Young Stroke Research Articles

Cerebral vasculitis as clinical manifestation of neuroborreliosis: Pattern of vascular pathology and prognostic factors of outcome.

Neuroborreliosis is a tick-borne condition that affects the central and/or peripheral nervous system. Cerebral infarction associated with neuroborreliosis-related vasculitis has been reported in only a handful of cases. Therefore, specific patterns of vascular pathology and prognostic outcome factors are still incompletely understood. To determine the pattern of vascular pathology and prognostic outcome factors in patients with neuroborreliosis-related vasculitis. We performed a longitudinal multicenter study between 1997 and 2022 in five academic study sites in Germany with a cumulative reference area of 1,620,000 inhabitants. All patients diagnosed with neuroborreliosis-associated cerebral vasculitis were included. The evaluation of clinical parameters, including NIH Stroke Scale (NIHSS), disability ranking (modified Rankin Scale, mRS), and neuroimaging, was performed at admission as well as after 3 and 12 months. Linear regression analysis was used to identify the independent predictors of recurrent strokes, involvement of posterior circulation, or multiple vessels. Patients with neuroborreliosis-related vasculitis (n = 51) were relatively young (mean age: 62 years) and displayed a predominance of vascular events within the posterior circulation (60.8%). A history of smoking was linked to recurrent strokes/TIA (64.7% vs. 23.5%; p = 0.006), strokes in multiple territories (100% vs. 35.9%; p < 0.0001), and posterior circulation events (64.5% vs. 30.0%, p = 0.017), whereas other cardiovascular risk factors showed no significant differences. Linear regression analysis corroborated smoking's association with recurrent strokes/ transient ischemic attacks (B: 0.412; p = 0.002), multiple territory strokes/TIA (B: 0.467; p = 0.033), and posterior circulation events (B: 0.317; p = 0.033). A thorough CSF examination for neuroborreliosis is crucial, especially in younger stroke patients, particularly those experiencing posterior circulation ischemic events. Smoking cessation should be prompted in patients with neuroborreliosis-associated cerebral vasculitis.

Study of Etiology and Clinical Profile of Patients with Young Stroke

Study of Etiology and Clinical Profile of Patients with Young Stroke

The healthcare experience of young stroke survivors: an interpretative phenomenological study

Purpose While stroke is becoming increasingly prevalent in young people (<65 years), diagnosis, treatment, rehabilitation, and management continue to reflect the needs of older people. This study aimed to characterise and appreciate the healthcare experiences of young stroke survivors, whose needs and trajectories differ from those of older people. Materials and methods Qualitative in-depth semi-structured interviews were conducted with 11 stroke survivors aged 18–49 using virtual conferencing software. The data were analysed using interpretative phenomenological analysis. Results Four main themes were identified that reflect the experiences and needs of young stroke survivors and are (1) The health system overlooks the experiences and needs of young stroke survivors; (2) Support is fragmented rather than holistic; (3) Feelings of helplessness at a time agency is required; and (4) Positive attitudes despite challenges. Conclusions The experiences of young stroke survivors are distinct. Health services that consider the unique trajectories of young stroke survivors will better facilitate rehabilitation and support for this population.

A-152 Enhancing PNH Diagnosis with Multicolor Flow Cytometry Immunophenotyping Protocol in a Medical Center in Taiwan

Abstract Background Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare hematopoietic stem cell disorder resulting from mutations in the X-linked PIG-A gene, leading to an inability to produce GPI-anchored proteins on RBCs and WBCs. PNH presents in three variants: classic (hemolytic), associated with specified bone marrow disorders, and subclinical. Flow cytometric analysis stands as the gold standard for PNH detection, crucial in diagnosis, monitoring, and clinical management. Recognizing potential variations in PNH testing among labs, it is essential to establish a precise and consistent protocol for accurate diagnosis and patient management. This report aims to demonstrate the effectiveness of a PNH immunophenotyping protocol adhering to ICCS/ESCCA PNH consensus guidelines. Methods A total of 501 samples were analyzed from Jan 1st, 2021 to Dec 31st, 2023. All the acquisitions were accomplished by a 3-laser and 10-PMT Navios EX (Beckman Coulter) flow cytometry. A typical combination of anti-CD235a-FITC (clone KC16) and anti-CD59-PE (clone MEM43) antibodies were adopted to identify the PNH clone size in the RBC tube. To achieve higher sensitivities in PNH granulocyte and PNH monocyte detection, a single tube, 6-color mixture of FLAER, monoclonal antibodies including CD14-APC, CD24-PE, CD33-APC-H7, CD15-PacB, and CD45-KrO, to immunostaining simultaneously was developed. An unstained control was run after the full-stained tube to determine the position of threshold for positivity, and to exam the potential carryover into the test sample. Results RBC and granulocyte assays can detect PNH phenotypes at the 0.009% level or higher with more than 50,000 cells of gated cells acquired, while the monocyte assay can detect at &amp;gt;=0.069% with at least 20,000 cells acquired. Analysis was conducted on five hundred and one patients to investigate potential PNH clones in their blood cells. Among them, 45 patients were identified as having classic PNH, while PNH clones were not detected in 168 cases, constituting 33.5% of total cases. Minor PNH clone (&amp;lt;1.0%) in single cell lineage were observed in 144 cases, making up 28.7% of all cases. Minor PNH clones found in more than one cell lineages were found in 155 cases (30.9% of 501). Additionally, minor PNH clones were identified across RBCs, granulocytes, and monocytes, with percentages of 32.9%, 23.8%, and 43.9%, respectively of all patients. Notably, monocyte clones exceeded granulocyte clones in 23.0% of cases with WBC PNH clones, irrespective of clone sizes. Furthermore, we investigated seven patients exhibiting persistent minor PNH clones in 2 to 3 cell lineages. Among them, five had aplastic anemia or myelodysplastic syndromes, while one underwent evaluation for young stroke and one was investigated for venous thromboembolism. Conclusions Flow cytometry labs aim not only to identify classic PNH patients but also to consistently detect minor or small clones in individuals with bone marrow disorders or subclinical conditions. Our findings are compatible with international reports, underscoring the importance of routinely examining patients with minor clones. Such assays serve as essential tools for ongoing monitoring, facilitating PNH diagnosis and management by physicians.

Development and validation of the Unmet Needs Questionnaire for young stroke survivors

Objective Owing to the lack of a suitable tool for detecting the unmet needs of young stroke survivors, this study aims to develop a validated questionnaire for evaluating these unmet needs. Design A cross-sectional, observational research design. Setting Chang Gung Memorial Hospital Linkou and Taoyuan branches in Taiwan. Participants A total of 211 participants (average age 53 years; within 6 months post-stroke) completed the questionnaire. Main measures A qualitative approach was used to create an item pool. Experts verified item suitability, and content validity was evaluated using the item content validity index. Item analysis was applied to determine item quality, and factor analysis was used to explore construct validity. In addition, parallel analysis was employed to ascertain the optimal number of factors. Results The scale development procedure resulted in a 27-item questionnaire that assesses the unmet needs of young stroke survivors after a stroke. The item content validity index was 1.0. The Unmet Needs Questionnaire has five factors: restoring prestroke abilities and life, rehabilitation-related resources, social support and self-adjustment, economic and post-stroke life adjustment, and stroke-related information. These five factors accounted for 54% of the variance. Cronbach's alpha for the total scale was 0.91, while the alpha for the subscales ranged from 0.74 to 0.88. Conclusions The Unmet Needs Questionnaire showed acceptable reliability and validity. It can help clinical professionals and government agencies identify stroke survivors’ unmet needs and develop tailored care plans. Future research should explore the trajectory of post-stroke unmet needs using this tool.

Validation of an algorithm that separates gaseous micro-embolic signals and artifacts during transcranial Doppler persistent foramen ovale examinations

ObjectivePersistent foramen ovale (PFO) is a risk factor for young stroke. Agitated saline serum is used to deliver small gaseous emboli to the brain in transcranial Doppler ultrasound (TCD) for the detection and grading of PFO. In this study we validated a PFO algorithm that can differentiate between gaseous emboli and artifacts. MethodsThe validation cohort comprised 18 patients with positive PFO examinations. The PFO algorithm uses a binary tree that separates high-intensity transients signals (HITs) into gaseous emboli or artifacts based on intensity, zero-crossing, and velocity parameters. ResultsThe cohort exhibited 385 macroscopic gaseous emboli meeting the >3 dB criterion. An additional 137 gaseous emboli were noticed below the 3-dB intensity cutoff value. The low-intensity gaseous emboli included both macroscopic and microscopic air bubbles observed in curtains. Nearly all emboli (98 %) above the 3-dB level showed overt frequency modulation. The overall accuracy of the PFO algorithm in discriminating macroscopic gaseous emboli and artifacts was 96.4 %, with a similar percentage of sensitivity and specificity (96.4 %). The inter-observer agreement of human experts was excellent (ic-CC 0.989 and 0.953). ConclusionsMacroscopic gaseous emboli and artifacts during PFO exams can be accurately discriminated by the PFO algorithm. The PFO algorithm cannot be used as a standalone system as microscopic air bubbles might escape proper identification. This knowledge will be important in the design of future PFO algorithms which should make it possible to classify the PFO grade without the interference of humans.

“I just kept asking and asking and there was nothing”: re-thinking community resources & supports for young adult stroke survivors

Purpose Stroke is often regarded as a disease of the elderly. However, 10–15% of strokes occur in people aged 18 to 50, and rates continue to rise. Young stroke survivors face unique challenges due to their occupational, family and personal commitments, which current stroke rehabilitation services may not fully address. Our qualitative study aimed to identify gaps in patient care and resources for young stroke survivors. We used these findings to develop recommendations to inform clinical care, healthcare system design, and health policy. Methods Using Interpretive Description, we conducted semi-structured interviews with 19 stroke survivors aged 18–55 living in British Columbia, Canada, to explore their experiences during stroke recovery and assess current gaps in support and resources. We applied broad-based coding and thematic analysis to the transcripts. Results Key themes included: (1) the need for longitudinal medical follow-up and information provision, (2) the need for psychological/psychiatric care, (3) the need to adapt community supports and resources to young survivors, and (4) the need to centralize and integrate community stroke services and resources. Conclusion Young stroke survivors experience unique challenges and lack appropriate services and resources. Many of our findings may be representative of remediable gaps that persist nationally and internationally.

Development of predictive model for post-stroke depression at discharge based on decision tree algorithm: A multi-center hospital-based cohort study

ObjectivePost-stroke depression (PSD) is one of the most common and severe neuropsychological sequelae after stroke. Using a prediction model composed of multiple predictors may be more beneficial than verifying the predictive performance of any single predictor. The primary objective of this study was to construct practical prediction tools for PSD at discharge utilizing a decision tree (DT) algorithm. MethodsA multi-center prospective cohort study was conducted from May 2018 to October 2019 and stroke patients within seven days of onset were consecutively recruited. The independent predictors of PSD at discharge were identified through multivariate logistic regression with backward elimination. Classification and regression tree (CART) algorithm was employed as the DT model's splitting method. ResultsA total of 876 stroke patients who were discharged from the neurology departments of three large general Class A tertiary hospitals in Wuhan were eligible for analysis. Firstly, we divided these 876 patients into PSD and non-PSD groups, history of coronary heart disease (OR = 1.835; 95 % CI, 1.106–3.046; P = 0.019), length of hospital stay (OR = 1.040; 95 % CI, 1.013–1.069; P = 0.001), NIHSS score (OR = 1.124; 95 % CI, 1.052–1.201; P = 0.001), and Mini mental state examination (MMSE) score (OR = 0.935; 95 % CI, 0.893–0.978; P = 0.004) were significant predictors. The subgroup analysis results have shown that hemorrhagic stroke, history of hypertension and higher modified Rankin Scale score (mRS) score were associated with PSD at discharge in the young adult stroke patients. ConclusionsSeveral predictors of PSD at discharge were identified and convenient DT models were constructed to facilitate clinical decision-making.

Technology for Young Adults with Stroke: An Australian Environmental Scan.

Technology has the potential to address the unique needs of young stroke survivors. Despite this, little is known about the technological resources available to support young adults with stroke. This study aimed to identify and compile available technological resources that cater to the specific needs of young adults (18-30 years) with stroke in Australia. An environmental scan was conducted from December 2023 to March 2024. Sources included websites, app stores, rehabilitation centres, hospitals, organisations, technology developers, and healthcare professionals. Of the 114 resources identified, 11% were for re-training limb movement, 40% for speech rehabilitation, 20% for medication reminders, and 29% were social media posts offering peer mentoring and support. Most limb movement (75%) and medication reminder (87%) apps were free. However, most speech therapy apps (78%) had associated costs. Social media posts were hosted on Facebook (64%), Instagram (21%), TikTok (9%), YouTube (3%), and other websites (3%). Forty-six percent of the social media posts targeting young stroke survivors did not specify the age group. These resources were identified as available to young people with stroke. Although the resources found focused on young stroke survivors, it was difficult to ascertain the specific age group that was being targeted.

Differential effects of theta-gamma tACS on motor skill acquisition in young individuals and stroke survivors: A double-blind, randomized, sham-controlled study

BackgroundTheta-gamma transcranial alternating current stimulation (tACS) was recently found to enhance thumb acceleration in young, healthy participants, suggesting a potential role in facilitating motor skill acquisition. Given the relevance of motor skill acquisition in stroke rehabilitation, theta-gamma tACS may hold potential for treating stroke survivors. ObjectiveWe aimed to examine the effects of theta-gamma tACS on motor skill acquisition in young, healthy participants and stroke survivors. MethodsIn a pre-registered, double-blind, randomized, sham-controlled study, 78 young, healthy participants received either theta-gamma peak-coupled (TGP) tACS, theta-gamma trough-coupled (TGT) tACS or sham stimulation. 20 individuals with a chronic stroke received either TGP or sham. TACS was applied over motor cortical areas while participants performed an acceleration-dependent thumb movement task. Stroke survivors were characterized using standardized testing, with a subgroup receiving additional structural brain imaging. ResultsNeither TGP nor TGT tACS significantly modified general motor skill acquisition in the young, healthy cohort. In contrast, in the stroke cohort, TGP diminished motor skill acquisition compared to sham. Exploratory analyses revealed that, independent of general motor skill acquisition, healthy participants receiving TGP or TGT exhibited greater peak thumb acceleration than those receiving sham. ConclusionAlthough theta-gamma tACS increased thumb acceleration in young, healthy participants, consistent with previous reports, it did not enhance overall motor skill acquisition in a more complex motor task. Furthermore, it even had detrimental effects on motor skill acquisition in stroke survivors.

Association of elevated lipoprotein(a) levels with ischemic stroke in young patients - a systematic review and meta-analysis

IntroductionLipoprotein(a) [Lp(a)] is an established independent causal risk factor for cardiovascular disease and atherosclerosis. However, its association with young-onset ischemic stroke is not well-established. A systematic review and meta-analysis was performed to investigate the association of elevated Lp(a) with young ischemic stroke. MethodsFour electronic databases: PubMed (MEDLINE), EMBASE, Scopus and Cochrane Library were systematically searched, profiling studies from inception till 6 Mar 2024. We included studies investigating the relationship between stratified Lp(a) levels and young ischemic stroke. We compared the odds of young stroke patients (age <65 years) having elevated Lp(a) compared to age-matched controls without stroke or transient ischemic attack. ResultsFive case-control studies comprising a total of 1345 patients were included; 57.7 % (776/1345) were females, with a mean age of 41.5 years. Among them, 22.5 % (264/1171) were smokers. Additionally, 16.8 % (197/1171) had hypertension, 5.9 % (69/1171) had diabetes, and 29.2 % (284/971) had hyperlipidemia. Young stroke patients were more likely to have high Lp(a) level than age-matched controls (OR 1.61, 95 %CI 1.24–2.10). Four studies defined a high Lp(a) level as ≥30mg/dL, whilst one study used a Lp(a) level of >23.2mg/dL as the cut-off. A sensitivity analysis excluding this study showed that young stroke patients were still more likely to have Lp(a) ≥30mg/dL than controls (OR 1.43, 95 %CI 1.08–1.88). ConclusionYoung stroke patients are more likely to have elevated Lp(a) compared to age-matched controls, suggesting an association between elevated Lp(a) and young stroke. Further research is warranted to evaluate the causal relationships between Lp(a) and young-onset ischemic stroke, as well as to conduct a cost-benefit analysis of Lp(a) screening in young adults as part of a primary prevention strategy.

Aging Intensifies Myeloperoxidase Activity after Ischemic Stroke.

Abnormally elevated oxidative stress underlies many diseases and contributes to aging. The myeloid enzyme myeloperoxidase (MPO) generates oxidative stress and contributes to damage after stroke. How aging changes MPO in stroke has not been studied. We aimed to determine the effects aging has on MPO and how these changes contribute to age-related differences in outcomes after ischemic stroke. To investigate tissue MPO activity we developed MPO Activatable Fluorescent Agent (MAFA). We found that aged mice exhibited worse neurological outcomes and higher mortality within the first few days after stroke. Accordingly, neuronal loss was higher in aged mice on day 3. MAFA imaging revealed that aged brains have markedly higher MPO activity that increased after stroke on day 3 compared to young adult brains. Correspondingly, we found more Iba1+ cells in aged brains compared to young adult brains before and after stroke. Interestingly, we found decreased percentage of MPO+ cells and lower MPO protein levels in aged on day 3, suggesting that most Iba1+ cells in aged mice have degranulated and secreted MPO in response to stroke. By day 10 MPO activity and Iba1+ cells decreased in both age groups, although MPO activity remained higher in aged mice. MPO inhibition in aged mice decreased MAFA signal and Iba1+ cells and improved neurobehavioral outcomes to near young adult stroke mice levels and improved mortality rate. While aging is an unmodifiable risk, by uncovering the connection between aging and MPO-related changes after stroke, new therapies can be developed to mitigate these adverse changes brought upon by aging.

Improving diagnostic accuracy of the Montreal Cognitive Assessment to identify post-stroke cognitive impairment

Given advantages in reperfusion therapy leading to mild stroke, less apparent cognitive deficits can be overseen in a routine neurological examination. Despite the widespread use of the Montreal Cognitive Assessment (MoCA), age- and education-specific cutoffs for the detection of post-stroke cognitive impairment (PSCI) are not established, hampering its valid application in stroke. We aimed to establish age- and education-specific MoCA cutoffs to better discriminate patients with and without acute PSCI. Patients with acute ischemic stroke underwent the MoCA and a detailed neuropsychological assessment. PSCI was defined as a performance < − 1.5 SD in ≥ 2 cognitive domains. As secondary data analysis, the discriminant abilities of the MoCAraw-score (not adding + 1 as correction for ≤ 12 years of education, YoE) cutoffs were automatically derived based on Youden Index and evaluated by receiver operating characteristic analyses across age- (< 55, 55–70, > 70 years old) and education-specific (≤ 12 and > 12 YoE) groups. 351 stroke patients (67.4 ± 14.1 years old; 13.1 ± 2.8 YoE) underwent the neuropsychological assessment 2.7 ± 2.0 days post-stroke. The original MoCA cutoff < 26 falsely classified 26.2% of examined patients, with poor sensitivity in younger adults (34.8% in patients < 55 years > 12 YoE) and poor specificity in older adults (55.0%, in > 70 years ≤ 12 YoE). By maximizing both sensitivity and specificity, the optimal MoCAraw cutoffs were: (i) < 28 in patients aged < 55 with > 12 YoE (sensitivity = 69.6%, specificity = 77.8%); (ii) < 22 and < 25 in patients > 70 years with ≤ 12 and > 12 YoE (sensitivity = 61.6%, specificity = 90.0%; sensitivity = 63.3%, specificity = 84.0%, respectively). In other groups the optimal MoCAraw cutoff was < 26. Age and education level should be considered when interpreting MoCA-scores. Though new age- and education-specific cutoffs demonstrated higher discriminant ability for PSCI, their performance in young stroke and adults with higher education level was low due to ceiling effects and MoCA subtests structure, and cautious interpretation in these patients is warranted.Trial registration: ClinicalTrials.gov Identifier: NCT05653141.

Exploring Caregiving Burden and Family Resilience Among Caregivers of Young and Middle-Aged Stroke Survivors in China

Background: Stroke, characterized by high morbidity, disability, and mortality, has increasingly affected younger populations. In China, the proportion of strokes among individuals aged 40-64 has risen significantly. This study explored the caregiving burden and family resilience among caregivers of young and middle-aged first-stroke survivors, comparing caregivers of those with good versus poor functional outcomes. Methods: A cross-sectional survey was conducted from January to June 2024, involving 119 family caregivers of stroke survivors from two tertiary hospitals in Yancheng City, Jiangsu Province, China. Data were collected using the Modified Rankin Scale (mRS), Zarit Burden Interview (ZBI), and the Family Resilience Assessment Scale (FRAS-C). Independent t-tests and Pearson's correlation analysis were performed to examine differences in care burden and family resilience between caregiver groups. Results: Caregivers had an average ZBI score of 28.32±20.66, with 39.5% reporting no or minimal burden, 29.4% light burden, and 25.2% moderate burden. Caregivers of patients with mRS 0-2 had significantly lower care burdens (23.84 vs. 37.17, p&lt;0.01) and higher family resilience (98.22 vs. 93.00, p&lt;0.05) compared to those with mRS 3-5. Care burden was negatively correlated with family resilience (r=-0.243, p=0.008). Conclusion: Caregivers of young and middle-aged stroke survivors generally experienced mild to moderate care burden, while family resilience was moderate. Caregivers of survivors with better functional outcomes had lower care burdens and higher family resilience. These findings highlight the need for targeted interventions to support caregivers of survivors with poorer functional outcomes to enhance family resilience and reduce care burden.

Self-Management among Stroke Survivors in the United States, 2016 to 2021.

Background: Self-management among stroke survivors is effective in mitigating the risk of a recurrent stroke. This study aims to determine the prevalence of self-management and its associated factors among stroke survivors in the United States. Methods: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) data from 2016 to 2021, a nationally representative health survey. A new outcome variable, stroke self-management (SSM = low or SSM = high), was defined based on five AHA guideline-recommended self-management practices, including regular physical activity, maintaining body mass index, regular doctor checkups, smoking cessation, and limiting alcohol consumption. A low level of self-management was defined as adherence to three or fewer practices. Results: Among 95,645 American stroke survivors, 46.7% have low self-management. Stroke survivors aged less than 65 are less likely to self-manage (low SSM: 56.8% vs. 42.3%; p < 0.0001). Blacks are less likely to self-manage than non-Hispanic Whites (low SSM: 52.0% vs. 48.6%; p < 0.0001); however, when adjusted for demographic and clinical factors, the difference was dissipated. Higher education and income levels are associated with better self-management (OR: 2.49, [95%CI: 2.16-2.88] and OR: 1.45, [95%CI: 1.26-1.67], respectively). Further sub-analysis revealed that women are less likely to be physically active (OR: 0.88, [95%CI: 0.81-0.95]) but more likely to manage their alcohol consumption (OR: 1.57, [95%CI: 1.29-1.92]). Stroke survivors residing in the Stroke Belt did not self-manage as well as their counterparts (low-SSM: 53.1% vs. 48.0%; p < 0.001). Conclusions: The substantial diversity in self-management practices emphasizes the need for tailored interventions. Particularly, multi-modal interventions should be targeted toward specific populations, including younger stroke survivors with lower education and income.

Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India.

This study aimed to determine the risk factors and stroke subtypes for young ischemic stroke patients and their outcomes at the time of discharge. This is a retrospective cross-sectional study of ischemic stroke patients (n = 264) between the age groups of 18 and 45. The study population was divided into two broad age groups: 18 to 35 years and 36 to 45 years; and compared based on demographics, risk factors, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and outcomes. The outcomes were compared based on the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) systems at the time of admission and discharge. The mean age of patients was 37.84±6.19 years. The male-to-female ratio was 2.5:1. The most common vascular risk factors identified were diabetes (29.16%), hypertension (49.62%), dyslipidaemia (DLP, 44.4%), and smoking (10.9%). The most common TOAST subtype was large vessel disease (38.63%), followed by the undetermined category (35.6%). The elderly group showed a high proportion of strokes secondary to small vessel disease (14.13%; p = 0.03), while cardioembolic strokes were common in the female subgroup (p = 0.05). The majority of strokes were in the anterior circulation (66.6%) as compared to the posterior (25.75%), and nearly 50% of the patients had intracranial disease. Overall, there was a favourable MRS outcome at discharge. Conventional vascular risk factors are equally prevalent, even among young stroke patients. The benchmark for young stroke age is showing a downward shift as more stroke patients above the age of 35 are showing similar risk factor trends as those of their older counterparts. The majority of stroke burden still falls under the undermined category, which requires aggressive risk factor identification and management.

Cognitive impairment in young adults following cerebellar stroke: Prevalence and longitudinal course

IntroductionCognitive impairment is a well-known result of a stroke, but for cerebellar stroke in young patients detailed knowledge on the nature and extent of cognitive deficits is limited. This study examined the prevalence and course of cognitive impairment in a large cohort of patients with cerebellar stroke. MethodsSixty young (18–49 years) cerebellar stroke patients completed extensive neuropsychological assessments in the subacute (<9 months post-stroke) and/or chronic phase (≥9 months post-stroke). Performance and course were assessed using standardized scores and Reliable Change Index analyses. Associations between cognitive deficits and lesion locations were explored using subtraction analyses, and associations with subjective cognitive complaints and fatigue were examined. ResultsSixty patients (52% male) were included with a mean age at event of 43.1 years. Cognitive impairment was observed in 60.3% of patients in the subacute phase and 51.2% during the chronic phase. Deficits were most frequent for visuo-spatial skills and executive functioning (42.5–54.6%). Both improvement and decline were observed over time, in 17.9% and 41.0% of participants, respectively. Cognitive deficits seem to be associated with lesions in certain cerebellar regions, however, no distinct correlation was found for a specific subregion. Subjective cognitive complaints were present in the majority of participants (61–80.5%) and positively correlated with fatigue in both phases (ρ = −.661 and ρ = −.757, p < .001, respectively). DiscussionCognitive impairment in cerebellar stroke patients is common, with deficits most pronounced for visuo-spatial skills and executive functioning, as in line with the Cerebellar Cognitive Affective Syndrome. The course of cognitive performance was heterogenous, with cognitive decline despite the fact that no recurrent strokes occurred. No clear association between lesion location and cognitive deficits was observed. Subjective cognitive complaints and fatigue were prevalent and positively correlated. Clinicians could use this information to actively screen for and better inform patients about possible cognitive sequalae.

Case Report: COVID-19 and Ischemic Stroke in A 16-Year-Old Patient

Introduction: Recent reports show an increasing trend of ischemic stroke at a young age. Diseases associated with ischemic stroke at a young age, namely hereditary hypercoagulable conditions. Case: In this case a 16-year-old boy with clinical complaints of sudden weakness of the right hand and leg, numbness, loss of appetite, nausea and vomiting. Laboratory tests showed results of increased levels of hemoglobin, hematocrit, erythrocyte count, platelet count, leukocyte count and NLR. The neutrophil-to-lymphocyte ratio (NLR), calculated as a simple ratio between the neutrophil and lymphocyte counts measured in peripheral blood. CT scan examination showed acute infarction in the medial left temporal lobe and old infarction in the left frontal lobe (medial gyrus). Thoracic CT Scan examination showed the results of bilateral pneumonia suggestive of viral. The patient encountered COVID-19. The patient experienced cough and shortness of breath and showed abnormal ABG results, namely respiratory alkalosis, decreased oxygen saturation, fever, increased procalcitonin and increased cardiac markers. Discussion: This case report prompts discussions on various aspects of ischemic stroke in young patients, including the role of COVID-19, hypercoagulable states, hematological abnormalities, and diagnostic challenges, with implications for patient management and future research directions. Conclusion: SARS CoV-2 can affect the nervous system through several mechanisms that cause persistent infection, resulting in neurological diseases, including stroke. Young ischemic stroke is usually hypercoagulable and the most common cause is APS. In this patient, polycythemia was occured,that causes blood flow slows and oxygen supply to the brain is reduced. This can cause ischemic stroke.

Ischaemic stroke as the initial presentation of a pheochromocytoma associated with neurofibromatosis type 1

Pheochromocytoma is a rare but well-recognised manifestation of neurofibromatosis type 1 (NF1). Ischaemic stroke has been rarely reported in patients with pheochromocytoma. It can be due to either hypertension or vasospasm. A 33-year-old woman presented with ischaemic stroke and was evaluated for young stroke. Examination revealed clinical diagnosis of NF 1. She had persistent regular tachycardia and mild hypertension. But she denied features suggestive of pheochromocytoma spells. 24-hour urinary metanephrine level was elevated and there was large left adrenal mass lesion. She underwent left sided adrenalectomy. Histology further confirmed the diagnosis of pheochromocytoma. There should be a lower threshold to suspect pheochromocytoma in patients with NF 1.

Comparative Study of Vestibular Rehabilitation and Dual Task Training on Balance and Quality of Life in Young Stroke Patients

Question: Is there any impact of vestibular rehabilitation and dual task training alongside conventional therapy on balance and quality of life in young stroke patients.  Design: Quasi-experimental study with treatment duration of 8 weeks. Simple random sampling was used to divide patients into 3 groups.  Participants: 30 subjects in the age group 18-45 years both males and females with diagnoses of unilateral hemiplegia within the previous six months.  Intervention: Group A received vestibular rehabilitation along with conventional therapy; Group B received dual task training alongside conventional therapy and Group C received only conventional therapy. Outcome measures: Assessment using Berg Balance Scale and Stroke Specific Quality of Life was conducted pre- and post-treatment.  Results: The results revealed a significant improvement (p&lt;0.05) in balance and quality of life scores in Group A as compared to Groups B and Group C.  Conclusion: Hence, it was concluded that vestibular rehabilitation along with conventional therapy is more effective in enhancing balance among young stroke patients compared to dual task training along with conventional therapy or conventional therapy alone.  Registration: BFUHS/2K23p-TH/11527.