Left Middle Cerebral Artery Stroke Research Articles

Efficacy of Dry Needling in Enhancing Hand Function and Reducing Spasticity in MCA Stroke Patients: A Prospective Case Report

Stroke, particularly involving the middle cerebral artery (MCA), often leads to persistent disability, significantly impairing hand function and inducing severe spasticity in the forearm flexors due to complex motor pathway involvement. This case report evaluates the effectiveness of combining dry needling therapy (DNT) with task-oriented training (TOT) in reducing spasticity and improving hand function in a post-MCA stroke patient. A 61-year-old male with right-side hemiplegia following a left MCA stroke, compounded by a history of diabetes, hypertension, and recent kidney stone diagnosis, participated in this study. The patient experienced severe functional limitations due to spasticity (grade 3 on the Modified Ashworth Scale) and scored 31 on the CAHAI-13, indicating significant hand dysfunction. DNT was applied to key forearm muscles (flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, and pronator teres), followed by TOT targeting daily tasks. Post-intervention, the patient demonstrated significant improvements: spasticity was reduced (Modified Ashworth Scale score decreased from grade 3 to grade 2), and muscle hypertonicity, as measured by EMG, was reduced in all targeted muscles. Functional hand use improved markedly, with the CAHAI-13 score increasing from 31 to 45. These improvements led to enhanced independence in daily activities. This case report highlights the clinical relevance of integrating DNT with TOT in stroke rehabilitation. The combined intervention not only reduced spasticity and improved neuromuscular function but also led to meaningful gains in hand function, enhancing the patient’s ability to perform daily activities independently. Given the promising results, this combined approach could serve as a practical and effective strategy for improving motor recovery and functional independence in post-stroke patients. Further studies with larger sample sizes are necessary to confirm these findings and explore the broader application of this approach in clinical practice.

Burr Hole Hemispherotomy-Modification of Trans-Sylvian Peri-Insular Technique: 2-Dimensional Operative Video.

Trans-sylvian peri-insular hemispherotomy represents a functional hemispherectomy with minimal brain removal used for treatment of refractory hemispheric epilepsy.1 Exposure for this procedure is achieved by craniotomy. Refinement in the hemispherotomy technique, including trends toward minimizing cortical resection, has contributed to a substantial drop in complication rates.2 We present a refinement of this technique, allowing for complete hemispheric disconnection through a single burr hole. In this instance, this technique was applied in the case of a 4-year-old girl who presented with medically refractory epilepsy, which had developed on the first day of life due to a perinatal incomplete left middle cerebral artery stroke. Postoperatively, the patient experienced no worsening of her preexisting right-sided hemiparesis and remains seizure-free 18 months postoperatively, now off medication. While the trans-sylvian peri-insular hemispherotomy represents an established surgical technique, this is the first report of this procedure performed in a minimally invasive fashion through a single burr hole. Beyond the minimal incision and small aperture in the skull, seldom appreciated nuances of hemispheric disconnection are described and demonstrated, including amygdala disconnection, hippocampal tail disconnection directly into splenium disconnection, concomitant intermediate disconnection and callosotomy, and frontobasal disconnection landmarks. Consent was obtained from the patient's parents for the surgical procedure, use of outcome videos, and for publication of this video and associated materials. The participants and patient's parents consented to publication of their images and that of the patient.

The difference of autonomic function in acute phase between right and left middle cerebral artery stroke

The difference of autonomic function in acute phase between right and left middle cerebral artery stroke

Improved language function for post-stroke aphasia in the long term following repeated repetitive transcranial magnetic stimulation and intensive speech-language-hearing therapy: a case report

BackgroundThere have been no papers reporting improvement in language function and changes in cerebral blood flow following repeated use of repetitive transcranial magnetic stimulation in combination with intensive speech-language-hearing therapy. This case report concerns the efficacy of repeated use of repetitive transcranial magnetic stimulation and intensive speech-language-hearing therapy for a certain patient suffering from aphasia following stroke, plus the findings of the cerebral blood flow measurements.Case presentationThe patient was a 71-year-old right-handed Japanese male who developed fluent aphasia following a left middle cerebral artery stroke. He underwent repetitive transcranial magnetic stimulation and intensive speech-language-hearing therapy five times in total. The repetitive transcranial magnetic stimulation was applied to right inferior frontal gyrus at the frequency of 1 Hz plus 2 hours per day of intensive speech-language-hearing therapy. The patient’s language function was evaluated in the short term and long term. Cerebral blood flow was measured with single photon emission computed tomography scan. As a result, in the short term, the patient’s language function improved especially during the initial hospitalization. In the long term, it improved gradually and stabilized.Cerebral blood flow was increased in the right hemisphere.ConclusionsThe findings of the study indicate that the repeated use of repetitive transcranial magnetic stimulation and intensive speech-language-hearing therapy may be effective in improving and preserving language function and increasing cerebral blood flow for aphasia following stroke.

Vasospasm secondary to responsive neurostimulator placement: a previously unreported complication. Illustrative case.

The Responsive Neurostimulation (RNS) system is an implantable device for patients with drug-resistant epilepsy who are not candidates for resection of a seizure focus. As a relatively new therapeutic, the full spectrum of adverse effects has yet to be determined. A literature review revealed no previous reports of cerebral vasospasm following RNS implantation. A 35-year-old man developed severe angiographic and clinical vasospasm following bilateral mesial temporal lobe RNS implantation. He initially presented with concerns for status epilepticus 8 days after implantation. On hospital day 3, a decline in his clinical examination prompted imaging studies that revealed a left middle cerebral artery (MCA) stroke with angiographic evidence of severe vasospasm of the left internal carotid artery (ICA), MCA, anterior cerebral artery (ACA), and right ICA and ACA. Despite improvements in angiographic vasospasm after appropriate treatment, a thrombus developed in the posterior M2 branch, requiring mechanical thrombectomy. Ultimately, the patient was stabilized and discharged to a rehabilitation facility with residual cognitive and motor deficits. Cerebral vasospasm as a cause of ischemic stroke after uneventful RNS implantation is exceedingly rare, yet demands particular attention given the potential for severe consequences and the growing number of patients receiving RNS devices.

Large Left Ventricular Pseudoaneurysm Presenting as an Embolic Stroke After a "Silent" Myocardial Infarction.

A 72-year-old woman with no history of coronary artery disease presented with an acute left middle cerebral artery stroke and was found to have a large left ventricular pseudoaneurysm measuring 8.7 × 7.6 cm and 2 large left ventricular thrombi, the source of her systemic embolization. Despite initial medical management, she developed refractory New York Heart Association functional class III heart failure, uncontrolled atrial fibrillation, and further enlargement of her pseudoaneurysm to 5.5 × 10.6 × 9.2 cm. She underwent urgent aneurysmectomy. Left ventricular pseudoaneurysms are rare and most commonly occur following an acute myocardial infarction when a ventricular free-wall rupture is contained by pericardium or thrombi. Historically, left ventricular angiography displaying a lack of an overlying coronary artery was the gold standard for diagnosis. Now, noninvasive imaging such as computed tomography, magnetic resonance imaging, and echocardiogram with ultrasound-enhancing agent, are reliable diagnostic tools. They can distinguish a pseudoaneurysm from a true left ventricular aneurysm using characteristic findings such as a narrow aneurysm neck, bidirectional doppler flow between the pseudoaneurysm and the left ventricle, and abrupt changes in the cardiac wall structures. Progressive dilation, wall thinning, and dyskinesis can result in refractory heart failure, arrhythmias, and thrombi formation from venous stasis. Pseudoaneurysms have a 30% to 45% risk of rupture and can be treated with left ventricular aneurysmectomy.

High Intensity Gait Training for Patient With Apraxia Following Ischemic and Hemorrhagic Stroke

<h3>Research Objectives</h3> High intensity gait training (HIGT) has strong research evidence for improved gait outcomes post-stroke; however, few studies address motor planning deficits within this framework. The purpose of this case study is to describe the application and outcomes of HIGT in a patient with apraxia undergoing inpatient rehabilitation after stroke. <h3>Design</h3> Case report. <h3>Setting</h3> Inpatient Rehabilitation Hospital. <h3>Participants</h3> An 81-year-old female with ischemic left middle cerebral artery stroke and hemorrhagic conversion with mild motor deficits but moderate motor planning and cognitive impairments impacting gait function. <h3>Interventions</h3> Interventions consisted of at least five, hour-long HIGT physical therapy sessions per week, tailored to remediate her motor planning impairments and promote independence with ambulation. To address her apraxia, the cognitive demands during HIGT were initially minimized then progressively challenged, achieved through careful selection of cues, feedback, assistive devices, and training environments. Dynamic stability and limb swing biomechanical subcomponents were progressively challenged as physical assistance/tactile cues were weaned. <h3>Main Outcome Measures</h3> Functional outcomes assessed with the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), 6-minute walk test, 10-meter walk test, and the Berg Balance Scale (BBS). <h3>Results</h3> Following a 30-day inpatient rehabilitation hospital stay, the patient demonstrated clinically meaningful improvements exceeding the minimal detectable change in functional outcomes as evidenced by the IRF-PAI (31-point gain, 124% improvement), the 6-minute walk test (0 ft at admission, 405 ft at discharge), 10-meter walk test (0.56 m/s at discharge), and the BBS (3/56 at admission, 26/56 at discharge). The patient was discharged home and achieved household ambulation with four-wheeled walker and supervision. <h3>Conclusions</h3> Implementation of HIGT customized to address this patient's apraxia and gait impairments resulted in global improvements in her functional skills and level of independence with walking skills. This case study provides a reflection on clinical strategies to remediate apraxia and motor learning deficits using a HIGT paradigm applied in a patient following acute stroke. <h3>Author(s) Disclosures</h3> Dr. Evans received a salary as a Physical Therapy Neurologic Resident at Mary Free Bed Rehabilitation Hospital.

Abstract 11157: A Rare Case of Concomitant Dual Genetic Cardiomyopathies in a Patient Complicated by Stroke

Background: Very little evidence exists on the prevalence of co-existing cardiomyopathies. We report in this case a highly atypical presentation of concurrent arrhythmogenic right ventricular cardiomyopathy (ARVC) and hypertrophic cardiomyopathy (HCM) likely attributable to simultaneous separate somatic mutations, complicated by stroke. Case: A 60-year-old male with a history of rheumatoid arthritis, sleep apnoea and obesity with no significant coronary disease referred for review of asymptomatic ECG abnormalities was found to have severe asymmetrical left ventricular (LV) wall thickening with apical segment akinesis and an LV apex mass on echocardiogram. She had a family history of early sudden cardiac death, with an otherwise unremarkable history and physical examination. Clinical Course: Cardiac MRI (CMR) subsequently demonstrated aneurysmal dilatation of LV apical segments with a 17x13mm thrombus present. Systolic anterior mitral leaflet motion was seen, and a dilated right ventricle (RV) with 240ml end-diastolic volume and 27% ejection fraction. "Accordion" sign was present in the sub-tricuspid RV free wall with dyskinesia, and ECGs confirmed presence of epsilon waves. One week after CMR, she suffered a large left middle cerebral artery (MCA) stroke in the setting of warfarin cessation due to echocardiography-suggestive absence of thrombus. Discussion: Genetic analysis revealed a mutated Plakophillin 2 (PKP2) gene, and FHOD3 gene associated with HCM of uncertain significance. The diagnosis was concomitant genetic cardiomyopathies of ARVC and HCM complicated by large LV apical aneurysm and thrombus culminating in left MCA stroke. PKP2 mutations to date have not been associated with hypertrophic phenotypes. This case therefore demonstrates the unlikely 1 in 2,500 incidence of coexistence of two separate cardiomyopathies likely attributable to simultaneous separate somatic mutations, while also highlighting the central role of CMR in investigation and diagnosis of RV pathology. In addition to this case, prior studies have also shown echocardiography can only identify 50% of ARVC cases identified by CMR, suggesting that selective use of CMR may double the number of identified cases of this life-threatening disease.

Refractory Ventricular Tachycardia and Seizures With Lacosamide Overdose

We describe a 60-year-old female patient who suffered an apparently intentional overdose of lacosamide and who developed status epilepticus secondary to its toxicity, complicated by refractory ventricular arrhythmia necessitating advanced cardiac life support and percutaneous stellate ganglion blockade. Extracorporeal membrane oxygenation was considered, and arterial and venous small-bore sheaths were placed in order to allow for extracorporeal cardiopulmonary resuscitation if cardiac arrest recurred, but they were not ultimately used. She suffered an embolic left middle cerebral artery stroke but otherwise recovered from the episode. This eventful clinical course highlights the dangers of lacosamide in high doses.

An Incidental Discovery of a Serious Complication

An Incidental Discovery of a Serious Complication

Left Middle Cerebral Artery Stroke

Left Middle Cerebral Artery Stroke

Successful Intravenous Thrombolysis for A Common Carotid Artery Dissection Stroke Revealing Takayasu’s Arteritis: A Case Report from Cameroon

Takayasu’s arteritis is an inflammatory disease of large vessels, mainly the aorta and its branches. It is rare in persons of African descent and infrequently reveals itself by stroke and even more rarely causes arterial dissection. We report the case of a 26-year-old lady, who suffered a left total middle cerebral artery (MCA) stroke caused by an extracranial carotid artery dissection. She met 4 out of 6 criteria of the 1990 American College of Rheumatology for Takayasu’s arteritis. She successfully underwent intravenous (IV) thrombolysis using Tenecteplase and was subsequently started on steroids and methotrexate. After three months of follow-up, she was functionally independent with a modified Rankin score (mRs) of +1 and had no signs of active Takayasu’s disease. This report adds to the data on acute reperfusion therapy in ischemic stroke due to Takayasu’s arteritis and represents to the best of our knowledge the first reported case of successful IV thrombolysis in Cameroon.

Acute coronary syndrome and ischemic stroke in the course of COVID-19 infection

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pandemic has spread rapidly worldwide with 314 million infected and 5 million deceased worldwide (as of December 2021). SARS-Cov-2 has been shown to not only cause viral pneumonia, but also to lead to serious effects on the cardiovascular system. It has been proven that COVID-19 can be complicated by the Acute Coronary Syndrome through plaque rupture, vasospasm or microthrombi due to systemic inflammation or cytokine storm. An additional role is played by the hyperimmune response as well as the endothelial dysfunction, which contribute to the hypercoagulable state. &amp;#1058;here is a strong possibility that the high inflammatory load is the cause of de novo coronary lesions. We present a clinical case of a 53-year-old man presenting with toxico-infectious syndrome, angina and dyspnea. Conducted paraclinical and&amp;nbsp;clinical studies showed acut coronary syndrome without ST-elevation, left ventricular thrombosis, active SARS-CoV-2 infection and bilateral interstitial pneumonia. The patient was treated with percutaneous coronary intervention of LAD with drug-eluting stent, anticoagulant therapy, dual antiplatelet and anti-inflamatory therapy, beta blocker and ACE-inhibitor. On the 4th day of hospitalization the patient realized Left Middle Cerebral Artery Stroke. Our clinical case demonstrates unique prothromobotic properties of SARS-CoV-2, due to different mechanisms and complicated by thromboembolic events.

Case Report – Successful Thrombectomy After Critical Resuscitation Following a Cardiac Arrest

Sparse evidence exists to support a delayed attempt at thrombectomy after a periprocedural cardiac arrest or acute medical decompensation. This case highlights the presentation of a 23‐year‐old woman with dilated cardiomyopathy, who initially presented with a left middle cerebral artery stroke syndrome, but who had a cardiac arrest in the angiogram suite prior to the procedure starting. After aggressive resuscitation in the critical care unit, repeat imaging showed a persistent perfusion deficit in the left middle cerebral artery territory and she successfully underwent a thrombectomy. The case highlights that critical care efforts, even after a severe initial presentation, and significant resuscitative efforts in the intensive care unit setting, can still lead to a successful thrombectomy, and that eligibility for thrombectomy can be reassessed as the patient stabilizes.

Dual αV-integrin and neuropilin-1 targeting peptide CEND-1 plus nab-paclitaxel and gemcitabine for the treatment of metastatic pancreatic ductal adenocarcinoma: a first-in-human, open-label, multicentre, phase 1 study

CEND-1 is a novel cyclic peptide that targets αV integrins and neuropilin-1 and enhances tumour delivery of co-administered anticancer drugs. We investigated the safety, tolerability, and biological activity of CEND-1 in patients with metastatic pancreatic ductal adenocarcinoma in combination with nab-paclitaxel and gemcitabine. This open-label, multicentre, phase 1 study, conducted at three hospitals in Australia, enrolled participants aged 18 years or older with histologically confirmed metastatic pancreatic ductal adenocarcinoma who had one or more lesions measurable on MRI or CT, an Eastern Cooperative Oncology Group performance status score of 0 or 1, and a life expectancy of at least 3 months. Exclusion criteria included previous chemotherapy and brain metastases or other malignancy (unless receiving curative intent). There was no randomisation or masking. CEND-1 monotherapy was given as an intravenous fluid bolus on day 1 of a run-in phase of 7 days (0·2-3·2 mg/kg) followed by CEND-1 plus intravenous gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) on days 1, 8, and 15 of 28-day treatment cycles until disease progression. The primary safety endpoints were incidence, severity, and duration of treatment-emergent and treatment-related adverse events; overall survival; and clinical laboratory results, which were all assessed in the safety population. This study is registered with ClinicalTrials.gov, NCT03517176, and the Australian New Zealand Clinical Trials Registry, ACTRN12618000804280. Between Aug 13, 2018, and Nov 30, 2019, 31 patients were enrolled (eight in the dose-escalation phase [cohort 1a] and 23 in the expansion phase [cohort 1b]). Two patients were excluded from the efficacy population. No CEND-1 dose-limiting toxicities were observed in the safety population (n=31). The most common grade 3 or 4 events were neutropenia (17 [55%] patients), anaemia (eight [26%]), leukopenia (five [16%]), and pulmonary embolism (four [13%]). Serious adverse events occurred in 22 (71%) patients, mostly related to disease progression. Ten deaths occurred during the study due to progression of metastatic pancreatic cancer (n=9) and a left middle cerebral artery stroke (n=1). In the efficacy population (n=29), 17 (59%) patients had an objective response, including one complete response and 16 partial responses. After a median follow-up of 26 months (IQR 24-30), median overall survival was 13·2 months (95% CI 9·7-22·5). CEND-1 with nab-paclitaxel and gemcitabine has an acceptable safety profile, with no dose-limiting toxicities and encouraging activity. Adverse events were generally consistent with those seen with nab-paclitaxel and gemcitabine. Further randomised trials to determine the efficacy of CEND-1 are warranted. DrugCendR Australia Pty.

Transbrachial access for mechanical thrombectomy in a case of acute ischemic stroke with aortic bifurcation occlusion

Objective: To report successful mechanical thrombectomy through transbrachial route in a patient with left middle cerebral artery (MCA) stroke and aortic bifurcation occlusion. Background: Mechanical thrombectomy is the standard therapeutic approach for eligible candidates of acute ischemic stroke according to American Heart Association/American Stroke Association guidelines. Mostly, a transfemoral approach is used to perform mechanical thrombectomy. Few studies have shown use of radial route for this procedure. Few reports have shown alternate access routes for performing mechanical thrombectomy when transfemoral or radial routes are not accessible. Design/Methods: Case report and literature review. Results: A 51-year-old female presented with left MCA stroke. Computed tomography angiography showed left internal carotid artery T occlusion extending into left MCA. Associated left atrial thrombus and occlusion at the aortic bifurcation were diagnosed in this patient. A transbrachial route was taken to perform mechanical thrombectomy in this patient resulting in complete recanalization. Conclusion: This case emphasizes the role of alternate access routes to perform mechanical thrombectomy in challenging situations.

Case Report: True Motor Recovery of Upper Limb Beyond 5 Years Post-stroke

Most of motor recovery usually occurs within the first 3 months after stroke. Herein is reported a remarkable late recovery of the right upper-limb motor function after a left middle cerebral artery stroke. This recovery happened progressively, from two to 12 years post-stroke onset, and along a proximo-distal gradient, including dissociated finger movements after 5 years. Standardized clinical assessment and quantified analysis of the reach-to-grasp movement were repeated over time to characterize the recovery. Twelve years after stroke onset, diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS) analyses of the corticospinal tracts were carried out to investigate the plasticity mechanisms and efferent pathways underlying motor control of the paretic hand. Clinical evaluations and quantified movement analysis argue for a true neurological recovery rather than a compensation mechanism. DTI showed a significant decrease of fractional anisotropy, associated with a severe atrophy, only in the upper part of the left corticospinal tract (CST), suggesting an alteration of the CST at the level of the infarction that is not propagated downstream. The finger opposition movement of the right paretic hand was associated with fMRI activations of a broad network including predominantly the contralateral sensorimotor areas. Motor evoked potentials were normal and the selective stimulation of the right hemisphere did not elicit any response of the ipsilateral upper limb. These findings support the idea that the motor control of the paretic hand is mediated mainly by the contralateral sensorimotor cortex and the corresponding CST, but also by a plasticity of motor-related areas in both hemispheres. To our knowledge, this is the first report of a high quality upper-limb recovery occurring more than 2 years after stroke with a genuine insight of brain plasticity mechanisms.

FMRI informed voxel-based lesion analysis to identify lesions associated with right-hemispheric activation in aphasia recovery

Several mechanisms have been attributed to post-stroke loss and recovery of language functions. However, the significance and timing of domain-general and homotopic right-hemispheric activation is controversial. We aimed to examine the effect of left-hemispheric lesion location and time post-stroke on right-hemispheric activation. Voxel-based lesion analyses were informed by auditory language-related fMRI activation of 71 patients with left middle cerebral artery stroke examined longitudinally in the acute, subacute and early chronic phase. Language activation was determined in several right-hemispheric regions of interest and served as regressor of interest for voxel-based lesion analyses. We found that an acute to chronic increase of language activation in the right supplementary motor area was associated with lesions to the left extreme capsule as part of the ventral language pathway. Importantly, this activation increase correlated significantly with improvement of out-of-scanner comprehension abilities. We interpret our findings in terms of successful domain-general compensation in patients with critical left frontotemporal disconnection due to damage to the ventral language pathway but relatively spared cortical language areas.

Abstract 1122‐000165: Endovascular Intervention for a Thrombotic Adverse Event During Andexanet Alfa Infusion

Introduction : Andexanet alfa is the only specific reversal agent for factor Xa inhibitors and received FDA approval in 2018. Here we report an early infusion adverse event in a patient with acute intraventricular hemorrhage (IVH) that received Andexanet alfa, with an unfavorable outcome. Methods : A 73‐year‐old male presented to our emergency department (ED) after he developed sudden onset of severe headache without other associated neurological symptoms. An outpatient brain MRI showed IVH, that remained stable in size (2.4 cm3) on a follow‐up head CT performed in our ED. CT angiogram showed a 60% stenosis of the left supraclinoid internal carotid artery. The patient was taking apixaban 5 mg twice daily for atrial fibrillation (last dose 5.5 hours prior to presentation). Results : The anticoagulation was reversed with Andexanet alfa, 400 mg bolus given at 18:30, followed by 480 mg infusion over 2 hours started at 19:00 (12 hours from last apixaban dose). At 19:00, he developed left middle cerebral artery (MCA) ischemic stroke symptoms (global aphasia) that resolved with head‐of‐the‐bed flattening. CT perfusion demonstrated left ICA territory mismatch (342 ml) and 76 ml core. Shortly after CT perfusion, the patient developed a persistent complete left MCA stroke syndrome with NIH stroke scale (NIHSS) score 23. Decision was made to perform emergent cerebral angiogram which demonstrated a large, fresh thrombus in the left cervical ICA. Thrombectomy was successful with TICI score 2B. Patient’s neurological status initially improved. However, despite this intervention, patient developed a large territory infarct. As neurologic status remained poor, family withdrew care and patient died. Conclusions : ANNEXA‐A and ANNEXA‐R were parallel trials of Andexanet alfa for factor Xa inhibitor reversal that demonstrated a transient increase in prothrombotic factors post Andexanet alfa infusion. Neither of these phase 3 trials nor the previous phase 2 trials reported a clinical thrombotic event very early during the infusion. The ANNEXA‐4 trial (Phase 3) enrolled subjects with active major bleeding on a factor Xa inhibitor and 10% developed a thrombotic event during the 30‐day follow‐up period. 41% of the thrombotic complications were acute ischemic stroke (AIS), 35% (5 patients) experienced an AIS in the first six days post‐administration and the earliest reported thrombotic event occurred day 1 post infusion. Our case report illustrates an early cerebrovascular thrombotic event with dismal outcome despite timely and effective mechanical reperfusion therapy, which could be due to vessel re‐obstruction in setting of a hypercoagulable state. We aim to make vascular neurologists, neurointensivists and neurosurgeons aware of this possible occurrence when reversing patients with factor Xa‐related intracranial hemorrhages.

A longitudinal study of narrative discourse in post-stroke aphasia

ABSTRACT Background Previous findings have demonstrated the importance of discourse analysis in post-stroke aphasia, as it allows for in-depth examination of language impairment and represents key components of functional communication. However, little is known about the recovery of discourse over time. Aims The main aim of this study is to measure the longitudinal changes in descriptive discourse production from the acute to chronic stages of post-stroke aphasia recovery. The secondary aim is to explore the association between discourse measures and overall language impairment severity measures at different testing points. Methods & Procedure Seventeen French-Canadian speakers with various types and severities of aphasia following a first left middle cerebral artery stroke participated in this study. They underwent three language assessments (acute: 0 to 72 hours; subacute: 7 to 14 days; chronic: 6 to 12 months post-onset). The picture description from the Western Aphasia Battery was analyzed at three time points. Changes in terms of thematic informativeness and microstructural variables were analyzed. Outcomes & Results Regarding the micro-structural variables, the mean length of utterances (MLU) and the number of words per minute showed significant positive changes between the acute and chronic phases. For the thematic informativeness measures, the number of thematic units (TUs), the number of thematic units per minute (TUs/min) and the number of thematic units per utterance (TUs/utt) increased significantly between the acute and chronic phases. Positive correlations between TUs and MLU in the acute phase and a general language impairment severity measure in the acute and chronic phases suggest a relationship between these measures and global language performance suggesting the potential predictive value of these variables in the acute phase. Conclusions & Implications These findings support the use of thematic units in descriptive discourse analysis during an acute clinical examination of language as they require minimal additional time to score and track changes in post-stroke aphasia recovery. They capture long-term changes in discourse abilities and appear related to overall language measures in both the acute and chronic stages of recovery. The interpretation of the changes in MLU and the number of words per minute is less straightforward, as improvements in these measures carry different interpretations depending on the type of aphasia. Nonetheless, further studies are required to investigate test-retest reliability and the effect of therapy on the changes observed over time when using thematic units to document change in discourse.