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Background: Acute encephalitis (AE) is associated with a high burden of mortality and permanent disability and has a spectrum of underlying etiologies. The prognosis of encephalitis is difficult and almost all the patients seem to be at a high risk of poor outcomes. A number of physiological changes take place during encephalitis and have been evaluated for their prognostic value. Platelet count, which has been recognized as a surrogate prognostic marker in various viral illnesses, has recently been recognized to have a prognostic value in AE too. In the present study, we attempted to study the role of thrombocytopenia in the prognosis of AE. Methods: Total of 98 cases based on clinical, cerebrospinal fluid, and radiological profiles consistent with the diagnosis of AE were enrolled in the study. A clinical profile was noted, and platelet count was assessed. Thrombocytopenia was defined as platelet count <150,000/mm3. Platelet count 100,000–150,000, 50,000–99,999, and <50,000/mm3 were considered mild, moderate, and severe thrombocytopenia. The underlying etiology was explored, and patients were followed till discharge/outcome. The outcome was noted in terms of the Modified Rankin score (MRS). MRS 0–2 was considered good, 3–4 fair, and 5–6 as poor outcome. Results: The mean age of patients was 34.06 ± 18.76 years. Majority of patients were women (54.1%). Prevalence of thrombocytopenia was 75.5%. A total of 34 (45.9%) had mild, 30 (40.5%) had moderate, and 10 (13.5%) had severe thrombocytopenia. Acute viral encephalitis (unclassified) was the most common etiology (33.7%), followed by scrub meningoencephalitis (24.5%) and Japanese encephalitis (12.2%), respectively. Good, fair, and poor outcomes were noted in 48 (49%), 21 (21.4%), and 29 (29.6%) cases. On univariate analysis, no significant association of poor outcome was seen with age, sex, duration of fever, and mechanical ventilation need (P > 0.05). Low Glasgow Coma Scale (GCS), splenomegaly, low platelet count, and Japanese encephalitis virus/scrub typhus etiologies were found to be significantly associated with poor outcomes (P < 0.05). Thrombocytopenia compared to normal platelet count and severe thrombocytopenia compared to mild and moderate thrombocytopenia were significantly associated with poor outcomes (P < 0.05). On multivariate analysis, GCS <8 (odds ratio [OR] =4.52; 95% confidence interval [CI] =1.56–13.20) and thrombocytopenia (OR = 11.92; 95% CI = 1.38–103.32) emerged as independent predictors of poor outcome. Conclusions: The findings of the study showed that low GCS and thrombocytopenia could be used as predictors of poor outcomes in AE cases. [ABSTRACT FROM AUTHOR]

Background: This study investigated whether point-of-care platelet function measurements could predict favorable outcomes in patients with acute ischemic stroke (AIS). Antiplatelet agents, such as aspirin, are known to reduce the risk of recurrent stroke by 20–30%. However, identifying nonresponders to therapy remains a clinical challenge. The study aimed to assess the prognostic value of serial Platelet Function Analyzer (PFA)-100 measurements and hematological ratios in AIS patients. Methods: A prospective cohort study was conducted on 212 AIS patients in Taiwan. Platelet function was assessed at baseline, week 2, and week 4 using PFA-100. The primary outcome was functional recovery, defined by a modified Rankin Scale (mRS) score of 0–3, at 1-month and 1-year. Subgroup analyses compared outcomes between pre- and post-aspirin administrations. Statistical analyses examined the association between changes in platelet function and clinical outcomes. Results: Difference in collagen and epinephrine (CEPI) measurements between baseline and week 2 was associated with favorable mRS scores (p < 0.001). A difference in CEPI closure time greater than 99 seconds was most predictive of a favorable outcome with an adjusted odds ratio of 11.859 (95% CI 2.318–60.669) at 1-month follow-up. Subgroup analyses revealed predictive value in pre-aspirin measurements at 1-month follow-up (p = 0.007). Conclusions: Serial PFA-100 measurements and hematological biomarkers, specifically changes in on-treatment CEPI closure times, may help predict favorable clinical outcome in AIS patients. These findings suggest that dynamic platelet function assessment could play a role in optimizing antiplatelet therapy in AIS management. [ABSTRACT FROM AUTHOR]

The optimal prehospital blood pressure in patients following traumatic brain injury (TBI) remains controversial. We aimed to assess the association between the systolic blood pressure (SBP) at emergency department triage and patient outcomes following isolated moderate-to-severe TBI. We conducted a cross-national multicenter retrospective cohort study using the Pan-Asia Trauma Outcomes Study database from January 1, 2016, to November 30, 2018. The enrollees were adult patients with isolated moderate-to-severe TBI defined by the International Classification of Diseases code, a Glasgow Coma Scale (GCS) <13 at triage, and a nonhead Abbreviated Injury Scale ≤3. The studied variables were SBPs at triage categorized into different ranges. The primary outcome was 30-day mortality, and the secondary outcome was poor functional status at hospital discharge defined by the modified Rankin Scale ≥4. Multivariable logistic regression was applied to adjust for confounders including country, sex, age, mechanism of injury, prehospital vascular access, respiratory rate, GCS, oxygen saturation, intubation, Injury Severity Score, head surgery, intensive care unit admission, and length of hospital stay. Subgroup analyses were performed on different severity of TBI. A total of 785 patients (median age, 42 years; male patients 77.5%; mean SBP at triage, 136.3 ± 33.1 mmHg) were included in the primary analysis. The lowest 30-day mortality rate existed in patients with SBP of 100–119 mmHg. Taking it as baseline, the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of SBP <100 mmHg, 120–139 mmHg, 140–159 mmHg, and ≥160 mmHg were 7.05 (2.51–19.78), 3.14 (1.14–8.65), 2.91 (1.04–8.17), and 3.28 (1.14–9.42). As for the secondary outcome, the aORs and 95% CIs were 1.36 (0.68–2.68) of <100 mmHg, 0.99 (0.57–1.70) of 120–139 mmHg, 1.23 (0.67–2.25) of 140–159 mmHg, and 1.52 (0.78–2.95) of ≥160 mmHg. Subgroup analyses revealed trends of the best outcomes in both moderate and severe TBI patients with SBP 100–119 mmHg, whereas statistical significance appeared only in patients with severe TBI. SBP of 110–119 mmHg at triage is associated with the lowest 30-day mortality in patients following isolated moderate-to-severe TBI and possibly related to a better functional outcome. [ABSTRACT FROM AUTHOR]

Background: Hyperosmolar therapy has long been a cornerstone in managing increased intracranial pressure and improving outcomes in severe traumatic brain injury (TBI). This therapy hinges on elevating serum osmolality, creating an osmotic gradient that draws excess water from the brain's cellular and interstitial compartments and effectively reducing cerebral edema. Given this information, we hypothesized that the serum hyperosmolality prior to any treatment could significantly impact the clinical outcomes of patients with severe TBI, potentially mitigating secondary cerebral edema after trauma. Methods: Data were extracted from the Korean Multi-center Traumatic Brain Injury data bank, encompassing 4628 patients with TBI admitted between January 2016 and December 2018. Of these, 507 patients diagnosed with severe TBI (Glasgow Coma Scale score < 9) were selected for comprehensive analysis across four data domains: clinical, laboratory, initial computed tomography scan, and treatment. Serum osmolality was assessed prior to treatment, and the hyperosmolar group was defined by a pretreatment serum osmolality exceeding 320 mOsm/L, whereas favorable outcomes were characterized by a modified Rankin Scale score of ≤ 3 at 6 months after trauma. Multivariate regression with receiver operating characteristic curve analysis and propensity score matching were used to dissect the data set. Results: Multivariate analysis showed serum osmolality is significantly associated with clinical outcome in patients with severe TBI (p < 0.001). The optimal cutoff value for predicting favorable outcome was 331 mOsm/L, with a sensitivity of 38.9% and a specificity of 87.7%. Notably, the propensity score matching analysis comparing patients with pretreatment serum hyperosmolality with those without indicated a markedly improved functional outcome in the former group (32.5% vs 18.8%, p = 0.025). Conclusions: The present study has uncovered a significant correlation between the pretreatment serum osmolality and the clinical outcomes of patients with severe TBI. These findings offer a novel perspective, indicating that a serum hyperosmolality prior to any treatment might potentially have a neuroprotective effect in patients with severe TBI. [ABSTRACT FROM AUTHOR]

Background: Mitochondrial damage is significant in autoimmune diseases, with mitochondrial N-formyl methionine peptide (fMet) being released from damaged mitochondria. However, its potential as a marker for assessing the severity of two kinds of encephalitis - anti-N-methyl-D-aspartate receptor (anti-NMDAR) and anti-leucine-rich glioma-inactivated 1 (LGI1) - remains uncertain. We measured CSF fMet levels in anti-NMDAR encephalitis and anti-LG1 encephalitis patients, assessing its diagnostic and therapeutic potential. Methods: Twenty-five patients diagnosed with anti-NMDAR encephalitis and nineteen patients with anti-LGI1 encephalitis were included in the study. Their cerebrospinal fluid (CSF) fMet levels were assessed using enzyme-linked immunosorbent assays. Results: The findings revealed a significant increase in CSF fMet levels, which correlated with modified Rankin Scale (mRS) scores in both anti-NMDAR encephalitis and anti-LGI1 encephalitis patients. Conclusion: The CSF fMet levels were found to be associated with disease severity in patients diagnosed with both anti-NMDAR encephalitis and anti-LGI1 encephalitis. These findings suggest that preventing mitochondrial damage could serve as an effective treatment strategy for managing these diseases. [ABSTRACT FROM AUTHOR]

Background: Decompressive craniectomies (DCs) are recommended for the treatment of raised intracranial pressure after acute ischaemic stroke. Some studies have demonstrated improved outcomes with early decompressive craniectomy (< 48 h from onset) in patients with malignant cerebral oedema following middle cerebral artery infarction. Limited data is available on suboccipital decompressive craniectomy after cerebellar infarction. Aims: Our primary objective was to determine whether the timing of DCs influenced functional outcomes at 6 months. Our secondary objectives were to analyse whether age, gender, the territory of stroke, or preceding thrombectomy impacts functional outcome post-DC. Methods: We conducted a retrospective study of patients admitted between January 2014 and December 2020 who had DCs post-acute ischaemic stroke. Data was collected from ICU electronic records, individual patient charts, and the stroke database. Results: Twenty-six patients had early DC (19 anterior/7 posterior) and 21 patients had late DC (17 anterior/4 posterior). There was no difference in the modified Rankin Scale (mRS) score of the two groups at 90 (p = 0.318) and 180 (p = 0.333) days post early vs late DC. Overall outcomes were poor, with 5 out of 46 patients (10.9%) having a mRS score ≤ 3 at 6 months. There was no difference in mRS scores between the patients who had hemicraniectomies for anterior circulation stroke (n = 35) and suboccipital DC for posterior circulation stroke (n = 11) (p = 0.594). Conclusion: In this single-centre retrospective study, we found no significant difference in functional outcomes between patients who had early or late DC after ischaemic stroke. [ABSTRACT FROM AUTHOR]

Background: The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline (Stryker Neurovascular, Fremont, California), is not directly established and largely inferred. Purpose: This study aimed to compare the efficacy of different FDs in treating sidewall ICA intracranial aneurysms. Methods: We conducted a retrospective review of prospectively maintained databases from eighteen academic institutions from 2009–2016, comprising 444 patients treated with one of four devices for sidewall ICA aneurysms. Data on demographics, aneurysm characteristics, treatment outcomes, and complications were analyzed. Angiographic and clinical outcomes were assessed using various imaging modalities and modified Rankin Scale (mRS). Propensity score weighting was employed to balance confounding variables. The data analysis used Kaplan-Meier curves, logistic regression, and Cox proportional-hazards regression. Results: While there were no significant differences in retreatment rates, functional outcomes (mRS 0–1), and thromboembolic complications between the four devices, the probability of achieving adequate occlusion at the last follow-up was highest in Surpass device (HR: 4.59; CI: 2.75–7.66, p < 0.001), followed by FRED (HR: 2.23; CI: 1.44–3.46, p < 0.001), PED (HR: 1.72; CI: 1.10–2.70, p = 0.018), and Silk (HR: 1.0 ref. standard). The only hemorrhagic complications were with Surpass (1%). Conclusion: All the first-generation devices achieved good clinical outcomes and retreatment rates in treating ICA sidewall aneurysms. Prospective studies are needed to explore the nuanced differences between these devices in the long term. [ABSTRACT FROM AUTHOR]

Background: Stroke is already an epidemic, and the awareness about stroke, prevalence of risk factors, presentations, response to treatment, and outcome are variable in different parts of a country. We aimed to study the details of acute stroke patients who presented to a tertiary care private hospital in eastern India. We wanted to know how the patient’s family members, as well as private doctors in the community, responded to the acute stroke. Methodology: In this prospective and retrospective study for 2 years, from September 2021 to August 2023, we included patients over 18 years of age who presented with acute stroke symptoms within 24 h and were admitted to our hospital. In relation to an acute stroke, we noted patient demographics, clinical, radiological, and hematological details, treatment, and outcome (in hospital and after 3 months). Results: We included 366 patients and found that 74% were hypertensives and 50% were diabetics. We thrombolyzed 24 patients and performed mechanical thrombectomy on eight of them. In a significant number of cases, patients arrived late (only 45 out of 366 were candidates for acute stroke intervention), and attendants were not immediately ready with their consent for 15 of these 45 patients. Conclusion: We urgently need more public awareness programs to educate everyone about the “acute stroke pathway” and help them confidently accept the benefits and drawbacks of acute stroke intervention. We need to institute more stroke prevention clinics at the earliest to address the modifiable risk factors of stroke.

Abstract Acute internal carotid artery occlusion (AICAO) can result in malignant cerebral edema and unfavorable patient outcomes. This study evaluated the utility of transcranial Doppler (TCD) in assessing contralateral flow compensation and predicting outcomes in patients with AICAO. We enrolled 51 patients within 6 h of symptom onset and conducted TCD examinations to evaluate collateral circulation. Among the 51 patients, 40 (78.4%) had collateral flow. TCD showed excellent agreement with magnetic resonance angiography (MRA)/CT angiography (CTA) in assessing anterior communicating artery (ACoA) status (kappa = 0.873, p

Background: Intra cranial hematoma (ICH) can be a life-threatening condition in many cases. The outcome depends on various factors, one such being spontaneous ICH expansion. Timely identification of ICH expansion can help us prognosticate the patient and provide individualized care. The present study aimed to determine the incidence of ICH expansion and determine the clinical and radiological variables predicting expansion; along with the prognosis of these patients. Materials and Methods: This prospective and observational study included 94 ICH patients, who presented within 24 h of symptom onset. ICH volume was measured using ABC/2 method, and repeat computed tomography was done within 72 h or when clinically indicated. Clinical and radiological parameters were noted and looked for the prognosis of patient after expansion in the form of average hospital stay, ICH score, and modified Rankin Scale (mRS). Results: Out of 94 patients, 14 (15%) patients showed expansion (10 males [71%], 4 females [29%]). In clinical profile, headache (P = 0.04) and hemiparesis (P < 0.001), and radiologically marginal irregularity (P < 0.001), hypodensities (P < 0.001), ovoid shape (P = 0.004), and circular shape (P = 0.04) showed significant results. While initial volume (P = 0.16), systolic blood pressure (P = 0.28), fluid level (P = 0.15), cerebral edema (P = 0.18), and Intra ventricular extension (IV) (P = 0.98) were more in expander group but did not reach to statistically significant level. Prognosis worsened with prolonged stay (P = 0.05) and deterioration of ICH score (P = 0.02) as well as mRS. Conclusions: Certain clinical (early presentation and hemiparesis) and radiological (hypodensity within hematoma, marginal irregularity, and ellipsoid shapes) parameters are significantly associated with hematoma expansion. Insight into these predictors can improve the prognosis of hematoma expansion in patients with spontaneous ICH.

Abstract Severe central nervous system infections (CNSI), including community-acquired CNSI (CA-CNSI) and healthcare-associated ventriculitis and meningitis (HAVM), present high morbidity and mortality. Intraventricular antibiotic treatment (IVT) is advisable for these infections, though evidence is limited. We retrospectively analyzed data on 27 patients who received IVT for severe CA-CNSI and HAVM over 10 years, assessing clinical and paraclinical features, such as baseline severity and functional outcome, antibiotics, microbiological and laboratory data. Comparisons were made between patients affected by CNSI and HAVM and those with favorable and unfavorable outcomes, based on the modified Rankin scale. Gram-positive organisms dominated in CA-CNSI (64%), while gram-negative organisms were more frequent in HAVM (64%). Patients received a median of 30 days of intravenous antibiotics and 11 days of IVT, with no significant difference between CA-CNSI and HAVM. IVT-associated toxicity was rare. Patients with favorable outcomes (64%) had higher initial cerebrospinal fluid- white blood cell count (CSF-WBC), that decreased more rapidly than in patients with unfavorable outcomes. CSF-WBC dynamics did not differ between CA-CNSI and HAVM patients. Rapid decline in CSF-WBC after initiation of IVT was associated with favorable outcome. Despite severe neurological impairment at admission, most survivors achieved favorable long-term outcomes.

Abstract Objective Identifying the predictive factors of mortality and functional outcomes following decompressive craniectomy (DC) surgery in patients with malignant middle cerebral artery infarction (MMCAI) is essential for decision-making regarding conservative versus surgical treatment. This study aimed to assess the mortality and functional outcomes of MMCAI patients after DC surgery and to identify the predictive factors associated with mortality and functional outcomes. Methods A total of 76 patients with MMCAI who underwent surgical DC were included. The mortality rates and functional outcomes were assessed, and factors associated with mortality and functional outcomes were identified through univariate analysis followed by multivariate logistic regression analysis. Results The mortality rate was 44.8%, while a favorable functional outcome was observed in 28.9% of the patients. modified Glasgow coma scale (GCS) before DC (OR = 0.416, 95% CI = 0.261–0.662, P

OBJECTIVE We aimed to determine the role of plasma alpha- and beta-synuclein levels and other routine inflammatory parameters in the diagnosis, outcome, and mortality of acute ischemic stroke (AIS). METHODS In our study, serum alpha- and beta-synuclein levels and clinical data were prospectively evaluated in 93 subjects (43 controls and 50 AIS patients) admitted to the emergency department. The outcome status and prognostic classification were performed according to the modified Rankin Scale (mRS) scores on the 30th day from hospital admission. RESULTS The mean age of the subjects was 70.6 ± 11 years. Thirty-eight percentage were female. Plasma α-synuclein levels in the AIS group (33.6 ± 8.5 ng/mL) were significantly higher than those in the control group (4.22 ± 2.1 ng/mL) (P < 0.001). Plasma β-synuclein levels in the AIS group (13.07 ± 2.7 ng/mL) were significantly higher than those in the control group (2.17 ± 1.4 ng/mL) (P < 0.001). There was no significant difference in alpha- and beta-synuclein levels between the subgroups formed according to the 30th-day results of the patients using the mRS scores (P = 0.813 and 0.812, respectively). CONCLUSION The serum alpha- and beta-synuclein concentrations of patients with AIS at admission were significantly higher than the healthy control group. At admission, serum alpha- and beta-synuclein levels do not have definitive clinically predictive value in predicting stroke progression and outcome in patients with AIS.

Abstract The purpose of this study was to investigate early stage dynamic changes in relevant indicators in neurocritical patients to identify biomarkers that can predict a poor prognosis at an early stage (1–4 days after admission). This study retrospectively collected clinical data, inflammatory indicators, and nutritional indicators from 77 patients at the neurology intensive care unit. The 3-month modified Rankin scale score was used as the outcome indicator. A linear mixed model was used to analyze changes in inflammatory indicators and nutritional indicators in neurocritical patients over time from 1–4 days after admission. Logistic regression was used to determine the independent risk factors for a poor prognosis in neurocritical patients and to construct a predictive model. The predictive efficacy of the model was verified using leave-one-out cross-validation and decision curve analysis methods. The analysis results showed that 1–4 days after admission, the inflammatory indicators of white blood cell and absolute monocyte counts and the nutritional indicators of body cell mass(BCM), fat-free mass, body cell mass/phase angle (BCM/PA), intracellular water, extracellular water, and skeletal muscle index increased overall, while the nutritional indicators of albumin and visceral fat area decreased overall. The logistic multivariate regression model showed that the Charlson comorbidity index (CCI) (odds ratio (OR) = 2.526, 95% CI [1.202, 5.308]), hemoglobin (Hb)(on admission)-Hb(min) (OR = 1.049, 95% CI [1.015, 1.083), BCM(on admission) (OR = 0.794, 95% CI [0.662, 0.952]), and the change in BCM/PA 1–4 days after admission (OR = 1.157, 95% CI [1.070, 1.252]) were independent risk factors for a poor prognosis in neurocritical patients. The predictive analysis showed that the predictive power of Model 1 with BCM/PA (area under the curve (AUC) = 0.95, 95% CI (0.90, 0.99)) was 93%, 65%, 141%, and 133% higher than that of Model 2 without BCM/PA, the CCI, the APACHE II score, and the NRS2002 score (all P

Severe central nervous system infections (CNSI), including community-acquired CNSI (CA-CNSI) and healthcare-associated ventriculitis and meningitis (HAVM), present high morbidity and mortality. Intraventricular antibiotic treatment (IVT) is advisable for these infections, though evidence is limited. We retrospectively analyzed data on 27 patients who received IVT for severe CA-CNSI and HAVM over 10 years, assessing clinical and paraclinical features, such as baseline severity and functional outcome, antibiotics, microbiological and laboratory data. Comparisons were made between patients affected by CNSI and HAVM and those with favorable and unfavorable outcomes, based on the modified Rankin scale. Gram-positive organisms dominated in CA-CNSI (64%), while gram-negative organisms were more frequent in HAVM (64%). Patients received a median of 30 days of intravenous antibiotics and 11 days of IVT, with no significant difference between CA-CNSI and HAVM. IVT-associated toxicity was rare. Patients with favorable outcomes (64%) had higher initial cerebrospinal fluid- white blood cell count (CSF-WBC), that decreased more rapidly than in patients with unfavorable outcomes. CSF-WBC dynamics did not differ between CA-CNSI and HAVM patients. Rapid decline in CSF-WBC after initiation of IVT was associated with favorable outcome. Despite severe neurological impairment at admission, most survivors achieved favorable long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Autoimmune encephalitis (AE) poses significant challenges in clinical management, requiring effective monitoring tools for therapeutic success and relapse detection. This study aims to assess the Clinical Assessment Scale in Autoimmune Encephalitis (CASE) as compared to the modified Rankin scale (mRS) in evaluating AE patients and to determine the real-world adoption of the CASE score. Methods: A retrospective cohort study was conducted on 20 AE patients, assessing clinical data including symptomatology, diagnostic findings, and therapeutic regimens. Furthermore, we performed a systematic review on the test performance criteria and the real-world use of the CASE score. Results: The CASE score showed a higher sensitivity in detecting clinical changes compared to the mRS, with a significant correlation between the two scales throughout the disease course (r = 0.85, p < 0.01). A systematic review of 150 articles revealed widespread adoption of the CASE score, especially in Asian populations, demonstrating high reliability and internal consistency. Discussion: Despite limitations such as retrospective design and small sample size, our findings underscore the CASE score's utility in both clinical practice and research settings. The CASE score emerges as a valuable tool for monitoring AE patients, offering improved sensitivity over existing scales like the mRS. Further validation studies in diverse populations are warranted to establish its broader applicability and inform future therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: Identifying the predictive factors of mortality and functional outcomes following decompressive craniectomy (DC) surgery in patients with malignant middle cerebral artery infarction (MMCAI) is essential for decision-making regarding conservative versus surgical treatment. This study aimed to assess the mortality and functional outcomes of MMCAI patients after DC surgery and to identify the predictive factors associated with mortality and functional outcomes. Methods: A total of 76 patients with MMCAI who underwent surgical DC were included. The mortality rates and functional outcomes were assessed, and factors associated with mortality and functional outcomes were identified through univariate analysis followed by multivariate logistic regression analysis. Results: The mortality rate was 44.8%, while a favorable functional outcome was observed in 28.9% of the patients. modified Glasgow coma scale (GCS) before DC (OR = 0.416, 95% CI = 0.261–0.662, P < 0.001) and infarct volume before DC (OR = 1.000-1.012, 95% CI = 1.000-1.012, P = 0.037) were independent risk factors for death. Age (OR = 0.88, 95% CI = 0.812–0.952, P = 0.002), modified GCS before DC (OR = 2.477, 95% CI = 1.395-4.4, P = 0.002), and infarct volume before DC (OR = 0.987, 95% CI = 0.975–0.999, P = 0.035) were independent factors associated with favorable functional outcomes. Conclusion: Preoperative modified GCS and preoperative infarct volume were independent factors associated with both mortality and functional outcomes. Age was only associated with functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Intravenous alteplase is a drug treatment administered as an emergency measure within the early hours of patient admission. Objectives: This study aimed to determine the role of hyperdense signal length in the middle cerebral artery on the degree of disability in patients with arterial ischemic stroke who exhibit evidence of vascular involvement. Methods: In this cross-sectional study, patients with stroke who were referred to the emergency department of Imam Hossein Hospital in Tehran were included. The tools used were the demographic profile form and the Modified Rankin Scale (mRS). At the time of admission, the demographic profile form and the mRS tool were completed. The mRS tool was then administered again at discharge and 3 months after discharge. Following data collection, the patients' information was entered into SPSS version 16 software for analysis. Results: The results showed that there was no relationship between the patient's age and the disability score at admission (P = 0.11). However, at discharge and 3 months after discharge, the level of disability had a significant relationship with the patient's age, with younger patients reporting less disability. Additionally, after admission and thrombectomy, the patient's disability status significantly improved compared to the status at admission (P = 0.000). The mean ± SD mRS score at admission was 4.78 ± 0.44, while at discharge it was 3.94 ± 1.84. The mean ± SD disability score 3 months after discharge decreased from 4.78 ± 0.44 to 3.72 ± 2.25. This reduction compared to the discharge score was not statistically significant (P = 0.06). Conclusions: Older patients and those with higher middle cerebral artery (MCA) levels reported greater disability. Therefore, it is necessary to implement preventive measures to address this issue. [ABSTRACT FROM AUTHOR]

Background: Intra cranial hematoma (ICH) can be a life-threatening condition in many cases. The outcome depends on various factors, one such being spontaneous ICH expansion. Timely identification of ICH expansion can help us prognosticate the patient and provide individualized care. The present study aimed to determine the incidence of ICH expansion and determine the clinical and radiological variables predicting expansion; along with the prognosis of these patients. Materials and Methods: This prospective and observational study included 94 ICH patients, who presented within 24 h of symptom onset. ICH volume was measured using ABC/2 method, and repeat computed tomography was done within 72 h or when clinically indicated. Clinical and radiological parameters were noted and looked for the prognosis of patient after expansion in the form of average hospital stay, ICH score, and modified Rankin Scale (mRS). Results: Out of 94 patients, 14 (15%) patients showed expansion (10 males [71%], 4 females [29%]). In clinical profile, headache (P = 0.04) and hemiparesis (P < 0.001), and radiologically marginal irregularity (P < 0.001), hypodensities (P < 0.001), ovoid shape (P = 0.004), and circular shape (P = 0.04) showed significant results. While initial volume (P = 0.16), systolic blood pressure (P = 0.28), fluid level (P = 0.15), cerebral edema (P = 0.18), and Intra ventricular extension (IV) (P = 0.98) were more in expander group but did not reach to statistically significant level. Prognosis worsened with prolonged stay (P = 0.05) and deterioration of ICH score (P = 0.02) as well as mRS. Conclusions: Certain clinical (early presentation and hemiparesis) and radiological (hypodensity within hematoma, marginal irregularity, and ellipsoid shapes) parameters are significantly associated with hematoma expansion. Insight into these predictors can improve the prognosis of hematoma expansion in patients with spontaneous ICH. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We aimed to determine the role of plasma alpha- and beta-synuclein levels and other routine inflammatory parameters in the diagnosis, outcome, and mortality of acute ischemic stroke (AIS). METHODS: In our study, serum alpha- and beta-synuclein levels and clinical data were prospectively evaluated in 93 subjects (43 controls and 50 AIS patients) admitted to the emergency department. The outcome status and prognostic classification were performed according to the modified Rankin Scale (mRS) scores on the 30th day from hospital admission. RESULTS: The mean age of the subjects was 70.6 ± 11 years. Thirty-eight percentage were female. Plasma α-synuclein levels in the AIS group (33.6 ± 8.5 ng/mL) were significantly higher than those in the control group (4.22 ± 2.1 ng/mL) (P < 0.001). Plasma β-synuclein levels in the AIS group (13.07 ± 2.7 ng/mL) were significantly higher than those in the control group (2.17 ± 1.4 ng/mL) (P < 0.001). There was no significant difference in alpha- and beta-synuclein levels between the subgroups formed according to the 30th-day results of the patients using the mRS scores (P = 0.813 and 0.812, respectively). CONCLUSION: The serum alpha- and beta-synuclein concentrations of patients with AIS at admission were significantly higher than the healthy control group. At admission, serum alpha- and beta-synuclein levels do not have definitive clinically predictive value in predicting stroke progression and outcome in patients with AIS. [ABSTRACT FROM AUTHOR]

Introduction: Sleep Disordered Breathing (SDB) has been shown to increase the risk of stroke and despite recommendations, routine evaluation for SDB in acute stroke is not consistent across institutions. The necessary logistics and expertise required to conduct sleep studies in hospitalized patients remain a significant barrier. This study aims to evaluate the feasibility of high-resolution pulse-oximetry (HRPO) for the screening of SDB in acute stroke. Secondarily, considering impact of SDB on acute stroke, we investigated whether SDB at acute stroke predicts functional outcome at discharge and at 3 months post-stroke. Methods: Patients with acute mild to moderate ischemic stroke underwent an overnight HRPO within 48 h of admission. Patients were divided into SDB and no-SDB groups based on oxygen desaturations index(ODI > 10/h). Stepwise multivariate logistic regression analysis was applied to identify the relevant predictors of functional outcome (favorable [mRS 1–2 points] versus unfavorable [mrS > = 3 points]). Results: Of the 142 consecutively screened patients, 96 were included in the analysis. Of these, 33/96 (34%) were identified as having SDB and were more likely to have unfavorable mRS scores as compared to those without SDB (odds ratio = 2.70, p-value = 0.032). Conclusion: HRPO may be a low-cost and easily administered screening method to detect SDB among patients hospitalized for acute ischemic stroke. Patients with SDB (as defined by ODI) have a higher burden of neurological deficits as compared to those without SDB during hospitalization. [ABSTRACT FROM AUTHOR]

\nIntroduction: We aimed to explore the predictive value of pre-stroke frailty index (FI) on functional dependency and mortality 3 years after stroke. Methods: Based on the Rockwood 36-item FI score, we calculated the pre-stroke FI from medical conditions recorded at baseline in the multicenter prospective Nor-COAST study 2015–2017. Participants with a FI score and a modified Rankin scale (mRS) 0–6 3 years post-stroke were included in this study. We used logistic regression analysis with unfavorable mRS (over 2 vs. 0–2) at 3 years, or dead within 3 years, as dependent variable, and frailty and pre-stroke mRS, one at a time, and simultaneously, as predictors. The analyses were carried out unadjusted and adjusted for the following variables one at a time: Age, sex, years of education, stroke severity at admission, infections treated with antibiotics and stroke progression. We report odds ratio (OR) per 0.10 increase in FI. Results: At baseline, the 609 included patients had mean age 72.8 (standard deviation [SD] 11.8), 261 (43%) were females, and had a FI mean score of 0.16 (SD 0.12), range 0–0.69. During 3 years, 138 (23%) had died. Both the FI, and pre-stroke mRS, were strong predictors for unfavorable mRS (OR 4.1 and 2.7) and dead within 3 years (OR 2.2 and 1.7). Only adjusting for age affected the result. The OR for pre-stroke mRS decreased relatively more than the OR for FI when entered as predictors simultaneously. Conclusions: FI is a stronger predictor than premorbid mRS for prognostication after stroke. Stroke is a leading cause of dead and disability in the world. It is an acute condition prevalent in older populations. As more older adults surviving previously fatal strokes, the prevalence of stroke survivors with different functional and cognitive impairments increase. There is a great heterogeneity in outcome after stroke, even in milder strokes. We know less of what predict poor outcome. While increasing age in general is associated with poor outcome, at individual plan the relationship with age is more uncertain. Frailty is a concept gaining more attention over the recent years. It is defined as a condition of vulnerability associated with an increased risk of adverse health outcomes such as functional decline and mortality. Frail people have an increased risk of developing disease when something extraordinary occurs. Less is known about the relationship between stroke and frailty. Frailty assessment is not yet part of routine stroke care. In this study, we explored the impact of pre-stroke frailty on functional dependency and mortality 3 years after stroke. We found that the degree of frailty before stroke had a huge impact on functional status and mortality 3 years after stroke, even when we adjusted for important factors, like stroke severity and age. This demonstrates the importance of implementing frailty measures as a routine tool in stroke medicine. It also underline the value of developing preventing mechanisms of frailty in the older population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate early stage dynamic changes in relevant indicators in neurocritical patients to identify biomarkers that can predict a poor prognosis at an early stage (1–4 days after admission). This study retrospectively collected clinical data, inflammatory indicators, and nutritional indicators from 77 patients at the neurology intensive care unit. The 3-month modified Rankin scale score was used as the outcome indicator. A linear mixed model was used to analyze changes in inflammatory indicators and nutritional indicators in neurocritical patients over time from 1–4 days after admission. Logistic regression was used to determine the independent risk factors for a poor prognosis in neurocritical patients and to construct a predictive model. The predictive efficacy of the model was verified using leave-one-out cross-validation and decision curve analysis methods. The analysis results showed that 1–4 days after admission, the inflammatory indicators of white blood cell and absolute monocyte counts and the nutritional indicators of body cell mass(BCM), fat-free mass, body cell mass/phase angle (BCM/PA), intracellular water, extracellular water, and skeletal muscle index increased overall, while the nutritional indicators of albumin and visceral fat area decreased overall. The logistic multivariate regression model showed that the Charlson comorbidity index (CCI) (odds ratio (OR) = 2.526, 95% CI [1.202, 5.308]), hemoglobin (Hb)(on admission)-Hb(min) (OR = 1.049, 95% CI [1.015, 1.083), BCM(on admission) (OR = 0.794, 95% CI [0.662, 0.952]), and the change in BCM/PA 1–4 days after admission (OR = 1.157, 95% CI [1.070, 1.252]) were independent risk factors for a poor prognosis in neurocritical patients. The predictive analysis showed that the predictive power of Model 1 with BCM/PA (area under the curve (AUC) = 0.95, 95% CI (0.90, 0.99)) was 93%, 65%, 141%, and 133% higher than that of Model 2 without BCM/PA, the CCI, the APACHE II score, and the NRS2002 score (all P < 0.05), respectively. The CCI, Hb(on admission)-Hb(min), BCM(on admission), and an increase in BCM/PA 1–4 days after admission were independently associated with a poor prognosis in neurocritical patients. Of these variables, BCM/PA may be a valid indicator for early stage prediction of a poor prognosis in neurocritical patients. [ABSTRACT FROM AUTHOR]

Background: We aimed to use lactate dehydrogenase (LDH) as a marker of inflammation burden and quantify post-stroke inflammation's direct and indirect effect on functional disability. Methods: We analyzed 5,129 patients with acute ischemic stroke (AIS) admitted to Shenyang First People's Hospital. Stroke recurrence and functional outcome measured by the modified Rankin Scale (mRS) were assessed at 90 days. Functional disability was defined as mRS score > 2. Receiver operating characteristic curve and restricted cubic spline (RCS) analysis were conducted to illustrate the associations between LDH levels and 90-day functional outcomes in patients with AIS. Mediation analyses were performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between LDH and functional outcome. Positive correlation between LDH and hs-CRP was found and mediation effects of stroke recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results. Results: Among 5,129 included AIS patients, the median (IQR) level of LDH was 186 (161-204.4) U/L. Functional disability was seen in 1200 (23.4%) patients and recurrence was observed in 371(7.2%) patients at 90-day follow-up. Each standard deviation increase in the concentration of LDH was linked to an increased risk of functional disability (adjusted odds ratio[aOR], 1.07; 95%CI,1.04-1.09) and stroke recurrence (aOR,1.02; 95%CI, 1.01-1.04) within 90 days. The highest quartile of LDH (>204.2 U/L) had an elevated risk of suffering functional disability (aOR, 1.21; 95%CI, 1.00-1.47) and recurrence (aOR, 1.21; 95%CI,1.00-1.47) compared with the lowest quartile of LDH (<161 U/L). Stroke recurrence during follow-up explained 12.90% (95%CI, 6.22-21.16%) of the relationship between LDH and functional disability. Positive correlation between LDH and hs-CRP was found and mediation effects of recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results. Conclusion: The relationship between LDH and functional disability at 90 days among AIS patients is partially mediated by stroke recurrence, accounting for less than 20%. LDH deserves equal attention as hs-CRP in predicting recurrence and functional outcome. In addition to traditional secondary prevention measures, innovative anti-inflammatory strategies warrant further investigation. [ABSTRACT FROM AUTHOR]

This article explores the management of patients with aneurysmal subarachnoid hemorrhage (aSAH) and the challenges in determining fluid balance and blood transfusion thresholds. The authors analyze a clinical trial and find that positive fluid balance is associated with lower hemoglobin levels and an increased risk of secondary infarctions and unfavorable neurologic outcomes. Packed red cell transfusions are also found to be predictive of worse neurologic outcomes. The study suggests that careful, goal-directed circulation management is crucial for maximizing favorable functional outcomes in patients with aSAH. The article emphasizes the importance of maintaining a mean daily neutral fluid balance and targeting euvolemia, while also highlighting the need for consensus among healthcare professionals on definitions and personalized management. It raises questions about the implementation of fluid balancing and the design of randomized trials for fluid management strategies. Overall, the article provides practical insights for managing patients with aSAH. [Extracted from the article]

ObjectiveTo investigate the association between insulin resistance, measured by the triglyceride-glucose (TyG) index, and clinical outcomes in patients with acute ischemic stroke who underwent intravenous thrombolysis with alteplase.MethodsThis retrospective study included 165 patients with acute ischemic stroke treated with intravenous alteplase. Insulin resistance was evaluated using the TyG index, and its relationship with the modified Rankin Scale (mRS) scores was analyzed. The analysis was conducted using R software (version R 4.1.3) to evaluate the correlation between the TyG index and functional outcomes at 14, 30, and 90 days post-stroke.ResultsThe study found that each unit increase in the TyG index significantly raised the risk of poor functional outcomes at 14 days (OR 9.86; 95% CI: 3.32–32.21; P < 0.001), 30 days (OR 5.82; 95% CI: 2.08–17.45; P = 0.001), and 90 days (OR 9.79; 95% CI: 3.33–31.66; P < 0.001) following a stroke. Higher TyG index values were associated with worse neurological outcomes. Although male gender, older age, and smoking were also linked to poorer outcomes, these associations did not reach statistical significance.ConclusionThe findings suggest that a higher TyG index, indicating greater insulin resistance, is associated with worse neurological outcomes in stroke patients. Early intervention targeting insulin resistance may improve clinical outcomes in ischemic stroke patients, and further research is needed to explore additional factors affecting neurological recovery.

Purpose The aim of this study was to develop a prognostic nomogram which could predict the prognosis of north Chinese patients with autoimmune cerebellar ataxia (ACA) after immunotherapy.Methods Patients with an initial diagnosis of ACA who accepted first-line immunotherapy at our hospital from March 2018 to May 2023 were retrospectively reviewed. Modified Rankin Scale (mRS) was used to evaluate neurological outcomes. According to the mRS scores after immunotherapy, patients with ACA were divided into good prognosis group (mRS 0–2) and poor prognosis group (mRS 3–6). The nomogram for poor prognosis of ACA patients were built based on logistic regression analysis. The validation of the prognostic model was evaluated by concordance index (C-index), calibration curves, and decision curve analyses (DCAs).Results A total of 86 patients with ACA who received immunotherapy at our hospital were included in this study. They were randomly divided into a training cohort (n = 60) and a validation cohort (n = 26) at a ratio of 7:3. Multivariate analyses revealed that that prognostic variables significantly related to the poor prognosis of ACA were age, elevated cerebrospinal fluid (CSF) albumin (ALB) and abnormal magnetic resonance imaging (MRI). The nomogram was constructed based on above 3 factors. The C-index of the nomogram was 0.935 (95% CI: 0.884-0.991) in the training set and 0.933 (95% CI: 0.763-0.994) in the validation set. The calibration plots for the nomogram showed that predictions of risk of poor prognosis were almost consistent with actual observations. The DCAs showed great clinical usefulness of the nomograms.Conclusion We successfully developed a nomogram to predict poor prognosis for ACA patients using risk factors of age, elevated CSF-ALB and abnormal MRI.

Background Surgical clipping has been a gold standard procedure for management of intracranial aneurysms. Outcome studies of surgical clipping at institutional level are important to identify modifiable factors and further improve the results. These are even more important in areas where resources are limited, and patient presents late due to ignorance and lack of education. This study is a review of our institutional experience in microsurgical clipping of ruptured intracranial aneurysms.

Background: Worldwide, stroke is the most common cause of death after coronary artery disease (CAD). The risk factor stratification and prognostication of stroke patients are vital in planning and allocating health-care resources. Methods: We conducted a prospective, comparative observational study. Fifty age- and sex-matched cases each of ischemic stroke (IS) and intracerebral hemorrhage (ICH) stroke were enrolled, and baseline demographic, risk factor profile, Glasgow Coma Scale, modified Rankin scale (mRS), and Barthel Index (BI) were recorded, and the cases were followed up for 90 days or till death. We looked at the risk factors associated with IS and ICH and functional outcome of IS vis-à-vis ICH using mRS and BI at 90 days postenrollment. We also compared the mortality of IS vis-à-vis ICH. Results: The presence of hypertension (100% vs. 88%) and smoking (50% vs. 26%) was significantly higher in ICH (P < 0.05). The presence of diabetes mellitus (40% vs. 18%) and CAD (12% vs. 2%) was significantly more in IS cases (P < 0.05). Consumption of alcohol was more prevalent in ICH patients compared to IS patients (30% vs. 24%). Based on mRS and BI at 90 days, ICH cases had significantly poorer functional outcome compared to IS cases (P < 0.0001). Mortality of IS cases (4%) was also significantly less compared to ICH cases (30%). Conclusions: A combination of hypertension, smoking, and history of alcohol consumption had a higher predilection for the occurrence of ICH, whereas a combination of hypertension, diabetes mellitus, and CAD favored the occurrence of IS. The functional outcome of cases of ICH 90 days poststroke was significantly poorer compared to IS cases. The most important factors for poor outcome of ICH cases were more stroke severity at baseline compared to IS cases and the presence of intraventricular hemorrhages in some cases. Mortality was also found to be more in patients with ICH compared to IS.

Background: Acute febrile encephalopathy (AFE) in spite of being a common clinical condition is less known to the general population thereby resulting in delay in seeking medical attention with detrimental consequences. The causes can range from infectious central nervous system (CNS) and systemic diseases to non-infectious conditions such as neuroleptic malignant syndrome, poisoning, and drug overdose. Early diagnosis and prompt medical management can result in good clinical outcome in terms of morbidity and mortality. Aims and Objectives: The aims and objectives are to study the clinical profile, etiology, seasonal variation, and outcome in patients admitted as case of AFE in a tertiary care hospital. Materials and Methods: All patients of AFE fulfilling the inclusion and exclusion criteria admitted in the departments of neurology and general medicine in Batra Hospital and Medical Research Centre (BHMRC) New Delhi, a tertiary care hospital were subjected to study analysis. The patients underwent detailed history, examination, baseline, and special investigations such as cerebrospinal fluid and magnetic resonance imaging brain whenever needed. Patients of AFE were studied according to the prevalence, etiological diagnosis, and seasonal variations. The final outcome at discharge was based on modified Rankin scale (mRs). Results: About 122 serially admitted patients diagnosed with AFE were found eligible and included in the study. About 47 (45%) patients had acute pyogenic CNS infection while as 36 (35%) had non-pyogenic CNS infection followed by malarial, tubercular, and cryptococcal CNS infection. We found maximum number of cases (n=61, 50%) of AFE during monsoon followed by 36 patients (30%) in post-monsoon, 15 patients (12%) were in summer, and only 10 cases (8%) during winter. We found higher and statistically significant disability in CNS infection group, patients with delayed hospitalization (P=0.001), and lower Glasgow coma scale (0.00001). Conclusion: AFE being a condition with serious consequences, we conclude that clinical suspicion, sensitization, and swift response from the treating physicians are required to avoid worse outcomes associated with the delayed diagnosis and late hospitalization of these patients.

Abstract Background Edaravone dexborneol has been reported as an effective neuroprotective agent in the treatment of acute ischemic stroke (AIS). This study aimed at investigating the impact of edaravone dexborneol on functional outcomes and systematic inflammatory response in AIS patient. Methods All participants were recruited from the AISRNA study (registered 21/11/2019, NCT04175691 [ClinicalTrials.gov]) between January 2022 and December 2022. The AIS patients were divided into two groups based on whether they received the treatment of edaravone dexborneol (37.5 mg/12 hours, IV) within 48 h after stroke onset. Inflammatory response was determined by detecting levels of cytokines (interleukin-2 [IL-2], IL-4, IL-5, IL-8, IL-6, IL-10, IL-12p70, IL-17, tumor necrosis factor-α [TNF-α], interferon-γ [IFN-γ], IFN-α, and IL-1β) within 14 days after stroke onset. Results Eighty-five AIS patients were included from the AISRNA study. Patients treated with edaravone dexborneol showed a significantly higher proportion of modified Rankin Scale score 0.05). Conclusions Treatment with edaravone dexborneol resulted in a favorable functional outcome at 90 days post-stroke onset when compared to patients without this intervention; it also suppressed proinflammatory factors expression while increasing anti-inflammatory factors levels. Trial registration ClinicalTrials.gov NCT04175691. Registered November 21, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04175691 .

Abstract Background The most dangerous and least curable type of stroke is spontaneous intracerebral hemorrhage (ICH), and prognosis is highly correlated with location and size in the posterior fossa. The objective of this work was to estimate the frequency of posterior fossa hemorrhage (PFH) in Tanta University Hospitals, as well as identify functional outcomes and mortality in PFH. Methods This study was performed on 33 posterior fossa hemorrhagic patients and 119 posterior ischemic stroke patients (PCIS) submitted to the CT brain and the MRI brain, using the following scales: GCS and NIHSS, and the intracerebral hemorrhage scale (ICH score). Results Posterior fossa hemorrhage (PFH) represents 16.83% of total hemorrhagic stroke in the ER. Vertigo and DCL are more common in PFH (60.6%, 48.4%) than in PCIS. 82% of PFH patients had hypertension (HTN) hemorrhage. The cerebellum is the most common site for PFH (48%), pontine (24%), thalamic (18%), and midbrain (9%). PFH had unfavorable outcomes in 55% of the studied patients; the MRS mean was 4; and 39% died in the follow-up. Conclusion Posterior fossa hemorrhage is a potentially serious neurovascular emergency associated with complex symptomatology. PFH demonstrates diverse prognoses depending on the location of the intracerebral hemorrhage and the size of the hematoma.

Stroke is one of the leading causes of death worldwide. Understanding the risk factors for post-stroke mortality is crucial for improving patient outcomes. This study analyzes and predicts post-stroke mortality using the modified Rankin Scale (mRS), a functional neurological evaluation scale. Several Machine Learning models were developed and assessed using a dataset of 332 stroke patients from Hospital de Faro, Portugal, from 2016 to 2018. The Random Forest model outperformed others, achieving an accuracy of 98.5% and a recall of 91.3. Twenty-four risk factors were identified, with stroke severity as the most critical. These findings provide healthcare professionals with valuable tools for early identification and intervention for high-risk stroke patients, enabling informed decision-making and customized treatment plans. This research advances healthcare predictive analytics, offering a precise mortality prediction model and a comprehensive analysis of risk factors, potentially improving clinical outcomes and reducing mortality rates. Future applications could extend to patient monitoring and management across various medical conditions.

We wanted to evaluate if optical coherence tomography angiography OCTA findings could predict the functional outcome in extracranial carotid artery atherosclerotic disease (ECAD) associated stroke. This exploratory study was performed on adults with acute ischaemic stroke due to ECAD at 3–6 weeks following stroke onset with risk factor matched controls without carotid artery stenosis. Twenty-three stroke patients (cases) and 23 controls were enrolled. There was significant difference between cases and controls in deep vessel density at the macula (p =.0007) and in radial peripapillary capillary perfusion density (RPCPD) at the optic nerve head (ONH) (p =.0007). Statistically significant difference was noted in the total superficial vessel density (SVD) at the macula (SVD within 1 standard deviation [SD] versus SVD beyond 1 SD of control data) in the ipsilateral eye and functional outcome at 3 months (poor versus very good outcome, modified Rankin scale [mRS] 0–1 versus mRS 2–6, respectively; p =.0361). There was statistically insignificant correlation between the RPCPD at the ONH and the National Institutes of Health Stroke Scale score at admission, mRS at discharge, and mRS at 3 months following stroke onset (r =.33, r =.35, r =.39; p =.11, p =.09, p =.06, respectively). The findings of this exploratory study suggested that OCTA findings may predict 3 month outcomes in cases of ECAD-related stroke and could be useful in decision making in future intervention studies as to whether intervene or not in patients having critical or non-critical ECAD for preventing stroke. [ABSTRACT FROM AUTHOR]

Background and objective: The Modified Rankin Scale (mRS) is a widely adopted scale for assessing stroke recovery. Despite limitations, the mRS has been adopted as primary outcome in most recent clinical acute stroke trials. Designed to be used by multidisciplinary clinical staff, the congruency of this scale is not consistent, which may lead to mistakes in clinical or research application. We aimed to develop and validate an interactive and automated digital tool for assessing the mRS—the iRankin. Methods: A panel of five board-certified and mRS-trained vascular neurologists developed an automated flowchart based on current mRS literature. Two international experts were consulted on content and provided feedback on the prototype platform. The platform contained five vignettes and five real video cases, representing mRS grades 0–5. For validation, we invited neurological staff from six comprehensive stroke centers to complete an online assessment. Participants were randomized into two equal groups usual practice versus iRankin. The participants were randomly allocated in pairs for the congruency analysis. Weighted kappa (kw) and proportions were used to describe agreement. Results: A total of 59 professionals completed the assessment. The kw was dramatically improved among nurses, 0.76 (95% confidence interval (CI) = 0.55–0.97) × 0.30 (0.07–0.67), and among vascular neurologists, 0.87 (0.72–1) × 0.82 (0.66–0.98). In the accuracy analysis, after the standard mRS values for the vignettes and videos were determined by a panel of experts, and considering each correct answer as equivalent to 1 point on a scale of 0–15, it revealed a higher mean of 10.6 (±2.2) in the iRankin group and 8.2 (±2.3) points in the control group (p = 0.02). In an adjusted analysis, the iRankin adoption was independently associated with the score of congruencies between reported and standard scores (beta coefficient = 2.22, 95% CI = 0.64–3.81, p = 0.007). Conclusion: The iRankin adoption led to a substantial or near-perfect agreement in all analyzed professional categories. More trials are needed to generalize our findings. Our user-friendly and free platform is available at https://www.irankinscale.com/. [ABSTRACT FROM AUTHOR]

Background: Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Early and accurate imaging is crucial for effective management and improving patient outcomes. Functional MRI (fMRI) and CT perfusion imaging (CTP) are two advanced imaging modalities used to assess ischemic lesions. This study aims to compare the effectiveness and accuracy of fMRI and CTP in acute stroke management. Objective: To compare the effectiveness and accuracy of fMRI and CTP in acute stroke management, focusing on early detection, lesion characterization, and outcome prediction. Methods: A prospective cohort study was conducted on 100 patients presenting with acute ischemic stroke within 6 hours of symptom onset. Each patient underwent both fMRI and CTP imaging. Key metrics assessed included time to image acquisition, sensitivity, specificity, lesion detection and characterization, and predictive value for functional outcomes measured by the modified Rankin Scale (mRS) at 90 days. Results: The mean time from patient arrival to image acquisition was 30 minutes (±5) for fMRI and 25 minutes (±4) for CTP (p < 0.05). Sensitivity for detecting ischemic lesions was 95% for fMRI and 90% for CTP, while specificity was 92% for fMRI and 88% for CTP (p < 0.05). fMRI detected 120 lesions compared to 110 by CTP and characterized penumbra versus core infarct in 90% of cases compared to 85% for CTP (p < 0.05). The correlation coefficient for predicting functional outcomes was 0.85 for fMRI and 0.80 for CTP (p < 0.01). Functional independence (mRS 0-2) was achieved in 60% of fMRI patients and 55% of CTP patients (p < 0.05). Conclusion: Both fMRI and CTP are effective in acute stroke management. However, fMRI showed higher sensitivity, specificity, superior lesion detection and characterization, and better predictive value for functional outcomes. fMRI may be a more reliable tool for early stroke assessment, though CTP remains a valuable alternative when fMRI is not available. [ABSTRACT FROM AUTHOR]

Background: Transcranial Doppler (TCD) is a technique to assess blood flow velocity in the cerebral arteries. TCD is frequently used to monitor aneurysmal subarachnoid hemorrhage (aSAH) patients. This study compares TCD-criteria for vasospasm and its association with Delayed Cerebral Ischemia (DCI). An overall score based on flow velocities of various intracranial arteries was developed and evaluated. Methods: A retrospective diagnostic accuracy study was conducted between 1998 and 2017 with 621 patients included. Mean flow velocity (MFV) of the cerebral artery was measured between 2–5 days and between 6–9 days after ictus. Cutoff values from the literature, new cutoff values, and a new composite score (Combined Severity Score) were used to predict DCI. Sensitivity, specificity, and area under the curve (AUC) were determined, and logistic regression analysis was performed. Results: The Combined Severity Score showed an AUC 0.64 (95%CI 0.56-.71) at days 2–5, with sensitivity 0.53 and specificity 0.74. The Combined Severity Score had an adjusted Odds Ratio of 3.41 (95CI 1.86–6.32) for DCI. MCA-measurements yielded the highest AUC to detect DCI at day 2–5: AUC 0.65 (95%CI 0.58–0.73). Optimal cutoff MFV of 83 cm/s for MCA resulted in sensitivity 0.73 and specificity 0.50 at days 2–5. Conclusion: TCD-monitoring of aSAH patients may be a valuable strategy for DCI risk stratification. Lower cutoff values can be used in the early phase after the ictus (day 2–5) than are commonly used now. The Combined Severity Score incorporating all major cerebral arteries may provide a meaningful contribution to interpreting TCD measurements. [ABSTRACT FROM AUTHOR]

Background: The most dangerous and least curable type of stroke is spontaneous intracerebral hemorrhage (ICH), and prognosis is highly correlated with location and size in the posterior fossa. The objective of this work was to estimate the frequency of posterior fossa hemorrhage (PFH) in Tanta University Hospitals, as well as identify functional outcomes and mortality in PFH. Methods: This study was performed on 33 posterior fossa hemorrhagic patients and 119 posterior ischemic stroke patients (PCIS) submitted to the CT brain and the MRI brain, using the following scales: GCS and NIHSS, and the intracerebral hemorrhage scale (ICH score). Results: Posterior fossa hemorrhage (PFH) represents 16.83% of total hemorrhagic stroke in the ER. Vertigo and DCL are more common in PFH (60.6%, 48.4%) than in PCIS. 82% of PFH patients had hypertension (HTN) hemorrhage. The cerebellum is the most common site for PFH (48%), pontine (24%), thalamic (18%), and midbrain (9%). PFH had unfavorable outcomes in 55% of the studied patients; the MRS mean was 4; and 39% died in the follow-up. Conclusion: Posterior fossa hemorrhage is a potentially serious neurovascular emergency associated with complex symptomatology. PFH demonstrates diverse prognoses depending on the location of the intracerebral hemorrhage and the size of the hematoma. [ABSTRACT FROM AUTHOR]

Background: Edaravone dexborneol has been reported as an effective neuroprotective agent in the treatment of acute ischemic stroke (AIS). This study aimed at investigating the impact of edaravone dexborneol on functional outcomes and systematic inflammatory response in AIS patient. Methods: All participants were recruited from the AISRNA study (registered 21/11/2019, NCT04175691 [ClinicalTrials.gov]) between January 2022 and December 2022. The AIS patients were divided into two groups based on whether they received the treatment of edaravone dexborneol (37.5 mg/12 hours, IV) within 48 h after stroke onset. Inflammatory response was determined by detecting levels of cytokines (interleukin-2 [IL-2], IL-4, IL-5, IL-8, IL-6, IL-10, IL-12p70, IL-17, tumor necrosis factor-α [TNF-α], interferon-γ [IFN-γ], IFN-α, and IL-1β) within 14 days after stroke onset. Results: Eighty-five AIS patients were included from the AISRNA study. Patients treated with edaravone dexborneol showed a significantly higher proportion of modified Rankin Scale score < 2 compared to those who did not receive this treatment (70.7% versus 47.8%; P = 0.031). Furthermore, individuals receiving edaravone dexborneol injection exhibited lower expression levels of interleukin (IL)-1β, IL-6, and IL-17, along with higher levels of IL-4 and IL-10 expression during the acute phase of ischemic stroke (P < 0.05). These trends were not observed for IL-2, IL-5, IL-8, IL-12p70, tumor necrosis factor-α, interferon-γ [IFN-γ], and IFN-α (P > 0.05). Conclusions: Treatment with edaravone dexborneol resulted in a favorable functional outcome at 90 days post-stroke onset when compared to patients without this intervention; it also suppressed proinflammatory factors expression while increasing anti-inflammatory factors levels. Trial registration: ClinicalTrials.gov NCT04175691. Registered November 21, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04175691. [ABSTRACT FROM AUTHOR]

Background: Stroke is the third most common cause of disability and the second most common cause of death worldwide. Prognosis assessment in acute ischemic stroke is challenging for clinicians. The development of simple and easily performed prognostic markers that correlate with the outcome of patients can be of immense benefit. The aim of this study was to find out the prognostic significance of total leukocyte count, red cell distribution width and erythrocyte sedimentation rate in patients with acute ischemic stroke. Methods: A descriptive cross‐sectional study was conducted in a tertiary center after ethical approval from the Institutional Review Committee. The study period spanned from April 18, 2022 to June 17, 2023, a period of 14 months. 136 patients diagnosed with acute ischemic stroke with total leukocyte count (TLC), red cell distribution width (RDW), erythrocyte sedimentation rate (ESR), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) were included in the study after fulfilling the inclusion criteria. The modified Rankin Scale (mRS) was obtained 28 days following admission. Data was collected and analyzed through Microsoft Excel 365 and SPSS version 22. Spearman Correlation and multivariate regression analysis were used to analyze the association. Results: TLC, RDW, and ESR were significantly associated with an mRS at 28 days showing a positive correlation between them. Total in‐hospital mortality has been significantly associated with TLC only (p < 0.05). Conclusions: The prognostic value of TLC, RDW, and ESR in patients with acute ischemic stroke was found to be significant and similar to the studies done in similar settings. [ABSTRACT FROM AUTHOR]

Background: Acute febrile encephalopathy (AFE) in spite of being a common clinical condition is less known to the general population thereby resulting in delay in seeking medical attention with detrimental consequences. The causes can range from infectious central nervous system (CNS) and systemic diseases to non-infectious conditions such as neuroleptic malignant syndrome, poisoning, and drug overdose. Early diagnosis and prompt medical management can result in good clinical outcome in terms of morbidity and mortality. Aims and Objectives: The aims and objectives are to study the clinical profile, etiology, seasonal variation, and outcome in patients admitted as case of AFE in a tertiary care hospital. Materials and Methods: All patients of AFE fulfilling the inclusion and exclusion criteria admitted in the departments of neurology and general medicine in Batra Hospital and Medical Research Centre (BHMRC) New Delhi, a tertiary care hospital were subjected to study analysis. The patients underwent detailed history, examination, baseline, and special investigations such as cerebrospinal fluid and magnetic resonance imaging brain whenever needed. Patients of AFE were studied according to the prevalence, etiological diagnosis, and seasonal variations. The final outcome at discharge was based on modified Rankin scale (mRs). Results: About 122 serially admitted patients diagnosed with AFE were found eligible and included in the study. About 47 (45%) patients had acute pyogenic CNS infection while as 36 (35%) had non-pyogenic CNS infection followed by malarial, tubercular, and cryptococcal CNS infection. We found maximum number of cases (n=61, 50%) of AFE during monsoon followed by 36 patients (30%) in post-monsoon, 15 patients (12%) were in summer, and only 10 cases (8%) during winter. We found higher and statistically significant disability in CNS infection group, patients with delayed hospitalization (P=0.001), and lower Glasgow coma scale (0.00001). Conclusion: AFE being a condition with serious consequences, we conclude that clinical suspicion, sensitization, and swift response from the treating physicians are required to avoid worse outcomes associated with the delayed diagnosis and late hospitalization of these patients. [ABSTRACT FROM AUTHOR]

Background Surgical clipping has been a gold standard procedure for management of intracranial aneurysms. Outcome studies of surgical clipping at institutional level are important to identify modifiable factors and further improve the results. These are even more important in areas where resources are limited, and patient presents late due to ignorance and lack of education. This study is a review of our institutional experience in microsurgical clipping of ruptured intracranial aneurysms. Methods A retrospective study of patients who underwent surgical clipping for ruptured intracranial aneurysms from January 2014 to February 2020. The medical records of patients were reviewed for demographic data, clinical presentation, radiological investigations, surgery performed and neurological outcome. Outcome at discharge and outcome at follow-up were measured by modified Rankin scale (mRS). Results In this study of 289 patients, 194 patients (67.13%) had good outcome at discharge (mRS0–2), while 95 patients (32.87%) had poor outcome at discharge (mRS 3–6) and 50 patients (17.30%) expired during hospital stay. Out of 289 patients, 208 patients (71.97%) were admitted after more than 3 days of ictus. Significant factors affecting outcome were neurological status determined by Glasgow coma scale (GCS) score, World Federation of Neurosurgical Societies (WFNS) grade or Hunt and Hess Grade, time interval from onset of subarachnoid hemorrhage to admission, and time interval from admission to surgery. Conclusion The present study identifies factors for improving outcome in patients of ruptured aneurysm at institutional and community level. Time from ictus to admission and admission to surgery are important modifiable factors in our study. [ABSTRACT FROM AUTHOR]

Aim: The aim of this analysis was to assess the cost–effectiveness of the EmboTrap Revascularization Device compared with the Solitaire™ Revascularization Device and Trevo Retriever for the treatment of acute ischemic stroke (AIS) from the perspective of the Chinese healthcare system. Methods: According to MASTRO I, a recent living systematic literature review and meta-analysis, mechanical thrombectomy (MT) with EmboTrap in the treatment of AIS resulted in better functional outcomes compared with the use of Solitaire or Trevo. Based on the proportion of patients that achieved 90-day modified Rankin Scale (mRS) scores of 0–2, 3–5 and 6 reported in MASTRO I, a combined 90-day short-term decision tree and Markov model with a 10-year time horizon was used to compare the cost–effectiveness of the three devices. The primary outcome was the incremental cost–effectiveness ratio (ICER), representing the incremental cost (in 2022 Chinese Yuan [CNY]) per incremental quality-adjusted life-year (QALY). The ICERs were compared against willingness-to-pay (WTP) thresholds of 1, 1.5 and 3-times the 2022 national gross domestic product (GDP) per capita in China. Results: Treatment with EmboTrap resulted in total QALYs of 3.28 and total costs of 110,058 CNY per patient. Treatment with Trevo resulted in total QALYs of 3.05 and total costs of 116,941 CNY per patient. Treatment with Solitaire resulted in total QALYs of 2.81 and total costs of 99,090 CNY per patient. Trevo was dominated by EmboTrap as it was a more costly and less effective intervention. As such, Trevo was not cost-effective at any WTP threshold. Compared with Solitaire, EmboTrap was more effective and more costly, with an ICER of 23,615 CNY per QALY. This result suggests that EmboTrap is cost-effective when compared with Solitaire since the ICER was lower than all WTP thresholds assessed. Conclusion: EmboTrap dominated Trevo and is cost-effective for the treatment of patients with AIS compared with Solitaire when assessed from the perspective of the Chinese healthcare system and based on the devicelevel meta-analysis MASTRO I. Selecting a stent retriever (SR) that optimizes 90-day mRS score is an important consideration from both a clinical and healthcare payer perspective in China as it is associated with reduced long-term costs and increased quality of life.

ObjectiveThis study aimed to determine whether brain volume at the time of ischemic stroke injury is a better biomarker for predicting functional outcomes than brain atrophy.BackgroundBrain parenchymal fraction (BPF) has been used as a surrogate measure of global brain atrophy and a neuroimaging biomarker of brain reserve in studies evaluating clinical outcomes after brain injury. Brain volume itself is affected by natural aging, cardiovascular risk factors, and biological sex, among other factors. Recent studies have shown that brain volume at the time of injury can influence functional outcomes, with larger brain volumes being associated with better outcomes.MethodsAcute ischemic stroke cases at a single center between 2003 and 2011, with neuroimaging obtained within 48 h of presentation were eligible for the study. Functional outcomes represented by the modified Rankin Scale (mRS) score at 90 days post-admission (mRS score ≤ 2 deemed a favorable outcome) were obtained through patient interviews or per chart review. Deep learning–enabled automated segmentation pipelines were used to calculate brain volume, intracranial volume, and BPF on the acute neuroimaging data. Patient outcomes were modeled through logistic regressions, and a model comparison was conducted using the Bayes information criterion (BIC).ResultsA total of 467 patients with arterial ischemic stroke were included in the analysis, with a median age of 65.8 years and 65.3% of the participants being male. In both models, age and a larger stroke lesion volume were associated with worse functional outcomes. Higher BPF and a larger brain volume were associated with favorable functional outcomes; however, a comparison of both models suggested that the brain volume model (BIC = 501) better explains the data than the BPF model (BIC = 511).ConclusionThe extent of global brain atrophy (and its surrogate biomarker BPF) has been regarded as an important biomarker for predicting functional post-stroke outcomes and resilience to acute injury. In this study, we demonstrate that a higher global brain volume at the time of injury better explains favorable functional outcomes, which can be directly measured in a clinical setting.

Introduction: Stroke is a leading cause of disability with devastating consequences. Serum albumin has emerged as a significant prognostic marker in various conditions, including stroke. This study aims to investigate the relationship between serum albumin levels and stroke severity and outcomes in patients with acute ischemic stroke (AIS). Methods: An observational, cross-sectional study was conducted over six months at Bir Hospital, among patients admitted in medicine ward. Total population sampling was done. Serum albumin at the time of diagnosis was measured. Ischemic stroke severity was scored based on NIHSS score on admission and the functional outcome was evaluated as modified Rankin Scale (mRS). Finally, correlation of serum albumin with the severity and the outcome of stroke (mRS) was made. Results: The study of 37 patients showed significant correlation between serum albumin and NIHS score. For high severity (NIHSS≥10), logistic regression analysis identified (OR: 0.086; 95% CI: 0.01-0.75, p-value 0.027) indicating there is strong association between serum albumin and NIHSS score (or severity). The study showed significant correlation between serum albumin and modified Rankin scale at the 0.01 level (2 tailed). The mean serum albumin level was 0.364 units higher (95% CI: 0.103 to 0.625) units higher in non-poor mRS score compared to poor mRS score. P-value of 0.003 suggested strong association between Serum albumin and mRS score. Conclusion: Significant correlation of serum albumin level with clinical severity at the time of admission and with the outcome during discharge was found. Thus serum albumin has prognostic significance in acute ischemic stroke.

Background and Purpose The accurate prediction of functional outcomes in patients with acute ischemic stroke (AIS) is crucial for informed clinical decision-making and optimal resource utilization. As such, this study aimed to construct an ensemble deep learning model that integrates multimodal imaging and clinical data to predict the 90-day functional outcomes after AIS. Methods We used data from the Korean Stroke Neuroimaging Initiative database, a prospective multicenter stroke registry to construct an ensemble model integrated individual 3D convolutional neural networks for diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR), along with a deep neural network for clinical data, to predict 90-day functional independence after AIS using a modified Rankin Scale (mRS) of 3–6. To evaluate the performance of the ensemble model, we compared the area under the curve (AUC) of the proposed method with that of individual models trained on each modality to identify patients with AIS with an mRS score of 3–6. Results Of the 2,606 patients with AIS, 993 (38.1%) achieved an mRS score of 3–6 at 90 days post-stroke. Our model achieved AUC values of 0.830 (standard cross-validation [CV]) and 0.779 (time-based CV), which significantly outperformed the other models relying on single modalities: b-value of 1,000 s/mm2 (P