Acute Cerebral Ischemic Stroke Research Articles

Automated diagnosis of acute cerebral ischemic stroke lesions from diffusion-weighted magnetic resonance images in assessment with modified Rankin Scale

Purpose: Automated diagnosis of acute cerebral ischemic stroke lesions (ACISL) is an evolving science. Early detection and exact delineation of ACISL automatically from diffusion-weighted magnetic resonance (DWMR) images are crucial for initiating prompt treatment. Thus, this work aims to determine the appropriate slice out of 60 pieces using multi-fractal analysis (MFA) and to segment the lesions in DWMR images using a hybrid optimization method. Features extracted from the segmented images were clinically correlated with the modified Rankin Scale (mRS). Methods: Thirty-one real-time stroke patients’ images were collected from Rajiv Gandhi Government General Hospital, Chennai, India. Multiple MRI slices were taken from each patient and filtered using an anisotropic diffusion filter (ADF). These filtered images were skull-stripped automatically by the maximum entropy thresholding technique incorporating mathematical morphological operations (MEM). The multi-fractal analysis (MFA) identifies the prominent slice with the significant infarct lesion. An isodata algorithm that integrated differential evolution with the particle swarm optimization method based on Kapur’s (IDPK) and Otsu’s (IDPO) approaches was attempted to segment the ACISL. Finally, the geometric and moment features extracted from the segmented lesions categorized the stroke severity and were correlated with the mRS. Results: The findings of the experimental work confirm that the suggested IDPK approach achieved usual normalized values for image similarity indices such as Sokal-Michener Coefficient (98.51%), Roger-Tanimoto Coefficient (90.16%), Sokel-Sneath-2 (91.04%), and Sorenson Index (90.04%) are superior to IDPO. Statistical significance proved that the segmented lesions’ area (r = 0.820, p < 0.0001) and perimeter (r = 0.928, p < 0.0001) were strongly correlated with the mild and moderate criteria of mRS. Conclusion: The proposed work effectively detected ischemic stroke lesions and their severity within the studied image groups. It could be a promising and potential tool to aid radiologists in validating their diagnosis.

Abstract TP40: Identification of Domain-Specific Cognitive Phenotypes of Post Stroke Vascular Contributions to Cognitive Impairment and Dementia

Introduction: Vascular contributions to cognitive impairment and dementia (VCID) are variably expressed following stroke. The purpose of this investigation is to identify the domain-specific cognitive phenotypes of VCID in the acute and sub-acute post-stroke interval measured using the Mark VCID battery. Methods: Mark VCID neurocognitive test battery was administered to 33 patients with incident ischemic stroke in the left (n=15), right (n=17), and bilateral (n=1) hemispheres including the anterior and middle cerebral artery territory, and 39 age and sex matched healthy controls (HC). Participants ranged in age from 42 to 88 years (Patient M=65.64 yrs, Control M=64.97 yrs). Patient group consisted of 17 males and 22 females, and the control group had 20 males and 13 females. Mean post stroke interval was 8 weeks (Range: 2.5 to 19 weeks). The test battery assessed: language (naming, fluency), perception (facial recognition, spatial orientation), psychomotor speed (digit symbol substitution), memory (word list, story recall), and attention (trails, number span). Normative test scores were converted to z-scores for assessment of between group differences using independent t-tests. Results: Patients with stroke performed significantly worse (p<0.05) than HCs on measures of language (semantic and phonemic fluency), perception (facial recognition and spatial orientation), and psychomotor speed (symbol digit modalities test) (Figure 1). There were no significant group differences in the scores of memory (Hopkins Verbal Learning, Craft Story) and attention tracking (Oral Trails A, Number Span). Conclusion: Cognitive abnormalities in these acute stoke patients represent impairments in diverse dominant (language) and non-dominant (perceptual/spatial) hemisphere cortical and subcortical (psychomotor speed) abilities. At the group level, the findings suggest a phenotype of VCID in patients with acute middle and anterior cerebral artery ischemic stroke.

A Life Threatening Bleeding Arteriovenous Malformation of the Maxilla Complicated with an Acute Cerebral Ischemic Stroke Recovered: Case Report and Review of Literature

Arteriovenous malformation (AVM) of the head and neck is a rare and potentially life-threatening entity due to massive hemorrhage, which poses a challenge to surgeons treating patients with these lesions. The head and neck region accounts for approximately 50% of all arteriovenous malformations (AVM), and the same region also accounts for about approximately 50% of intraosseous AVM in the maxillary facial region, which can be very dangerous, as a simple tooth extraction or a biopsy can lead to a major hemorrhage that may eventually cause death. The Treatment may be surgical or non-surgical. We present the case of a 27-year-old patient with an AVM of the maxilla complicated during his hospitalization for an acute cerebral ischemic stroke, from which he recovered.

Neglect scoring modifications in the National Institutes of Health Stroke Scale improve right hemisphere stroke lesion volume prediction.

The National Institutes of Health Stroke Scale (NIHSS) does not equitably assess stroke severity in the two cerebral hemispheres. By attributing a maximum of two points for neglect and seven for language, it undervalues right hemisphere deficits. We aimed to investigate if NIHSS equally predicts right hemisphere lesion volumes in patients with and without neglect, and if a modification of the neglect scoring rules could increase its predictive capacity. We analyzed a prospective cohort of acute right middle cerebral artery ischemic stroke patients. First, we calculated the correlation between NIHSS scores and lesion volume and analyzed the partial correlation of neglect. Then, we applied different modifications in the neglect scoring rules and investigated how they interfered with lesion volume predictive capacity. A total of 162 ischemic stroke patients were included, 108 with neglect and 54 without. The correlation between lesion volume and NIHSS was lower in patients with neglect (r = 0.540 vs. r = 0.219, p = 0.004) and neglect was a statistically significant covariate in the partial correlation analysis between NIHSS and lesion volume (p = 0.017). With the neglect score tripled and with the duplication or triplication of all neglect modalities, the correlation was significantly higher than with the standard NIHSS (p = 0.043, p = 0.005, p = 0.001, respectively). With these modifications, neglect was no longer a significant covariable in the partial correlation between lesion volume and NIHSS. A modification of NIHSS neglect scoring might improve the scale's capacity to predict lesion volume.

Sovateltide: First Approval.

Sovateltide (Tycamzzi™), a highly selective endothelin-B receptor agonist and synthetic analog of endothelin-1, is being developed by Pharmazz, Inc. as a neural progenitor cell therapeutic agent for the treatment of acute cerebral ischemic stroke (ACIS), hypoxic-ischemic encephalopathy (HIE), spinal cord injuries and Alzheimer's disease. In May 2023, sovateltide was approved in India for the treatment of cerebral ischemic stroke within 24 h of stroke onset. This article summarizes the milestones in the development of sovateltide leading to this first approval for use in patients with ACIS.

Mechanical Thrombectomy for Acute Ischemic Stroke in A Mekong Delta Medical University Hospital

Introduction: Mechanical thrombectomy has become more and more common in the treatment of acute cerebral ischemic stroke. We report our 3-year outcomes of mechanical thrombectomy for ischemic stroke.
 Method and subjects: A descriptive study was conducted cross-sectionally. Each patient with a National Institute of Health Stroke Scale (NIHSS) score of 10 or higher who presented to our hospital within eight hours of the onset of the first symptom would be considered. The mechanical thrombectomy procedure is performed with aspiration techniques or in combination with stent retrievers, with or without rescue angioplasty and stenting.
 Results: From January 1st, 2018, to December 31st, 2020 (36 months), a total of 53 patients were included. Forty-four (44) patients had thrombectomy only, and another 9 patients had thrombectomy with stenting. The total technical success rates were 47/53 (88.6%). The death rate was 15/53 (28.3%). There were 31/53 patients (58.4%) who had significant recovery in motor movement, language, and cognition within 2 months.
 Conclusion: Our revascularization rate of mechanical thrombectomy was 88.6% with 58.4% of patients showing improved outcomes.

Red blood cell distribution width combined with age as a predictor of acute ischemic stroke in stable COPD patients.

This retrospective study aimed to investigate the independent clinical variables associated with the onset of acute cerebral ischemic stroke (AIS) in patients with stable chronic obstructive pulmonary disease (COPD). A total of 244 patients with COPD who had not experienced a relapse within 6 months were included in this retrospective study. Of these, 94 patients hospitalized with AIS were enrolled in the study group, and the remaining 150 were enrolled in the control group. Clinical data and laboratory parameters were collected for both groups within 24 h after hospitalization, and the data of the two groups were statistically analyzed. The levels of age, white blood cell (WBC), neutrophil (NEUT), glucose (GLU), prothrombin time (PT), albumin (ALB), and red blood cell distribution width (RDW) were different in the two groups (P < 0.01). Logistic regression analysis showed that age, WBC, RDW, PT, and GLU were independent risk factors for the occurrence of AIS in patients with stable COPD. Age and RDW were selected as new predictors, and the receiver operating characteristic curves (ROC) were plotted accordingly. The areas under the ROC curves of age, RDW, and age + RDW were 0.7122, 0.7184, and 0.7852, respectively. The sensitivity was 60.5, 59.6, and 70.2%, and the specificity was 72.4, 86.0, and 60.0%, respectively. The combination of RDW and age in patients with stable COPD might be a potential predictor for the onset of AIS.

Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report

BackgroundSARS-CoV-19 infection is associated with an increased risk of thrombotic events. We present a case of acute middle cerebral artery ischemic stroke in a patient with SARS-CoV-19 infection despite being on warfarin with supratherapeutic INR (International Normalized Ratio).Case presentationA 68-year-old Caucasian female with multiple comorbidities was admitted to the hospital with symptoms of upper respiratory tract infection. A rapid antigen test confirmed the diagnosis of COVID-19 pneumonia, and intravenous remdesivir was initiated. On the fifth day of admission, the patient experienced sudden onset confusion, slurred speech, left-sided hemiplegia, right-sided eye deviation, and left-sided facial droop. Imaging studies revealed an occlusion of the distal anterior M2 segment of the right middle cerebral artery, and an MRI of the brain confirmed an acute right MCA infarction. Notably, the patient was receiving warfarin therapy with a supratherapeutic INR of 3.2.ConclusionsThis case report highlights the potential for thromboembolic events, including stroke, in patients with COVID-19 infection, even when receiving therapeutic anticoagulation therapy. Healthcare providers should be vigilant for signs of thrombosis in COVID-19 patients, particularly those with pre-existing risk factors. Further research is necessary to understand the pathophysiology and optimal management of thrombotic complications in COVID-19 patients.

Acute cerebral ischemic stroke as a presentation of polycythemia vera: a case report and a review of literature.

In the presenting study, we report a 60-year-old male patient who presented with a right-side weakness for 3 days. After laboratory and brain imaging, he was diagnosed with an acute cerebral infarct affecting the left basal ganglion secondary to PV. PV as the cause of ischemic stroke is a rare condition but can be encountered in clinical practice, and clinicians should be familiar with this combination.

Abstract 88: A Multicentric, Randomized, Controlled Phase III Study With Sovateltide (Tycamzzi™) Improving Outcomes In Patients With Acute Cerebral Ischemic Stroke

Sovateltide (Tycamzzi™), a selective endothelin-B receptor agonist, has antiapoptotic activity, protects neural mitochondria, and produces neurogenesis. It showed significant safety and efficacy in preclinical and clinical phase I and II studies. A prospective, multicentric, randomized phase III study was conducted in acute cerebral ischemic stroke (ACIS) patients aged 18 through 78 years. Patients with radiologic confirmation of ischemic stroke could be enrolled if presenting up to 24 hours with NIHSS score of greater than 5. Patients with intracranial hemorrhage and those receiving endovascular therapy were excluded. Sovateltide was administered in three doses, each dose of 0.3 μg/kg, as an intravenous bolus at an interval of 3 hours ± 1 hour on day 1, day 3, and day 6 (total dose/day: 0.9 μg/kg). The primary objectives were to determine the neurological outcome based on the mRS score, NIHSS score, and BI scale score from day 1 through day 90. A total of 158 patients with ACIS were enrolled, of which 137 completed a 90-day follow-up. Patients received saline (n=70, 62% male) or sovateltide (n=67, 66% male) at 16.85 ± 0.74 and 17.40 ± 0.67 hours (mean ± SEM) of stroke onset, respectively. The baseline characteristics and SOC in both cohorts were similar. ASPECTS mean value was similar in the control (7.44) and sovateltide (7.61) groups. A significantly greater number of patients in the sovateltide group had an improvement of mRS of ≥2 points (p=0.004) and NIHSS of ≥6 points (p=0.033) vs. baseline at 90 days of treatment. However, an improvement in BI (change of ≥40 points vs. baseline) missed significance (p=0.063). At 90 days, mRS (p=0.007) and NIHSS (p=0.003) were significantly lower, while BI (p=0.011) and EuroQol-EQ-5D (p=0.0055) were significantly higher in the sovateltide compared to the control group. Sovateltide is safe, well-tolerated, and significantly improved neurological outcomes in ACIS patients and may prove to be a novel, effective agent for its treatment.

Abstract WP190: Central Retinal Artery Occlusion: Do Patient Presentation Patterns Complicate Use Of Potential Treatments?

Introduction: For patients diagnosed with central retinal artery occlusion (CRAO), timely screening for underlying risk factors to prevent secondary stroke and other cardiovascular events is required. Given the profound impact on vision, there is also great interest in the potential to treat CRAO. Thrombolytic therapy is the current standard of care in acute ischemic cerebral stroke, but the window for administration is short. As part of a larger pilot to investigate the prospect of intravenous thrombolysis for patients presenting with acute CRAO in our institution, we set out to evaluate the specific presentation patterns of this population within our system. Methods: Retrospective study performed on 804 patients correctly diagnosed with CRAO from 2011-2020. From this cohort of patients, we identified 484 for whom we could accurately determine the time of first symptoms, the time of first contact with the healthcare system, and the time of evaluation by an ophthalmologist. Results: While 18.0% (87/484) of patients waited over 24 hours from time of vision loss to contact the health care system, 50.2% of patients did connect in under 4.5 hours (243/484). However, only 16.7% (81/484) of patients saw an ophthalmologist within that window, and 35.5% (172/484) did not have any ophthalmologic evaluation within 24 hours of vision loss. Conclusion: Half of CRAO patients within our institution connect with the health care system within a potential window for intravenous thrombolytic treatment, but the majority do not receive ophthalmic diagnosis within that time frame. In conclusion, public health education efforts to speed up presentation times and system-based strategies to decrease the time to ophthalmic diagnosis are needed if thrombolytic treatment either via compassionate use or within a clinical trial setting is to be more widely offered.

529: SOVATELTIDE (TYCAMZZI) IN PATIENTS WITH CEREBRAL ISCHEMIC STROKE: A RANDOMIZED MULTICENTER STUDY

Introduction: Sovateltide (Tycamzzi™) is a novel first-in-class ETB receptor agonist and a synthetic analog of endothelin-1, which promotes neuroprotection, neuroregeneration, and neurovascular remodeling following CNS damage. Methods: A phase III, prospective, multicentric, randomized study was conducted in acute cerebral ischemic stroke (ACIS) patients 18 through 78 years of age. Following radiologic confirmation of ischemic stroke, patients could be enrolled with NIHSS score greater than 5. Excluded were patients with intracranial hemorrhage and those receiving endovascular therapy. Sovateltide was administered in three doses, each dose of 0.3 μg/kg, as an intravenous bolus at an interval of 3 hours ± 1 hour on day 1, day 3, and day 6 (total dose/day: 0.9 µg/kg). The primary objectives were to determine the neurological outcome based on the modified Rankin Scale (mRS) score, National Institute of Health Stroke Scale (NIHSS) score, and Barthel Index (BI) scale score from day 1 through day 90. Results: A significantly (p=0.004) greater number of patients in the sovateltide group (76.1%) had an improvement of mRS of ≥2 points from the baseline compared to the control group (52.8%) at 90 days of treatment. The scores on the mRS at 90 days show an ordinal shift that highly favors sovateltide therapy (56% in control vs. 81% in sovateltide shift in mRS range 0-2). The median score (IQR) of the NIHSS scale at 90 days was 3 (0 to 6) in the control and 1 (0 to 3) in the sovateltide group (p=0.003). An improvement of NIHSS of ≥6 points vs. baseline at 90 days of treatment was significant (p=0.033) in sovateltide (80.6%) compared to the control (64.2%) group. The median score (IQR) of the BI scale at 90 days was 85 (60 to 100) in control and 95 (80 to 100) in the sovateltide group (p=0.01). The number needed to treat (NNT) patients (having mRS of 2 or less at 90 days) with sovateltide was 5 (95% CI 2.6 to 12.2). All-cause mortality was 2.56% in the control and 5.00% in the sovateltide group. Conclusions: Sovateltide demonstrated a statistically significant and clinically meaningful improvement in neurological outcomes in patients with ACIS compared to the standard of care. In addition, sovateltide produced a remarkable ordinal shift in the mRS across the range at day 90 post-randomization.

Diffuse optical detection of global cerebral ischemia in an adult porcine model.

Rapid screening for ischemic strokes in prehospital settings may improve patient outcomes by allowing early deployment of vascular recanalization therapies. However, there are no low-cost and convenient methods that can assess ischemic strokes in such a setting. Diffuse correlation spectroscopy (DCS) is a promising method for continuous, noninvasive transcranial monitoring of cerebral blood flow. In this study, we used a DCS system to detect cerebral hemodynamics before and after acute ischemic stroke in pigs. Seven adult porcines were chosen to establish ischemic stroke models via bilateral common carotid artery ligation (n=5) or air emboli (n=2). The results showed a significant difference in blood flow index (BFI) between the normal and ischemic groups. Relative blood flow index (rBFI) exhibited excellent results. Therefore, the diffuse optical method can assess the hemodynamic changes in acute cerebral ischemic stroke onset in pigs, and rBFI may be a promising biomarker for identifying cerebral ischemic stroke.

Psychosocial Considerations in Management of Corticobasal Degeneration in Indian American Population

AbstractBackgroundCorticobasal degeneration (CBD) is a neurodegenerative tauopathy primarily affecting the cerebral cortex and basal ganglia, often featuring cognitive decline and parkinsonism. With no proven treatments for this rare condition, the goals of management are to improve patients' quality of life. We evaluate here the unique psychosocial factors that were considered for two women of Asian Indian descent with CBD.MethodPatient 1 was a 77‐year‐old woman who exhibited short‐term memory loss, and then suffered an acute left anterior cerebral artery territory ischemic stroke with right‐sided hemiparesis and neurogenic pain. MRI Brain confirmed the stroke’s location, but did not account for cognitive decline. Patient 2 was a 75‐year‐old woman who initially experienced dysphagia, and then developed right‐sided hemiparesis, right neck spasms, unstable gait, and short‐term memory loss. MRI Brain and Cervical Spine revealed only showed mild chronic microvascular changes and multilevel cervical spondylosis.ResultsPET‐FDG Brain studies were performed for both patients. Patient 1’s study revealed severe hypometabolism affecting bilateral basal ganglia, bilateral thalami, and left supplementary motor cortex, out of proportion to the known stroke and consistent with CBD. Patient 2’s study revealed mild hypometabolism at the left frontal and parietal lobes, sparing the precuneus and posterior cingulate, also consistent with CBD and helping to explain the right‐sided hemiparesis.ConclusionVarious psychosocial factors were considered during the evaluation and management for both patients. Both had limited English proficiency, so cognitive testing was performed with the aid of a medical interpreter to ensure accurate results. Symptomatic treatment was tailored for each patient: Patient 1 received carbidopa/levodopa for parkinsonian tremors, and Patient 2 received cyclobenzaprine for intermittent muscle spasms. Both patients had multigenerational households, and results and prognoses were discussed with multiple relatives so they could coordinate responsibilities. Both families initially resisted recommendations to have home health aides, expressing their cultural belief that families should take care of their relatives on their own. As we discussed this belief over time, and explained the expected progression of symptoms over time, both families came to be more accepting of introducing home health aides, seeing them as a supplement, and not a replacement, for the family’s role.

ENDOVASCULAR INTERVENTION FOR ACUTE ISCHEMIC STROKE AT CAN THO UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Introduction: Acute cerebral ischemic stroke is a life-threatening emergency with high incidence of mortality and morbidity. Endovascular revascularization has been increasingly used as one of the treatment options. In this article, we report our outcomes of endovascular intervention for the treatment of ischemic stroke and highlight some technical experiences. Materials and methods: A cross-sectional descriptive study was conducted on all cerebral ischemic stroke patients who came to Can Tho University of Medicine and Pharmacy Hospital within 8 hours from the first symptom would be included. National Institute of health stroke (NIHSS) scale was used for stroke grading which should be 10 or above. The vascularization procedure would be performed with the thrombus aspiration systems or stent retrievers with or without angioplasty and stenting. Postprocedure care would be conducted for at least 2 weeks before discharge. Results: A total of 53 patients were recruited from 1st of January 2018 to 30th December 2020 (24 months). Male to female ratio was 1.54:1. Ages ranged from 38 to 90 (mean 64). NIHSS scores ranged from 12-25. Approximately 98% of patients had comorbidities with hypertension, diabetes, atrial fibrillation , mitral valve stenosis and valvular insufficiency, A-V block. Totally there were 44 patients experiencing thrombectomy with catheter-based distal aspiration (35), stent retrievers (03), aspiration and stent retriever combination (06). The total technical success rates for all procedures were 47/53 (88.6%)). The total death rate was 15/53 (28.3%) due to combining comorbiditiese. There were 31/53 patients (58.4%) who had significant recovered in muscle movement, language and cognition after 2 weeks. Conclusion: Endovascular intervention is a one of the good options for the management of acute ischemic stroke, which has a high revascularization rate (88.6%) and can save up to 58.4% of patients out of disability. Successful revascularization is the crucial first step to salvage the patients and obtain a better prognosis.

Impact of coronavirus infection on asthenic syndrome in patients with ischemic stroke

It is known that the presence of asthenic syndrome is characteristic of ischemic brain damage. At the same time, patients with acute cerebral ischemic stroke, who have been diagnosed with a laboratory-confirmed coronavirus infection with a mild and asymptomatic course without signs of damage to other organs, are of particular interest. The aim of the research was to identify and study the severity and duration of asthenic syndrome in patients with ischemic stroke under conditions of the coronavirus infection in order to determine the effect of asthenia on the quality of life in the post-COVID period. The subjects were patients with acute cerebral ischemic stroke with the NIHSS neurological deficit score of 12.0 [9.0;15.0], whose mean age was 58.82±3.29 years [Me=54; Mo=60.0]. The main group (38 people) included patients with laboratory-confirmed coronavirus infection without signs of damage to other organs; the comparison group (31 people) consisted of patients with AMI only, comparable to the main group in all respects, including the set of vascular risk factors. All patients underwent a clinical and neurological examination, an examination by a general practitioner and / or a cardiologist, CT using an angio mode, the MFI-20 questionnaire, A. M. Wein questionnaire, Spielberger and Khanin scale. Quality of life was assessed using a short version of the MOS SF-36‑ltem questionnaire. Statistical analysis of the obtained results was carried out via statistical programs Microsoft Office Excel 2007 (USA) and Statistica for Windows, v. 10.0. It has been established that the coronavirus infection aggravates the course of asthenic syndrome in patients with acute ischemic stroke, has a long-term effect on the recovery process, remains relevant in the post-COVID period, and is accompanied by anxiety and vegetative disorders. Organic symptomatic asthenia largely determines the course of the pathological process, affecting the general condition, performance, social adaptation and, as a result, the quality of life of the patient.

Research hotspots and trends of multimodality MRI on vascular cognitive impairment in recent 12 years: A bibliometric analysis.

Background:Multimodality magnetic resonance imaging (MRI) is widely used to detect vascular cognitive impairment (VCI). However, a bibliometric analysis of this issue remains unknown. Therefore, this study aimed to explore the research hotspots and trends of multimodality MRI on VCI over the past 12 years based on the Web of Science core collection using CiteSpace Software (6.1R2).Methods:Literature related to multimodality MRI for VCI from 2010 to 2021 was identified and analyzed from the Web of Science core collection database. We analyzed the countries, institutions, authors, cited journals, references, keyword bursts, and clusters using CiteSpace.Results:In total, 587 peer-reviewed documents were retrieved, and the annual number of publications showed an exponential growth trend over the past 12 years. The most productive country was the USA, with 182 articles, followed by China with 134 papers. The top 3 active academic institutions were Capital Medical University, Radboud UNIV Nijmegen, and UNIV Toronto. The most productive journal was the Journal of Alzheimer’s Disease (33 articles). The most co-cited journal was Neurology, with the highest citations (492) and the highest intermediary centrality (0.14). The top-ranked publishing author was De Leeuw FE (17 articles) with the highest intermediary centrality of 0.04. Ward Law JM was the most cited author (123 citations) and Salat Dh was the most centrally cited author (0.24). The research hotspots of multimodal MRI for VCI include Alzheimer disease, vascular cognitive impairment, white matter intensity, cerebrovascular disease, dementia, mild cognitive impairment, neurovascular coupling, acute ischemic stroke, depression, and cerebral ischemic stroke. The main frontiers in the keywords are fMRI, vascular coupling, and cerebral ischemic stroke, and current research trends include impact, decline, and classification.Conclusions:The findings from this bibliometric study provide research hotspots and trends for multimodality MRI for VCI over the past 12 years, which may help researchers identify hotspots and explore cutting-edge trends in this field.

Upregulated lncRNA NORAD can diagnose acute cerebral ischemic stroke patients and predict poor prognosis.

Acute cerebral ischemic stroke (AIS) dramatically influences patients' quality of life. lncRNA NORAD (NORAD) has been studied in cerebrovascular diseases, which are potential risk factors for AIS. The specific significance of NORAD is unclear. This study aimed to assess the role of NORAD in AIS, and to provide therapeutic value for its' treatment. A total of 103 AIS patients and 95 healthy individuals (control) were enrolled into this study. Expression level of NORAD in the plasma of all participants was analyzed by PCR. Diagnostic potential of NORAD in AIS was evaluated by ROC analysis, while Kaplan-Meier and Cox regression analyses were conducted to assess its' prognostic value in AIS. A significantly increased level of NORAD was observed in AIS patients compared with healthy individuals. The upregulation of NORAD could dramatically discriminate AIS patients from healthy individuals with high sensitivity (81.60%) and specificity (88.40%). NORAD was positively correlated with patients' high-sensitivity C-reactive protein (hs CRP, r = 0.796), matrix metalloproteinase-9 (MMP9, r = 0.757), and NIHSS scores ( r = 0.840), and negatively related to pc-ASPECTS scores ( r = -0.607). Moreover, NORAD upregulation was associated with patients' unfavorable prognosis and served as an independent prognostic biomarker, together with NIHSS and pc-ASPECTS scores of AIS patients. NORAD was upregulated in AIS, which can discriminate AIS patients, and was closely correlated with severe development and poor prognosis of patients.

Neurological Manifestations and Mortality in Hospitalized Coronavirus Disease 2019 Patients

Purpose: The purpose of the study is to analyze the neurological manifestations and to determine the association between these symptoms and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and Methods: Five hundred and forty-seven hospitalized patients with positive reverse transcriptase-polymerase chain reaction tests for severe acute respiratory syndrome coronavirus in a nasopharyngeal swab were included in this study. The demographic features, laboratory data, and radiologic imaging, neurological symptoms of hospitalized patients with COVID-19 were collected. Results: Of 547 hospitalized COVID-19 patients, the median age was 61 (range 18–93), 61.4% were male. Three hundred and forty-seven (63.4%) patients had a severe infection and 200 (36.6%) patients had a mild infection. Eighty-eight patients (16.1%) died during hospitalization. One hundred and fifty-four (28.2%) patients had at least one neurological symptom. Thirty-five (6.4%) patients manifested with only neurological symptoms at hospital admission. The most frequent neurological symptoms were headache (15.2%), taste and smell disorders (9.1%), and myalgia (6.6%). The other initial neurological manifestations were acute cerebral ischemic stroke, impaired consciousness, epileptic seizure, and posterior reversible encephalopathy. The late-onset neurological complications were autoimmune encephalitis and Guillain-Barre syndrome. The neurological manifestation was linked to the severity of disease (P = 0.005) but not correlated with mortality (P = 0.137). Conclusion: Neurological symptoms were frequent in COVID-19 patients. The neurological symptoms can be the initial symptoms or can be late-onset complications of COVID-19.

Bioactive Flavonoids Icaritin and Icariin Protect against Cerebral Ischemia-Reperfusion-Associated Apoptosis and Extracellular Matrix Accumulation in an Ischemic Stroke Mouse Model.

Stroke, which is the second leading cause of mortality in the world, is urgently needed to explore the medical strategies for ischemic stroke treatment. Both icariin (ICA) and icaritin (ICT) are the major active flavonoids extracted from Herba epimedii that have been regarded as the neuroprotective agents in disease models. In this study, we aimed to investigate and compare the neuroprotective effects of ICA and ICT in a middle cerebral artery occlusion (MCAO) mouse model. Male ICR mice were pretreated with both ICA and ICT, which ameliorated body weight loss, neurological injury, infarct volume, and pathological change in acute ischemic stroke mice. Furthermore, administration of both ICA and ICT could also protect against neuronal cell apoptotic death, oxidative and nitrosative stress, lipid peroxidation, and extracellular matrix (ECM) accumulation in the brains. The neuroprotective effects of ICT are slightly better than that of ICA in acute cerebral ischemic stroke mice. These results suggest that pretreatment with both ICA and ICT improves the neuronal cell apoptosis and responses of oxidative/nitrosative stress and counteracts the ECM accumulation in the brains of acute cerebral ischemic stroke mice. Both ICA and ICT treatment may serve as a useful therapeutic strategy for acute ischemic stroke.