroke, right hemiparesis, and foot drop underwent AMBLE training after reaching dependent ambulation (FAC 1) at 15 weeks post-stroke. He completed thirty 45-minute AMBLE-assisted sessions over 6 weeks, plus matched conventional therapy. Assessments at baseline (T0), post-training (T1), and 12-week follow-up (T2) included FAC, Fugl-Meyer Lower Extremity (FM), 10MWT, 6MWT, Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and gait biomechanics. Results: Robotics training data shows steps/session increased 3X, cadence 2X, and paretic heel first foot strikes from <4% to 40% over 6 weeks training. Improvements in mobility outcomes between T0 and T1 were maintained at T2:FM+11(12->23->24), 10MWT+0.32 m/s(0.24->0.45->0.56 m/s), 6MWT +109 m(71->115 m->180), BBS +12(37->46->49), and DGI +7(0->9->7). Gait analysis showed improved FAC (1->4->4), velocity (0.12->0.25->0.25 m/s), paretic step length (-0.07->0.14->0.14 m), % stance time (72->63->59%), and dorsiflexion angle (-8.8->0.58->0.82°) during unassisted over-ground walking. Conclusions: Adaptive ankle robotics can be integrated with therapist-guided rehabilitation in subacute stroke with severe hemiparesis. Randomized trials are warranted to compare this approach with conventional therapy.

Regression-based normative data for neuropsychological assessment in Buenos Aires, Argentina: RAVLT, trail making test, digit span, and verbal fluency

2026-09-30T15:49:18Z

Regression-based normative data for neuropsychological assessment in Buenos Aires, Argentina: RAVLT, trail making test, digit span, and verbal fluency Corvalán, Nicolás; Morello García, Florentina; Leiva, Samanta; Allegri, Ricardo Francisco; Crivelli, Lucía Objective: To develop regression-based normative data for a set of widely used neuropsychological tests and to provide a freely accessible normative data calculator for use in Buenos Aires, Argentina. Methods: Participants were drawn from a large clinical dataset and selected to reflect preserved global cognition, intact memory performance, and functional independence. Regression-based norms were developed for the Rey Auditory Verbal Learning Test, Verbal Fluency, Trail Making Test, and Digit Span tasks. For each model, predictors included age, sex, and years of education, as well as polynomial terms and interaction effects; final models were obtained via stepwise backward elimination procedures. Model assumptions were evaluated, and predictive performance was estimated using 10-fold cross-validation. Results: 393 participants met inclusion criteria. Age was negatively associated with verbal memory, fluency, and executive function, whereas higher educational attainment was associated with better performance. Women outperformed men in verbal memory and phonological fluency. Demographic variables explained between 2% and 23% of variance across tests. An open-access calculator was developed to facilitate individualized normative estimation in clinical settings. Conclusions: This study provides locally developed, regression-based norms for neuropsychological assessment in Buenos Aires – Argentina, addressing the lack of culturally relevant norms and limitations of traditional methods.

Essential genetic testing in movement disorders - results from a Delphi study

2026-09-30T14:47:18Z

Essential genetic testing in movement disorders - results from a Delphi study Carvalho, Vanessa; Correia Guedes, Leonor; Gatto, Emilia M.; Rodriguez-Violante, Mayela; Klein, Christine; Rodriguez-Porcel, Federico; Morgante, Francesca; Rossi, Malco Damián; Miranda, Marcelo; Ganos, Christos; Riboldi, Giulietta M.; Cesarini, Martin; Darling, Alejandra; Skorvanek, Matej; Van de Warrenburg, Bart; Shalash, Ali; Cossu, Giovanni; Friedman, Jennifer; Albanese, Alberto; Cardozo, Adriana Background: While genetic testing in Movement Disorders (MD) has expanded enormously, access to genetic testing and genetic counseling remains asymmetric at the global scale. Guidance on efficient testing strategies for clinicians, governments and stakeholders is crucial. Objectives: Establish a list of genetic movement disorders considered essential as determined by a group of MD experts. Methods: All genes associated with MD were searched using the OMIM and MDS Gene database. We collected all additional tests available at 4 different laboratories from the EuroGentest database. The results were compiled in 6 questionnaires. A genetic test was considered essential if molecular testing had a direct impact in the management of the patient, including treatment of the disease or its comorbidities, or genetic counseling of the patient and family members. Two Delphi rounds were conducted asking MD experts which specific tests they considered essential in an adult MD clinic. Results: Fifty-nine disorders were considered essential to genetically identify by the MD experts. This included 25 genes associated with ataxia, 15 with parkinsonism, 14 with dystonia, eight with chorea, five with paroxysmal disorders, four with myoclonus, four with hereditary spastic paraparesis, and one with tremor. Sixteen disorders reached 100% consensus among experts: Huntington's disease, PxMD-PPRT2, Wilson's disease, DYT-SGCE, DYT-THAP1, DYT-TOR1A, DYT/PARK-GCH1, Fragile-X Tremor-ataxia syndrome, PARK-GBA, PARK-LRRK2, PARK-PINK1, PARK-PRKN, PARK-SNCA, Cerebrotendinous Xanthomatosis, Ataxia-Telangiectasia, and Niemann-Pick disease type C. Conclusion: This study provides a list of genetic MD that should be molecularly tested in adult centers with a compatible phenotype according to a group of MD experts.