Diagnosis Of Cerebrovascular Disease Research Articles

#2929 Plasma levels of brain injury markers NfL and GFAP are independently predicted by glomerular filtration rate in patients with chronic kidney disease

Abstract Background and Aims Patients with chronic kidney disease (CKD) have a high prevalence of cerebrovascular disease and cognitive impairment. The aim of the present study was to measure brain injury biomarkers in plasma in a cohort of patients with CKD stages 3 and 4, without a diagnosis of cerebrovascular disease, and to determine factors that independently predicted plasma levels of these biomarkers. Method This was a cross-sectional cohort study including 110 patients with CKD stages 3 and 4, and 55 healthy, matched, controls, recruited from the outpatient clinic at Sahlgrenska university hospital, Gothenburg, Sweden. None of the included study subjects had a diagnosis of cerebrovascular disease, cognitive impairment, or any other neurological disease. Plasma concentrations of neurofilament light (NfL), glial fibrillary acidic protein (GFAP) and phosphorylated Tau (p-Tau231) were analyzed with ultrasensitive single molecule array (SIMOA). Measured GFR (mGFR) was determined by plasma clearance of ⁵¹Cr-EDTA. Values are medians [interquartile range]. For linear regression analyses standardised beta coefficients (β) are presented. Results Characteristics of CKD patients and healthy controls are presented in Table 1. Plasma concentrations of NfL (37.5 [22.1-47.5] vs. 13.4 [10.5-16.7] ng/L, p < 0.001), p-Tau231 (25.7 [19.1-38.7] vs. 13.9 [10.5-16.3] ng/L, p < 0.001) and GFAP (190 [140-281] vs. 153 [116-211] ng/L, p = 0.001) were significantly elevated in patients with CKD vs. controls. In CKD patients, mGFR showed statistically significant inverse correlations to plasma concentrations of NfL, p-Tau231, and GFAP (Table 2). In multiple regression analyses, mGFR was associated with plasma levels of NfL (β = −0.457, p < 0.001) and GFAP (β = −0.322, p < 0.001) independently of diabetes, age, troponin-T, b-hemoglobin, and aortic pulse-wave velocity. However, mGFR was not significantly associated with plasma levels of p-Tau231 in a multiple regression analysis. Conclusion Plasma levels of brain injury markers NfL, p-Tau231 and GFAP were elevated in patients with CKD stages 3 and 4, without a history of cerebrovascular disease, compared to healthy controls. Furthermore, mGFR independently predicted plasma concentrations of NfL and GFAP in multiple regression models. These results raise the possibility that reduced GFR per se may be associated with subclinical brain injury.

Spiral time-of-flight magnetic resonance angiography for intracranial vascular imaging: performance compared to conventional Cartesian angiogram.

Computed tomography angiography (CTA) and digital subtraction angiography (DSA) usually raise the risk of potential malignancies with cumulative radiation doses. Current time-of-flight magnetic resonance angiography (TOF-MRA) (dubbed as cTOF), which is based on Cartesian sampling mode, may show limited diagnostic conspicuity at sinuous or branching regions. It is also prone to relatively high false positive diagnoses and undesirable display of distal intracranial vessels. This study aimed to use spiral TOF-MRA (sTOF) as a noninvasive alternative to explore possible improvement, such that the application of magnetic resonance angiography (MRA) can be extended to facilitate clinical examination or cerebrovascular disease diagnosis and follow-up studies. Initially, 37 patients with symptoms of dizziness or transient ischemic attack were consecutively recruited for suspected intracranial vascular disease examination from Zhongshan Hospital of Xiamen University between July 2020 and April 2021 in this cross-sectional prospective study. After excluding 1 patient with severe scanning artifacts, 1 patient whose scanning scope did not meet the requirement, and 1 patient with confounding tumor lesions, a total of 34 participants were included according to the inclusion and exclusion criteria. Each participant underwent intracranial vascular imaging with both sTOF and cTOF sequences on a 3.0 T MR scanner with a conventional head-neck coil of 16 channels. Contrast CTA or DSA was also performed for 15 patients showing pathology. Qualitative comparisons in terms of image quality and diagnostic efficacy ratings, quantitative comparisons in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel length, and sharpness were evaluated. Pair-wise Wilcoxon test was performed to evaluate the imaging quality derived from cTOF and sTOF acquisitions and weighted Cohen's Kappa was conducted to assess the rating consistency between different physicians. Compared to cTOF, sTOF showed better performance with fewer artifacts. It can effectively alleviate false positives of normal vessels being misdiagnosed as aneurysm or stenosis. Improved conspicuity was observed in cerebral distal regions with more clearly identifiable vasculature at finer scales. Quantitative comparisons in selected regions revealed significant improvement of sTOF in SNR (P<0.01 or P<0.001), CNR (P<0.001), vessel length (P<0.001), and sharpness (P<0.001) as compared to cTOF. Besides, sTOF can depict details of M1 and M2 segments of middle cerebral artery (MCA) at metallic implant region, showing its resistance to magnetic susceptibility. The sTOF shows higher imaging quality and lesion detectability with reduced artifacts and false positives, representing a potentially feasible surrogate in intracranial vascular imaging for future clinic routines.

The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview.

Cerebrovascular diseases, including ischemic strokes, hemorrhagic strokes, and vascular malformations, are major causes of morbidity and mortality worldwide. The advancements in neuroimaging techniques have revolutionized the field of cerebrovascular disease diagnosis and assessment. This comprehensive review aims to provide a detailed analysis of the novel imaging methods used in the diagnosis and assessment of cerebrovascular diseases. We discuss the applications of various imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and angiography, highlighting their strengths and limitations. Furthermore, we delve into the emerging imaging techniques, including perfusion imaging, diffusion tensor imaging (DTI), and molecular imaging, exploring their potential contributions to the field. Understanding these novel imaging methods is necessary for accurate diagnosis, effective treatment planning, and monitoring the progression of cerebrovascular diseases.

A Comparative Study of Transcranial Color-Coded Doppler (TCCD) and Transcranial Doppler (TCD) Ultrasonography Techniques in Assessing the Intracranial Cerebral Arteries Haemodynamics.

Cerebrovascular disease (CVD) poses a major public health and socio-economic burden worldwide due to its high morbidity and mortality rates. Accurate assessment of cerebral arteries' haemodynamic plays a crucial role in the diagnosis and treatment management of CVD. The study compared a non-imaging transcranial Doppler ultrasound (TCD) and transcranial color-coded Doppler ultrasound (with (cTCCD) and without (ncTCCD)) angle correction in quantifying middle cerebral arteries (MCAs) haemodynamic parameters. A cross-sectional study involving 50 healthy adults aged ≥ 18 years was conducted. The bilateral MCAs were insonated via three trans-temporal windows (TTWs-anterior, middle, and posterior) using TCD, cTCCD, and ncTCCD techniques. The MCA peak systolic velocity (PSV) and mean flow velocity (MFV) were recorded at proximal and distal imaging depths that could be visualised on TCCD with a detectable spectral waveform. A total of 152 measurements were recorded in 41 (82%) subjects with at least one-sided open TTW across the three techniques. The mean PSVs measured using TCD, ncTCCD, and cTCCD were 83 ± 18 cm/s, 81 ± 19 cm/s, and 93 ± 21 cm/s, respectively. There was no significant difference in PSV between TCD and ncTCCD (bias = 2 cm/s, p = 1.000), whereas cTCCD yielded a significantly higher PSV than TCD and ncTCCD (bias = -10 cm/s, p < 0.001; bias = -12 cm/s, p ≤ 0.001, respectively). The bias in MFV between TCD and ncTCCD techniques was (bias = -0.5 cm/s; p = 1.000), whereas cTCCD demonstrated a higher MFV compared to TCD and ncTCCD (bias = -8 cm/s, p < 0.001; bias = -8 cm/s, p ≤ 0.001, respectively). TCCD is a practically applicable imaging technique in assessing MCA blood flow velocities. cTCCD is more accurate and tends to give higher MCA blood flow velocities than non-imaging TCD and ncTCCD techniques. ncTCCD is comparable to non-imaging TCD and should be considered in clinical cases where using both TCD and TCCD measurements is needed.

Abstract WP66: Increases in Emergency Department Utilization of CT Angiography Brain and CT Perfusion in the Transferred Patient Population Across the Endovascular Therapy Era

Background: With the advent of endovascular therapy as a treatment modality for LVO stroke, the importance of stroke networks has become increasingly clear. We sought to understand the way advanced neuroimaging is utilized in transferred emergency department (ED) encounters using a large national dataset. Methods: Retrospective cohort study of adult ED encounters, comparing ED transfers (to other acute care hospitals) to discharged patients. Data from the 2013-2018 National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters were analyzed. CTA Head, CTP, MRI Brain, and Non-contrast CT Head imaging use was determined from Common Procedural Terminology (CPT) codes. ICD10 Codes I60-I69 were used to indicate cerebrovascular disease. Statistical comparisons used 95% CI for rate per 100,000 ED visits. Results: ED utilization of advanced neuroimaging was higher in transferred patients than discharged patients in all years studied (Fig). Between 2013 and 2018, utilization of CTA and CTP increased 8-fold and 20-fold, respectively in the transferred population. Noncontrast head CT and MRI were relatively stable but more frequent in transferred encounters. Between 2013 and 2018, encounters associated with a transfer came disproportionately from smaller hospitals (45% from hospitals with &lt;=20,000 ED visits per year, and 24% from ED visits at hospitals with between 20,000 and 40,000 ED visits per year). In 2018 transferred encounters with a CTA Head or CTP, 75% (72-77) and 76%(70-83), respectively had a diagnosis code associated with cerebrovascular disease. Conclusions: Utilization of CTA and CTP increased substantially between 2013-2018 in the ED transfer population, and most of these encounters are associated with a cerebrovascular disease diagnosis. Detailed diagnosis and hospital demographic data to be presented. These results have implications for the design and optimization of stroke systems of care.

Clinical, neurological, laboratory and neuropsychological features of the course of cerebrovascular diseases in patients infected with SARS-CoV-2

The rapid global spread of the COVID-19 virus has caused an unprecedented pandemic, in the conditions of which a significant number of pathological consequences of this disease have appeared. In particular, COVID-19 affected the course of cerebrovascular disease, the consequences of which cause disorders of the normal functioning of the brain. Therefore, the aim of the study was to improve the diagnosis of cerebrovascular disease in patients infected with SARS-CoV-2 by studying clinical, neurological, laboratory and neuropsychological indicators. The trial uses Beck's Anxiety Inventory, Hamilton Depression Rating Scale; neuropsychological tests – Mina Mental State Examination, Montreal Cognitive Assessment; clinical – neuro­logical status; laboratory – complete blood count, erythrocyte sedimentation rate), C-reactive protein, D-dimer, indi­cators of the blood coagulation system, procalcitonin; polymerase chain reaction, a test for the detection of ribonucleic acid of the COVID-19 virus; statistical. The revealed results indicate deviations from the norm of most indicators in patients infected with SARS-CoV-2 in particular such as leukocytes (t=3.18, p≤0.01), lymphocytes (t=3.83, p≤0.01), band neutrophils (t=2.33, p≤0.05), segmented neutrophils (t=2.29, p≤0.05), erythrocyte sedimentation rate (t=2.17, p≤0.05), platelets (t =2.86, p≤0.01), prothrombin index (t=3.17, p≤0.01), D-dimer (t=2.11, p≤0.05), fibrinogen (t=2 .53, p≤0.05), C-reactive protein (t=2.97, p≤0.01), procalcitonin (t=2.64, p≤0.05). Patients with a history of SARS-CoV-2 had significantly lower indicators of cognitive (t=-2.17, p≤0.05), visuospatial function (t=-2.84, p≤0.01), as well as a higher level of depression (t=2.87, p≤0.01) than patients who did not suffer from COVID-19. No statistical differences were found in terms of anxiety in both groups. A direct correlation was established between the level of leukocytes and cognitive functions (r=0.477, p≤0.01) and also visuospatial function (r=0.591, p≤0.05). An inverse correlation between procalcitonin level and mental status was also established (r=-0.622, p≤0.01). The conducted study proved the statistical significance of clinical-neurological, laboratory and neuropsychological indicators of patients with cerebrovascular disease infected with SARS-CoV-2.

Cerebrovascular diseases epidemiology in the Stavropol region rural residents in the implementation context of the regional program «Fighting mediavascular diseases in the Stavropol region»

Relevance. During the implementation of the program for the prevention and treatment of cardiovascular diseases in the Stavropol Territory, measures were taken to prevent hemorrhagic and ischemic strokes, train medical personnel in methods of timely detection of cerebrovascular diseases (CVD), recognition (including through training of the general population) and routing patients with acute cerebrovascular accidents; during a pandemic, opening specialized departments. This organizational experiment required an assessment of its impact on the most medically complex group of the population - rural residents. The aim was to study in dynamics the epidemic situation of CVD among the rural population in the Stavropol Territory in comparison with the Russian Federation. Materials and Methods. Information from official statistical observation forms on the incidence of CVD and mortality from them was studied. Results and Discussion. In the period from 2010 to 2022, there was an increase in the incidence of CVD in the rural population from 464.6 to 1045.1 per 100,000 rural population, which is partly due to the aging of the population, and partly due to improved diagnosis of CVD. The overall incidence of CVD increased from 1275.5 to 3416.1, which suggests an improvement in patient survival. The incidence of strokes of all types tended to decrease, which indicates the effectiveness of the impact on the risk factors for their development. The incidence of unspecified strokes decreased significantly, which led to an increase in the primary incidence of cerebral infarctions (which, however, grew more slowly in the Stavropol Territory than in the Russian Federation as a whole; the coefficients of the regression equations were 2.5 and 4.3, respectively). Between 2015 and 2022. the mortality rates (from 208.4 to 161.1) and mortality (from 5.8 to 2.8) from CVD decreased rapidly (relative to mortality from CVD in the Russian Federation). Conclusion. The proposed set of measures for the prevention and treatment of CVD, including preventive measures, a system of social mobilization, FAST-test, patient routing systems with the delivery of eligible persons to vascular centers within an hour, timely response to new risk factors for the development of CVD, was effective and can be recommended for implementation in similar areas with a high proportion of rural population.

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.

TaG-Net: Topology-aware Graph Network for Centerline-based Vessel Labeling.

Anatomical labeling of head and neck vessels is a vital step for cerebrovascular disease diagnosis. However, it remains challenging to automatically and accurately label vessels in computed tomography angiography (CTA) since head and neck vessels are tortuous, branched, and often spatially close to nearby vasculature. To address these challenges, we propose a novel topology-aware graph network (TaG-Net) for vessel labeling. It combines the advantages of volumetric image segmentation in the voxel space and centerline labeling in the line space, wherein the voxel space provides detailed local appearance information, and line space offers high-level anatomical and topological information of vessels through the vascular graph constructed from centerlines. First, we extract centerlines from the initial vessel segmentation and construct a vascular graph from them. Then, we conduct vascular graph labeling using TaG-Net, in which techniques of topology-preserving sampling, topology-aware feature grouping, and multi-scale vascular graph are designed. After that, the labeled vascular graph is utilized to improve volumetric segmentation via vessel completion. Finally, the head and neck vessels of 18 segments are labeled by assigning centerline labels to the refined segmentation. We have conducted experiments on CTA images of 401 subjects, and experimental results show superior vessel segmentation and labeling of our method compared to other state-of-the-art methods.

Role of artificial intelligence and machine learning in the diagnosis of cerebrovascular disease.

Cerebrovascular diseases are known to cause significant morbidity and mortality to the general population. In patients with cerebrovascular disease, prompt clinical evaluation and radiographic interpretation are both essential in optimizing clinical management and in triaging patients for critical and potentially life-saving neurosurgical interventions. With recent advancements in the domains of artificial intelligence (AI) and machine learning (ML), many AI and ML algorithms have been developed to further optimize the diagnosis and subsequent management of cerebrovascular disease. Despite such advances, further studies are needed to substantively evaluate both the diagnostic accuracy and feasibility of these techniques for their application in clinical practice. This review aims to analyze the current use of AI and MI algorithms in the diagnosis of, and clinical decision making for cerebrovascular disease, and to discuss both the feasibility and future applications of utilizing such algorithms. We review the use of AI and ML algorithms to assist clinicians in the diagnosis and management of ischemic stroke, hemorrhagic stroke, intracranial aneurysms, and arteriovenous malformations (AVMs). After identifying the most widely used algorithms, we provide a detailed analysis of the accuracy and effectiveness of these algorithms in practice. The incorporation of AI and ML algorithms for cerebrovascular patients has demonstrated improvements in time to detection of intracranial pathologies such as intracerebral hemorrhage (ICH) and infarcts. For ischemic and hemorrhagic strokes, commercial AI software platforms such as RapidAI and Viz.AI have bene implemented into routine clinical practice at many stroke centers to expedite the detection of infarcts and ICH, respectively. Such algorithms and neural networks have also been analyzed for use in prognostication for such cerebrovascular pathologies. These include predicting outcomes for ischemic stroke patients, hematoma expansion, risk of aneurysm rupture, bleeding of AVMs, and in predicting outcomes following interventions such as risk of occlusion for various endovascular devices. Preliminary analyses have yielded promising sensitivities when AI and ML are used in concert with imaging modalities and a multidisciplinary team of health care providers. The implementation of AI and ML algorithms to supplement clinical practice has conferred a high degree of accuracy, efficiency, and expedited detection in the clinical and radiographic evaluation and management of ischemic and hemorrhagic strokes, AVMs, and aneurysms. Such algorithms have been explored for further purposes of prognostication for these conditions, with promising preliminary results. Further studies should evaluate the longitudinal implementation of such techniques into hospital networks and residency programs to supplement clinical practice, and the extent to which these techniques improve patient care and clinical outcomes in the long-term.

Low-dose dynamic cerebral perfusion CT reconstruction based on voxel-level TAC correction (VTC)

Dynamic cerebral perfusion computed tomography (DCP-CT) is an advanced imaging technique that helps in the clinical diagnosis of cerebrovascular diseases (CVDs). However, radiation dose deposition during repeated CT scans seriously limits its clinical application. Effective DCP-CT imaging method based on low-dose protocol is needed. A regularized least-squares method with high interpretability based on voxel-level time-attenuation curve (TAC) correction (VTC) is proposed in this study for low-dose DCP-CT image reconstruction. The theory of third-order Hermite interpolation (THI) is applied to voxel-level TAC correction during dynamic images reconstruction. The peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) are used to quantitatively evaluate the proposed method in terms of imaging accuracy and noise reduction, while hemodynamic maps, including cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transition time (MTT), are calculated to validate its ability to restore hemodynamic parameters. It is proven that the proposed VTC method for low-dose DCP-CT imaging has better performance than several state-of-the-art dynamic CT imaging methods. It can be expected that the VTC method can play an important role in the promotion of the clinical application of DCP-CT for the diagnosis of CVD.

Review:Research status of cardiovascular and cerebrovascular diseases and non-coding RNA

Cardiovascular and cerebrovascular diseases (CVD) encompass a range of conditions affecting the heart, brain, and blood vessels, including coronary heart disease, hypertension, and stroke. In recent years, there has been growing evidence highlighting the significant role of non-coding RNAs (ncRNAs) in the development and progression of cardiovascular diseases. Among the various types of ncRNAs, long-stranded non-coding RNAs (lncRNAs) and circular RNAs (circRNAs) have emerged as prominent players in cardiovascular research. Advancements in technology and in-depth research have revealed that ncRNAs and circRNAs exert regulatory effects on the biological functions of the cardiovascular system through various pathways. For instance, they can modulate the proliferation, migration, and apoptosis of vascular endothelial cells, as well as regulate cardiac muscle contraction and cardiomyocyte apoptosis. Additionally, ncRNAs and circRNAs can influence downstream targets and pathways involved in cardiovascular diseases. The exploration of ncRNAs and circRNAs in cardiovascular research has opened up new avenues for the diagnosis and treatment of CVDs. By understanding the intricate regulatory mechanisms mediated by these non-coding RNAs, researchers have gained valuable insights into the pathogenesis of cardiovascular diseases and identified potential therapeutic targets. Consequently, these studies have provided novel ideas and approaches for the diagnosis, prevention, and management of CVDs.

Subfatin, asprosin, alamandine and maresin-1 in cerebral ischemia, intracranial and subarachnoid hemorrhages.

Cerebrovascular diseases (CVDs) remain an important public health issue due to the increasing number of deaths worldwide. Changes in the synthesis and release of peptides in CVDs may play an important role in elucidating the physiopathology of the disease. Therefore, this study was to investigate the fate of maresin-1 (MaR-1), subfatin (SUB), asprosin (ASP), and alamandine (ALA) levels in patients with cerebral infarction (CI), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH) evaluated within the scope of CVDs, and voluntary healthy controls. The study participants were divided into 4 groups: CI patients, ICH patients, SAH patients, and healthy volunteers. The diagnosis of CVDs was made based on the National Institutes of Health Stroke Scale (NIHSS), Intracerebral Hemorrhage Score (ICHS), Botterel-Hunt-Hess Scale (BHHS), and cranial computed tomography (CT). The levels of MaR-1 (ng/mL), SUB (ng/mL), ASP (ng/mL), and ALA (pg/mL) in the blood samples collected from the participants were studied using the ELISA method. Other parameters included in the study were obtained from the patient records of our hospital. The comparison of MaR-1 [(control 1.38 ± 0.14), SAH (0.98 ± 0.087), CI (0.67 ± 0.04), ICH (0.51 ± 0.03)], SUB [(control (13.2 ± 1.4), SAH (10.1 ± 1.2), CI (7.9 ± 0.8), ICH (5.8 ± 0.5)], and ALA [(control (67.2 ± 7.9), SAH (58.2 ± 4.3), CI (42.1 ± 3.7), and ICH (34.2 ±3.9)] values revealed a significant decrease compared to the control values. The comparison of the ASP values of SAH, CI, and ICH patients and control values (11.6 ± 1.2) showed significantly higher asprosin values in SAH (13.8 ± 1.1), CI (15.4 ± 1.2) and ICH (28.9 ± 2.8) patients. Similarly, systolic blood pressure (SBP), diastolic blood pressure (DBP), and glucose levels of CKD patients were also high. Decreased MaR-1, SUB, ALA and increased ASP compared to the control values may play a role in the physiopathology of these diseases. MaR-1, SUB, ALA, and ASP differences between SAH, CI and ICH patients may also guide clinicians along with SBP, DBP and glucose values.

Preexisting Cerebrovascular Disease in Pregnancy: a Case Series on Pregnancy Outcomes (S3.004)

<h3>Objective:</h3> To characterize adverse pregnancy outcomes (APO) in patients with preexisting cerebrovascular disease (CVD). <h3>Background:</h3> Detailed data are lacking regarding APO in pregnant patients with CVD, limiting neurologists’ ability to counsel patients. <h3>Design/Methods:</h3> We reviewed medical records of 35 patients with CVD evaluated in a neuro-obstetrics subspecialty clinic embedded within a high risk maternal-fetal medicine practice between August 2019 and December 2021. Patients were referred for neurological evaluation during or prior to pregnancy. We described subsequent maternal and fetal APO, including hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), pre term birth (PTB), fetal growth restriction (FGR), and small for gestational age infant (SGA), as well as delivery mode, postpartum readmissions and recurrent acute CVD. <h3>Results:</h3> A total of 35 patients were included (6 TIA, 14 ischemic stroke, 1 subarachnoid hemorrhage, 1 intracerebral hemorrhage, 5 cerebral venous thrombosis, 3 unruptured aneurysm, 2 arteriovenous malformation, 1 cervical artery dissection, 2 reversible cerebral vasoconstriction syndrome [RCVS]). Average age at delivery was 33 years, and most patients (91%) had vascular risk factors including obesity (23%), chronic hypertension (20%), diabetes mellitus (11%), history of prior APO (26%), and migraine (57%). All patients with prior TIA, ischemic stroke, or cerebral venous thrombosis received antithrombotics during pregnancy. Overall, APO occurred in 44% of pregnancies, and included PTB (28%), HDP (19%), GDM (14%), FGR (8%), and SGA (8%). Cesarean deliveries occurred in 42% of pregnancies, all for obstetric indications. Two patients were readmitted postpartum, one for neurological symptoms (headache) with normal brain imaging, and one for an obstetrical complication. One patient experienced recurrent postpartum CVD (RCVS), without readmission. <h3>Conclusions:</h3> In patients with CVD history, APO were common but recurrent acute CVD was rare. Patients with prior CVD may be at high risk for APO due to underlying vascular risk factors rather than specific CVD diagnosis. <b>Disclosure:</b> Ms. Wyckoff has nothing to disclose. Dr. Mammadli has nothing to disclose. Dr. Booker has nothing to disclose. Dr. D’Alton has a non-compensated relationship as a Advisory Board with Merck for Mothers that is relevant to AAN interests or activities. Dr. LaSala has nothing to disclose. Stephanie Purisch has nothing to disclose. Prof. Valeri has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for McLean Hospital. Prof. Valeri has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA. The institution of Prof. Valeri has received research support from National Institute of Health. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edwards Scientific. Dr. Willey has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for RECARDIO. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Uptodate. Dr. Willey has received personal compensation in the range of $500-$4,999 for serving as a Review chapter author, MKSAP 16-20 with American College of Physicians. Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Miller has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Argionis and Associates LLC. The institution of Dr. Miller has received research support from National Institutes of Health.

Postmortem pericardial fluid sLOX-1 levels and LOX-1 immunostaining in forensic specimens: Relation to cause of death

Lectin-like oxidized LDL receptor-1 (LOX-1) is the endothelial receptor for oxidized LDL. This receptor's extracellular domain is released into the blood as soluble LOX-1 (sLOX-1) and has been linked to ischemic heart disease (IHD), cerebrovascular diseases (CVDs), obesity, and diabetes. We recently reported that sLOX-1 fluid levels in postmortem pericardial fluid were comparable to clinical values in live patients and that significant increases in sLOX-1 were observed in patients with IHD. However, postmortem serum and urine sLOX-1 levels were higher than serum levels in living patients. Here, we conducted LOX-1 immunostaining in forensic specimens (aorta and heart) and evaluated pericardial fluid sLOX-1 in 221 medicolegal autopsy cases (67 IHD, 11 CVD, 17 inflammatory diseases, and 126 control cases) with a postmortem interval < 72 h to assess the diagnostic efficiency of postmortem pericardial fluid sLOX-1. Furthermore, we evaluated the relationships between pericardial fluid sLOX-1 and body mass index (BMI), blood HbA1c, serum C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-C), and low-density-lipoprotein cholesterol (LDL-C). LOX-1 immunostaining positivity was found in the aortic intima. Pericardial fluid sLOX-1 levels were considerably higher in patients with IHD and CVD. However, there were no significant differences in patients with inflammatory diseases and controls. No associations between pericardial fluid sLOX-1 and BMI, HbA1c, CRP, HDL-C, or LDL-C were found. These results indicate sLOX-1 utility in the postmortem diagnosis of IHD and CVD.

Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: a narrative review.

Cerebrovascular diseases (CVDs), particularly cerebral stroke, remain a primary cause of disability and death worldwide. Accurate diagnosis of CVDs is essential to guide therapeutic decisions and foresee the prognosis. Different CVDs have different pathological processes while they have many signs in common with some other brain diseases. Thus, differential diagnoses of strokes from other primary and secondary CVDs are especially important and challenging. This review is composed mainly based on searching PubMed articles between September, 2013 and December 26, 2022 in English. Neuroimaging is a powerful tool for CVD diagnosis including cerebral angiography, ultrasound, computed tomography, and positron emission tomography as well as magnetic resonance imaging (MRI). MRI excels other imaging techniques by its features of non-invasive, diverse sequences and high spatiotemporal resolution. It can detect hemodynamic, structural alterations of intracranial arteries and metabolic status of their associated brain regions. In acute stroke, differential diagnosis of ischemic from hemorrhagic stroke and other intracranial vasculopathies is a common application of MRI. By providing information about the pathological characteristics of cerebral diseases exhibiting different degrees of behavioral alterations, cognitive impairment, motor dysfunction and other indications, MRI can differentiate strokes from other primary CVDs involving cerebral small vessels and identify vascular dementia from hyponatremia, brain tumors and other secondary or non-primary CVDs. Recent advances in MRI technology allow clinical neuroimaging to provide unique reference for differentiating many previously inconclusive CVDs. MRI technology is worthy of full exploration while breaking its limitations in clinical applications should be considered.

Ischemic stroke recurrence and mortality in different imaging phenotypes of ischemic cerebrovascular disease: The SMART-MR Study.

Diagnosis of cerebrovascular disease is based on both clinical and radiological findings, however, they do not always correlate. To investigate ischemic stroke recurrence and mortality in patients with different imaging phenotypes of ischemic cerebrovascular disease. Within the SMART-MR study, a prospective patient cohort with arterial disease, cerebrovascular diseases of participants at baseline were classified as no cerebrovascular disease (reference group, n = 828), symptomatic cerebrovascular disease (n = 204), covert vascular lesions (n = 156), or imaging negative ischemia (n = 90) based upon clinical and MRI findings. Ischemic strokes and deaths were collected at 6 month-intervals up to 17 years of follow-up. With Cox regression, relationships between phenotype and ischemic stroke recurrence, cardiovascular mortality, and non-vascular mortality were studied adjusted for age, sex, and cardiovascular risk factors. Compared to reference group risk for recurrent ischemic stroke was increased not only in the symptomatic cerebrovascular disease (HR 3.9, 95% CI 2.3-6.6), but also in the covert vascular lesion (HR 2.5, 95% CI 1.3-4.8) and the imaging negative ischemia groups (HR 2.4, 95% CI 1.1-5.5). Risk for cardiovascular mortality was increased in the symptomatic cerebrovascular disease (HR 2.2, 95% CI 1.5-3.2) and covert vascular lesions groups (HR 2.3, 95% CI 1.5-3.4), while the risk was less strong but also increased in the imaging negative ischemia group (HR 1.7, 95% CI 0.9-3.0). People with all imaging phenotypes of cerebrovascular disease have increased risk of recurrent ischemic stroke and mortality compared to other arterial diseases. Strict preventive measures should be performed even when imaging findings or clinical symptoms are absent. For use of anonymized data, a reasonable request has to be made in writing to the UCC-SMART study group and the third party has to sign a confidentiality agreement.

Management of patients with cognitive impairment

The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Issues of diagnostics and therapy of patients with CI and their high mortality during the period of coronavirus infection are discussed. A wide prevalence of patients with mild CI (MCI), an important role of neuropsychological research in establishing CI, and frequent diagnosis of CI only at the stage of dementia were noted. In our country, CI is poorly diagnosed, the most common cause of CI in the elderly – Alzheimer's disease (AD) – is rarely established, patients are observed for a long time with a diagnosis of cerebrovascular disease (CVD). Some non-drug and drug methods can reduce the manifestations of CI, improve the quality of life of both the patients themselves and those around them. In severe CI, socio-psychological methods, stimulating patients to feasible household and social, physical and mental activity, and avoiding prolonged hospitalization are of primary importance. In addition to lifestyle changes, much attention in CI is given to the prevention of stroke, the treatment of arterial hypertension and diabetes mellitus. At the stage of dementia, cholinomimetic drugs (acetylcholinesterase inhibitors, donepezil, rivastigmine, galantamine) and the glutamate receptor blocker memantine are used. The use of choline alfoscerate in CI and the results of the multicenter, placebo-controlled ASCOMALVA study are discussed, in which, in patients with AD and CVD, the addition of choline alfoscerate to donepezil reduced the severity of CI, manifestations of depression, anxiety, and apathy. A new oral form of choline alfoscerate (Cerpechol) is reported that may improve patient compliance and be used in patients with swallowing disorders.

Adherence to treatment in patients with cerebrovascular disease as a multifactorial problem

The most important component of the treatment effectiveness is the adherence of patients to the recommendations of the attending physician, which can affect the course and prognosis of the disease. The problem of adherence in cerebrovascular disease (CVD), depending on the clinical picture of the disease and comorbid diseases, is currently poorly studied. Objective : to assess the degree of adherence to treatment in patients with the main diagnosis of CVD and to determine the factors influencing it. Material and methods . 161 patients with cerebrovascular pathology aged 58–70 years (mean age 64 years) were examined. The assessment of somatic and neurological status, neuropsychological examination, assessment of adherence to therapy using standardized national questionnaires: the Russian Scale of Quantitative Assessment Adherence to Treatment (QAA-25) and the Domestic Therapy Adherence Questionnaire (DTAQ), laboratory studies were performed. The influence of cognitive impairments (CI), background and comorbidities, as well as drug therapy in the framework of the prevention of cardiovascular diseases were evaluated. Results . In patients with CVD, according to the results of the QAA-25 questionnaire, adherence to medical support was 33.4 [26.3; 57.5] %, drug therapy – 44.4 [29.7; 59.0] %, the lifestyle modifications – 31 [26; 55] %, overall adherence to treatment – 31 [26; 56] %. The proportion of patients with low adherence according to the DTAQ test reached 19.9%. In patients with a low adherence, the result on the Montreal Cognitive Assessment Test (MoCA) was 21 points, in patients with very high adherence – 26 points. An increase in the total number of prescribed basic drugs was accompanied by a decrease in adherence according to the results of DTAQ (p=0.041) and QAA-25 (p&lt;0.05) tests. The worst indicators of adherence were noted in CI and the presence of such factors as arterial hypertension (AH), an increase in waist circumference, the severity of carbohydrate metabolism disorders, especially the combination of AH and type 2 diabetes mellitus (DM). Conclusion . The conducted study demonstrated insufficient adherence to treatment in patients with chronic CVD. Adherence deterioration factors are CI, an increase in the number of drugs administered, comorbid diseases, of which the combination of AH and type 2 DM is of the greatest importance.

Current source density (sLORETA) in patients undergoing cognitive rehabilitation using dual task in the early postoperative period of coronary artery bypass grafting

Highlights. For the first time, the method of standardized low resolution electromagnetic tomography – sLORETA was used to assess the neurophysiological correlates of the success of cognitive rehabilitation using dual task to recover the brain functions affected by ischemia during cardiac surgery.The patients who were successfully rehabilitated have demonstrated lower postoperative values of resting state theta activity within the right hemisphere, indicating the transfer effect, which is an important component of successful cognitive rehabilitation.Aim. Visualization and monitoring of brain ischemia is important for the diagnosis of cerebrovascular diseases. The aim of the study was to evaluate the possibilities and applicability of the method of standardized low resolution electromagnetic brain tomography – sLORETA for analyzing brain electrical activity in patients undergoing cognitive rehabilitation using dual tasks to recover impaired brain functions during ischemia associated with cardiac surgery.Methods. The study included 16 male patients (45–75 years old) who were admitted for planned coronary artery bypass grafting (CABG) to the Clinic at the Research Institute for Complex Issues of Cardiovascular Diseases. Clinical and neurophysiological examinations were performed 2–3 days before CABG and 1 week after surgery. All patients underwent cognitive rehabilitation that started at postoperative day 3 or 4 and lasted until discharge, the outcome was assessed as well. Monopolar EEG (62 channels) was recorded at rest in a sitting position with eyes closed in a light- and noise-insulated room using a Neuvo SynAmps2 Amplifier. Data processing of EEG background activity for sLORETA analysis was performed using the EEGLAB in MATLAB software (The MathWorks, Natick, MA, USA). The sLORETA algorithms were used to calculate dynamic cross spectrum and current source density within the analyzed frequency range (4–6 Hz). Statistical analysis of current source density indicators was carried out by using the method of statistical non-parametric mapping in the sLORETA software package, and the difference between the current source density in the pre- and postoperative period (after cognitive rehabilitation) was calculated as well.Results. Cognitive rehabilitation was successful in 44% (7 patients) of cases. The differences have been revealed between the groups with successful and unsuccessful cognitive rehabilitation by using sLORETA. The group with unsuccessful cognitive rehabilitation demonstrated higher current source density estimates in theta rhythm compared with the successful rehabilitation group, it was most pronounced (t&gt;- 8.42; p&lt;0.004) in the right hemisphere – Brodmann area 22, temporal lobe and superior temporal gyrus.Conclusion. The sLORETA method demonstrated the positive effect of cognitive training on changes in the spatial patterns of brain activity in patients undergoing onpump CABG. The successful cognitive rehabilitation was associated with lower postoperative resting state theta activity within the right hemisphere, indicating the transfer effect, which is an important component of successful cognitive rehabilitation.