Modified Ranking Scale Research Articles

The impact of asymptomatic intracranial atherosclerotic stenosis on the clinical outcomes of patients with single subcortical infarction.

The presence of parental arterial disease (PAD) is correlated with the outcomes of patients with a single subcortical infarction (SSI). Due to the relatively low incidence of PAD, the predictors of outcomes seem to be limited for SSI patients without PAD. This study aims to investigate the association between asymptomatic intracranial atherosclerotic stenosis (aIAS) and outcomes in patients with SSI and in the subgroup without PAD. Patients with SSI were consecutively enrolled. aIAS referred to a stenosis of ≥50% in intracranial arteries irrelevant to SSI by using magnetic resonance angiography. A poor outcome refers to a modified Ranking Scale >2 points at discharge. In total, 298 participants were enrolled. The presence of aIAS could predict a poor outcome for all SSI patients [adjusted relative risk (aRR) = 2.14, 95% confidence interval (CI) = 1.17-3.93, p = 0.014] and in the subgroup without PAD (aRR = 3.12, 95% CI = 1.47-6.62, p = 0.003), but not in the subgroup with PAD. Compared with participants with neither aIAS nor PAD, the risk of a poor outcome increased approximately 2-fold in those with aIAS only (aRR = 2.95, 95% CI = 1.55-5.60, p = 0.001) and in those with concomitant aIAS and PAD (aRR = 3.10, 95% CI = 1.62-5.95, p = 0.001). The presence of aIAS is a predictor of a poor outcome in SSI patients, especially in those without PAD.

Effect of mechanical thrombectomy with and without intravenous thrombolysis on the functional outcome of patients with different degrees of thrombus perviousness.

This study aimed to investigate the long-term functional outcome of patients with different degrees of thrombus perviousness (TP) undergoing mechanical thrombectomy alone and those undergoing combined intravenous thrombolysis (IVT) plus mechanical thrombectomy. We conducted a retrospective analysis of consecutive patients with acute ischemic stroke due to large vessel occlusion who underwent mechanical thrombectomy alone or bridging therapy between January 2016 and October 2020. TP was quantified by thrombus attenuation increase (TAI) on admission computed tomography angiography compared with non-contrast computed tomography. After dichotomization of TAI as higher or lower perviousness, Fisher exact tests were performed to estimate the associations of different therapies with favorable functional outcomes [Modified Ranking Scale score at 90days (90-day mRS) of 0 to 2]. A total of 73 patients were included in our study. 35 (47.9%) thrombi were classified as higher-perviousness clots with TAI of ≥ 24 HU, and the other 38 thrombi were lower-perviousness clots. A favorable outcome with a 90-day mRS of 0 to 2 was observed in 32 patients. In patients with thrombi of lower perviousness, favorable outcome was more common in the bridging therapy group than in the thrombectomy-alone group (p = 0.013), whereas in patients with thrombi of higher perviousness, the long-term neurological outcome did not significantly differ between two therapy groups (p = 0.094). Patients with thrombi of lower perviousness were recommended to undergo intravenous alteplase followed by endovascular thrombectomy, and those with thrombi of higher perviousness could undergo thrombectomy alone.

The impact on clinical outcomes after 1 year of implementation of an artificial intelligence solution for the detection of intracranial hemorrhage

BackgroundTo assess the effect of a commercial artificial intelligence (AI) solution implementation in the emergency department on clinical outcomes in a single level 1 trauma center.MethodsA retrospective cohort study for two time periods—pre-AI (1.1.2017–1.1.2018) and post-AI (1.1.2019–1.1.2020)—in a level 1 trauma center was performed. The ICH algorithm was applied to 587 consecutive patients with a confirmed diagnosis of ICH on head CT upon admission to the emergency department.Study variables included demographics, patient outcomes, and imaging data. Participants admitted to the emergency department during the same time periods for other acute diagnoses (ischemic stroke (IS) and myocardial infarction (MI)) served as control groups. Primary outcomes were 30- and 120-day all-cause mortality. The secondary outcome was morbidity based on Modified Rankin Scale for Neurologic Disability (mRS) at discharge.ResultsFive hundred eighty-seven participants (289 pre-AI—age 71 ± 1, 169 men; 298 post-AI—age 69 ± 1, 187 men) with ICH were eligible for the analyzed period. Demographics, comorbidities, Emergency Severity Score, type of ICH, and length of stay were not significantly different between the two time periods. The 30- and 120-day all-cause mortality were significantly reduced in the post-AI group when compared to the pre-AI group (27.7% vs 17.5%; p = 0.004 and 31.8% vs 21.7%; p = 0.017, respectively). Modified Rankin Scale (mRS) at discharge was significantly reduced post-AI implementation (3.2 vs 2.8; p = 0.044).ConclusionThe added value of this study emphasizes the introduction of artificial intelligence (AI) computer-aided triage and prioritization software in an emergent care setting that demonstrated a significant reduction in a 30- and 120-day all-cause mortality and morbidity for patients diagnosed with intracranial hemorrhage (ICH). Along with mortality rates, the AI software was associated with a significant reduction in the Modified Ranking Scale (mRs).

Nonprogrammable Shunts for Communicating Hydrocephalus and Three-Dimensional Volumetry: A Retrospective Analysis

Although the use of different types of valves have been extensively studied in shunt surgeries for communicating hydrocephalus (cHC), a consensus about the valve type remains absent. The objective of this study is to evaluate our results with the primary placement of non-programmable valves (NPV) for this indication. We retrospectively analyzed all first NPV implanted between 2014-2020 for cHC. We studied the revision rate, clinical outcome described by modified Ranking Scale (mRS) and radiological evolution using Evans index (EI) and ventricular volumes 3D-semiautomatic segmentation (vv-3DSAS). Forty-one patients were shunted for post-hemorrhagic (61%), post-traumatic (24.4%) and tumoral (14.6%) hydrocephalus (HC). Mean age was 65 years (range 25-89yrs). Overall, 59 procedures were performed including 18 revision surgeries in 12 patients (29.3%). Underlying reason for first shunt revision were valve type related: valve dysfunction, overdrainage, underdrainage and non-valve type related: malpositioning, infection, shunt migration. The shunt-related revision rate was 17.1%. Twenty-eight patients (68.3%) had an mRS improvement of 1 or more points. We found a good correlation between ventricle volumes (VV) and EI and a significant reduction in VV measured by EI and vv-3DSAS was observed. However, the mRS improvement was not correlated with a reduction of ventricle volumes. Overall, our results in terms of shunt revisions as well as clinical and radiological evolution are comparable with the literature for NPV. vv-3DSAS can be used and could be useful to detect small changes in VV in patients with cHC.

Clinical Profile of the Stroke Recovering Patients in the Acute Rehabilitation Setting in Peshawar

All stroke patients across the stroke spectrum frequently experience functional deficits of varying degrees. Despite the idea of post-stroke functional advancement, there is a lack of information regarding post-acute stroke recovery. Objective: To track the progress of acute stroke patients admitted to acute stroke rehabilitation centers in terms of functional recovery. Methods: A cohort study was designed and extracted the data of ninety-five (N=95) acute stroke patients admitted to the center for the acute rehabilitation program (ARP). Ninety-five (N=95) post-stroke patients with the mRS 3-4 (Modified ranking scale) admitted to the centers were enrolled for this retrospective cohort study. All enrolled patients for the study went through functional, neurophysiological and quality of life assessment/evaluation was taken at the time of admission to the center and before the discharge from the center. The score at the discharge were the functional outcomes and were used to compare them with the score taken at the time of admission (baseline score). Results: The results of the retrospective cohort showed that the average length of stay was 56.40 days. After the intervention of the intensive ARP significant improvement were observed in all test score. The removal rate for foley catheter (p=0.003), Nasogastric tubes (p=0.00) was found for all patients at the time of discharge. Conclusions: The study's findings demonstrated that ARP can help acute stroke patients who have functional deficits improve their functional status. To find more efficient forms of intervention in the acute-stroke rehabilitation, this study advises future research

Safety of Mechanical Thrombectomy in Patients on Antiplatelet/Anticoagulation

Mechanical thrombectomy (MT) is performed in patients who are already on anticoagulation (AC)/antiplatelet therapy (AP). However, data are insufficient regarding MT's safety and efficacy profiles in these patients. Investigate the outcome of stroke patients already on anticoagulation/antiplatelet receiving MT. We included consecutive acute ischemic stroke patients treated with MT for 10years (2012-2022) in a comprehensive stroke center. Baseline variables, efficacy (recanalization [Thrombolysis in Cerebral Infraction]≥2b), good functional outcome (modified Ranking Scale ≤ 2 at 3months), and safety (symptomatic intracranial hemorrhage [sICH], mortality rates) were evaluated. Additionally, we conducted a subgroup analysis of patients with prior single-AP versus DAPT. Six hundred forty-six patients were included (54.5% women, median age 71years), 84 (13%) were on AC, 196 (30.3%) on AP, and 366 (56.7%) in the control group. The AC and AP groups were older and had more comorbidities. sICH occurred in 7.3% of cases. There was no significant difference in sICH incidence across the groups. The AC group had a lower rate of intravenous thrombolysis (15.9%; P < 0.001), a higher rate of sICH (11.9% vs. AP 7.7% and control 6%; P= 0.172), and higher mortality at discharge (17.9% vs. AP 8.7% and control 10.4%; P= 0.07). However, the groups had similar functional outcomes and mortality rates at 3months. Successful recanalization was achieved in 92.7% and was similar across groups. Multivariable logistic regression and the subgroup analysis (single-AP vs. dual AP) did not reveal statistically significant associations. MT in patients with prior anticoagulation and AP presenting with acute ischemic strokeis feasible, effective, and safe.

Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study.

The efficacy of patent foramen ovale (PFO) closure in the elderly population is unclear. We aimed to investigate the efficacy and safety of PFO closure in non-elderly and elderly patients. Patients over 18 years of age with cryptogenic stroke (CS) or transient ischemic attack and PFO were prospectively enrolled and classified into two groups according to treatment: (1) closure of PFO (the PFOC group) and (2) medical treatment alone (the non-PFOC group). The primary outcome was a composite of recurrent cerebral ischemic events and all-cause mortality during the follow-up period. A modified Ranking Scale [mRS] at 180 days was recorded. The safety outcomes were procedure-related adverse events and periprocedural atrial fibrillation. The results between the PFOC and non-PFOC groups in non-elderly (<60 years) and elderly (≥60 years) patients were compared. We enrolled 173 patients, 78 (45%) of whom were elderly. During a mean follow-up of 2.5 years, the incidence of primary outcome was significantly lower in the PFOC group (6.2% vs. 17.1%, hazard ratio[HR] = 0.35, 95% CI 0.13-0.97, p = 0.043) in adjusted Cox regression analysis. Compared with the non-PFOC group, the PFOC group had a numerically lower risk of the primary outcome in both the elderly (HR 0.26, 95% CI 0.07-1.01, p = 0.051) and the non-elderly (HR 0.61, 95% CI 0.11-3.27, p = 0.574) groups. In addition, patients with PFO closure in the elderly group had a lower median mRS at 180 days (p = 0.002). The rate of safety outcome was similar between the non-elderly and elderly groups. PFO closure was associated with a reduced risk of the primary outcome in patients with PFO and CS in our total cohort, which included non-elderly and elderly patients. Compared to those without PFO closure, elderly patients with PFO closure had a better functional outcome at 180 days. PFO closure might be considered in selected elderly patients with PFO.

Retrospective comparison clinical presentation and outcome of Natalizumab and Fingolimod-associated PML (P7-3.004)

Retrospective comparison clinical presentation and outcome of Natalizumab and Fingolimod-associated PML (P7-3.004)

Outcome of Lacunar vs Non-lacunar Infarcts in a Prospective Stroke Database (P14-5.029)

<h3>Objective:</h3> To prospectively compare recovery outcomes, presentation with NIH stroke scale and modified ranking scale (MRS) in the study population with follow up at discharge. <h3>Background:</h3> Earlier studies suggested lacunar stroke has a better prognosis compared to other strokes, but recent studies show prognosis of lacunar stroke is simiar or worse when compared to large strokes. <h3>Design/Methods:</h3> We prospectively collected demographic information, admission NIH stroke scale, and modified ranking scale with serial measurements during hospitalized course in single tertiary care hospital in six-month period(n=74). We also collected information on discharge disposition between lacunar and non-lacunar stroke groups. Two groups adjusted for sex and race. Independent t-test is used for comparing continuous variables and chi-square test for comparing categorical variables. <h3>Results:</h3> There were 30 lacunar stroke patients and 44 non-lacunar stroke patients with mean age of 60 years for lacunar stroke patients and 70 for non-lacunar stroke patients. Mean admission NIH stroke scale was 11 in the non-lacunar group with MRS of 0.4 compared to 6 (p= 0.009) and 1(p=0.006), respectively in the lacunar group. Discharge NIH and MRS values were 7 and 2.3 respectively for the non-lacunar group compared to 4(p=0.03) and 2.2(p=0.88) for the lacunar group. ΔNIH (admit-discharge) is 4 and 2 for non-lacunar and lacunar group, respectively. ΔMRS (admit-discharge) is −1.9 and −1.3 for non-lacunar and lacunar group, respectively. Discharge to home was 46.7% &amp; 37% (p=0.03) in non-lacunar group and lacunar group, respectively. Discharge to Skilled nursing facility was 13.3% and 18.5%(p=0.03) in non-lacunar group and lacunar group, respectively. <h3>Conclusions:</h3> Despite the relatively small volume of infarct associated with lacunar stroke compared to typically large infarcts seen with non-lacunar stroke, we found that the outcome was similar if not worse in terms of recovery for lacunar type stroke based upon prospective information collected in our six-month database extending from May 2021 to November <b>Disclosure:</b> Dr. Buchhanolla has nothing to disclose. Dr. PANDEY has nothing to disclose. Dr. Bir has nothing to disclose. Dr. Javalkar has nothing to disclose. Dr. Kelley has nothing to disclose.

The Effect of Metformin on Stroke Prognosis in Diabetic Patients; a Clinical Trial (P7-5.015)

<h3>Objective:</h3> To eavluate the stroke severity and outcomes in daibetic patients with acute ischemic stroke who had been treating with metformin compared to other diabetic controlling agents in patients with Diabetes Mellitus Type 2 before stroke. <h3>Background:</h3> The effect of metformin in Diabetes type-2 (DM-2) on neural tissue survival encountering ischemia is proposed in experimental studies. It is theorized that this effect is depenant from its effect in controlling blood glucose level. However, in humans the benefit of pre- metformin use on the severity and prognosis of stroke in a clinical setting is yet to be understood. <h3>Design/Methods:</h3> According to the inclusion and exclusion criteria, we extracted data from patients with DM-2 with acute ischemic stroke referred to a Central Stroke Center. Their medications during the diabetes disease (druge history) before stroke were recorded. Symptoms’ severity was measured according to the national institutes of health stroke scale (NIHSS) score on admission. Confounding bias including factors affecting stroke severity and outcome were controlled. Stroke outcome was measured by a modified Ranking scale (mRS), 3 months after stroke onset. The optimal functional outcome was considered a Modified Rankin Scale(mRS) score of 2 or lower. <h3>Results:</h3> Of 126 patients with DM-2, 82 (65.08%) patients had been taking metformin before the stroke and 44 (34.92%) had been receiving other antidiabetic agents. The severity of symptoms measured by NIHSS was similar in both groups. After including confounders in the regression model, there was no meaningful difference between the two groups in functional outcome (p-value&gt;0.053) <h3>Conclusions:</h3> Prior Diabetes treatment with metformin seems not to have a significant effect on either severity of onset or outcomes of acute ischemic stroke in diabetic type 2 patients compared to other diabetic treatments. <b>Disclosure:</b> Dr. Esmaeili has nothing to disclose. Dr. Mirzaasgari has nothing to disclose. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Zabeti has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Zabeti has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Horizon. Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Janssen . Dr. Zabeti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for BMS.

Efficacy and Safety of Injection Tenecteplase in 4.5 to 24 hours imaging eligible window patients with Acute Ischemic Stroke (EAST-AIS) (P7-5.016)

<h3>Objective:</h3> To determine the efficacy and safety of injection Tenecteplase along with standard treatment in acute ischemic stroke with or without large vessel occlusion presenting within 4.5 to 24 hours of onset <h3>Background:</h3> Currently in Acute Ischemic stroke (AIS) patients, intravenous thrombolysis is approved for the 0-to-4.5-hour window period and mechanical thrombectomy for large vessel occlusion up to 24 hours of stroke onset in eligible patients. Previous studies have evaluated the safety and efficacy of Tenectplasse in a small number of patients in the period beyond 4.5hours of stroke onset. In the present study, we evaluate the safety and efficacy of injction of Tenectplase in AIS patients (with or without large vessel occlusion) in the time window 4.5 to 24 hours of stroke onset. <h3>Design/Methods:</h3> Patients will be enrolled primarily based on imaging the eligibility criteria with a perfusion lesion-ischemic core mismatch greater than1.8 between the volume of hypoperfusion and the volume of the ischemic core, with the absolute difference in volume being greater than 10 ml, and ischemic-core volume less than 70 ml. Additional inclusion criteria are patients age should be &gt; 18 years, onset period between 4.5 to 24 hours with NIHSS&gt;5, and pre-stroke Mrs value of 2 or less. A total of one hundred patients are planned to be enrolled, 50 each in Tenectlase are (cases-0.25mg/kg; maximum 25mg) and placebo arm (controls) in a ratio of 1:1 administered as a singlr bolus injection. An independent data safety and monitoring board (DSMB) will share responsibility for regular oversight of patient safety during the study. <h3>Results:</h3> This is ongoing randomized control trial. <h3>Conclusions:</h3> The study is an investigator initiated prospective and randomized controlled trial design. The safety endpoints along with efficacy of Tenecteplase using the modified Ranking Scale (mRS) score at 90 days of stroke onset will be determined. <b>Disclosure:</b> Dr. Jatwani has nothing to disclose. Awadh K. Pandit has nothing to disclose. Ms. Tangri has nothing to disclose. Dr. Srivastava has nothing to disclose. Dr. Bhatia has nothing to disclose. Ajay Garg has nothing to disclose. Dr. Vibha has nothing to disclose. Vishnu VY has nothing to disclose. Dr. Das has nothing to disclose. Divya MR has nothing to disclose.

Artery of Percheron Infarction: Clinical Presentation and Outcomes (P6-5.032)

<h3>Objective:</h3> We sought to characterize the presentation, acute treatment, and outcomes in patients with artery of Percheron (AOP) strokes. <h3>Background:</h3> The AOP is an uncommon vascular variant whose occlusion produces bilateral thalamic infarction often resulting in deficits of arousal. <h3>Design/Methods:</h3> We conducted a keyword search of our institution’s neuroimaging database from 2014–2022. All possible cases of AOP infarction were reviewed by two neurologists. We abstracted patient demographics, clinical presentation, acute treatment, acute neuroimaging findings, and laboratory results from the medical record. The median modified Ranking Scale (mRS) and interquartile range (IQR) at baseline, 3 months, and 12 months was analyzed to assess post-AOP stroke disability. Descriptive statistics were used to report clinical findings. <h3>Results:</h3> Our initial search identified 192 potential AOP cases. Fourteen cases of AOP infarction were confirmed and included in our study (8 female [57.1%], median age 67.5 [IQR 60.75–75], median presenting NIHSS 6 [IQR 2–15.25]). Hypertension or systolic blood pressure &gt; 140 (78.5%), decreased level of consciousness (6, 42.8%), and diplopia (6, 42.8%) were the most common presenting complaints. Eleven cases (78.6%) presented to the emergency department (ED). Median time from symptom onset to ED arrival was 14.3 hours (IQR 3.4–63.1); four cases (28.6%) arrived within the conventional thrombolysis time window. Median time from ED arrival to stroke diagnosis was 4.6 hours (IQR 3.8–15.8). Only one patient (7.1%) received IV thrombolysis. Median mRS increased from 2.0 (IQR 0–4) at baseline to 4.0 (IQR 3–5) at 3 months, and 4.0 (IQR 3–4.5) at 12 months. <h3>Conclusions:</h3> Apart from diplopia and hypertension, AOP infarction patients had diverse, non-specific clinical presentations resulting in delayed diagnosis. As a result, despite AOP infarction causing considerable long-term disability, only one patient received IV thrombolysis. Clinicians should maintain a high degree of suspicion for AOP stroke and intervene aggressively in appropriately selected patients. <b>Disclosure:</b> Dr. Ramezani Hashtjin has nothing to disclose. Dr. Ikramuddin has nothing to disclose. Dr. Streib has nothing to disclose.

Four‐Year Follow‐Up on the First‐in‐Human Experience With Nautilus Intrasaccular System Assisted Coiling for Unruptured Intracranial Aneurysms

Background The authors present the long‐term (4 year) results of a first‐in‐man, single‐center case series with the Nautilus Intrasaccular System for the embolization of wide‐neck intracranial aneurysms. Methods From February 2018 to July 2018, the authors enrolled 5 patients into a first‐in‐human study of the Nautilus device. After treatment, patients underwent 6 months with digital subtraction angiography and 3 years with magnetic resonance angiography according to institutional standard of care. Occlusion rates were core‐laboratory adjudicated for the digital subtraction angiography and independently assessed by a neurointerventionalist not part of the care team for the magnetic resonance angiography. Neurological outcome (modified Ranking scale score) was evaluated at 24 hours, 7 days, 6 months, and 1, 2, 3, and 4 years, and adverse events were collected during the first 6 months post treatment. Results Five patients with unruptured, wide‐necked aneurysms were treated and followed up for 4 years. Aneurysm locations included basilar bifurcation (2 of 5), internal carotid artery terminus (1 of 5), superior cerebellar artery (1 of 5), and the anterior communicating artery (1 of 5). The average aneurysm size was 7.6 mm and the average neck diameter was 5.2 mm. Immediate complete and near‐complete occlusion (Raymond–Roy classification class I and II) was achieved in 80% (4 of 5) of the aneurysms. Occlusion results improved at 6 months and remained stable at 3 years, without retreatment (Raymond–Roy classification class I 80%, class I and II 100%). All patients maintained good neurological outcome at all follow‐ups (modified Ranking scale 0). Conclusion This initial clinical experience provides early evidence of the long‐term safety and effectiveness of the new intrasaccular neck bridging device, Nautilus. The Nautilus appears to add a simple, safe, and effective option and solution to the coil embolization of the wide‐neck aneurysm.

A Study to Assess the Functional Independance and Disability Evaluvation Among Stroke Patients

Introduction: Stroke is medically called cerebrovascular accident (CVA) that's described as a surprising lack of feature due to harm to the brain (hemorrhagic stroke) and absence of blood deliver to the brain (ischemic stroke) reasons weak spot of muscle specifically on one aspect of the body, confusion, trouble in speaking, visible disturbances, trouble in walking, surprising intense headache which ends up in long time disability. The World Health Organization has currently proposed a brand new International Classification of Functioning, Disability and Health that defines additives of functioning and disability, in addition to sports and participation. The latter thing describes nine domain names of interest and participation: getting to know and making use of knowledge; widespread responsibilities and demands; communication; mobility; self-care; home lifestyles; interpersonal interplay and relationships; main lifestyles areas; and community, social, and civic lifestyles. Although scientific trials of stroke interventions robotically use mortality as an outcome, different results are each essential for scientific investigations and applicable to patients.Methods:A descriptive research design was adopted for the study. (n=60 )Samples patients with stroke whowere met the inclusion criteria is selected by using convenience sampling technique. After selecting the sample, the investigator introduced him-self and explained the purpose of the study to the participants’. Informed consent was obtained from the patients relatives after assured confidentiality. The Demographic and clinical variables were collected by using multiple choice questionnaires. The functional independence and disability assessing by using Barthel Index and Modified Ranking Scale. The score is monitored on the day of data collection. Each score evaluation will take 10 minutes. The data were tabulated and analyzed by descriptive and inferential statistics. Results: The level of functional independence among stroke patients study finding shows that out of 60 samples in level of functional independence by using Barthel index, 22(36.7%) were severely dependent, 20(33.3%) were moderately dependent, 11918.3%) were slightly dependent and 7(11.7%) were totally dependent and level of disability among stroke patients study finding despite that out of 60 samples, 22(36.7%) had moderately severe disability, 14(23.3%) had moderate disability, 11(18.3%) had slight disability, 10(16.7%) had severe disability and 3(5%) had no significant disability. Conclusion:A Barthel index and Modified Ranking Scale was effective scale to assessing the functional independence and disability among stroke patients.

Status dystonicus in adult patients with anti-N-methyl-D-aspartate-acid receptor encephalitis.

Status dystonicus (SD) is a severe movement disorder (MD) and has rarely been recognized in anti-N-methyl-D-aspartate-acid receptor (NMDAR) encephalitis, particularly in adult patients. We aim to explore the clinical characteristics and outcome of SD in anti-NMDAR encephalitis. Patients with anti-NMDAR encephalitis admitted to Xuanwu Hospital from July 2013 to December 2019 were prospectively enrolled. SD was diagnosed based on the patients' clinical manifestations and video EEG monitoring. Outcome was evaluated 6 and 12months after enrollment using the modified Ranking Scale (mRS). A total of 172 patients with anti-NMDAR encephalitis, including 95 males (55.2%) and 77 females (44.8%) with a median age of 26years (interquartile range 19 to 34) were enrolled. Eighty patients (46.5%) presented with movement disorder (MD), 14 of whom suffered from SD, which manifested as chorea (14/14, 100%), orofacial dyskinesia (12/14, 85.7%), generalized dystonia (8/14, 57.1%), tremor (8/14, 57.1%), stereotypies (5/14, 35.7%), and catatonia (1/14, 7.1%) of the trunk and limbs. All SD patients exhibited disturbed consciousness and central hypoventilation, requiring intensive care. SD patients also had high cerebrospinal fluid NMDAR antibody titers, a higher proportion of ovarian teratoma, higher mRS scores upon enrollment, longer duration to recover, and poorer outcomes at 6 (P < 0.05) but not at 12months as compared to non-SD patients. SD is not uncommon in anti-NMDAR encephalitis patients and relates to the severity and worse short-term outcome of the anti-NMDAR encephalitis. Early recognition of SD and timely treatment is important to shorten the time needed for recuperation.

Clinical score for early diagnosis and treatment of stroke-like episodes in MELAS syndrome.

Stroke-like episodes (SLEs) in patients with MELAS syndrome are often initially misdiagnosed as acute ischemic stroke (AIS), resulting in treatment delay. We aimed to determine clinical features that may distinguish SLEs from AISs and explore the benefit of early L-arginine treatment on patient outcomes. We looked retrospectively for MELAS patients admitted between January 2005 and January 2022 and compared them to an AIS cohort with similar lesion topography. MELAS patients who received L-arginine within 40days of their first SLE were defined as the early treatment group and the remaining as late or no treatment group. Twenty-three SLEs in 10 MELAS patients and 21 AISs were included. SLE patients had significantly different features: they were younger, more commonly reported hearing loss, lower body mass index, had more commonly a combination of headache and/or seizures at presentation, serum lactate was higher, and hemiparesis was less common. An SLE Early Clinical Score (SLEECS) was constructed by designating one point to each above features. SLEECS ≥ 4 had 80% sensitivity and 100% specificity for SLE diagnosis. Compared to late or no treatment, early treatment group patients (n = 5) had less recurrent SLEs (total 2 vs. 11), less seizures (14% vs. 25%, p = 0.048), lower degree of disability at first and last follow-up (modified ranking scale, mRS 2 ± 0.7 vs. 4.2 ± 1, p = 0.005; 2 ± 0.7 vs. 5.8 ± 0.5, p < 0.001, respectively), and a lower mortality (0% vs. 80% p = 0.048). The SLEECS model may aid in the early diagnosis and treatment of SLEs and lead to improved clinical outcomes.

Collateral circulation predicts 3-month functional outcomes of subacute ischemic stroke patients: A study combining arterial spin labeling and MR angiography

ObjectiveCollateral circulation could help preserve the blood supply and protect penumbra in ischemic stroke (IS), critical for late-window therapeutic decisions and clinical outcomes. In this study, we aimed to investigate the prognostic value of two collateral indexes measured by arterial spin labeling (ASL) and MR angiography (MRA) in subacute IS patients. Materials and MethodsFifty-five subacute IS patients with large artery atherosclerosis were retrospectively collected. Arterial transit artifact (ATA) on ASL and good circulation (GC) on MRA were ranked as markers of leptomeningeal collaterals and fast collaterals, respectively. Volume and relative cerebral blood flow (rCBF) of infarct and hypoperfusion area were calculated. Stroke severity was determined by baseline- and discharge- National Institute of Hospital Stroke Scale (NIHSS). Functional independence (FI) was defined as 3-month modified Ranking Scale ≤2. Univariate analyses and multivariable logistic regression analyses were conducted to identify the independent predictors of FI. ResultsThirty-eight patients (69.1 %) presented ATA and 29 (52.7 %) patients presented GC. Univariate analyses showed that baseline-NIHSS, discharge-NIHSS, rCBF of infarct, presence of ATA and GC were associated with FI (P < 0.05). After multivariable adjustment, ATA (adjusted Odds Ratio [OR]: 13.785, 95 % CI: 2.608–72.870, P = 0.002) and GC (adjusted OR: 8.317, 95 % CI: 1.629–42.454, P = 0.011) remained independent predictors of FI. Besides, patients with both ATA and GC had the highest frequencies of FI while patients with neither of them showed the lowest (94.7 % vs 14.3 %, P < 0.001), indicating a positive synergistic effect between ATA and GC. ConclusionThe combination of ASL and MRA simultaneously reflects leptomeningeal collaterals and fast collaterals, providing a useful method to predict functional outcomes of subacute IS patients.

Outcomes of intervention treatment for concurrent cardio-cerebral infarction: a case series and meta-analysis

Background: The concurrent occurrence of acute ischemic stroke and acute myocardial infarction is an extremely rare emergency condition that can be lethal. The causes, prognosis and optimal treatment in these cases are still unclear. Methods: We conducted the literature review and 2 additional cases at Al-Shifa Hospital, we analyzed clinical presentations, risk factors, type of myocardial infarction, site of stroke, modified ranking scale and treatment options. We compare the mortality rate among patients with combination intervention treatment (both percutaneous coronary intervention for coronary arteries and mechanical thrombectomy for cerebral vessels) and medical treatment at the hospital and 90 days after stroke. Results: In addition to our cases, we identified 94 cases of concurrent cardio-cerebral infarction from case reports and series with a mean age of 62.5 ± 12.6 years. Female 36 patients (38.3%), male 58 patients (61.7%). Only 21 (22.3%) were treated with combination intervention treatment. The mortality rate at hospital discharge was (33.3%) and the mortality rate at 90 days was (49.2%). In patients with the combination intervention treatment group: the hospital mortality rate was 13.3% and the 90-day mortality rate was: 23.5% compared with the mortality rate in medical treatment (23.5% at the hospital and 59.5% at 90 days (p value 0.038 and 0.012 respectively) Conclusion: Concurrent cardio-cerebral infarction prognosis is very poor, about a third of patients died before discharge and half of the patients died 90 days after stroke. Despite only one-quarter of patients being treated by combination intervention treatment, this treatment modality significantly reduces the mortality rate compared to medical treatment.

Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study

IntroductionAutonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care.Patients and methodIn a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up.ResultsThe cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1–4) and modified Ranking Scale 2 (1–3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10–100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time.ConclusionIn this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.

The Role of Ascending Ventral-Tegmental Fibers for Recovery after Stroke.

The integrity of cortical motor networks and their descending effector pathway (the corticospinal tract [CST]) is a major determinant motor recovery after stroke. However, this view neglects the importance of ascending tracts and their modulatory effects on cortical physiology. Here, we explore the role of such a tract that connects dopaminergic ventral tegmental midbrain nuclei to the motor cortex (the VTMC tract) for post-stroke recovery. Lesion data and diffusivity parameters (fractional anisotropy) of the ipsi- and contralesional VTMC tract and CST were obtained from 133 patients (63.9 ± 13.4 years, 45 women) during the acute and chronic stage after the first ever ischemic stroke in the middle cerebral artery territory. Degeneration of VTMC tract and CST was quantified and related to clinical outcome parameters (National Institute of Health Stroke Scale with motor and cortical symptom subscores; modified Fugl-Meyer upper extremity score; modified Ranking Scale [mRS]). A significant post-stroke degeneration occurred in both tracts, but only VTMC degeneration was associated with lesion size. Using multiple regression models, we dissected the impact of particular tracts on recovery: Changes in VTMC tract integrity were stronger associated with independence in daily activities (mRS), upper limb motor impairment (modified Fugl-Meyer upper extremity score) and cortical symptoms (aphasia, neglect) captured by National Institute of Health Stroke Scale compared to CST. Changes in CST integrity merely were associated with the degree of hemiparesis (National Institute of Health Stroke Scale motor subscale). Post-stroke outcome is influenced by ascending (VTMC) and descending (CST) fiber tracts. Favorable outcome regarding independence (modified Ranking Scale), upper limb motor function (modified Fugl-Meyer upper extremity score), and cortical symptoms (aphasia, neglect) was more strongly related to the ascending than descending tract. ANN NEUROL 2023;93:922-933.