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Background Acute ischemic stroke is a disease with multiple etiologies. Therefore, identifying the mechanism of acute ischemic stroke is fundamental to its treatment and secondary prevention. The Trial of Org 10172 in Acute Stroke Treatment classification is currently the most widely used system, but it often has a limitations of classifying unknown causes and inadequate inter-rater reliability. Therefore, we attempted to develop a three-dimensional (3D)-convolutional neural network (CNN)-based algorithm for stroke lesion segmentation and subtype classification using only the diffusion and apparent diffusion coefficient information of patients with acute ischemic stroke. Methods This study included 2,251 patients with acute ischemic stroke who visited our hospital between February 2013 and July 2019. Results The segmentation model for lesion segmentation in the training set achieved a Dice score of 0.843±0.009. The subtype classification model achieved an average accuracy of 81.9%, with accuracies of 81.6% for large artery atherosclerosis, 86.8% for cardioembolism, 72.9% for small vessel occlusion, and 86.3% for control. Conclusion We developed a model to predict the mechanism of cerebral infarction using diffusion magnetic resonance imaging, which has great potential for identifying diffusion lesion segmentation and stroke subtype classification. As deep learning systems are gradually developing, they are becoming useful in clinical practice and applications.

Background: In general, disease severity has been found to be associated with abnormal chloride levels in critically ill patients, but hyperchloremia is associated with mixed results regarding patient-centered clinical outcomes. We aimed to investigate the impact of maximum serum chloride concentration on the clinical outcomes of critically ill patients with large hemispheric infarction (LHI).Methods: We conducted a retrospective observational cohort study using prospective institutional neurocritical care registry data from 2013 to 2018. Patients with LHIs involving over two-thirds of middle cerebral artery territory, with or without infarction of other vascular territories, and a baseline National Institutes of Health Stroke Scale score of ≥13 were assessed. Those with a baseline creatinine clearance of

OBJECTIVE:Carotid intraplaque hemorrhage (IPH) is a well-known risk indicator of thromboembolism, but it is not easy to rapidly detect IPH in acute symptomatic carotid disease. The aim of this study was to assess the utility of time-of-flight (TOF) magnetic resonance angiography (MRA) in the detection of IPH and evaluate the degree of stenosis and stroke patterns in patients with acute symptomatic carotid disease. METHODS:We retrospectively identified consecutive patients with acute symptomatic carotid disease who were admitted within 12 h after stroke onset. Fifty-nine patients underwent TOF MRA at admission and were categorized according to the presence or absence of intraplaque high signal intensity (HSI). The severity of carotid stenosis and diffusion-weighted magnetic resonance imaging lesion patterns were evaluated. RESULTS:Intraplaque HSI was detected in 28.8% of the enrolled patients (17/59). Mild-to-moderate symptomatic carotid stenosis was more frequent in the intraplaque HSI-positive group (70.6%) than in the intraplaque HSI-negative group (42.8%) (p = 0.015). The patients with intraplaque HSI more frequently exhibited a disseminated small infarction pattern (76.5% in the intraplaque HSI-positive group, 47.6% in the -negative group), and did not exhibit a border-zone infarction pattern (0% in the positive group, 16.7% in the negative group). CONCLUSIONS:TOF MRA may be a useful noninvasive and rapid tool to detect IPH in patients with acute symptomatic carotid disease. IPH was common in those with a lower degree of carotid stenosis and manifested as a disseminated small infarction pattern. Intraplaque HSI on TOF MRA in acute symptomatic carotid disease may help to determine the mechanism of stroke and establish early treatment plans.

Objectives: To validate a visual rating scale reflecting sub-regional patterns of putaminal hypointensity in susceptibility-weighted imaging of patients with multiple system atrophy (MSA).Methods: Using a visual rating scale (from G0 to G3), 2 examiners independently rated putaminal hypointensities of 37 MSA patients and 21 control subjects. To investigate the correlation with the scales, R2* values and the volume of the entire putamen were measured.Results: MSA patients with parkinsonian variant had significantly higher scores than those with cerebellar variant. Visual rating scores in MSA were correlated with R2* values [General estimating equation (GEE), Wald chi-square = 25.89, corrected p < 0.001] and volume (Wald chi-square = 75.44, corrected p < 0.001). They correlated with UPDRS motor scores. Binary logistic regression analyses revealed that the visual rating scale was a significant predictor for discriminating MSA patients from controls [multivariate model adjusted for age and sex, odds ratio 52.722 (corrected p = 0.009)]. Pairwise comparison between areas under the curve (AUCs) revealed that the visual rating scale demonstrated higher accuracy than R2* values [difference between AUCs; univariate model = 0.247 (corrected p < 0.001); multivariate model = 0.186 (corrected p = 0.003)]. There were no significant differences in clinical characteristics between the high-iron group, defined as putamen with visual rating scale ≥ G2 and R2* values ≥ third quartile, and the remaining patients.Conclusion: The visual rating scale, which reflects quantitative iron content and atrophy of the putamen as well as motor severities, could be useful for the discrimination and evaluation of patients with MSA.

Background This study investigated the impact of premorbid functional dependency on post-stroke mortality in patients with anterior circulation stroke (ACS) and posterior circulation stroke (PCS). Methods This study enrolled 9,698 patients who experienced ischemic stroke between January 2011 and December 2022. The patients were classified into the ACS and PCS groups. Premorbid functional dependency was defined as modified Rankin Scale of ≥3. The risks of premorbid functional dependency and mortality at 3 months and 1-year post-stroke were assessed. A subgroup analysis was further performed to evaluate the risk of premorbid functional dependency in patients who underwent intravenous thrombolysis and endovascular treatment (EVT). Results Among 6,358 patients with ACS and 3,340 with PCS, those with premorbid dependency were older, predominantly female, and had a higher proportion of vascular risk factors and stroke severity. Premorbid functional dependency was associated with increased mortality at both 3 months and 1 year in the PCS (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.00–3.13; P=0.04 and OR, 2.87; 95% CI, 1.86–4.38; P

Understanding the effectiveness of statin treatment is essential for developing tailored stroke prevention strategies. We aimed to evaluate the efficacy of statin treatment in preventing recurrent stroke among patients with various ischemic stroke subtypes. Using data from the Clinical Research Collaboration for Stroke-Korea-National Institute for Health (CRCS-K-NIH) registry, we included patients with acute ischemic stroke admitted between January 2011 and July 2020. To evaluate the differential effects of statin treatment based on the ischemic stroke subtype, we analyzed patients with large artery atherosclerosis (LAA), cardio-embolism (CE), and small vessel occlusion (SVO). The primary outcomes were recurrent ischemic stroke and recurrent stroke events. The hazard ratio for outcomes between statin users and nonusers was compared using a Cox proportional hazards model adjusted for covariates. A total of 46,630 patients who met the inclusion criteria were analyzed. Statins were prescribed to 92%, 93%, and 78% of patients with LAA, SVO, and CE subtypes, respectively. The hazards of recurrent ischemic stroke and recurrent stroke in statin users were reduced to 0.79 (95% confidence interval [CI], 0.63-0.99) and 0.77 (95% CI, 0.62-0.95) in the LAA subtype and 0.63 (95% CI, 0.52-0.76) and 0.63 (95% CI, 0.53-0.75) in CE subtype compared to nonusers. However, the hazards of these outcomes did not significantly decrease in the SVO subtype. The effectiveness of statin treatment in reducing the risk of recurrent stroke in patients with LAA and CE subtypes has been suggested. Nonetheless, no significant effect was observed in the SVO subtype, suggesting a differential effect of statins on different stroke subtypes.

Background Although atrial fibrillation (AF)-associated acute ischemic stroke (AIS) is on the rise, is devastating, and life-threatening, there is limited data on the clinical course and in-hospital mortality of patients treated in the intensive care unit (ICU). This study aimed to describe the clinical course and factors associated with in-hospital mortality in AF-associated AIS patients admitted to the ICU. Methods This study was a retrospective analysis of a prospective nationwide multicenter cohort including non-valvular AF-AIS patients receiving ICU care admitted to 14 stroke centers in South Korea from 2017 to 2020. In-hospital outcomes, including in-hospital mortality and neurological deterioration (ND) have been described. Results Amongst 2,487 AF-associated AIS patients, 259 (10.4%) were treated in the ICU. In-hospital mortality and ND occurred in 8.5% and 17.0% of the patients, respectively. Higher rates of initial National Institute for Health Stroke Scale scores, symptomatic steno-occlusive lesions, and CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65–74, Female) scores were found in those with in-hospital mortality. The CHA2DS2-VASc score after admission increased the risk of in-hospital mortality (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.00–2.18) were associated with in-hospital mortality. Antithrombotic use within 48 hours was related to decreased in-hospital mortality (OR, 0.26; 95% CI, 0.10–0.67). Conclusion ICU care in AF-associated AIS is common, and the establishment of optimal treatment strategies in the ICU may be needed.