Acute Cerebrovascular Disorders Research Articles

Sphenopalatine ganglion stimulation for the treatment of cerebrovascular ischemia.

The parasympathetic effects of the sphenopalatine ganglion (SPG) on the cerebral vasculature provide a compelling rationale for its therapeutic application in cerebrovascular ischemia. In recent years, attempts have been made to stimulate the SPG to achieve beneficial effects on cerebral circulation. This review synthesizes the available publications on SPG stimulation. It critically evaluates the evidence from preclinical studies and clinical trials to assess its potential as a treatment for acute cerebrovascular disorders and outlines aspects that still require more study. The medical literature provides consistent evidence of the significant effects of stimulating the SPG on cerebrovascular circulation. In addition, considerable evidence supports the therapeutic role of SPG stimulation in patients with cerebral ischemia. Given the current understanding, future research could explore the potential of SPG stimulation as a non-reperfusion intervention to improve long-term outcomes for individuals with ischemic cerebrovascular conditions.

Application of Transcranial Magnetic Stimulation to Improve Upper Limb Motor Function Following Cerebral Infarction: A Clinical Case Analysis

Background. Cerebral infarction, a form of acute cerebrovascular disorder affecting the brain or spinal cord, presents with focal neurological symptoms that persist for more than 24 hours post-onset. Managing complications arising from cerebral infarction typically involves a multifaceted and prolonged therapeutic approach. Recent advancements, such as the application of transcranial magnetic stimulation (TMS), have shown the potential to significantly accelerate the rehabilitation process by enhancing neuroplasticity and motor recovery. Aim. The objective of this report is to present and discuss the clinical case of a patient who received transcranial magnetic stimulation (TMS) as part of a rehabilitation program following cerebral infarction. This case aims to provide physicians across various specialties with insights into the therapeutic outcomes associated with TMS, highlighting its potential role in enhancing motor recovery during post-stroke rehabilitation. Methods. A retrospective analysis was conducted on the medical history of a patient who underwent transcranial magnetic stimulation (TMS) to enhance upper limb motor function following a cerebral infarction. The patient participated in an inpatient rehabilitation program (Rehabilitation Stage III) for 54 days, with TMS initiated on the 7th day. A total of 10 TMS sessions were administered. Functional outcomes were assessed and compared between the start and completion of the rehabilitation program, and results are presented as a clinical case analysis to illustrate the therapy’s impact. Results. During rehabilitation, the patient’s independence improved. Muscle strength in the upper limbs increased: the right hand’s strength improved by 133.33%, and the left hand by 66.67%. Fine motor skills and dexterity in the hands also improved. Conclusions. Transcranial magnetic stimulation (TMS) is an emerging, effective approach in rehabilitative treatment. In this clinical case, marked improvements in the patient’s motor functions and independence were observed, supporting the efficacy of TMS as an adjunct to standard rehabilitation techniques for enhancing functional recovery following a cerebral infarction. Keywords: rehabilitation, transcranial magnetic stimulation, cerebral infarction, stroke.

The efficiency of X-Ray endovascular care in decreasing of population mortality from acute coronary syndrome and acute disorder of cerebral circulation

The article considers results of assessment of dynamics of mortality from cardiovascular diseases and the most important nosologic forms - acute cerebrovascular disorders and coronary heart disease with acute coronary syndrome and development of accessibility of X-Ray endovascular care of patients in the Oblast. The results of analysis of changes in mortality after implementation of new model of care of patients with acute vascular diseases are presented. The relationship between accessibility of X-Ray endovascular interventions and decrease of mortality was analyzed. The reliable significantly strong connection was found for cerebrovascular diseases, and medium negative connection for coronary heart disease with acute coronary syndrome.

AI in Acute Cerebrovascular Disorders: What can the Radiologist Contribute?

AI in Acute Cerebrovascular Disorders: What can the Radiologist Contribute?

New onset tremor in patients with COVID-19: can be a possible link with parkinsonism?

Aims: SARS-CoV-2 is a highly pathogenic member of the coronavirus family. We notice that some patients who were following in outpatient service have a new onset tremor. Our aim to describe these patients and interpreting new onset tremor after Covid-19 that possible link with parkinsonism. Methods: Forty-two patients with tremor who applied to Alanya Alaaddin Keykubat University Hospital neurology outpatient clinic between the 2021-2022 years were included the study. The data related to demographic characteristics, reasons for application of outpatient neurology clinic, pre-diagnosis and treatment were collected retrospectively. Results: The patients had a viral infection up to 3 months before the diagnosis of tremor was examined from the hospital system. It was determined that a total of 7 patients had viral infections due to upper respiratory infections and these were confirmed by polymerase chain reaction (PCR). Since two of these patients had concomitant thyroid dysfunction, one had diabetes and one had a history of acute cerebrovascular disorder, they were not included in the study. Covid-19 results were found to be positive wit PCR in 3 patients with a diagnosis of new onset tremor. It was determined in the neurology outpatient clinic notes of the patients that their complaints started after Covid-19. Conclusion: We haven’t enough data about Covid-19 yet but it should be included in the differential diagnosis of patients with new onset neurological symptoms, especially in epidemic situations.. Extensive clinical, neurological, and electrophysiological investigations of the patients may help to understand the virus's role in causing neurological manifestations

Oxidative stress and antioxidant protection in disorders of cerebral circulation

At the present stage, great progress has been achieved in understanding the mechanisms of the development of cerebral ischemia. This became possible due to the achievements of theoretical disciplines, in connection with which the general biological approach was formed in the study of pathogenesis of acute and chronic cerebrovascular disorders (CVD). The discovery of pathways of free radical oxidation in cerebral ischemia made it possible to substantiate and develop therapeutic strategies using drugs with antioxidant and neuroprotective activity. The article presents our own data on the effectiveness of Mildronat in patients with CVD.

A rare neurological complication of COVID-19: Pediatric Miller Fisher Syndrome. A case report

The SARS-CoV-2 pandemic has significantly transformed the world. While it was initially viewed as a respiratory virus, it has now been found to cause cardiovascular, gastrointestinal, and psychological complications. Moreover, the nervous system (NS) is also greatly affected. Research has identified dizziness, headaches, as well as disturbances in one's taste and smell abilities as the most frequent symptoms of NS involvement. Even more significant changes may occur in patients who get infected with SARS CoV-2, such as the development of acute cerebrovascular disorders (stroke), multiple sclerosis, acute disseminated encephalitis, Guillain-Barré syndrome, encephalitis, and myelitis. It is important to note these potential complications and monitor patients closely. A retrospective study conducted in Wuhan, China revealed that CNS (central nervous system) involvement occurred three times more frequently than PNS (peripheral nervous system) involvement. This emphasizes the critical importance of studying and describing CNS manifestations. This case report depicts Miller Fisher syndrome in a 5-month-old infant after SARS CoV-2 infection and explores literature on pediatric cases and potential pathogenic mechanisms.

USING INTRAVENOUS IMMUNOGLOBULIN IN A PATIENT WITH SEPTIC SHOCK AND MULTIPLE COMORBIDITIES: A REVIEW BASED ON A CLINICAL CASE

The review focused on managing sepsis and septic shock patients by administering intravenous immunoglobulins (IVIG). Treatment outcomes and survival prognosis of septic patients were discussed in view of different regimens and dosages of IVIG. The principles of determining the appropriate dosage of IVIG in different medical facilities were compared. Own clinical case of complex treatment of septic shock using IVIG was proposed. The patient experienced a septic shock after transurethral resection of the prostate to treat a prostate abscess. Additionally, the patient was diagnosed with acute cerebrovascular disorder and various cardiovascular ailments, including type 2 diabetes mellitus and stage 2 chronic kidney disease. This septic patient was diagnosed with immunodeficiency disorder with lymphopenia, hypoproteinemia, procalcitoninemia, and significant secondary autoimmune inflammatory disorders. Despite the expected unfavorable prognosis, after comprehensive treatment with early application of moderate doses of IVIG, the patient’s condition stabilized, and organ functions remained satisfactory. Therefore, early administration of intravenous immunoglobulin had a favorable clinical outcome in the treatment of septic shock, thereby indicating the need to utilize a multidisciplinary approach, including involving an immunologist, in managing septic conditions.

Multipotent mesenchymal stromal cells of various origins reduce reactive gliosis in the hippocampal CA1 area during acute ischemia-reperfusion of the rat brain

Neuroprotective therapy in acute cerebrovascular disorders is directly aimed at preserving neurons in the penumbra zone, but it also emphasizes the importance of gliogenesis in the affected area. Glial cells exhibit rapid reactivity and are highly sensitive to cerebral ischemic damage. Recent experimental studies have demonstrated the successful application of multipotent mesenchymal stromal cells (MMSCs) in stroke to modulate microglial activation. The aim of the study was to investigate the impact of MMSCs of different origins, MMSC lysate, and citicoline on glial components in a model of cerebral ischemia-reperfusion in rats. Materials and methods. The experiments were conducted on 190 male Wistar rats aged 4 months, weighing 160-190 g. After modeling cerebral ischemia-reperfusion through bilateral 20-minute occlusion of the internal carotid arteries, rats were intravenously administered MMSCs derived from human Wharton’s jelly, human adipose tissue, and rat Wharton’s jelly at a dose of 106 cells per animal. Other groups received fetal rat fibroblasts (106 cells/animal in 0.2 ml of physiological solution) and lysate from human Wharton’s jelly at a dose of 0.2 ml per animal. Control animals received 0.2 ml of physiological solution intravenously. The last group of rats received a single dose of the reference drug citicoline at a dose of 250 mg/kg. On the 7th and 14th days, the area and fluorescence intensity of cells expressing markers of astrocytes (GFAP), microglia (Iba1), and oligodendrocytes (Rip) were quantitatively assessed in CA1 hippocampal region slices using immunohistochemical examination and confocal microscopy. Results. On the 7th and 14th days after cerebral ischemia-reperfusion in rats, the intensity of fluorescence of GFAP-positive astrocytes and Iba1-positive microglial cells increased, indicating pronounced reactive astrogliosis and microglial activation in the CA1 region of the hippocampus. Meanwhile, ischemia-reperfusion had a significant impact on the content of Rip-positive oligodendrocytes in brain slices. The application of all treatments (transplantation of MMSCs of different origins, their lysate, or the reference drug citicoline) had a cytoprotective effect, reducing reactive astrogliosis and microgliosis both on the 7th and 14th days after injury. The best result was demonstrated with the treatment using MSCs from human Wharton’s jelly.s. Conclusion. Cerebral ischemia-reperfusion induces reactive gliosis through the activation of GFAP- and Iba1-positive glial cells in all layers of the hippocampus. The application of MSCs from human Wharton’s jelly and fetal rat fibroblasts significantly reduces its intensity on both the 7th and 14th days after injury modeling.

Anatomical factors of intracavitary thrombus formation in the pathogenesis of cardioembolic stroke

Cardioembolic stroke, like other types of acute cerebrovascular disorders, is a global priority medical and social problem. This review analyzes the role of anatomical factors, which, along with other factors of thrombus formation in the heart chambers, may represent an important and yet insufficiently studied link in the pathogenesis of this disease.

Rare non-heritable causes of acute cerebrovascular disorders

Rare non-heritable causes of acute cerebrovascular disorders

“Evaluation and Prediction of Cognitive Changes Accompanying Panic Attacks in Stroke Patients”

One of the most urgent problems of modern medicine is the rapid growth of acute cerebrovascular disorders (ACCI), their “aging”, and high rates of death and disability in surviving patients. As a result of the disability of the working-age population, long-term treatment and rehabilitation costs, stroke causes a great economic loss to society, and therefore the problem is of social importance.
 The relationship between stroke and depression is significant. Panic attacks in stroke patients were studied and evaluated based on questionnaires and scales. Ways to eliminate cognitive disorders associated with post-stroke panic attacks, and the effectiveness of treatment have been studied.

Public knowledge of early stroke symptoms in the Vilnius region

Background and aim. Stroke remains one of the most common causes of death and disability in the world. The evident decline in disabling outcomes can be attributed to the increasing use of reperfusion therapies. Stroke recognition and urgent admission of patients to specialized stroke centres after the onset of first stroke symptoms are essential for treatment outcomes. This study aims to assess public stroke awareness and its change since 2019.Methods. An anonymous cross-sectional study involving 300 Vilnius residents was conducted in 2022, the results of which were compared with the data of 502 respondents in 2019. A closed-ended questionnaire was used for the study. Statistical analysis was performed using IBM SPSS software with p<0.05 significance level.Results. Stroke was identified as an acute cerebrovascular disorder by 83.3% of respondents in 2022 (82.7% in 2019). At least one correct warning sign of stroke was indicated by 98.7% of respondents (96.4% in 2019). The most commonly mentioned symptoms of stroke were one-sided face, arm or leg sensory disturbances, paralysis, or weakness (90.0%) and speech disorder (83.3%), with 82.1% and 81.5% respectively in 2019. Only 58% (45.4% in 2019) of respondents reported visual impairment as a stroke symptom. Women had better knowledge of stroke than men (p<0.05). The internet was the main source of information for 63.3% of respondents (64.9% in 2019).Conclusions. Since 2019, stroke awareness has improved in Vilnius. This proves that F.A.S.T. campaign has reached the public. Women have better knowledge of stroke than men. Visual impairment is the least known symptom of stroke. Therefore, the search for new information programmes, especially directed to the targeted audience, can be useful for better publicity.

Some problematic issues of rehabilitation of patients with the stroke consequences at the present stage

Background. Acute cerebrovascular disorders are one of the main causes of severe disability in modern society. Russian and foreign researchers register the emerging trend towards rejuvenation of the patients with stroke, which, in turn, significantly increases the relevance of the treatment and rehabilitation of these patients at various stages.The aim. To study the social and hygienic characteristics of the stroke patients and to determine their need for medical rehabilitation in the early recovery period.Materials and methods. We studied the social and hygienic characteristics of 109 patients who had stroke in 2020 and 2021 and underwent rehabilitation in the specialized rehabilitation department of the Southern District Medical Center of the Federal Medical and Biological Agency, and determined their need for medical rehabilitation using the analytical method, the method of expert assessments and questionnaires.Results. The average portrait of a patient with a stroke in the early recovery period is as follows: this is a man aged 61 to 70 years with a higher or secondary specialized education, unemployed, living in the city. Up to 30 % of stroke survivors were recognized as disabled; among which, the persons with more severe disability (groups I and II) predominate – up to 90 %. Implementation of rehabilitation measures in the acute period in the hospital and in the early recovery period in the outpatient clinic is carried out at a fairly low level. The percentage of patients being examined by a multidisciplinary rehabilitation team ranges from 17.4 to 10.1 %.Conclusion. The availability of medical rehabilitation measures in a specialized rehabilitation center is quite limited; more than half of the surveyed contingent (52.3 %) experienced problems in obtaining a referral to treatment, about half of the respondents (46.8 %) waited up to 6 months for a referral, which indicates the need to expand the network of such institutions at the regional level.

Long-term risk of seizure after posterior reversible encephalopathy syndrome.

Patients with posterior reversible encephalopathy syndrome (PRES) can develop seizures during the acute phase. We sought to determine the long-term risk of seizure after PRES. We performed a retrospective cohort study using statewide all-payer claims data from 2016-2018 from nonfederal hospitals in 11 US states. Adults admitted with PRES were compared to adults admitted with stroke, an acute cerebrovascular disorder associated with long-term risk of seizure. The primary outcome was seizure diagnosed during an emergency room visit or hospital admission after the index hospitalization. The secondary outcome was status epilepticus. Diagnoses were determined using previously validated ICD-10-CM codes. Patients with seizure diagnoses before or during the index admission were excluded. We used Cox regression to evaluate the association of PRES with seizure, adjusting for demographics and potential confounders. We identified 2095 patients hospitalized with PRES and 341,809 with stroke. Median follow-up was 0.9 years (IQR, 0.3-1.7) in the PRES group and 1.0 years (IQR, 0.4-1.8) in the stroke group. Crude seizure incidence per 100 person-years was 9.5 after PRES and 2.5 after stroke. After adjustment for demographics and comorbidities, patients with PRES had a higher risk of seizure than patients with stroke (HR, 2.9; 95% CI, 2.6-3.4). Results were unchanged in a sensitivity analysis that applied a two-week washout period to mitigate detection bias. A similar relationship was observed for the secondary outcome of status epilepticus. PRES was associated with an increased long-term risk of subsequent acute care utilization for seizure compared to stroke.

Effectiveness of physical therapy of a person with a hemorrhagic stroke during the recovery period: a clinical case

Purpose: to scientifically substantiate and develop a program of physical therapy for a patient after a hemorrhagic stroke (during the recovery period) and check its effectiveness. Material & Methods: the study was conducted on the basis of the "Skalyansky Clinic" Medical Center. The organization of the study involved conducting a comparative analysis of the dynamics of indicators obtained with the help of clinical tools for assessing the patient’s functional state in the process of applying the author’s physical therapy program. A 71-year-old patient with a diagnosis of "Acute cerebrovascular hemorrhagic disorder: subarachnoid-parenchymal hemorrhage with the formation of a stroke-hematoma of the left temporal-subcortical area of the brain with breakthrough into the ventricular system with right-sided hemiplegia, sensorimotor aphasia" by a multidisciplinary team (doctor, physical therapist, speech therapist and psychologist) an individual program of physical therapy was developed. In order to evaluate the effectiveness of the experimental methodology, a formative experiment was conducted. Clinical tools for assessing the functional state of the patient during the research were domains in the form of the ICF-core-set tool (a set of ICF basic categories) (ICF Research Branch, 2022) for complex stroke: Lovett’s test, Barthel scale, Gait Velocity (GV) tests and Berg Balance scale (BBS), Montreal Scale of Cognitive Assessment (MoCA), Get Up and Go Tests, Trunk Control Test, Functional Independence Measure (FIM). The developed individual program of physical therapy for hemorrhagic stroke in the recovery period is a comprehensive course of physical therapy, occupational therapy, which is carried out in stages and includes the following components: therapeutic gymnastics classes; electrical stimulation of the shoulder, psychological (psychological counseling, psychological support, developmental classes for the recovery of cognitive impairments) and speech therapy (speech therapy gymnastics, articulation exercises, Su-Jok (massage ball and ring) component. After applying the specified author’s individual physical therapy program, qualitatively positive changes in the functional and psychophysical state of the patient, in particular: b7301.4 to b7301.2; d550.2 to d550.1; d510.3 to d510.2; d520.3 to d520.2; d540.3 to d540. 2; d598.3 to d598.2; d4100.3 to d4100.2; d450.3 to d450.2; d469.4 to d469.3; d330.3 to d330.1; d355.3 to d355.3; d998.3 to d998.2. Results: after applying the author’s program of physical therapy, we found qualitatively positive changes in the functional and psychophysical state of the patient, as evidenced by the positive dynamics of the studied indicators. The psychological and speech therapy work carried out contributed to the improvement in the process of restoring the patient’s cognitive functions (from moderate to mild impairment), stabilization of his emotional state, acquisition of stress resistance skills, harmonization of the patient’s system of relationships with himself, Conclusions: the effectiveness of using the author’s individual program of physical therapy is confirmed by the dynamics of qualitatively positive changes in the functional and psychophysical state of the patient.

Cardiovascular disease risk in males and females with new onset diabetes: a population-based study in universal health care setting

Abstract Background The evidence on whether long-term cardiovascular disease (CVD) outcomes differ among males and females with incident diabetes remains equivocal. Objective To examine sex-differences in the association between incident diabetes and 5-year risk of CVD and mortality at the population-level. Methods The study population consisted of an inception cohort of individuals between 40 and 80 years without diabetes or CVD on April 1, 2013 in the province of Alberta, Canada (N=1,315,885). Incident diabetes during a 3-year period was used to categorize males and females by diabetes status as of March 31, 2016. Primary outcome of interest was a combination of CVD hospitalization (defined as a hospitalization with a primary diagnosis of heart failure, acute coronary syndromes, cerebrovascular disorders, atrial fibrillation and flutter, ventricular arrhythmia, or sudden cardiac death) or all-cause mortality over a 5-year period until March 31, 2021. Inverse probability of treatment weighting (IPTW) was used to reduce the impact of confounders between individuals with and without diabetes. Kaplan-Meier curves were used to examine unadjusted outcomes and Cox-proportional hazards models were used to examine the impact of diabetes on outcomes in males and females after adjusting for the following: age, hypertension, material deprivation, urban/rural residence, and comorbidity burden. Results Among 672,881 females and 643,004 males, 27,082 (4.0%) and 33,054 (5.1%) developed incident diabetes, respectively. Regardless of sex, individuals with diabetes were older and had higher rates of hypertension and other comorbidities. Overall, CVD hospitalization/mortality rates per 1000 person years were 7.5% (95% confidence interval (CI): 7.4–7.6) among females compared to 11.7% (95% CI: 11.6–11.8) among males. When stratified by diabetes status, the rates of the combined endpoint were 7.2% (95% CI: 7.1–7.3) among females with no diabetes (F w/o DM), 11.2% (95% CI: 11.1–11.3) among males with no diabetes (M w/o DM), 14.7% (95% CI: 14.0–15.3) among females with diabetes (F with DM) and 20.9% (95% CI: 20.1–21.6) among males with diabetes (M with DM, Figure 1). The adjusted hazard ratio (aHR) associated with diabetes on outcomes was similar among males (aHR 1.38 95% confidence interval (CI): 1.36–1.41) and females (aHR 1.39 95% CI: 1.36–1.42). Conclusions The presence of diabetes weakens the possible cardio-protection of female sex with respect to CVD outcomes. Future work aims to assess CVD prevention, management and treatment among males with females with incident diabetes. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR) Sex and Gender Science Chair

Clinical and metabolic features of diabetic encephalopathy

BACKGROUND: Actual mindset, concerning the pathogenesis of type 2 diabetes mellitus and its complications, is described in the glucocentric, lipocentric and lipokine theories. At the same time, it is known, that acute cerebrovascular disorder in type 2 diabetes mellitus can also develop with normoglycemia. The mechanism of association between obesity and type 2 diabetes mellitus in metabolic syndrome has not yet been studied, and 40% of diabetic patients are not obese. In the physiological state hyperglycemia is prevented by pancreatic regulatory oligopeptides rather than insulin, and protein glycation occurs before the development of diabetes symptoms. That facts indicate the need to continue investigation of the pathogenesis in general and diabetic encephalopathy in particular from the standpoint of metabology in order to substantiate the peptidergic theory of the diabetes mellitus and dyscirculatory encephalopathy pathogenesis.
 AIM: To consider little-known clinical, morphological and metabolic manifestations of diabetic encephalopathy from the standpoint of improving the disease diagnosis.
 MATHERIALS AND METHODS: Among 162 elderly and senile patients in the pre-stroke and stroke stages of diabetic encephalopathy, modern methods of radiological, laboratory, histological, psychometric and clinical analysis have been used: the relationship between low total cholesterol and disease progression has been determined according to Schulte and MMSE psychometric tests with the same hyperglycemia in different age groups sick; cases of amyloid angioencephalopathy on magnetic resonance imaging in the ultrasensitive weighted imaging mode and amyloidosis have been identified.
 Staining post-mortem ultrathin tissue biopsy sections with Congo red allowed to find amyloid deposition in 12% of autopsy cases in the absence of diagnosing amyloidosis during life; preparations, in which Congo red staining was positive for the presence of amyloid, were taken for inspection in polarizing light and typing of amyloid. Staining of histological preparations with hematoxylin-eosin and Van Gieson revealed a morphological characteristic of diabetic encephalopathy different from that of atherogenic and hypertensive dyscirculatory encephalopathy; using immunological studies, a statistically significant increased content of induced interleukin-1 production, a trigger for the serum amyloid analogue in the liver synthesis, was determined, and an experimental method for beta-amyloid peptide adhesion by monocytes and the density of amyloid expression on the surface of monocytes in patients with diabetic encephalopathy at senile age at 23 times higher than the density of the peptide in the elderly and in the patients with dyscirculatory encephalopathy of the same old age.
 RESULTS: It has been established that a fairly frequent and early manifestation of metabolic disorders in diabetic encephalopathy is a violation of protein metabolism with its final conformation into toxic amyloid tissue components. These observations indicate the multifactorial nature of diabetic encephalopathy. Literature data on the parametabolism of the serotonin mediator and tryptophan in the pathogenesis of diabetic encephalopathy are presented.
 CONCLUSIONS: Modern immunological, morphological, and histochemical capabilities make it possible to diagnose the conformation of the protein matrix and develop a protein-centric hypothesis of diabetic encephalopathy.

Detection of Subarachnoid Hemorrhage in Computed Tomography Using Association Rules Mining.

Subarachnoid hemorrhage (SAH) is one of the serious strokes of cerebrovascular accidents. There is an approx. 15% probability of spontaneous subarachnoid hemorrhage in all acute cerebrovascular accidents (CVAs). Most spontaneous subarachnoid hemorrhages are caused by ruptures of intracranial aneurysms, accounting for about 85% of all occurrences. About 15% of acute cerebrovascular disorders are caused by spontaneous subarachnoid hemorrhage. This illness is mostly caused by brain/spinal arteriovenous malformations, extracranial aneurysms, and hypertension. Computed tomography (CT) scan is the common diagnostic modality to evaluate SAH, but it is very difficult to identify the abnormality. Thus, automatic detection of SAH is required to recognize the early signs and symptoms of SAH and to provide appropriate therapeutic intervention and treatment. In this article, the gray-level cooccurrence matrix (GLCM) is used to extract useful features from CT images. Then, the New Association Classification Frequent Pattern (NCFP-growth) algorithm is applied, which is based on association rules. Then, it is compared with FP-growth methods with association rules and FP-growth methods without association rules. The experimental results indicate that the suggested approach outperforms in terms of classification accuracy. The proposed approach equates to a 95.2% accuracy rate compared to the conventional data mining algorithm.

Inpatient virtual shared medical appointments to improve health literacy, increase patient self-efficacy, and reduce provider burnout in acute cerebrovascular pathology patients and their caregivers: a pilot study.

Admission to the hospital for an acute cerebrovascular condition such as stroke or brain hemorrhage can be a traumatic and disorienting experience for patients and their family members. The COVID-19 pandemic has further intensified this experience in addition to exacerbating clinician and resident burnout. To ameliorate some of these concerns, a team of resident and medical student trainees implemented a virtual shared medical appointment (vSMA) program for inpatients with acute cerebrovascular disorders and their caregivers. The authors hypothesized that an early intervention in the form of a vSMA improves patient and caregiver health literacy and preparedness while simultaneously educating clinical trainees on effective communication skills and reducing clinician burnout. Patients and caregivers of admitted patients were identified through a census of neurosurgery, neurocritical care, and neurology electronic medical records. A weekly 60-minute secure virtual session consisted of introductions and a 10-minute standardized presentation on cerebrovascular disease management, followed by participant-guided discussion. Participants completed presession and postsession surveys. Through this small feasibility study data were obtained regarding present challenges, both expected and unforeseen. A total of 170 patients were screened, and 13 patients and 26 caregivers participated in at least 1 vSMA session. A total of 6 different healthcare providers facilitated sessions. The vSMA program received overwhelmingly positive feedback from caregivers. Survey responses demonstrated that 96.4% of caregivers and 75% of patients were satisfied with the session, 96.4% of caregivers and 87.5% of patients would recommend this type of appointment to a friend or family member, and 88.8% of providers reported feeling validated by conducting the session. The participant group had a 20% greater percentage of patients discharged home without home needs compared to the nonparticipant group. The primary obstacles encountered included technological frustrations with the consent process and the sessions themselves. Implementation of a vSMA program at a tertiary care center during a pandemic was feasible. Themes caregivers expressed on the postsession survey included better understanding of caring for a stroke patient and coping with the unpredictability of a patient's prognosis. The pandemic has precipitated shifts toward telehealth, but this study highlights the importance of avoiding marginalization of elderly and less technologically inclined populations.