Stroke Research Articles

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial

ObjectiveTo investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.DesignA feasibility randomised controlled trial with a parallel process evaluation.SettingAcute Stroke Unit...

Low-Cost Strategies for the Development of Neurocritical Care in Resource-Limited Settings.

This review explores low-cost neurocritical care interventions for resource-limited settings, including economical devices, innovative care models, and disease-specific strategies. Devices like inexpensive ventilators, wearable technology, smartphone-based ultrasound, brain4care, transcranial Doppler, and smartphone pupillometry offer effective diagnostic and monitoring capabilities. Initiatives such as intermediate care units, minimally equipped stroke units, and tele-neurocritical care have demonstrated benefits by reducing hospital stays, preventing complications, and improving clinical and economic outcomes. The review emphasizes locally applicable tailored approaches for diagnosing and managing conditions such as traumatic brain injury, neuroinfections, status epilepticus, autoimmune neurological disorders, and acute stroke as viable and affordable solutions.

Platelet-white cell ratio is more strongly associated with mortality than other common risk ratios derived from complete blood counts

Complete blood count indices and their ratios are associated with adverse clinical outcomes for many acute illnesses, but the mechanisms generating these associations are not fully understood. Recent identification of a consistent pattern of white blood cell and platelet count co-regulation during acute inflammatory recovery provides a potentially unifying explanation. Here we show that the platelet-to-white-cell ratio, which was selected based on this conserved recovery pattern, is more strongly associated with mortality than other blood count markers and ratios in four important illnesses involving acute inflammation: COVID-19, acute heart failure, myocardial infarction, and stroke. Patients recovering well from these acute illnesses tend to follow a joint white cell and platelet trajectory that can be reduced to this one-dimensional ratio. The platelet-to-white-cell ratio’s association with prognosis is consistent with recently identified inflammatory dynamics and may provide a convenient and interpretable summary of patient inflammatory state.

Polyphenylalanine-Baicalein Nanomicelles Reduce Nerve Cell Apoptosis and Inflammation to Enhance Neuroprotection and Poststroke Rehabilitation.

Cerebral ischemic stroke, neuronal death, and inflammation bring difficulties in neuroprotection and rehabilitation. In this study, we developed and designed the ability of natural lactoferrin-polyethylene glycol-polyphenylalanine-baicalein nanomicelles (LF-PEG-PPhe-Bai) to target and reduce these pathological processes, such as neurological damage and cognitive impairment in the stages of poststroke. Nanomicelles made from biocompatible materials have improved bioavailability and targeted distribution to afflicted brain areas. The results showed that LF-PEG-PPhe-Bai greatly improved the antioxidation, antiapoptosis, and anti-inflammation activity in vitro. Meanwhile, LF-PEG-PPhe-Bai improved the behavioral and cognitive impairment of 2-VO model mice, protected nerve cells in the hippocampus, and reduced inflammation at the brain injury site in vivo. In conclusion, LF-PEG-PPhe-Bai nanomicelles are employed for enhancing neuroprotection and poststroke rehabilitation. The development of this technology might provide a new technique for neural repair after ischemia in the future.

Efficacy and Safety of Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Occlusion Ischemic Stroke Patients on Low-Dose Aspirin.

Acute ischemic stroke (AIS) from distal medium vessel occlusion (DMVO) presents unique treatment challenges. Mechanical thrombectomy (MT) is emerging as a viable option for these patients, yet the role of pre-stroke aspirin treatment is unclear. This study evaluates the impact of pre-stroke low-dose aspirin on outcomes in DMVO patients undergoing MT. We conducted a multinational, multicenter, propensity score-weighted analysis within the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. Patients with AIS due to DMVO, treated with MT, were included. We compared outcomes between patients on pre-stroke low-dose aspirin (75-100 mg) and those not on antiplatelet therapy. The primary outcome was functional independence at 90 days (mRS 0-2). Secondary outcomes included excellent functional outcome at 90 days (mRS 0-1), mortality, and day-one post-MT NIHSS score. Safety outcomes focused on hemorrhagic complications, including symptomatic intracerebral hemorrhage (sICH). Among 1,354 patients, 150 were on pre-stroke low-dose aspirin. After applying Inverse Probability of Treatment Weighting (IPTW), Aspirin use was associated with significantly better functional outcomes (mRS 0-2: OR =1.89 , 95% CI, 1.14 to 3.12 ) and lower 90-day mortality (OR = 0.56, 95% CI, 0.32 to 1.00). The aspirin group had lower NIHSS scores on day one (β = -1.5, 95% CI, -2.8 to - 0.27). The sICH rate was not significantly different between the groups (OR = 0.92, 95% CI, 0.60 to 1.43). Pre-stroke low-dose aspirin was associated with improved functional outcomes and reduced mortality in patients with DMVO undergoing MT, without a significant increase in sICH. These findings suggest that low-dose aspirin may be safe and associated with more frequent excellent outcomes for this patient population. Further prospective studies are needed to validate these results and assess long-term outcomes.

Impact of Dual Antiplatelet Therapy Versus Monotherapy in Acute Stroke Management: A Systematic Review

Impact of Dual Antiplatelet Therapy Versus Monotherapy in Acute Stroke Management: A Systematic Review

Hyperosmolar Coma: Diagnostic Difficulties on the Clinical Example

Hyperosmolar hyperglycemic state is an acute complication of diabetes mellitus, the mortality rate of which reaches 50 %. One of the reasons for the unfavorable outcome is untimely diagnosis, which is often due to insufficient awareness of doctors regarding the features of clinical and laboratory manifestations of this diabetic complication. Hyperosmolar state often develops in older patients with polymorbidity, and neurological symptoms predominate in the clinical picture, which also complicates diagnosis and causes diagnostic errors. The article presents a clinical case of hyperosmolar hyperglycemic state, the diagnosis of which caused difficulties at all stages, including postmortem pathological examination. Initially, acute cerebrovascular accident was assumed, then the patient’s severe condition was associated with acute myocardial infarction, and based on the results of the pathological examination, a conclusion was made about sepsis and septic shock. Review of the patient’s medical history showed that the most probable diagnosis was hyperosmolar state, which developed as a result of decompensation of diabetes mellitus against the background of the inflammatory process. Severe dehydration of the patient, as the cause of her soporous state, was confirmed by the data of examination and laboratory and instrumental examination: dry skin and mucous membranes, small amount of urine, signs of blood thickening and prerenal acute renal failure. At the same time, the absence of obvious focal neurological disorders, clinically significant changes in the cardiovascular system, fever and hemodynamic disturbances did not allow, in our opinion, to associate the patient’s severe condition with acute cerebrovascular accident, myocardial infarction or septic shock. Dehydration was complicated by the development of disseminated vascular coagulation syndrome, gastrointestinal bleeding and hemorrhagic shock with a fatal outcome. This clinical case demonstrates that in differential diagnostics of diseases a more reliable approach is the analysis of the clinical picture from the point of view of the pathogenesis of disorders. Analysis of such clinical situations can serve as an aid for doctors in diagnosing hyperosmolar state.

A Forgotten Rare Cause of Unilateral Basal Ganglia Calcinosis Due to Venous Angioma and Complicating Acute Stroke Management: A Case Report

Background: Unilateral basal ganglia calcinosis (BGC) is a rare radiological finding that can be diagnosed on computed tomography (CT) and magnetic resonance imaging (MRI) but often presents challenges for clinicians and radiologists in determining its underlying cause. So far, only a few potential causes that could explain unilateral BGC have been described in the literature. Case Report: A 54-year-old Caucasian male was admitted to a tertiary university hospital due to the sudden onset of speech impairment and right-sided weakness. The patient had no significant medical history prior to this event. Non-enhanced computed tomography (NECT) of the brain revealed no evidence of acute ischemia; CT angiography (CTA) showed acute left middle cerebral artery (MCA) M2 segment occlusion. CT perfusion (CTP) maps revealed an extensive penumbra-like lesion, which is potentially reversible upon achieving successful recanalization. However, a primary neoplastic tumor with calcifications in the basal ganglia was initially interpreted as the potential cause; therefore, acute stroke treatment with intravenous thrombolysis was contraindicated. A follow-up CT examination at 24 h revealed an ischemic lesion localized to the left insula, predominantly involving the left parietal lobe and the superior gyrus of the left temporal lobe. Subsequent gadolinium-enhanced brain MRI revealed small blood vessels draining into the subependymal periventricular veins on the left basal ganglia. Digital subtraction angiography was conducted, confirming the diagnosis of venous angioma. Conclusions: Unilateral BGC caused by venous angioma is a rare entity with unclear pathophysiological mechanisms and heterogeneous clinical presentation. It may mimic conditions such as intracerebral hemorrhage or hemorrhagic brain tumors, complicating acute stroke management, as demonstrated in this case. Surrounding tissue calcification may provide a valuable radiological clue in diagnosing venous angiomas DVAs and vascular malformations.

Persistent Penumbral Profiles Indicate a Potentially Good Outcome in Acute Stroke Patients Without Major Reperfusion.

It is acknowledged that penumbra can exist beyond 24 hours after stroke onset. The aim of this study was to explore the association between penumbral persistence at 24-72 hours and clinical outcomes in patients who did not achieve major reperfusion. Eligible patients participating in the International Stroke Perfusion Imaging Registry with repeated 24-72 hours perfusion imaging were retrospectively included in this study. Persistent penumbra was evaluated as the volume of hypoperfusion lesion on repeated perfusion imaging divided by infarct volume on the follow-up imaging at 24-72 hours post arrival. Short-term clinical outcomes were defined as neurological deterioration at 24-72 hours and modified Rankin Scale (mRS) 0-2 at discharge. Long-term outcome was defined as mRS 0-2 at 3 months. The association between persistent penumbra and clinical outcomes was explored using multivariable-adjusted logistic regression models. A total number of 203 patients were included in this study. Persistent penumbra was associated with decreased odds of neurological deterioration at 24-72 hours (multivariable-adjusted OR=0.3, 95% CI 0.1-0.8, P=0.01) and increased odds of mRS 0-2 at 3 months (multivariable-adjusted OR=2.7, 95% CI 1.1-6.8, P=0.03). Persistent penumbra was not associated with mRS 0-2 at discharge (multivariable-adjusted OR=2.5, 95% CI 0.4-14.7, P=0.30). Persistent penumbra in acute stroke patients without major reperfusion was generally associated with a better clinical outcome. This evidence suggested that there were patients with persistent hemodynamic support, for whom major reperfusion might not be pivotal to achieve a good clinical outcome. How to identify these patients and what treatment strategy can be made to stabilize the hemodynamics need future investigation. Anonymized data not published within this article will be made available at the request of qualified investigators whose proposal of data use has been approved by an independent review committee.

Self-reported health status of patients with acute retinal ischemia and stroke related hemianopia.

We aimed to assess impairments on health-related quality of life, and mental health resulting from Retinal artery occlusion (RAO) with monocular visual field loss and posterior circulation ischemic stroke (PCIS) with full or partial hemianopia using patient-reported outcome measures (PROMs). In a prospective study, consecutive patients with acute RAO on fundoscopy and PCIS on imaging were recruited during their surveillance on a stroke unit over a period of 15 months. Baseline characteristics were determined from medical records and interviews. Health-related quality of life (PROM Information System 10-Question-Short-Form, PROMIS-10), and mental health symptoms (Patient-Health-Questionnaire-4, PHQ-4) were assessed 3 and 12 months after admission postally and via phone. Ffity-seven patients with RAO and 19 with isolated full or partial hemianopia determined by the NIHSS (median = 2; IQR:0/2) according to PCIS were included. Characteristics of cardiovascular risk factors, and functional status pre-stroke were comparable between the groups. At 3 months, mean ± standard deviation T-scores of PROMIS physical and mental health were 47.1 ± 8.8 and 46.7 ± 8.8 for patients with RAO, and 43.4 ± 9.8 and 43.2 ± 6.2 for PCIS. Compared to 50 ± 10 in the general population, scores after RAO (p = 0.04; p = 0.02) and PCIS (p = 0.01; p < 0.001) were lower in both domains after 3 months. Concerning PCIS, scores in the mental health domain remained decreased at 12 months (p = 0.04). On the PHQ-4, 25% of patients with RAO, and 62% with PCIS scored indicative for anxious and/or depressive syndromes at 3 months. RAO led only to partial and to less persistent mental impairments than PCIS. This suggests that a different approach involving complex visual and neuropsychological treatment over a longer period of time needs to be considered for post-stroke care of PCIS. The trial was submitted at http://www.clinicaltrials.gov, under NCT03795948.

EEG Responses to Upper Limb Pinprick Stimulation in Acute and Early Subacute Motor and Sensorimotor Stroke: A Proof of Concept.

Electroencephalogram (EEG) during pinprick stimulation has the potential to unveil neural mechanisms underlying sensorimotor impairments post-stroke. A proof-of-concept study explored event-related peak pinprick amplitude and oscillatory responses in healthy controls and in people with acute and subuacutemotor and sensorimotor stroke, their relationship, and to what extent EEG somatosensory responses can predict sensorimotor impairment. In this study, 26 individuals participated, 10 people with an acute and early subacute sensorimotor stroke, 6 people with an acute and early subacute motor stroke, and 10 age-matched controls. Pinpricks were applied to the dorsa of the impaired hand to collect somatosensory evoked potentials. Time(-frequency) analyses of somatosensory evoked potential (SEP) data at electrodes C3 and C4 explored peak pinprick amplitude and oscillatory responses across the three groups. Also, in stroke, (sensori-)motor impairments were assessed with the Fugl Meyer Assessment Upper Extremity (FMA) and Erasmus modified Nottingham Sensory Assessment (EmNSA) at baseline and 7 to 14days later. Mixed model analyses were used to address objectives. It was demonstrated that increased beta desynchronization magnitude correlated with milder motor impairments (R2adjusted = 0.213), whereas increased beta resynchronization and delta power were associated to milder somatosensory impairment (R2adjusted = 0.550). At the second session, larger peak-to-peak SEP amplitude and beta band resynchronization at baseline were related to greater improvements in EMNSA and FMA scores, respectively, in the sensorimotor stroke group. These findings highlight the potential of EEG combined with somatosensory stimuli to differentiate between sensorimotor and motor impairments in stroke, offering preliminary insights into both diagnostic and prognostic aspects of upper limb recovery.

Impact of Brain Lesion Characteristics on Motor Function and Cortical Reorganization in Hemiplegic Cerebral Palsy

Background and Objectives: Hemiplegic or unilateral cerebral palsy (UCP) is primarily characterized by motor impairment, mainly affecting the upper limb. Research has centered on factors influencing the varying degrees of motor deficit in UCP, using neuroscience advancements for in vivo exploration of brain structure (morphometry) and cortical reorganization (functional magnetic resonance imaging (fMRI)). This study aims to evaluate functional activation in the motor cortex in UCP and to explore how lesion characteristics and timing affect neuroplasticity and motor function. Materials and Methods: Between 2017 and 2021, structural and functional MRIs were performed on 44 UCP patients (mean age 15.5 years, 24 males, 20 females), all with Manual Ability Classification System (MACS) levels I-III and Intelligence Quotient (IQ) ≥ 50. The lesion characteristics of size, type, and time of occurrence (ante-, peri-, or early postnatal) were analyzed. An association was sought between the characteristics of the lesion and the degree of motor deficit of the upper limb, as determined by the MACS level. fMRI assessed cortical activation during a finger-tapping task for the paretic hand and compared activation patterns based on lesion characteristics. Results: Six lesion types were identified, with arterial ischemic stroke being the most common and largest in volume. Lesion size strongly correlated with patients’ MACS levels, while lesion type and timing showed no association with the severity of motor impairment classified by MACS. Motor reorganization varied, with activation occurring ipsi-, contra-, or bilaterally to the affected hand, depending on lesion size and type. Smaller, subcortical lesions primarily showed ipsilesional activation, while larger, cortical lesions did not exhibit a specific group activation, possibly due to varying individual reorganization. No association was found between the lesion timing and the reorganization model. Conclusions: Motor functional reorganization in UCP is closely linked to lesion characteristics, with smaller, subcortical lesions favoring typical organization in the contralateral motor cortex. The timing of the lesion does not significantly affect cortical reorganization. Lesion size was a key determinant of motor function, whereas lesion type (e.g., ischemic stroke) and timing (early vs. late occurrence) were less critical for predicting functional outcome.

Integrated care management for patients following acute stroke: a systematic review.

Contemporary stroke care is moving towards more holistic and patient-centred integrated approaches, however, there is need to develop high quality evidence for interventions that benefit patients as part of this approach. This study aims to identify the types of integrated care management strategies that exist for people with stroke, to determine whether stroke management pathways impact patient outcomes, and to identify elements of integrated stroke care that were effective at improving outcomes. Systematic review with meta-analysis. The review was conducted using Medline, CINAHL, Web of Science and the Cochrane Database of randomised controlled trials from January 2012 to January 2024. Studies that evaluated interventions as part of integrated care against a control or standard treatment group were included. Primary outcomes included mortality, recurrent stroke and major bleeding. Secondary outcomes included quality of life, unplanned readmission, anxiety and depression, lifestyle and cardiovascular risk factors, and adherence to intervention. In total, 99 studies were included and 63 were meta-analysed. Patients receiving integrated stroke care had significant reductions in recurrent stroke (RR 0.79, 95% CI: 0.63-1.00, P = 0.05, I 2 = 39%), significant improvements in quality of life (SMD = 0.41, 95% CI: 0.26-0.56, P < 0.00001, I 2 = 91%) and reduced incidence of depression (RR 0.95, 95% CI: 0.92-0.99, P = 0.007, I 2 = 22%). There were no significant differences in mortality or major bleeding. The findings of this study showed that integrated care post-stroke is associated with better quality of life and reduced depression and recurrent stroke.

Rehabilitation success and related costs following stroke in a regional hospital: a retrospective analysis based on the Australian National Subacute and Non-Acute Patient (AN-SNAP) classification

BackgroundEvidence is limited on the factors influencing successful stroke rehabilitation in regional contexts. Additionally, the relationship between rehabilitation costs following acute stroke, based on Australian National Subacute and Non-Acute Patient (AN-SNAP) casemix classification, and rehabilitation success remains unclear.ObjectiveThis retrospective cohort study investigated the factors contributing to improved functional outcomes following stroke rehabilitation in an Australian regional hospital, also evaluating the respective average daily and total payments.MethodsStroke patients’ admission records, during 2010–2020, were linked with rehabilitation registry data. Rehabilitation success was defined as relative functional gain (RFG) ≥ 0.5 and Functional Independence Measure (FIM) efficiency ≥ 1. Multivariate mixed effects logistical regressions modelled the sociodemographic and medical (i.e., comorbidities and stroke type) predictors of rehabilitation success, while logarithms of average daily and total rehabilitation payments were modelled using robust regressions.ResultsOf 582 included patients, 315 (54.1%) achieved RFG ≥ 0.5 and 258 (52.2%) achieved FIM efficiency ≥ 1. A longer delay in starting rehabilitation was associated with a lower likelihood of achieving RFG success [Odds Ratio (OR): 0.85, 95% confidence interval (CI): 0.78–0.93, P < 0.001] and FIM efficiency success (OR: 0.89, 95% CI: 0.82–0.97, P = 0.010). A higher FIM score at admission was associated with decreased odds of FIM efficiency success (OR: 0.35, 95% CI: 0.20–0.60, P < 0.001). The average daily and total rehabilitation payments for inpatients were $AU1,255 (median) [interquartile range (IQR): 1,040, 1,771] and $AU28,363 (median) (IQR: 18,822, 41,815), respectively. FIM efficiency success was positively associated with the average daily payment (Beta: 0.25, 95% CI: 0.20–0.30, P < 0.001), but negatively correlated with the total payment (Beta: -0.18, 95% CI: -0.24–0.13, P < 0.001). No significant associations were found between RFG success and these payments.ConclusionThis study identifies key factors affecting stroke rehabilitation outcomes in a regional Australian setting. Delays in starting rehabilitation were linked to lower success rates, underscoring the importance of timely intervention. While higher average daily costs were associated with better FIM efficiency, total costs did not correlate with relative functional gains. These findings may inform rehabilitation practices and may influence future funding strategies for rehabilitation services.

Association between the Tpeak-Tend interval on admission and coronary microvascular dysfunction in Takotsubo syndrome.

The Tpeak-Tend interval on electrocardiogram may be a predictor of worse outcomes in Takotsubo syndrome (TTS), but the mechanisms have not been fully determined. This study aimed to investigate the relationships between the corrected Tpeak-Tend (cTp-e) interval and coronary microvascular-dysfunction (CMD) assessed by the angiography-derived index of microvascular resistance (Angio-IMR) and the in-hospital prognosis in patients with TTS. We retrospectively evaluated 111 consecutive patients admitted for TTS who underwent coronary angiography at Kindai University Hospital from October 2009 to July 2023. The Tpeak-Tend interval was defined as the time interval between the peak and the end of the T wave in electrocardiogram lead V5 on admission. Angio-IMR was assessed from aortic pressure, quantitative flow ratio (QFR), vessel length and hyperemic velocity using the formula described in validation studies. QFR, vessel length and hyperemic velocity was derived from coronary angiography and QAngio XA 3D software package. The degree of CMD was assessed by the maximum Angio-IMR value in each of the three coronary arteries. The primary endpoint was the relationship between the grade of a prolonged cTp-e interval on admission and Angio-IMR. The secondary endpoint was the relationship between the grade of a prolonged cTp-e interval on admission and in-hospital adverse cardiovascular events (composite of acute heart failure, cardiogenic shock, life-threatening arrhythmia, thrombotic events, stroke and all-cause death). The median age was 77.5 [71.0-83.0] years, and most patients were women (82.0%). The median cTp-e interval was 114.5 [91.2-147.0] ms. The patients were categorized according to the tertiles of the cTp-e interval (T1: 52.4-96.9ms; T2: 100.1-129.1ms; T3: 131.7-309.8ms). There was a stepwise increment in the values of maximum Angio-IMR in each of the three coronary arteries in tertiles of the cTp-e interval (T1 vs. T2 vs. T3: 16.1 [14.7-19.3] vs. 21.8 [16.0-31.1] vs. 29.0 [27.2-31.9], P<0.001). In-hospital adverse cardiovascular events occurred in 53 of 111 patients (47.7%). There was a stepwise increment in the incidence of in-hospital adverse cardiovascular events in tertiles of the cTp-e interval (T1 vs. T2 vs. T3: 27.1% vs. 54.1% vs. 62.2%, P=0.007). The multivariable analysis showed that prolonged cTp-e interval (OR: 1.30; 95% CI: 1.12-1.56; P<0.001) was independent predictors of in-hospital adverse cardiovascular events. The Tpeak-Tend interval on admission reflected CMD and predicts in-hospital adverse cardiovascular events in patients with TTS.

Infarct core segmentation using U-Net in CT perfusion imaging: a feasibility study.

The wide variability in thresholds on computed tomography (CT) perfusion parametric maps has led to controversy in the stroke imaging community about the most accurate measurement of core infarction. To investigate the feasibility of using U-Net to perform infarct core segmentation in CT perfusion imaging. CT perfusion parametric maps were the input of U-Net, while the ground truth segmentation was determined based on diffusion-weighted imaging (DWI). The dataset used in this study was from the ISLES2018 challenge, which contains 63 acute stroke patients receiving CT perfusion imaging and DWI within 8 h of stroke onset. The segmentation accuracy of model outputs was assessed by calculating Dice similarity coefficient (DSC), sensitivity, and intersection over union (IoU). The highest DSC was observed in U-Net taking mean transit time (MTT) or time-to-maximum (Tmax) as input. Meanwhile, the highest sensitivity and IoU were observed in U-Net taking Tmax as input. A DSC in the range of 0.2-0.4 was found in U-Net taking Tmax as input when the infarct area contains < 1000 pixels. A DSC of 0.4-0.6 was found in U-Net taking Tmax as input when the infarct area contains 1000-1999 pixels. A DSC value of 0.6-0.8 was found in U-Net taking Tmax as input when the infarct area contains ≥ 2000 pixels. Our model achieved good performance for infarct area containing ≥ 2000 pixels, so it may assist in identifying patients who are contraindicated for intravenous thrombolysis.

Risk factors, mechanisms, and clinical outcomes of stroke in young adults presenting to a North Central London stroke service: UCL Young Stroke Systematic Evaluation Study (ULYSSES).

Stroke incidence in younger adults is increasing worldwide yet few comprehensive studies exist from a UK population. We investigated the risk factors, mechanisms, functional outcome and stroke recurrence rate in a cohort of young adults with stroke. We included consecutive patients (<55 years) with ischaemic stroke or intracerebral haemorrhage (ICH) admitted to the University College London Hospitals Hyperacute Stroke Unit between 2017 and 2020. Ischaemic stroke was classified using Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria and ICH using modified CLAS-ICH criteria. Multivariable logistic regression was performed to identify predictors of unfavourable functional outcome (modified Rankin Scale [mRS] > 1) at 6 months. Five hundred fifty-two patients were included (median age 47, IQR 41-51; 33% female; 76% ischaemic stroke). Common risk factors included dyslipidaemia (57%), hypertension (40%), and cigarette smoking (34%). Ischaemic stroke was mostly due to cardioembolism (22%). Probable cerebral small vessel disease was the most frequent ICH aetiology (53%). Unfavourable functional outcome was prevalent in 50% at 6 months and was associated with ICH (OR 2.02, 95%CI 1.14-3.58, p = 0.017), female sex (OR 1.62, 95%CI 1.03-2.55, p = 0.037), admission stroke severity (per point increase, OR 1.11, 95%CI 1.07-1.16, p < 0.001) and pre-morbid mRS 2-5 (OR 3.16; 95%CI 1.11-9.03, p = 0.032). 4.4% had a recurrent stroke within 6 months. Traditional cardiovascular risk factors are common in young adults with stroke. Unfavourable functional outcome is associated with female sex, ICH, severe stroke and pre-morbid disability. These findings can inform national stroke prevention and rehabilitation strategies.

Use of balloon angioplasty for patients with intracranial large atherosclerotic acute ischemic stroke and cerebral cavernous malformation: a case report

Thus far, clinical data relating to the treatment of cerebral cavernous malformation (CCM) patients with acute stroke (AIS) are incredibly scare due to the low incidence of CCM. Furthermore, the safety profile of using tissue plasminogen activator, the only drug approved for AIS treatment within 4.5 h, remains controversial in patients with CCM. Recently, balloon angioplasty has been reported as a successful treatment for intracranial large atherosclerotic AIS patients. In our department, we treated a patient with intracranial large atherosclerotic AIS and CCM using balloon angioplasty, resulting in a positive outcome. Here, we discuss the safety and efficiency of balloon angioplasty for the treatment of intracranial large atherosclerotic AIS in patients with CCM. In conclusion, we suggest that balloon angioplasty may be a potentially safe and effective treatment for intracranial large atherosclerotic AIS patients with CCM. However, further research is needed to explore the use of mechanical revascularization in AIS patients with CCM.

Impact of anesthetic methods on outcomes for patients with large core stroke undergoing endovascular treatment

BackgroundThe optimal anesthetic method for endovascular therapy in acute large core stroke remains unclear. This study aimed to evaluate the impact of anesthetic methods on outcomes in patients with large...

Automated extraction of post-stroke functional outcomes from unstructured electronic health records.

Population level tracking of post-stroke functional outcomes is critical to guide interventions that reduce the burden of stroke-related disability. However, functional outcomes are often missing or documented in unstructured notes. We developed a natural language processing (NLP) model that reads electronic health records (EHR) notes to automatically determine the modified Rankin Scale (mRS). We included consecutive patients (⩾18 years) with acute stroke admitted to our center (2015-2024). mRS scores were obtained from the Get With the Guidelines registry and clinical notes (if documented), and used as the gold standard to compare against NLP-generated scores. We used text-based features from notes, along with age, sex, discharge status, and outpatient follow-up to train a logistic regression for prediction of good (0-2) versus poor (3-6) mRS, and a linear regression for the full range of mRS scores. The models were trained for prediction of mRS at hospital discharge and post-discharge. The models were externally validated in a dataset of patients with brain injuries from a different healthcare center. We included 5307 patients, 5006 in train and test and 301 in validation; average age was 69 (SD 15) and 65 (SD 17) years, respectively; 47% female. The logistic regression achieved an area under the receiver operating curve (AUROC) of 0.94 [CI 0.93-0.95] (test) and 0.94 [0.91-0.96] (validation), and the linear model a root mean squared error (RMSE) of 0.91 [0.87-0.94] (test) and 1.17 [1.06-1.28] (validation). The NLP-based model is suitable for use in large-scale phenotyping of stroke functional outcomes and population health research.