Acute Cerebrovascular Disease Research Articles

#2183 Does thrombotic microangiopathy drive the occurrence and pattern of cerebrovascular disease in malignant hypertension?

Abstract Background and Aims Malignant hypertension (MHT) is characterized by diffuse microvascular damage caused by severe hypertension, often presenting with multiple organ involvement. Cerebrovascular injury, occurring in both acute and chronic forms, stands as a hallmark of the disease, being identified in up to half of patients. Thrombotic microangiopathy (TMA), defined as the association of mechanical hemolytic anemia with thrombocytopenia, also emerges as a frequent complication in MHT patients. However, the potential contribution of TMA to cerebrovascular disease remains unexplored. The secondary objective of this study was to provide a comprehensive description of the patterns of cerebrovascular injury occurring in MHT, with a focus on acute ischemic strokes (AIS). Method We retrospectively assessed the brain MRI of patients admitted to the kidney intensive care unit at Tenon hospital for malignant hypertension during the 2017-2023 period. Brain MRIs were performed on a systematic basis regardless of neurological symptoms and were independently reviewed by two trained specialists in a blinded fashion. Patterns of acute cerebrovascular disease, defined as AIS, intracerebral hematoma (ICH) or posterior reversible encephalopathy syndrome (PRES), were systematically assessed. Number of AIS lesions, their size and localization were recorded. Underlying chronic cerebral small vessel disease (CSVD) was defined as presence of lacunes, white matter hyperintensities, cerebral microbleeds or perivascular spaces. Severity of the chronic cerebrovascular disease was measured using a validated CSVD score. Results A total of 60 patients were admitted for malignant hypertension, with a mean age of 42.9 years. 40 patients (66.7%) presented with severe acute kidney injury. Cerebrovascular disease, either acute or chronic, was found in 42 patients (70.0%). Underlying chronic CSVD was present in 33 patients (55.0%). Acute patterns of injury occurred in 27 patients (45.0%). AIS was the most frequent (33.3%), followed by PRES (21.7%). Only one patient presented with ICH. Among patients with AIS, 14 (70%) presented with multiple simultaneous lesions. Of note, most patients with AIS exhibited diffuse encephalopathy syndrome (60.0%) rather than focal deficit (40.0%). Systemic TMA was present at admission in 34 patients (56.7%). In an exploratory data analysis, presence of AIS on brain MRI was associated with the presence of underlying CVSD (p = 0.013), but not with the presence of TMA at admission (p = 0.79). No association was found between TMA and PRES (p = 0.22). Conclusion Our study confirmed the high incidence of cerebrovascular disease during MHT. Most notably, 1 in 3 patients presented with AIS. TMA did not appear to increase the incidence nor to influence the pattern of brain injury.

The influence of diagnostic subgroups, patient- and hospital characteristics for the validity of cardiovascular diagnoses-Data from a Norwegian hospital trust.

Cardiovascular discharge diagnoses may serve as endpoints in epidemiological studies if they have a high validity. Aim was to study if diagnoses-specific characteristics like type, sub-categories, and position of cardiovascular diagnoses affected diagnostic accuracy. Patients (n = 7,164) with a discharge diagnosis of acute myocardial infarction, heart failure or cerebrovascular disease were included. Data were presented as positive predictive values (PPV) and sensitivity. PPV was high (≥88%) for acute myocardial infarction (n = 2,189) (except for outpatients). For heart failure (n = 4,026) PPV was 67% overall, but higher (>99%) when etiology or echocardiography was included. For hemorrhagic (n = 257) and ischemic (n = 1,034) strokes PPVs were 87% and 80%, respectively, with sensitivity of 79% and 75%. Transient ischemic attacks (n = 926) had PPV 56%, but sensitivity 86%. Primary diagnoses showed higher validity than subsequent diagnoses and inpatient diagnoses were more valid than outpatient diagnoses (except for transient ischemic attack). The diagnoses of acute myocardial infarction and heart failure where most valid when placed at cardiology units, while ischemic stroke when discharged from an internal medicine unit. The diagnoses of acute myocardial infarction and stroke had excellent validity when placed during hospital stays. Similarly, heart failure diagnoses had excellent validity when echocardiography was performed before placing the diagnosis, while overall the diagnoses of heart failure and transient ischemic attack were less valid. In conclusion, the results indicate that cardiovascular diagnoses based on objective findings such as acute myocardial infarction and stroke have excellent validity and may be used as endpoints in clinical epidemiological studies with less rigid validation.

Influencing factors of corticomuscular coherence in stroke patients.

Stroke, also known as cerebrovascular accident, is an acute cerebrovascular disease with a high incidence, disability rate, and mortality. It can disrupt the interaction between the cerebral cortex and external muscles. Corticomuscular coherence (CMC) is a common and useful method for studying how the cerebral cortex controls muscle activity. CMC can expose functional connections between the cortex and muscle, reflecting the information flow in the motor system. Afferent feedback related to CMC can reveal these functional connections. This paper aims to investigate the factors influencing CMC in stroke patients and provide a comprehensive summary and analysis of the current research in this area. This paper begins by discussing the impact of stroke and the significance of CMC in stroke patients. It then proceeds to elaborate on the mechanism of CMC and its defining formula. Next, the impacts of various factors on CMC in stroke patients were discussed individually. Lastly, this paper addresses current challenges and future prospects for CMC.

Asymmetric and symmetric dimethylarginine as markers of endothelial dysfunction in cerebrovascular disease: A prospective study

Background and aimAsymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) have been proposed as mediators of endothelial dysfunction. In this study, we aimed to investigate the diagnostic and prognostic role of ADMA and SDMA in acute cerebrovascular disease. Methods and resultsA prospective case-control study was performed, enrolling 48 patients affected by ischemic stroke with no cardioembolic origin, 20 patients affected by TIA, 40 subjects at high cardiovascular risk and 68 healthy subjects.ADMA levels were significantly lower in high-risk subjects (18.85 [11.78–22.83] μmol/L) than in patients with brain ischemic event, both transient (25.70 [13.15–40.20] μmol/L; p = 0.032) and permanent (24.50 [18.0–41.33] μmol/L; p = 0.001). SDMA levels were different not only between high-risk subjects and ischemic patients, but also between TIA and stroke patients, reaching higher levels in TIA group and lower levels in stroke group (1.15 [0.90–2.0] vs 0.68 [0.30–1.07] μmol/L; p < 0.001). SDMA was also correlated with short-term prognosis, with lower levels in case of adverse clinical course, evaluated by type of discharge (p = 0.009) and need of prolonged rehabilitation (p = 0.042). ConclusionsThe present study highlights the relationship between l-arginine, ADMA, SDMA and acute cerebrovascular events. Therefore, our results suggested a potential role of SDMA as a specific marker of transient ischemic damage and as a short-term positive prognostic marker.

The Economic Burden of Epstein–Barr Virus Infection in the Russian Federation

Introduction: Epstein–Barr virus-related diseases are of great medical and social importance, which requires assessment of economic losses due to costs of medical care and sickness absenteeism. Objective: To propose a methodology for assessing economic damage and to use it for quantification of total damages caused by Epstein–Barr virus (EBV) infections in the Russian Federation in 2022. Materials and methods: The economic damage from EBV infections was determined using official statistics on cases of infectious mononucleosis (2022), upper respiratory tract infections, cardiac arrhythmias, atopic dermatitis, dorsopathy, chronic tonsillitis in the acute phase, cerebrovascular disease, psoriasis, and multisystem inflammatory syndrome associated with COVID-19. Results: Based on the methodology for assessing economic damages described in the article, we found that the total financial losses from EBV-associated diseases in the Russian Federation in 2022 amounted to 1,203.0 billion or 1.2 trillion rubles, which is significantly higher than similar values for all other registered infectious diseases with the exception of COVID-19. COVID-19-related multisystem inflammatory syndrome, upper respiratory tract infections, and cerebrovascular disease account for more than 90 % of all losses. The structure of total costs is dominated by indirect economic losses (1,096.75 billion rubles or 91.2 %) due to sickness absence from work. Conclusion: The findings allow us to outline directions of developing measures to reduce the economic damage from EBV-associated diseases.

Medium-intensity statin with ezetimibe versus high-intensity statin in acute ischemic cerebrovascular disease (MESIA): A randomized clinical trial

BackgroundHigh-risk stroke patients are recommended to receive high-intensity statin therapy to reduce the risk of stroke recurrence. However, doubling the dosage of statin drugs did not increase the achievement rate of LDL-C target or provide additional clinical benefits, but significantly increased the risk of adverse reactions. Statins and ezetimibe work through different mechanisms and the combined use of statins and ezetimibe significantly improves outcomes with comparable safety profiles. We tested the hypothesis that moderate-intensity statin with ezetimibe may offer advantages over the conventional high-intensity statin regimen in terms of efficacy and safety. MethodsWe conducted a randomized controlled trial. Eligible participants were aged 18 years or older with acute ischemic cerebrovascular disease. We randomly assigned (1:1) participants within the acute phase of ischemic stroke, i.e., within 1 week after the onset of mild ischemic stroke (NIHSS score ≤ 5), within 1 month for severe cases (NIHSS score ≥ 16), and within 2 weeks for the rest, as well as patients with TIA within 1 week of symptom onset, to receive either moderate-intensity statin with ezetimibe (either 10–20 mg atorvastatin calcium tablets plus a 10 mg ezetimibe tablet, or 5–10 mg rosuvastatin calcium tablets once per day plus a 10 mg ezetimibe tablet once per day) or high-intensity statin (40 mg atorvastatin calcium tablets or 20 mg rosuvastatin calcium tablets once per day) for 3 months. Randomization was performed using a random number table method. The primary efficacy outcome was the level and achievement rate of LDL-C after 3 months of treatment, specifically LDL-C ≤ 1.8 mmol/L or a reduction in LDL-C ≥ 50 %. The secondary outcome was the incidence of new stroke or transient ischemic attack (TIA) within 3 months. The safety outcome was liver and renal function tests, and the occurrence of statin-related muscle events within 3 months. FindingsThis trial took place between March 15, 2022, and March 7, 2023. Among 382 patients screened, 150 patients were randomly assigned to receive either medium-intensity statins with ezetimibe (n = 75) or high-intensity statins (n = 75). Median age was 60.0 years (IQR 52.75-70.25); 49 (36.6 %) were women and 85 (63.4 %) were men. The target achievement of LDL-C at 3 months occurred in 62 (89.86 %) of 69 patients in the medium-intensity statin with ezetimibe group and 46 (70.77 %) of 65 patients in the high-intensity statin group (P=0.005, OR=0.273, 95 % CI: 0.106, 0.705). The reduction magnitude of LDL-C in moderate-intensity statin with ezetimibe group was significantly higher (-56.540 % vs -47.995 %, P=0.001). Moderate-intensity statin with ezetimibe group showing a trend of a greater reduction in LDL-C absolute value than high-intensity statin group but without statistical significance (-1.77±0.90 vs -1.50±0.89, P=0.077). New AIS or TIA within 3 months, liver and renal function tests, and the occurrence of statin-related muscle events within 3 months were also statistically insignificant. Multivariate logistic regression analysis showed that both gender and lipid-lowering regimen as independent risk factors influencing the rate of LDL-C achievement in individuals diagnosed with acute ischemic cerebrovascular disease, but only lipid-lowering regimen had predictive value. InterpretationCompared to guideline-recommended high-intensity statin therapy, moderate-intensity statin with ezetimibe further improved the achievement rate of LDL-C in patients with acute ischemic cerebrovascular disease, with a higher reduction magnitude in LDL-C. In terms of safety, there was no significant difference between the two regimens, suggesting that moderate-intensity statin with ezetimibe can also be considered as an initial treatment option for patients with acute ischemic cerebrovascular disease.

Patient experiences on the quality of cerebrovascular diseases counselling using digital solutions in hospital-A qualitative research study.

To describe patients' experiences of the quality of counselling to develop new digital counselling solutions for patients with cerebrovascular disease. A descriptive, qualitative approach. Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and treated as inpatients at a single university hospital in Finland between September 2021 and February 2022. Data were analysed using deductive and inductive content analysis. The identified facilitators, barriers and possible solutions for the development of new digital counselling solutions were deductively categorized into five main categories: (1) background factors, (2) resources, (3) implementation, (4) sufficiency, and (5) effects and 12 generic categories. Patients with cerebrovascular diseases worry about symptoms affecting their ability to receive information and valued a supportive atmosphere. Staff should have more time for counselling and use motivational digital counselling solutions in plain language, moderate length and with multimedia content. Patients desired reminders, easy search functions and possibilities for two-way communication. New digital counselling solutions could be beneficial in supporting the patients' knowledge, emotions and adherence. For the success of such solutions, patients' special needs concerning different levels of cognitive impairment need to be considered. The results of this study may benefit healthcare organizations in the development of digital counselling solutions that meet the patients' needs. We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. Patients were involved as the study population.

Abstract 91: Patients With Intracranial Hemorrhage Have Greater Post-Stroke Mood Disturbance Than Those With Ischemic Stroke

Background: Patients with stroke frequently suffer from post-stroke mood disturbances (PSMD) which decrease their quality of life. It remains unclear whether the prevalence of PSMD differs according to stroke subtype. The aim of our study was to investigate PSMD incidence among stroke subtypes in the large, prospective Field Administration of Stroke Therapy - Magnesium (FAST-MAG) Trial. Methods: In the publicly-available FAST-MAG database, we identified all patients with imaging-confirmed diagnoses of ischemic stroke (IS), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH). Data on age, sex, NIHSS at presentation, stroke subtypes, and Stroke Impact Scale (SIS) 64 v3.0 at 90 days were collected. Differences in SIS Emotion Domain scores between IS, TIA, and ICH were assessed using the Mann-Witney U Test. Results: SIS Emotion Domain scores were available in 1239/1370 (90.4%) of patients. Mean age was 68.7 years (SD 13.4), and 41% were female. Median NIHSS was 7.0 (IQR 3-14). 65.3% had IS, 14.3% TIA, and 20.3% ICH. The preponderance of SIS-64 scores were patient-reported (86%) with the remainder completed by a patient proxy (14%). Emotion domain scores at 3 months were: lowest (most abnormal) in ICH patients (median 77.8, IQR 58.3-88.9); intermediate in IS patients (median 83.3, IQR 66.7-94.4); and highest in TIA patients (median 88.9, IQR 72.2-97.2), p&lt;.01) (Figure). Neither age nor sex were strongly associated, but more abnormal mood scores were associated with greater presenting deficit severity (NIHSS 0-4: median SIS-64 mood score 88.9; NIHSS 5-14: 81.3; NIHSS ≥15: 75.0; Spearman’s rho: -0.30, p&lt;.01). Conclusions: In this prospective study of a large population with broad enrollment criteria, mood disturbances at 90 days were most common among ICH patients and least common among TIA patients. Further work should investigate the driving factors of greater PSMD in patients with ICH compared to other patients with acute cerebrovascular disease.

Electroencephalogram findings in 10 patients with post-stroke epilepsy: A retrospective study.

Post-stroke epilepsy is a common and easily overlooked complication of acute cerebrovascular disease. Long-term seizures can seriously affect the prognosis and quality of life of patients. Electroencephalogram (EEG) is the simplest way to diagnose epilepsy, and plays an important role in predicting seizures and guiding medication. To explore the EEG characteristics of patients with post-stroke epilepsy and improve the detection rate of inter-seizure epileptiform discharges. From January 2017 to June 2020, 10 patients with post-stroke epilepsy in our hospital were included. The clinical, imaging, and EEG characteristics were collected. The stroke location, seizure type, and ictal and interictal EEG manifestations of the patients with post-stroke epilepsy were then retrospectively analyzed. In all 10 patients, epileptiform waves occurred in the side opposite to the stroke lesion during the interictal stage; these manifested as sharp wave, sharp-wave complex, or spike discharges in the anterior head lead of the side opposite to the lesion. In EEG, epileptiform waves can occur in the side opposite to the stroke lesion in patients with post-stroke epilepsy.

Challenges and needs in cerebrovascular disease pathway: A qualitative descriptive study from the patients' and healthcare professionals' perspectives.

To understand patients' and healthcare professionals' experiences to improve care in and across different domains of the cerebrovascular disease pathway. A qualitative descriptive study. Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and 26 healthcare professionals taking care of them in a single tertiary-level hospital from August 2021 to March 2022. Data were analysed using deductive and inductive content analysis. The consolidated criteria for reporting qualitative research was used to ensure reliable reporting. Overall, 19 generic and 79 sub-categories describing perceived challenges with 17 generic and 62 sub-categories describing perceived needs were identified related to primary prevention, organization of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment, and life after stroke. Several challenges and needs were identified in and across the different domains of the cerebrovascular disease pathway. There is a requirement for adequate resources, early initiation of treatment, early diagnostics and recanalization, dedicated rehabilitation services, long-term counselling and support, and impact evaluation of services to improve cerebrovascular disease care. Future research on caregivers', and clinical leadership experiences in and across the cerebrovascular disease pathway is needed to explore the provision of services. The results of this study can be applied by organizations, managers and research for developing and improving services in the cerebrovascular disease pathway. This study identified several patient-related, organizational and logistical needs and challenges, with suggestions for required actions, that can benefit the provision of effective, high-quality cerebrovascular disease care. We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. No patient or public involvement.

Retracted: Clinical Effect of Digital Subtraction Angiography Combined with Neurointerventional Thrombolysis for Acute Ischemic Cerebrovascular Disease and Its Influence on Vascular Endothelial Function and Oxidative Stress.

[This retracts the article DOI: 10.1155/2022/2777865.].

Dual-modality probe nanodrug delivery systems with ROS-sensitivity for atherosclerosis diagnosis and therapy.

Most acute cardiovascular and cerebrovascular diseases are caused by atherosclerotic plaque rupture leading to blocked arteries. Targeted nanodelivery systems deliver imaging agents or drugs to target sites for diagnostic imaging or the treatment of various diseases, providing new insights for the detection and treatment of atherosclerosis. Based on the pathological characteristics of atherosclerosis, a hydrogen peroxide-sensitive bimodal probe PPIS@FC with integrated diagnosis and treatment function was designed. Bimodal probes Fe3O4@SiO2-CDs (FC) were prepared by coupling superparamagnetic iron oxide and carbon quantum dots synthesized with citric acid, and self-assembled with hydrogen peroxide stimulus-responsive amphiphilic block polymer PGMA-PEG modified with simvastatin (Sim) and target molecule ISO-1 to obtain drug-loaded micelles PGMA-PEG-ISO-1-Sim@FC (PPIS@FC). PPIS@FC could release Sim and FC in an H2O2-triggered manner, achieving the goal of releasing drugs using the special microenvironment at the plaque. At the same time, in vivo magnetic resonance and fluorescence imaging results proved that PPIS@FC possessed targeting ability, magnetic resonance imaging and fluorescence imaging effects. The results of the FeCl3 and ApoE-/- model showed that PPIS@FC had an excellent therapeutic effect and in vivo safety. Therefore, dual-modality imaging drug delivery systems with ROS response will become a promising strategy for the diagnosis and treatment of atherosclerosis.

Inhibition of 15-hydroxyprostaglandin dehydrogenase protects neurons from ferroptosis in ischemic stroke.

Ischemic stroke is an acute serious cerebrovascular disease with high mortality and disability. Ferroptosis is an important regulated cell death (RCD) in ischemic stroke. 15-Hydroxyprostaglandin dehydrogenase (15-PGDH), a degrading enzyme of prostaglandin E2 (PGE2), is shown to regulate RCD such as autophagy and apoptosis. The study aimed to determine whether 15-PGDH regulates ferroptosis and ischemic stroke, and further the exact mechanism. We demonstrated that overexpression of 15-PGDH in the brain tissues or primary cultured neurons significantly aggravated cerebral injury and neural ferroptosis in ischemic stroke. While inhibition of 15-PGDH significantly protected against cerebral injury and neural ferroptosis, which benefits arise from the activation of the PGE2/PGE2 receptor 4 (EP4) axis. While the impact of 15-PGDH was abolished with glutathione peroxidase 4 (GPX4) deficiency. Then, 15-PGDH inhibitor was found to promote the activation of cAMP-response element-binding protein (CREB) and nuclear factor kappa-B (NF-κB) via the PGE2/EP4 axis, subsequently transcriptionally upregulate the expression of GPX4. In summary, our study indicates that inhibition of 15-PGDH promotes the activation PGE2/EP4 axis, subsequently transcriptionally upregulates the expression of GPX4 via CREB and NF-κB, and then protects neurons from ferroptosis and alleviates the ischemic stroke. Therefore, 15-PGDH may be a potential therapeutic target for ischemic stroke.

Aconitum coreanum alleviates cerebral ischemic stroke through the PI3K/Akt signaling pathway in gerbils model

Cerebral ischemic stroke (CIS) is a kind of acute cerebrovascular disease with fast onset, low-cure rate, and high case-fatality rate. The application of Aconitum coreanum on CIS was recorded in many ancient books in China with it mechanism and effective components unclear. This study aimed to analyze the potential mechanism and effetvie components of A. coreanum on treating CIS. Neurological function score, cerebral infarction rate, and inflammatory indicators were applied to evaluate the efficacy of A. coreanum on gerbils with CIS. The prototype compounds in A. coreanum which were absorbed into blood was analyzed and identified by Ultra high performance liquid chromatography-Q exactive focus-Mass spectrometer (UPLC-QE-MS). And bioinformatics analysis was used to predict their potential targets or pathways of action. Western blotting and immunofluorescence were adopted to validate the targets or pathway with high relation. After treatment with A. coreanum, the neurological function status of gerbils with CIS was significantly improved, the ischemic area of the brain and the levels of inflammatory indicators significantly reduced. 22 prototype compounds in A. coreanum absorbed into blood were identified mainly including C-20 and C-19 diterpenoid alkaloids. Gene ontology (GO) function enrichment analysis illustrated that A. coreanum acted on protein phosphorylation, receptor complexes, protein kinase activity, and inflammatory response to impove CIS. The kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis results revealed that PI3K/Akt signaling pathway was a key pathway. Western blotting and immunofluorescence validated that A. coreanum acted on PI3K/Akt signaling pathway. In conclusion, A. coreanum improved the inflammantory condition in CIS by acting on PI3K/Akt signaling pathway and the effective components were the diterpenoid alkaloids in it.

Association between COVID-19 and outstanding academic performance at a Spanish university

BackgroundSARS-CoV-2 is the causative agent of COVID-19 identified in December 2019, an acute infectious respiratory disease that can cause persistent neurological and musculoskeletal symptoms such as headache, fatigue, myalgias difficulty concentrating, among others including acute cerebrovascular disease with a prevalence of 1–35%. The aim of this study is to evaluate the impact of COVID-19 in undergraduate students on their academic performance as an indicator of their intellectual ability and performance in a university that maintained 100% face-to-face teaching during the 2020–2021 academic year.MethodsA total of 7,039 undergraduate students were analyzed in a prospective cohort study at the University of Navarra. A questionnaire including sociodemographic and behavioral questions was sent. PCRs were performed throughout the academic year for the diagnosis of SARS-CoV-2 infection and students’ academic results were provided by the academic center, adjusted descriptive and multivariate models were performed to assess the association.ResultsA total of 658 (9.3%) participants were diagnosed with COVID-19, almost 4.0% of them achieved outstanding academic results, while uninfected students did so in 7.3%. SARS-CoV-2 infection was associated with a significant decrease in having outstanding academic results (OR = 0.57; 95% CI: 0.38–0.86).ConclusionHaving COVID-19 disease, decreased academic performance in undergraduate students. Therefore, it is necessary to prevent infection even in the youngest sections of the population.

Long-term recurrence of ischemic events in patients with intracranial atherosclerotic stenosis stratified by symptoms and pathogenesis

BackgroundIntracranial atherosclerotic stenosis (ICAS) can cause either transient ischemic attack (TIA) or acute ischemic stroke (AIS). Pathogenesis of ICAS-AIS can be divided into artery-to-artery embolism(A-A), hypoperfusion(HP), and parent-artery atherosclerosis occluding penetrating artery(POPA). However, the prognosis of each type remains uncertain. Our study aimed to investigate potential disparities in the recurrent risk among these four subtypes of symptomatic ICAS. MethodsFrom a prospective, single-center cohort study of acute cerebrovascular diseases from January 2017 to November 2021, we recruited 120 ICAS patients and classified them into four groups based on diffusion weighted imaging. Patients were retrospectively followed up for recurrence in December 2022. The primary outcome was recurrent cerebral vascular events (RCVE) in the same territory. ResultsAmong 120 recruited patients, POPA(33%) was the most common subtype, followed by A-A(32%), HP(29%), and TIA(6%). Cumulative recurrent rate was 31.2% with median months of follow-up as 27(20–45.5). There was no significant difference in the risk of RCVE in the same territory among four subgroups within three months. However, when considering the risk after three months, TIA(57%) had the highest risk of RCVE, followed by A-A(26%), while HP(4%) and POPA(8%) had lower risks (P = 0.001). Cox regression model indicated that symptom and pathogenesis was an independent risk factor for RCVE in long-term prognosis (P = 0.022), after adjusting for a history of hypertension and cerebral infarction. ConclusionsDistinctive symptoms and pathogenesis of ICAS exhibit varying risks of RCVE in long-term prognosis. The differentiation in recurrent risk may provide valuable insights for guiding secondary prevention strategies.

Strokes in Critically Ill COVID-19 Patients Diagnosed After Deep Sedation: A Single-Center Case Series.

In the Philippines, acute cerebrovascular disease is a common neurologic complication in coronavirus disease 2019 (COVID-19) patients. Because of sedation and limited neurological examination, the diagnosis of stroke in critically ill patients with COVID-19 may be delayed. This retrospective analysis was done on the medical records of adult patients with critical COVID-19 in 2021-2022 who were brought to a tertiary hospital in the Philippines, placed on mechanical ventilation, and later discovered to have had an ischemic or hemorrhagic stroke while under deep sedation. The study aimed to explore the delayed diagnosis of cerebrovascular disease clinically concealed by deep sedation and emphasizes the importance of a collaborative, multi-specialty approach to managing such patients. There were nine patients with strokes discovered on imaging after deep sedation due to severe COVID-19 infection. The median age of the cases was 63 years, and 55.5% (n=5) were males. Three of the nine patients had an ischemic stroke with hemorrhagic conversion, three with ischemic infarction, and the other three had a primary intracerebral hemorrhage. This series shows a pattern of delayed diagnosis of cerebrovascular disease clinically concealed by deep sedation that was essential in managing acute respiratory distress syndrome in the background of severe COVID-19 infection before the emergence of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) variants and the discovery of COVID-19 vaccines. The study demonstrates the significance of managing this unique population of patients in a collaborative and multi-specialty manner. With the continuing threat of SARS-CoV-2 and its variants, there is a need to strike a balance between the risks of ischemic and hemorrhagic stroke in COVID-19 infection and the care of this patient population.

Evaluation of inpatients neurology consultations in the department of gynecology, obstetrics, and reproductive medicine of a tertiary hospital in Turkey

Background &amp; Objective: It is important to be aware of hormonal changes in neurological disease in neurology training. We aimed to investigate the most common disorders which resulted in the clinicians from the Department of Gynecology, Obstetrics, and Reproductive Medicine (GORM) to ask for neurology consultation from the Department of Neurology. Methods: All the neurology consultations requested from the Department of GORM between 2015 and 2023 at Harran University Hospital, Sanliurfa, Turkey, were retrospectively evaluated with regard to demographic characteristics, the reason for referral, neurologic diagnoses, and treatment, imaging features. SPSS statistical software version 22 (IBM Inc. NC, USA) was used to perform all statistical analyses. Results: There were 333 patients with a mean age of 32.5 years (range 17-68) seeking consultations; 287 had obstetric problems, and 46 had gynecological issues. In the obstetric group, pre-eclampsia and Posterior Reversible Encephalopathy Syndrome (PRES) were the most frequent final neurological diagnoses, while headache and acute cerebrovascular disease were the most common frequent problems in the gynecological group. The number of consultations rose from 23 in 2015 to 66 in 2022. The predicted rate of final diagnosis of GORM residents was 58%. The neurologist’s contribution has substantial influence on the management of 208 (62%) patients. Conclusion: Neurologists have a significant contribution to the management of GORM inpatients. In neurological training, importance should be given to the effect of hormonal changes on neurological diseases in neurology training.

Socioeconomic and Inflammatory Correlates of Plasma Cortisol Among Individuals with Sickle Cell Disease

Introduction: Cortisol plays a critical role in the biological link between stress and health outcomes. It is frequently investigated in the association between socioeconomic stress and morbidity, and the hypothesized biological mechanism by which socioeconomic stress and cortisol impact health is through chronically elevated systemic inflammation. This research is relevant to individuals with sickle cell disease (SCD) for several reasons. First, up to 40% of children and adolescents with SCD are impacted by neighborhood poverty. Furthermore, individuals with SCD are faced with significant disease-related morbidities, such as chronic and acute pain, renal injury, and cerebrovascular disease that are further complicated by elevated inflammatory markers. Finally, cortisol is heavily understudied in this population, with no research investigating socioeconomic or inflammatory correlates. The purpose of this study was to investigate plasma cortisol and its association with neighborhood-level socioeconomic factors (income and poverty) and immunomodulatory cytokines (IL-6, IL-10), among individuals with SCD. Method: Plasma from individuals with SCD within Children's Hospital of Philadelphia (CHOP) and University of Pennsylvania School of Medicine (Penn Medicine) BioBanks were identified. A cortisol radioimmunoassay was used to determine plasma cortisol levels. The Olink immune response panel was used to measure plasma levels of 92 proteins involved in inflammatory pathways. Home address collected from electronic health records was used to determine neighborhood census tract geoid, which was then used to collect data on median neighborhood income and percentage of families living in poverty from the 2020 American Census Survey. Bivariate and multivariate analyses were conducted across 4 subgroups in the total sample: pediatric patients, adult patients, SCA (HbSS/HbSß 0), and other SCD genotypes (HbSC/HbSß +). Control samples (healthy and sickle cell trait; n = 22) without neighborhood information were also available for comparison. Results: Fifty-four independent outpatient samples were identified after excluding duplicates and siblings. Twenty-seven samples were from children and adolescents receiving pediatric care at CHOP (Range age = .8 to 21; Mage= 13.6, SD = 5.3; 51.9% female, 74.1% SCA) and 27 samples were from adults receiving care at Penn Medicine (Range age = 19 to 56; Mage= 35.8, SD = 10.1; 51.9% female, 51.9% SCA). There were no significant differences in cortisol levels across each subgroup ( Mpeds= 16.6, SDpeds = 6.2; Madult= 13.4, SDadult = 6.9; MSCA= 15.1, SDSCA = 7.1; MSCD= 14.9, SDSCD = 6.3). Neighborhood income and poverty did not differ across pediatric and adult patients, and income did not differ across SCD types. However, neighborhood poverty was lower among patients with SCA ( M = 13.9; SD = 11.9) relative to other SCD genotypes ( M = 21.7; SD = 13.5; p = .041). Bivariate Spearman analyses found that neighborhood variables were not correlated with cortisol or cytokines in the total sample or subgroups. Yet, multivariate analyses controlling for sex and time of blood draw showed a positive main effect for patient age ( p = .019) and a significant age by poverty interaction ( p = .041) predicting cortisol among pediatric patients. Cortisol levels were higher with age, yet the association among poverty and cortisol was strongest in younger patients. Analyses also showed a sex*poverty interaction among pediatric patients that approached significance ( p = .081), such that poverty only predicted cortisol in male patients. There were no significant differences for immunomodulatory cytokines across each SCD subgroups; however, IL-6 and IL-10 were elevated in patients with SCA relative to healthy controls ( p IL6 = .021; p IL10 = .003). Bivariate Spearman correlations showed that cortisol was positively related to IL-6 (rho [ρ]= .38, p = .027) and IL-10 (ρ= .34, p = .048) among patients with SCA. There were no additional significant bivariate or multivariate effects. Conclusion: Neighborhood factors likely have downstream effects on the biological stress response and inflammation in SCD. Further research must be conducted to elucidate concurrent and prospective associations among neighborhood socioeconomic factors, stress-related cortisol response, and inflammatory outcomes when extending this work to investigate the impact of stress on SCD morbidity and mortality.

The impact of long-term aspirin use on the patients undergoing shoulder arthroplasty

BackgroundAlthough aspirin is increasingly utilized to reduce the event of severe perioperative complications, the effect of long-term aspirin use (L-AU) on perioperative complications in patients undergoing shoulder arthroplasty (SA) has not been well studied. The goal of the present study is to identify the influence of L-AU on perioperative complications in individuals undergoing SA.MethodsWe selected data from the National Inpatient Sample database between 2010 and 2019, to identify adult patients with SA. Patients were subsequently categorized into L-AU and whole non-L-AU cohorts according to the presence of aspirin use. The demographic and comorbidity characteristics were matched using propensity score matching (PSM). The Pearson chi-square test, Wilcoxon rank test and logistic regression were utilized to assess the association of L-AU with perioperative complications.ResultsFrom 2010 to 2019, a total of 162,418 SA patients satisfied the inclusion criteria, with 22,659 (13.95%) using aspirin on a long-term basis. The vast majority of the patients with pre-existing L-AU were aged 65–74 years, female, White and had Medicare insurance. L-AU before surgery was linked to increased risks of perioperative complications, such as blood transfusion (adjusted odds ratio [aOR]: 1.339), genitourinary disease (aOR: 1.349), acute renal failure (aOR: 1.292), acute myocardial infarction (aOR: 1.494), higher total charge (L-AU vs. the whole non-L-AU vs. matched non-L-AU: $66,727.15 vs. $59,697.08 vs. $59,926.32), and prolonged hospitalization stay (LOS) (aOR: 0.837). However, L-AU was considered a protective factor of acute cerebrovascular disease (aOR: 0.722) and stroke (aOR: 0.725).ConclusionsOur study is based on the largest open-access all-payer inpatient database, revealing a noteworthy finding of aspirin's protective and adverse impact on different postoperative complications in the US population, such as acute cardiovascular disease, and stroke, etc. Further studies assessing the optimum preoperative aspirin duration and dosage to meet the best benefit quantity for patients with planned joint arthroplasties are suggested.