Hemispheric Stroke Research Articles

Abstract TMP36: Anatomical Predictors of Gastrostomy Tube Placement After Large Vessel Occlusion Ischemic Stroke

Dysphagia is a common neurologic deficit after ischemic stroke; as a result, patients often require percutaneous endoscopic gastrostomy (PEG) tube placement for safe maintenance of sufficient caloric intake. Right hemispheric strokes have previously been associated with post-stroke dysphagia. We examined whether topographic locations of post-stroke diffusion-weighted MRI (DWI) lesions associated with the need for placement of PEG tube. A registry of 898 patients evaluated for acute treatment of suspected large vessel occlusion (LVO) stroke was used. 65 patients underwent post-stroke PEG placement, and 65 additional patients were selected as propensity matches based on age, baseline NIH Stroke Scale score, and recanalization status. Binary masks of 24-to-72-hour post-stroke DWI lesions were co-registered to standard template space. Voxel-based lesion symptom mapping (V2.6), rewritten to perform logistic regression at each voxel, was used to generate statistical maps of lesion contribution to PEG placement. Uncorrected t-statistic maps demonstrated voxels in the right frontal, parietal, and temporal regions were associated with post-stroke PEG placement. Upon controlling for age and/or recanalization status, lesions in the right parietal lobe were associated with need for PEG. After controlling for lesion volume, this association weakened; once all variables were controlled for, there were no topographical regions associated with PEG placement. In this limited series, there is not a topographic region on post-stroke diffusion MRI that is significantly associated with need for PEG placement in patients with LVO stroke after controlling for appropriate covariates. PEG tube requirement may be a composite outcome, dependent on various inputs notably including lesion volume.

Abstract TP91: Baseline Comorbidities and Functional Status Are Associated With Subacute Post-Stroke Aphasia Severity

Speech or language changes are just one of the critical stroke warning signs. While symptoms may resolve with treatment, there are individuals for whom aphasia persists. The purpose of this study was to develop a better understanding of which factors are associated with aphasia status in the first six months after left hemisphere stroke to aid clinicians in discussing prognosis and preparing patients for what to expect in recovery. The sample consisted of a subset of individuals from a large, ongoing, federally funded, observational study of speech and language profiles, for whom an NIH Stroke Scale (NIHSS) total score was available (N=59, 35 female, mean age at stroke= 65 years, range = 38-92). We analyzed the complex interaction between the baseline medical (reperfusion/surgical intervention; comorbid hypertension, atrial fibrillation, high cholesterol, diabetes), functional (NIHSS total score), and demographic (age, sex, race) characteristics associated with the Quick Aphasia Battery (QAB) overall score, a measure of aphasia severity, using multiple linear regression. An additional one-way ANOVA was conducted to examine the relationship between baseline (NIHSS language subtest rating) and subacute aphasia status. The multiple linear model of the relationship between baseline factors and subacute aphasia severity was significant (F(114, 43)=1.956, p=0.047), though it accounted for less than 40% of the variance in aphasia severity scores. Of the factors included in the model, hypertension (F(1, 43)=4.513, p=0.039) and NIHSS total score (F(1, 43), p<0.001) were significant. In our secondary analysis, the one-way ANOVA was significant (F(3, 50)=6.106, p=0.001) with individuals rated as normal having, on average, a 3 point difference (p=.001) in overall QAB score from those rated as mute at baseline. This study examined the association between baseline comorbidities and functional status in adults with subacute post-stroke aphasia. We noted that hypertension and baseline NIHSS total score are significantly related to aphasia severity as measured by the QAB overall score in the subacute phase. Although much variation exists, our results may indicate that those with unimpaired language at baseline tend to perform better later in recovery.

A Case Report of Stroke-like Syndrome: Tuberculous Encephalopathy

Background: Stroke-like syndrome is a stroke mimic, usually common in the young and accurate diagnosis has considerable impact in terms of treatment choices and outcomes. Objectives: To emphasise the need for high index of suspicion and the need for multidisciplinary approach and accurate diagnosis of stroke-like syndrome. Case Report: 32 years old woman who presented with recurrent headache of a year duration with right upper limb weakness of 3 months that later involved lower limb 1month and inability to talk 2 days to presentation. Examination revealed a young woman, conscious but aphasic, emaciated, afebrile, anicteric and nil pedal oedema. Neurological findings includes expressive aphasia, right facioparesis and right hemiparesis. Other systemic examinations were essentially normal. A diagnosis of left hemispheric ischaemic stroke was initially entertained. Brain computerized tomography revealed infarct involving the left frontal and temporal lobes but Echocardiography revealed Tuberculous pericarditis, a suspicion of stroke mimic of infective origin was entertained. Diagnosis was confirmed by ‘trial of treatment’ of anti-tuberculosis, which resulted in dramatic resolution of symptoms within 4 weeks of anti-tuberculosis drugs. Conclusion: There is need for high index of suspicion, accurate diagnosis and multidisciplinary approach for appropriate treatment choices and outcomes.

Improving orientation with respect to gravity enhances balance and gait recovery after stroke: DOBRAS cohort

BackgroundLateropulsion is a deficit in body orientation with respect to gravity, frequent after stroke. Although it is a primary factor affecting mobility, the impact of its attenuation on balance and gait recovery has never been investigated. Moreover, most studies on the lateropulsion time-course focus on severe forms suspected to have a poor recovery, which is not proven. ObjectivesTo investigate lateropulsion attenuation and test 2 hypotheses: 1) lateropulsion attenuation greatly contributes to balance and gait recovery and 2) severe forms of lateropulsion recover slower than moderate forms. MethodsThis longitudinal study involved individuals included in the Determinants of Balance Recovery After Stroke (DOBRAS) cohort, after a first-ever hemispheric stroke, with data collected on day 30 (D30), D60 and D90 post-stroke. Body orientation with respect to gravity was assessed using the Scale for Contraversive Pushing (both scores and severity grouping), in parallel with balance (Postural Assessment Scale for Stroke) and gait (modified Fugl-Meyer Gait Assessment). ResultsAmong the 106 eligible individuals (mean age 66.5 [SD 9.7] years), on D30, 43 (41%) were considered upright and 63 (59%) showed lateropulsion: 30 (28%) moderate and 33 (31%) severe. Most individuals with lateropulsion (73%) improved their body orientation, progressing from severe to moderate lateropulsion, or becoming upright. However, half were still not upright on D90. The improvement in body orientation had a large impact on mobility, especially in individuals with severe lateropulsion, in whom it explained about 50% of balance and gait recovery between D30 and D60, then 20% (D60-D90). For moderate lateropulsion, its attenuation explained about 20% of balance and gait recovery until D90. Lateropulsion attenuation was not slower in individuals with severe forms. ConclusionsLateropulsion attenuation enhances balance and gait recovery in individuals after stroke suggesting that specific rehabilitation of body orientation with respect to gravity might help to recover mobility. RegistrationNCT03203109

An exploratory study of longitudinal trajectory of language, swallowing and cognition post endovascular clot retrieval.

Endovascular clot retrieval (ECR) is known to reduce global disability at 3 months post stroke however limited research exists regarding the trajectory of specific clinical impairments including language, swallowing and cognitive deficits between onset and 3 months. To assess language, swallowing, and cognitive performance following ECR and explore whether impairment severity is correlated with modified Thrombolysis in Cerebral Infarction score (mTICI), stroke severity or quality of life (QoL). Assessment was completed within 7 days (T1), 1 month (T2) and 3 months (T3) post-stroke. Performance was measured with the Functional Oral Intake Scale (FOIS), Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT A and B) and Brixton Spatial Awareness Test. The Western Aphasia Battery (WAB) was used for left hemisphere stroke. QoL was measured with the Stroke and Aphasia Quality of Life Scale. Twenty-five participants (median 72 years; 64% male) were prospectively recruited following ECR. High reperfusion success (68% mTICI 3) and low stroke severity post ECR (median 24h NIHSS = 3, IQR 7-18) were noted. At T1, 10 participants presented with aphasia, eight required a modified diet and 20 had impaired cognition. At T3 all had recovered to a normal oral diet, 39% had persistent cognitive impairment and 45% of patients with left hemisphere stroke remained aphasic. Performance on the WAB, FOIS, RBANS and TMT changed significantly over time (all p<0.05). The severity score at T1 for all measures, excluding TMT B and Brixton, was significantly correlated with 24h NIHSS. WAB scores at T3 were correlated with QoL (r = 0.618; p = 0.043). This exploratory study found the longitudinal performance of language, swallowing and cognition significantly improved over time and severity in the first-week post-ECR was correlated with 24h NIHSS rather than the degree of reperfusion. What is already known on the subject Randomised control trials have demonstrated the benefit of ECR in patients with ischemic stroke using global measures of disability and function. Limited research exists regarding the trajectory of specific clinical impairments including language, swallowing and cognitive deficits. There is also a reliance on screening assessments and a lack of consideration of the influence of co-occurring impairments. What this paper adds to existing knowledge This prospective study is amongst the first to explore the longitudinal trajectory of language, swallowing and cognitive impairment using a standardised assessment battery. Twenty-four-hour NIHSS was significantly correlated with language, swallowing, global cognition and some measures of executive function. Language performance post ECR was correlated with domain-specific cognitive assessment of attention, immediate memory and delayed memory, which differed from swallowing performance post ECR that correlated with measures of executive function. What are the potential or actual clinical implications of this work? It is important for speech-language pathologists and the wider medical team to monitor language, swallowing and cognitive performance post ECR regardless of treatment success. Stroke severity at 24h post-ECR influences the severity of language, swallowing and cognitive impairments.

Hemodynamic signal changes during volitional swallowing in dysphagia patients with different unilateral hemispheric stroke and brainstem stroke: A near-infrared spectroscopy study

Background and objectivesStrokes will result in decreased in cortical excitability and changed in the balance between the affected and unaffected hemispheres. Previous studies have focused on cortical changes in healthy subjects during swallowing, while they remain unknown in patients with stroke at different locations. Thus, the purpose of this study was to research cortical activation patterns of swallowing in patients with dysphagia and healthy subjects by the functional near-infrared spectroscopy (fNIRS). We also focus on the comparability of brain activation areas associated with swallowing between patients with different stroke locations and healthy subjects. Methodstotal of 104 participants were invited to our study, involving 86 patients with dysphagic unilateral hemispheric stroke and 18 age and sex matched healthy controls. The stroke patients were categorized into patients with left unilateral stroke lesions (n = 30), patients with right unilateral stroke lesions (n = 32) and patients with brainstem injury (n = 24) according to different stroke sites. All patients underwent a series of clinical swallowing function assessments, such as the Fiberoptic endoscopic dysphagia severity scale (FEDSS), penetration-aspiration scale (PAS) of Rosenbek, the gugging swallowing screen (GUSS) and the functional oral Intake scale (FOIS) after informed consent has been signed. All participants received the fNIRS system assessment. ResultsThe results showed that extensive areas of the cerebral cortex activated during the swallowing tasks in healthy participants (P < FDR 0.05). For patients with left unilateral stroke lesions, the HbO concentration were strongest over the right hemisphere (P < FDR 0.05). In addition, a less severe activation was also observed in the left hemisphere. Comparable to patients with left unilateral stroke lesions, the strongest activation during swallowing task were found in the left hemisphere in patients with right unilateral stroke lesions (P < FDR 0.05). Similarly, the right hemisphere also has activated less. In contrast, patients with brain stem injury showed more bilaterally activation patterns. ConclusionOur finding states that cortical activation areas differ between patients with different stroke locations and healthy subjects during swallowing. There was a more bilateral activation in healthy participants and patients with lesions in the brainstem while more cortical activation in unaffected hemisphere in patients with unilateral hemispheric stroke. It also provides a basis for the future treatment of dysphagia after stroke.

Utilizing fNIRS to investigate the impact of Baduanjin training on attentional function in post-stroke cognitive impairment patients: a study protocol for a randomized controlled trial

BackgroundPost-stroke cognitive impairment (PSCI) is a prevalent complication among stroke survivors. It not only directly impacts patients' cognitive abilities but also hampers their capacity to regain independence in daily activities, consequently diminishing their quality of life. Among the various cognitive deficits following stroke, impaired attention is the most frequently observed, influencing not only daily functioning but also higher cognitive functions like working memory, executive functioning, and language.Emerging evidence indicates that Baduanjin, a traditional Chinese exercise, may have a positive impact on enhancing attention in older adults with mild cognitive impairment and stroke survivors. However, the precise mechanisms behind this effect remain unclear. In this study, we employed Baduanjin training as an intervention to address attention decline in post-stroke cognitive impairment patients and to delve into the potential mechanisms through which Baduanjin training may enhance attention in individuals with PSCI.MethodsIn this prospective randomized controlled trial, we plan to recruit 72 participants diagnosed with post-stroke cognitive impairment (PSCI). These participants will be randomly assigned in a 1:1:1 ratio to one of three groups: Baduanjin training(left hemisphere stroke and right hemisphere stroke) and conventional treatment.The conventional treatment group will receive standard rehabilitation sessions. In addition to conventional treatment, participants in the octogenarian training groups will undergo octogenarian training sessions lasting 40 min, five times a week, over a total period of 12 weeks.The primary outcome measures will include the Montreal Cognitive Assessment (MoCA) scale and the Attentional Lateralization Index. These assessments will be conducted by a trained evaluator before the start of the intervention and at weeks 6 and 12 after the intervention begins.Secondary outcome measures will be assessed using the baseline Mandarin version of the Oxford Cognitive Screening (OCS-P) scale, the simplified Fugl-Meyer Motor Function Assessment (FMA) scale, the Pittsburgh Rehabilitation Participation (PRPS) scale, and the Activities of Daily Living (ADL) scale before and after the intervention, respectively.DiscussionThis trial aims to examine the impact of Baduanjin training on attentional lateralization among patients with post-stroke cognitive impairment (PSCI). Functional brain imaging utilizing near-infrared spectroscopy will be employed to investigate how Baduanjin exercise influences the structural and functional connectivity of distinct brain regions or brain networks.Trial registrationChictr.org.cn, ID: ChiCTR2300076533. Registered on 11 October 2023.

Identifying Spatial Neglect in Chronic Right Hemisphere Stroke Survivors Using the RHDBank Outcomes.

The chronicity of spatial neglect (SN) and the utility of existing diagnostic measures used by speech-language pathologists remain poorly understood. In this retrospective study, we examined how the RHDBank test battery informs the identification of SN after right hemisphere brain damage (RHD) during the chronic phase of recovery. Data from 29 right hemisphere stroke survivors were extracted from the RHDBank, including SN tests, for which we performed laterality index scoring: a 51-item demographic survey, the Apples Test, the Indented Paragraph Test, and the clock drawing task from the Cognitive Linguistic Quick Test (CLQT). Two groups (SN+ and SN-) were identified using the Apples Test. A hierarchical cluster analysis explored CLQT performance clusters in association with SN, and group comparisons of demographic variables and test scores were conducted. Ten patients were identified as having SN+ (34%) using the Apples Test. The Indented Paragraph Test and the CLQT's clock drawing test identified only two of the 20 stroke survivors with SN+. Cluster analyses showed that domain and task scores on the CLQT carried information to classify participants into SN+ and SN- in concordance with performance on the Apples Test. Participants in the SN+ cluster had moderately impaired attention and executive function skills and mildly impaired visuospatial skills. The Apples Test differentiated SN in a group of chronic right hemisphere stroke survivors. Using multiple measures from the CLQT seemed to capture a greater range of problems than clock drawing and paragraph reading tests alone. Therefore, the RHDBank test battery as a whole-and in part the CLQT, Apples Test, and Indented Paragraph Test-can detect certain subtypes of SN in the chronic deficit profile after RHD and is a starting point for diagnostic integration by speech-language pathologists.

Targeted non-invasive brain stimulation boosts attention and modulates contralesional brain networks following right hemisphere stroke

Right hemisphere stroke patients frequently present with a combination of lateralised and non-lateralised attentional deficits characteristic of the neglect syndrome. Attentional deficits are associated with poor functional outcome and are challenging to treat, with non-lateralised deficits often persisting into the chronic stage and representing a common complaint among patients and families.In this study, we investigated the effects of non-invasive brain stimulation on non-lateralised attentional deficits in right-hemispheric stroke. In a randomised double-blind sham-controlled crossover study, twenty-two patients received real and sham transcranial Direct Current Stimulation (tDCS) whilst performing a non-lateralised attentional task. A high definition tDCS montage guided by stimulation modelling was employed to maximise current delivery over the right dorsolateral prefrontal cortex, a key node in the vigilance network. In a parallel study, we examined brain network response to this tDCS montage by carrying out concurrent fMRI during stimulation in healthy participants and patients.At the group level, stimulation improved target detection in patients, reducing overall error rate when compared with sham stimulation. TDCS boosted performance throughout the duration of the task, with its effects briefly outlasting stimulation cessation. Exploratory lesion analysis indicated that response to stimulation was related to lesion location rather than volume. In particular, reduced stimulation response was associated with damage to the thalamus and postcentral gyrus. Concurrent stimulation-fMRI revealed that tDCS did not affect local connectivity but influenced functional connectivity within large-scale networks in the contralesional hemisphere.This combined behavioural and functional imaging approach shows that brain stimulation targeted to surviving tissue in the ipsilesional hemisphere improves non-lateralised attentional deficits following stroke. This effect may be exerted via contralesional network effects.

The relationship between the development of post-stroke cognitive impairment and changes in the coagulation component of hemostasis

To evaluate the relationship between the severity of post-stroke cognitive impairment (PSCI) and coagulation parameters assessed using the dynamic thrombophotometry. Thirty-five patients with hemispheric ischemic stroke (IS) with moderate neurological deficit at admission were included. All patients underwent a comprehensive clinical and instrumental assessment according to the current guidelines. On days 10-14, the cognitive status of patients was assessed using the Montreal Cognitive Assessment (MoCA). Coagulation parameters were assessed using the dynamic thrombophotometry at admission, on 6-8th days and 13-15th days from the onset of the disease. A database of laboratory studies of 30 apparently healthy volunteers was used as a comparison group. Data analysis revealed that a number of spatial and temporal parameters were within the reference values, and there were no significant changes over time. Nevertheless, though the optical density of the fibrin clot (D) was within the reference values, it showed a steady increase from the admission by the end of the 1st week of the disease (p=0.007) and by 13-15th days (p=0.009). Correlation and multivariate linear regression, including baseline stroke symptom severity, showed significant associations (p<0.01 in all tests) between the higher optical density of the fibrin clot (D) on days 6-8 and 13-15 and lower MoCA score, confirming the negative effect of altered hemostatic parameters on cognitive function in IS patients. The increase of optical density of the fibrin clot (D) by 6-8th and 13-15th days is a potential prognostic biomarker for the early development of PSCI.

Клиническое разнообразие афатических нарушений у больных в остром периоде ишемического полушарного инсульта. Взгляд невролога

Aphasia syndrome is a frequently diagnosed disorder in patients with acute cerebrovascular accident (ACVA), which is of great interest for study, since it affects all areas of human mental activity and has a number of distinctive features from aphasias of other etiologies. The article presents a literature review of speech disorders and describes the authors’ own observations of patients in the acute period of ischemic hemispheric stroke in the left middle cerebral artery basin suffering from various types of aphasic disorders.

Repetitive Transcranial Magnetic Stimulation Protocols for Swallowing Rehabilitation in Unilateral Hemispheric Stroke: A Scoping Review

Repetitive Transcranial Magnetic Stimulation Protocols for Swallowing Rehabilitation in Unilateral Hemispheric Stroke: A Scoping Review

Neurophysiological features in patients with psychopathological disorders in the right hemisphere stroke

Neurophysiological changes and functional activity of the brain on the electroencephalogram after a cerebral infarction reflect the direct electromagnetic activity of neurons that can be measured in the affected areas of the brain. EEG signals provide a non-invasive and sensitive indicator of brain function during mental processes. Its main use is in the assessment of cerebral function, and not in the detection of structural abnormalities. There is a lot of evidence that the analysis of the electrical fields of the brain can detect changes in the behavior of brain signals in neurological patients. The aim of the study was to establish correlational relationships between the development of psychopathological disorders and neurophysiological changes using EEG in right hemisphere stroke. The subject of the study was neglect and its relationship with neurophysiological changes and functional activity of the brain. Twenty-three patients with a right-hemisphere stroke who were undergoing inpatient treatment in the medical and diagnostic department No. 1 of the LORITOM PE. The correlation of the reduced α-index in patients with manifestations of unilateral neglect on the background curve was determined in the cohort of subjects. Moderate irritation phenomena was noted closer to the center in the parietal and to the right in the temporal and parietal leads in patients with neglect syndrome. While without manifestations of hemineglect, moderate phenomena of irritation was noted mainly parasagittal and on the left. A trend of slow-wave activity in the frontal areas in patients with neglect syndrome has been demonstrated. The prospect of further research in the field of psychopathological disorders is shown which will significantly increase the efficiency of diagnosis and treatment and as a result increase the degree of restoration of impaired functions of post-stroke patients, the level of their social and everyday adaptation and accordingly the quality of life. Keywords: electroencephalography, unilateral neglect, hemineglect.

CHARACTERISTICS OF COGNITIVE DYSFUNCTIONS IN PATIENTS WITH RIGHT-SIDE AND LEFT-SIDE ISCHEMIC STROKE

The goal of the study is to assess the characteristics of cognitive dysfunctions in patients with right-side and left-side ischemic stroke (IS).&#x0D; Materials and Methods. We examined 55 patients (aged 38–65) with right-side and left-side ischemic stroke during the early rehabilitation period. The patients were treated at the regional vascular center, District Clinical Hospital, Khanty-Mansiysk in 2019–2022. Mini-Mental State Examination (MMSE) was used to check patients for cognitive impairments: Frontal assessment battery, Verbal fluency test, Clock-drawing test, Backward digit span test, Visual assessment battery, Auditory assessment battery, and Verbal assessment battery.&#x0D; Results. Cognitive impairments are common post-stroke complications, which can significantly complicate rehabilitation therapy. In the early rehabilitation period, 41.8 % of patients with a hemispheric stroke demonstrate predementia. In patients with right-side stroke, predementia was observed in 22.2 %, whereas 60.7 % of patients with left-side stroke exhibited impaired abilities (p&lt;0.05). There was a significant decrease in short-term memory, time knowledge and orientation abilities in patients with left-side stroke. Assessment of visual, auditory and verbal memory also revealed poorer performance in patients with left-side stroke compared to those with right-side stroke – 20 (17–22) points versus 22 (22–24) points (p&lt;0.05). Moderate frontal dysfunction was detected in all patients (100 %).&#x0D; Conclusion. All patients with hemispheric stroke should undergo early cognitive rehabilitation, even if there are no active complaints. Particular attention should be paid to patients with left-side brain damage.

Analysis of the diagnostic informativity of non-contrast computed tomography markers of intracerebral hemorrhage expansion in assessment of the individual risk of early neurological deterioration in patients with hemorrhagic hemispheric stroke

The aim of the study was to evaluate the diagnostic informativity of non-contrast computed tomography (NCCT) markers of intracerebral hemorrhage (ICH) expansion in assessment of the individual risk of early neurological deterioration (END) in patients with hemorrhagic hemispheric stroke (HHS). Materials and methods. A prospective, cohort study was conducted involving 333 patients in the acute period of hypertensive spontaneous supratentorial ICH on the background of conservative therapy. The level of neurological deficit was assessed using the Full Outline of Unresponsiveness (FOUR) coma scale and the National Institute of Health Stroke Scale (NIHSS). The computed tomography of the brain was used to verify the ICH volume, the midline shift (MS), the secondary intraventricular hemorrhage volume (IVHV) and NCCT markers of intracerebral hemorrhage expansion. As a combined clinical endpoint, END was considered (decrease of the FOUR scale score ≥2 or/and increase of the NIHSS score ≥4 or/and lethal outcome within 48 hours of hospitalization). Results. Early neurological deterioration was registered in 112 patients. On the basis of a comparative analysis, it was established that the specific weight of END was significantly higher in subcohorts of patients with individual NCCT markers of intracerebral hemorrhage expansion, than it was in subcohorts of patients without corresponding NCCT signs (p ˂ 0.0001). It was established that the following NCCT markers of ICH expansion are the most sensitive predictors of END: hypodensity, swirl sign and irregular shape (sensitivity &gt;90.0 %). The most specific NCCT markers were island sign, black hole sign, blend sign, satellite sign and heterogeneous density (specificity &gt;87.0 %). In accordance with the multiple logistic regression analysis, hypodensity (OR (95 % CI) = 13.56 (4.54–40.49), p &lt; 0.0001) and island sign (OR (95 % CI) = 5.94 (2.05–17.16), p = 0.0010) are independently associated with the risk of END. A highly sensitive multi-prediction logistic regression model was elaborated in order to predict END in patients with HHS which takes into account the most informative NCCT markers of ICH expansion (hypodensity, island sign) and quantitative neuroimaging indicators (MS, IVHV) (AUC ± SE (95 % CI) = 0.92 ± 0.02 (0.89–0.95), р ˂ 0.0001). Conclusions. Non-contrast computed tomography markers of ICH expansion are associated with increased risk of END in patients with HHS. Hypodensity and island sign are independent predictors of END. The integration of NCCT markers of ICH expansion with quantitative neuroimaging indicators (MS, IVHV) in the structure of the multi-prediction logistic regression model allows to assess the individual risk of END with an accuracy of &gt;85.0 %.

Ruptured Intracranial Vascular Aneurysm with Subarachnoid Haemorrhage: Autopsy Case Series and Literature Review

Background: Subarachnoid haemorrhage (SAH) is a severe condition where bleeding occurs in the subarachnoid space surrounding the brain. SAH can be caused by a ruptured aneurysm or head injury leading to a stroke (with associated disability or death). Common symptoms include severe (thunderclap) headache, neck pain, nausea, vomiting, and sensitivity to light. Case Presentations: Firstly, a 58-year-old man presented with a history of severe headaches and inability to use the left side of his body, with a possible hemorrhagic right-sided hemispheric stroke diagnosis. Following death, an autopsy revealed a ruptured intracranial Charcot Bouchard aneurysm, with SAH as the cause. Secondly, a 35-year-old woman presented with a sudden loss of consciousness and three episodes of generalised tonic-clonic convulsion during a coital activity at a guest house. Following death, an autopsy revealed a ruptured middle cerebral artery’s saccular (berry) aneurysm, causing SAH with bilateral tonsillar herniation as the cause. These case series highlight the importance of autopsy in diagnosing SAH.

Diurnal variation in quantitative pupillary reactivity in large hemispheric stroke

Background: Pupillary light reflex (PLR) assessment is an important neurological examination reflecting neurological deterioration in severe stroke cases. This study investigated the impact of diurnal variation in the PLR using quantitative pupillometry in stable patients with large hemispheric stroke.Methods: We included 35 patients with large hemispheric stroke without neurological worsening, who were admitted to the neurological intensive care unit between April 2017 and November 2021. Quantitative pupillometry was performed every 4 hours. Pupillometer parameters of maximum pupil size, percentage of constriction (%CH), latency (LAT), constriction velocity (CV), dilation velocity (DV), maximum constriction velocity (MCV), and neurological pupil index (NPi) score were recorded. We evaluated changes in the pupillometer parameters over time using linear mixed model analysis.Results: The diurnal variations revealed that the following parameters were significantly higher at 04:00 than at 20:00: maximum pupil size (right [Rt]: 3.59 vs. 3.21 mm, P&lt;0.001; left [Lt]: 3.51 vs. 3.18 mm, P&lt;0.001), %CH (Rt: 31.48 vs. 25.72, P&lt;0.001; Lt: 31.42 vs. 24.98, P&lt;0.001), CV (Rt: 1.97 vs. 1.68 mm/sec, P&lt;0.001; Lt: 1.98 vs. 1.65 mm/sec, P&lt;0.001), and DV (Rt: 0.97 vs. 0.84 mm/sec, P&lt;0.001; Lt: 0.94 vs. 0.82 mm/sec, P=0.001). However, no significant diurnal variations were observed in the NPi values. Conclusion: Pupillary dynamics based on quantitative pupillometer parameters, including the NPi, demonstrated diurnal variations over 24 hours in large hemispheric stroke patients without neurological worsening. However, all changes in the pupillometer parameters were within normal ranges.

The impact of lesion side on bilateral upper limb coordination after stroke

BackgroundA stroke frequently results in impaired performance of activities of daily life. Many of these are highly dependent on effective coordination between the two arms. In the context of bimanual movements, cyclic rhythmical bilateral arm coordination patterns can be classified into two fundamental modes: in-phase (bilateral homologous muscles contract simultaneously) and anti-phase (bilateral muscles contract alternately) movements. We aimed to investigate how patients with left (LHS) and right (RHS) hemispheric stroke are differentially affected in both individual-limb control and inter-limb coordination during bilateral movements.MethodsWe used kinematic measurements to assess bilateral coordination abilities of 18 chronic hemiparetic stroke patients (9 LHS; 9 RHS) and 18 age- and sex-matched controls. Using KINARM upper-limb exoskeleton system, we examined individual-limb control by quantifying trajectory variability in each hand and inter-limb coordination by computing the phase synchronization between hands during anti- and in-phase movements.ResultsRHS patients exhibited greater impairment in individual- and inter-limb control during anti-phase movements, whilst LHS patients showed greater impairment in individual-limb control during in-phase movements alone. However, LHS patients further showed a swap in hand dominance during in-phase movements.ConclusionsThe current study used individual-limb and inter-limb kinematic profiles and showed that bilateral movements are differently impaired in patients with left vs. right hemispheric strokes. Our results demonstrate that both fundamental bilateral coordination modes are differently controlled in both hemispheres using a lesion model approach. From a clinical perspective, we suggest that lesion side should be taken into account for more individually targeted bilateral coordination training strategies.Trial registration: the current experiment is not a health care intervention study.

Risk factors for cognitive impairment and dementia after stroke: a systematic review and meta-analysis

Cognitive impairment and dementia are highly prevalent among stroke survivors and represent a major burden for patients, carers, and health-care systems. We studied the risk factors for post-stroke cognitive impairment (PSCI) and dementia (PSD) beyond the well established risk factors of age and stroke severity. In this systematic review and meta-analysis we conducted a systematic literature search from database inception until Sept 15, 2023. We selected prospective and retrospective cohort studies, post-hoc analyses from randomised controlled trials, and nested case-control studies of patients with acute stroke (ischaemic, haemorrhagic, and transient ischaemic attack), exploring associations between risk factors at baseline and PSCI or PSD over a follow-up period of at least 3 months. Study quality was assessed using the Newcastle-Ottawa quality assessment scale. We calculated pooled relative risks (RRs) with random-effects meta-analyses and performed subgroup, meta-regression, and sensitivity analyses. This study was preregistered with PROSPERO, CRD42020164959. We identified 162 eligible articles for our systematic review, of which 113 articles (89 studies, 160 783 patients) were eligible for meta-analysis. Baseline cognitive impairment was the strongest risk factor for PSCI (RR 2·00, 95% CI 1·66-2·40) and PSD (3·10, 2·77-3·47). We identified diabetes (1·29, 1·14-1·45), presence or history of atrial fibrillation (1·29, 1·04-1·60), presence of moderate or severe white matter hyperintensities (WMH; 1·51, 1·20-1·91), and WMH severity (1·30, 1·10-1·55, per SD increase) as treatable risk factors for PSCI, independent of age and stroke severity. For PSD, we identified diabetes (1·38, 1·10-1·72), presence of moderate or severe WMH (1·55, 1·01-2·38), and WMH severity (1·61, 1·20-2·14, per SD increase) as treatable risk factors. Additional risk factors included lower educational attainment, previous stroke, left hemisphere stroke, presence of three or more lacunes, brain atrophy, and low baseline functional status. Associations of risk factors with PSD were weaker in studies conducted and published more recently. We found substantial interstudy heterogeneity and evidence of reporting bias. Our results highlight the importance of cognitive impairment in the acute phase after stroke for long-term prediction of PSCI and PSD. Treatable risk factors include diabetes, atrial fibrillation, and markers of cerebral small vessel disease (ie, white matter hyperintensities and lacunes). Future trials should explore these risk factors as potential targets for prevention of PSCI and PSD. German Research Foundation.

Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke.

Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown. In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task. Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions. These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.