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Background Although decades have passed since the introduction of pharmacologically induced hypertensive therapy (PIHT) against early neurologic deterioration (END) in acute ischemic stroke, the optimal duration of PIHT remains elusive. Case Report A 70-year-old man developed right hemiplegia and aphasia 25 hours before arrival. Computed tomography angiography (CTA) revealed acute infarction in the left middle cerebral artery (MCA) territory and occlusion of the left internal carotid artery. He experienced END 36 hours after admission, and CTA revealed a newly developed proximal MCA occlusion. PIHT was initiated to augment cerebral perfusion. As his neurologic symptoms were highly dependent on blood pressure, PIHT was inevitably sustained for over 3 weeks. Follow-up CTA revealed recanalization of the MCA. Conclusion Although further investigation is required to expedite the future clinical application, prolonged PIHT may serve as a viable collateral-enhancing treatment for a certain subset of patients with END without alternative treatment options.

BackgroundAttention deficit hyperactivity disorder (ADHD) is clinically diagnosed; however, quantitative analysis to statistically analyze the symptom severity of children with ADHD via the measurement of head movement is still in progress. Studies focusing on the cues that may influence the attention of children with ADHD in classroom settings, where children spend a considerable amount of time, are relatively scarce. Virtual reality allows real-life simulation of classroom environments and thus provides an opportunity to test a range of theories in a naturalistic and controlled manner. The objective of this study was to investigate the correlation between participants’ head movements and their reports of inattention and hyperactivity, and to investigate how their head movements are affected by different social cues of different sensory modalities.MethodsThirty-seven children and adolescents with (n = 20) and without (n = 17) ADHD were recruited for this study. All participants were assessed for diagnoses, clinical symptoms, and self-reported symptoms. A virtual reality-continuous performance test (VR-CPT) was conducted under four conditions: (1) control, (2) no-cue, (3) visual cue, and (4) visual/audio cue. A quantitativecomparison of the participants’ head movements was conducted in three dimensions (pitch [head nods], yaw [head turns], and roll [lateral head inclinations]) using a head-mounted display (HMD) in a VR classroom environment. Task-irrelevant head movements were analyzed separately, considering the dimension of movement needed to perform the VR-CPT.ResultsThe magnitude of head movement, especially task-irrelevant head movement, significantly correlated with the current standard of clinical assessment in the ADHD group. Regarding the four conditions, head movement showed changes according to the complexity of social cues in both the ADHD and healthy control (HC) groups.ConclusionChildren and adolescents with ADHD showed decreasing task-irrelevant movements in the presence of social stimuli toward the intended orientation. As a proof-of-concept study, this study preliminarily identifies the potential of VR as a tool to understand and investigate the classroom behavior of children with ADHD in a controlled, systematic manner.