Circadian disruption is being increasingly recognized as a critical factor in the development and progression of Parkinson’s disease (PD). This review aims to provide an in-depth overview of the relationship between circadian disruption and PD by exploring the molecular, cellular, and behavioral aspects of this interaction. This review will include a comprehensive understanding of how the clock gene system and transcription–translation feedback loops function and how they are diminished in PD. The article also discusses the role of clock genes in the regulation of circadian rhythms, as well as the impact of clock gene dysregulation on mitochondrial function, oxidative stress, and neuroinflammation, including the microbiota-gut-brain axis, which have all been proposed as being crucial mechanisms in the pathophysiology of PD. Finally, this review highlights potential therapeutic strategies targeting the clock gene system and circadian rhythm for the treatment of PD.

Background: Approximately 25% to 40% of all acute ischemic strokes result from distal medium vessel occlusions. However, the effectiveness and safety of thrombectomy for distal medium vessel occlusions remain uncertain. Methods: A systematic search of PubMed, Cochrane, and Embase was conducted for randomized controlled trials published until February 2025. The primary outcomes were functional outcomes at 90 days (excellent, good, and favorable). The secondary outcomes included symptomatic intracranial hemorrhage (ICH), any ICH, and mortality at 90 days. Results: Three studies involving 1246 patients with stroke with distal medium vessel occlusion were included (614 patients receiving thrombectomy; others with medical management). At 3 months, the odds ratio for an excellent functional outcome was 0.92 (95%, 0.72–1.17), for a good functional outcome was 0.87 (95% CI, 0.70–1.09), and for a favorable functional outcome was 0.84 (95% CI, 0.64–1.10), indicating no significant difference between the 2 groups. However, thrombectomy was associated with a higher risk of hemorrhage, with an odds ratio of 2.18 (95% CI, 1.24–3.83) for symptomatic ICH and 1.96 (95% CI, 1.54–2.50) for any ICH. Mortality at 3 months was similar between the groups, with an odds ratio of 1.20 (95% CI, 0.85–1.70). Conclusions: Thrombectomy did not significantly improve functional outcomes or reduce mortality but increased symptomatic ICH and any ICH. Further recent randomized controlled trials are needed to define subgroups that may benefit. Registration: PROSPERO CRD420251073344.

In this study, we aim to elucidate the association between nondiabetic hyperglycemia and the short-term prognosis of critically ill patients with acute ischemic stroke. We extracted data using the Medical Information Mart for Intensive Care IV from 2008 to 2019. The primary outcomes were set as intensive care units (ICU) and in-hospital mortality. We developed a Cox proportional hazards model to determine the nonlinear association between serum glucose levels and primary outcomes. Of the 1086 patients included, 236 patients had hyperglycemia. Patients with hyperglycemia were associated with higher ages, female gender, higher Charlson Comorbidity Index scores, and higher Acute Physiology Score III scores. After propensity score matching, 222 pairs remained. The hyperglycemia group had a significantly higher ICU mortality (17.6% vs. 10.8%; p = 0.041). Meanwhile, no significant differences in ICU length of stay (5.2 vs. 5.2; p = 0.910), in-hospital mortality (26.6% vs. 18.9%, p = 0.054), and hospital length of stay (10.0 vs. 9.1; p = 0.404) were observed between the two groups. The Kaplan–Meier curves for ICU and in-hospital survival before matching suggested significant differences; however, after matching, they failed to prove any disparity. Non-diabetic patients with acute ischemic stroke have poor clinical characteristic while encountering hyperglycemic events; therefore, careful monitoring in the acute phase is still required.

Basilar-artery occlusion (BAO) usually accounts for devastating neurologic sequelae, poor prognosis, and even death. While endovascular thrombectomy (EVT) is the most successful treatment for anterior circulation stroke with large vessel occlusion, its effectiveness in treating acute BAO is still debatable. Our aim is to compare the efficacy and safety between EVT and conservative medical treatment (CMT) in BAO. Up until May 2022, relevant literature was gathered using searches in Embase, PubMed, and the Cochrane Library. The primary outcomes were defined as good functional outcome (modified Rankin Scale 0–2) and favorable functional outcome (modified Rankin Scale 0–3) at 3 months between EVT and CMT groups. The secondary outcomes included mortality at 3 months, symptomatic intracerebral hemorrhage (ICH), and any ICH. Eight studies involving 3733 patients with BAO were enrolled 2573 individuals underwent EVT, and the remaining 1160 patients received CMT. Compared with CMT, EVT achieved more favorable functional outcome (odds ratio (OR) 1.26, 95% CI 1.03–1.55, I² = 54%, p = 0.05) in BAO. The good functional outcome showed a similar tendency (OR 1.23, 95% CI 0.97–1.57, I² = 63%, p = 0.02) as well. EVT decreased mortality at 3 months (OR 0.81, 95% CI 0.70–0.93, I² = 31 %, p = 0.19), although having a tendency to cause symptomatic ICH (OR 2.91, 95% CI 1.38–6.18, I² = 22 %, p = 0.27). EVT in BAO provides superior functional outcomes and less mortality compared with CMT. Even though EVT has the propensity to cause symptomatic ICH, EVT nevertheless improved posterior circulation stroke.

Diagnosing Cerebrotendinous Xanthomatosis in a Middle-Aged Woman with Cervical Dystonia