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Panpan Zhang, Yurong Zhang Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of ChinaCorrespondence: Yurong Zhang, Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277, Yanta West Road, Xi’an, Shaanxi Province, People’s Republic of China, Tel/Fax +86-02985323443, Email zhangyurong72@mail.xjtu.edu.cnPurpose: Homocysteine (Hcy) is recognized as a risk factor for stroke. Our study examined the relationship between plasma Hcy levels and stroke, along with its subtypes, among Chinese patients who experienced an acute stroke episode.Patients and Methods: We retrospectively enrolled patients with acute stroke and age- and sex-matched healthy controls admitted to the First Affiliated Hospital of Xi’an Jiaotong University from October 2021 to September 2022. Ischemic stroke subtypes were classified using the modified TOAST criteria. Multivariate logistic regression models were employed to probe the associations of plasma Hcy levels with total stroke, ischemic stroke and its subtypes, and hypertensive intracerebral hemorrhage (HICH), and the correlation between plasma Hcy levels and the National Institute of Health Stroke Scale (NIHSS).Results: The mean age of the total group was 63 years, with women representing 30.6% (246 individuals). Elevated Hcy levels were significantly associated with total stroke (OR 1.054, 95% CI: 1.038– 1.070), HICH (OR 1.040, 95% CI: 1.020– 1.060), ischemic stroke (OR 1.049, 95% CI: 1.034– 1.065), and the TOAST subtypes of ischemic stroke in large-artery atherosclerosis (LAA) (OR 1.044, 95% CI: 1.028– 1.062) and small-artery occlusion (SAO) (OR 1.035, 95% CI: 1.018– 1.052), but not with cardioembolic (CE) stroke. Moreover, only in the case of SAO stroke were the Hcy levels positively correlated with the NIHSS score (B=0.030, 95% CI: 0.003– 0.056, P=0.030).Conclusion: Plasma Hcy levels were found to be positively correlated with the risk of stroke, particularly in the context of LAA, SAO stroke, and HICH. Additionally, Hcy levels demonstrated a positive correlation with stroke severity in patients presenting with SAO stroke. These findings suggest potential clinical implications in stroke prevention, particularly for ischemic stroke (LAA, SAO subtypes) and HICH by employing homocysteine-lowering therapies. Future investigations are warranted to fully elucidate these associations.Keywords: homocysteine, ischemic stroke, hypertensive intracerebral hemorrhage, TOAST, NIHSS

Lisda Amalia Department of Neurology, Medical Faculty, Universitas Padjadjaran/RSUP Dr. Hasan Sadikin, Bandung, IndonesiaCorrespondence: Lisda Amalia, Jl. Eykman 38, Bandung, 40161, Indonesia, Email dr.lisda@gmail.comIntroduction: The categorization system used in the Trial Org 10172 classification in Acute Stroke Treatment (TOAST) provided more insight into the causal process. The aims of this study were to characterize individuals with acute ischemic stroke using the TOAST criteria and to determine risk variables for patients with acute ischemic stroke during the COVID-19 pandemic.Methods: A cross-sectional study was done on the medical records of acute ischemic stroke patients at Hasan Sadikin Hospital (RSHS) Bandung, Indonesia, who were hospitalized in the Neurology Department of Hasan Sadikin Hospital from January to December 2021. Eligible patients were divided into 2 groups, with and without COVID-19 infection.Results: There were 136 participants with acute ischemic stroke. Thirty-one percent of strokes were caused by atherosclerosis in the large arteries (LAA), followed by small-vessel occlusion (SVO) (25%), cardioembolism (CE) (22.1%), an undetermined cause (21.3%), and an other etiology (1.5%). CE risk factor was atrial fibrillation (p < 0.001), while hypertension, diabetes, and smoking were significant for LAA (p < 0.05). However, in patients with COVID-19 who had an acute ischemic stroke, most of the subtypes were stroke of undetermined etiology (76%), and hypercoagulation was the main risk factor (p < 0.001).Conclusion: Patients with and without COVID-19 show varied distributions of stroke subtypes according to the TOAST categorization. Hypercoagulation is a major risk factor for stroke of undetermined etiology in individuals with COVID-19 who suffer from acute ischemic stroke. Increased viral-mediated endothelial inflammation leading to aberrant coagulopathy may explain the correlation between COVID-19 and acute ischemic stroke.Keywords: acute ischemic stroke, TOAST, COVID-19, pandemic