Search Results for: Stroke

Stroke, Ahead of Print. BACKGROUND:Stroke is increasingly understood as a network disorder with symptoms often arising from disruption of white matter connectivity. Previous connectome-based lesion-symptom mapping studies revealed that poststroke motor deficits are not only associated with damage to the core sensorimotor network but also with nonsensorimotor connections. However, whether task-specific initial impairment and outcome are based on distinct disconnection patterns remains unknown.METHODS:To address this question, we included lesion information and assessments of distinct aspects of upper limb motor impairment of 113 patients with early subacute stroke (mean age, 65.95 years). We used connectome-based lesion-symptom mapping, based on a normative structural connectome, and a machine learning algorithm to predict individual levels of task-specific motor impairment and outcome >3 months later.RESULTS:We identified task-specific disconnection patterns that significantly predicted initial motor impairment and outcome and a task-general reach-to-grasp network including both sensorimotor and nonsensorimotor areas. More complex reach-to-grasp movements showed a substantial overlap in disconnections for the prediction of impairment and outcome. Conversely, disconnections indicative of more basal aspects of motor control substantially differed between the prediction of initial impairment and outcome at the chronic stage poststroke. Similarly, the significance of interhemispheric disconnections changed in a task- and time-dependent fashion.CONCLUSIONS:In summary, our study identified distinct disconnection patterns indicative of specific aspects of motor impairment and outcome after stroke, highlighting a time- and task-dependent role of the contralesional hemisphere and suggesting a domain-general compensatory role of nonsensorimotor temporal areas. From a mechanistic perspective, differences in disconnection patterns predictive of initial motor impairment versus outcome suggest a stronger dependence of basal motor control on the brain’s structural reserve during motor recovery. Our results extend our current network-level understanding of task-specific motor impairment and recovery, and emphasize the potential of connectome-based lesion-symptom mapping for future clinical applications.

The effect of colchicine on subsequent stroke within 90 days may differ according to the presence of sICAS. Aging might be associated with an increased risk of early recurrent stroke in the patients with sICAS receiving colchicine treatment. Future prospective studies are needed to confirm these results.

Circulation, Ahead of Print. Background:Vascular smooth muscle cells (vSMCs), the predominant cell type in the aortic wall, play a crucial role in maintaining aortic integrity, blood pressure, and cardiovascular function. vSMC contractility and function depend on smooth muscle alpha-actin 2 (ACTA2). The pathogenic variantACTA2 c.536G >A(p. R179H) causes multisystemic smooth muscle dysfunction syndrome (MSMDS), a severe disorder marked by widespread smooth muscle abnormalities, resulting in life-threatening aortic disease and high-risk early mortality from aneurysms or stroke. No effective treatments exist for MSMDS.Methods:To develop a comprehensive therapy for MSMDS, we utilized CRISPR-Cas9 adenine base editing to correct theACTA2R179H mutation. We generated isogenic human induced pluripotent stem cell (iPSC) lines and humanized mice carrying this pathogenic missense mutation. iPSC-SMCs were evaluated for key functional characteristics, including proliferation, migration, and contractility. The adenine base editor (ABE) ABE8e-SpCas9-VRQR under control of either a SMC-specific promoter or a CMV promoter, and an optimized single guide RNA (sgRNA) under control of U6 promoter were delivered intravenously to humanized R179H mice using adeno-associated virus serotype 9 (AAV9) and phenotypic outcomes were evaluated.Results:The R179H mutation causes a dramatic phenotypic switch in human iPSC-SMCs from a contractile to a synthetic state, a transition associated with aneurysm formation. Base editing prevented this pathogenic phenotypic switch and restored normal SMC function. In humanized mice, the ACTA2R179H/+mutation caused widespread smooth muscle dysfunction, manifesting as decreased blood pressure, aortic dilation and dissection, bladder enlargement, gut dilation, and hydronephrosis. In vivo base editing rescued these pathological abnormalities, normalizing smooth muscle function.Conclusions:This study demonstrates the effectiveness of adenine base editing to treat MSMDS and restore aortic smooth muscle function. By correcting theACTA2R179H mutation, the pathogenic phenotypic shift in SMCs was prevented, key aortic smooth muscle functions were restored, and life-threatening aortic dilation and dissection were mitigated in humanized mice. These findings underscore the promise of gene-editing therapies in addressing the underlying genetic causes of smooth muscle disorders and offer a potential transformative treatment for patients facing severe vascular complications.

Objectives
The influence of short-term variations in blood pressure (BP) in acute stroke on clinical outcomes remains uncertain. Our study explores the relationship between BP variability (BPV) from stroke admission up to 72 hours and in-hospital and 1-year mortality.

Design
Retrospective observational cohort study.

Setting
Hamad General Hospital (HGH) a tertiary care stroke centre in Qatar.

Participants
2820 participants were initially included. After the exclusion of ineligible subjects, 2554 patients (82.5% male, median age 53±9 years) were included. 893 (34.96%) were from the Middle East and North Africa, 1302 (50.98%) were from South Asia, 258 (10.10%) from Southeast Asia, 9 (0.35%) were from East Asia and 92 (3.60%) were from other regions. Eligible participants were adult patients above 18 years of age who presented with acute ischaemic or haemorrhagic stroke. Excluded individuals were those younger than 18 years, had incomplete data, had transient ischaemic attack (TIA), had severe hypoglycaemia on admission (

Stroke, Ahead of Print. BACKGROUND:Poststroke cognitive impairment is associated with disability and decreased quality of life. We assessed whether individual or collective magnetic resonance imaging (MRI) biomarkers can aid in predicting cognitive impairment after lacunar infarction (LACI).METHODS:We conducted a retrospective analysis of data from the American Stroke Association Bugher Small Vessel Study, which included 134 patients within 2 years of an acute LACI, enrolled between 2007 and 2012 at 4 North Carolina hospitals. MRI brain measures at the time of the stroke included as follows: 1, total number of LACIs (index LACI and nonindex radiographic lacunes); 2, size of the largest lacune; 3, ventricular size; 4, cerebral atrophy; 5, radiographic locations (supratentorial, infratentorial, or both); and 6, white matter disease (WMD) extent. WMD extent, cerebral atrophy, and ventricular size were graded using the CHS (Cardiovascular Health Study) scores. The primary outcomes were as follows: 1, total score on Short-Form Montreal Cognitive Assessment to assess global cognition; and 2, time to complete TRAIL Making Test Part B (TMT-B) to evaluate executive function. Regression analyses were used to assess the association between the 6 MRI measures and cognitive function adjusting for demographic and clinical variables.RESULTS:One hundred thirty-four participants completed Short-Form Montreal Cognitive Assessment testing and 100 completed TMT-B at a mean of 76.5 (SD, 172.7) days from the index LACI. There were no associations between MRI characteristics and Short-Form Montreal Cognitive Assessment. On univariable analyses, cerebral atrophy (β=35 [95% CI, 14.17–55.83];P=0.0010), ventricular size (β=40.1 [95% CI, 22.24–57.96];P

Objective
This study aims to observe the correlation between infarction pattern and intracranial arterial stenosis (ICAS) on magnetic resonance and functional outcome in acute ischaemic stroke (AIS) patients after reperfusion therapy.

Design
This is a post hoc analysis of the Third China National Stroke Registry (CNSR-III) study.

Setting
The data was derived from the CNSR-III study, which was a nationwide clinical registry of ischaemic stroke or transient ischaemic attack based in China.

Participants
Patients with anterior circulation AIS who underwent reperfusion therapy were included for analysis. The patients were divided into single acute infarction and multiple acute infarctions (MAIs) based on the diffusion-weighted imaging findings. Additionally, patients were categorised according to the degree of ICAS assessed by magnetic resonance angiography as either ≥50% or

Objective
This study aims to observe the correlation between infarction pattern and intracranial arterial stenosis (ICAS) on magnetic resonance and functional outcome in acute ischaemic stroke (AIS) patients after reperfusion therapy.

Design
This is a post hoc analysis of the Third China National Stroke Registry (CNSR-III) study.

Setting
The data was derived from the CNSR-III study, which was a nationwide clinical registry of ischaemic stroke or transient ischaemic attack based in China.

Participants
Patients with anterior circulation AIS who underwent reperfusion therapy were included for analysis. The patients were divided into single acute infarction and multiple acute infarctions (MAIs) based on the diffusion-weighted imaging findings. Additionally, patients were categorised according to the degree of ICAS assessed by magnetic resonance angiography as either ≥50% or

Stroke, Ahead of Print. BACKGROUND:Accumulating evidence links air pollution exposure to late-life cognitive deterioration. Whether air pollution alters brain structure remains poorly understood. Thus, we aimed to quantify the association between long-term exposure to particulate matter ≤2.5 µm and ≤10 µm (PM2.5and PM10, respectively) and late-life brain structural changes.METHODS:In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 555 participants free from dementia underwent brain magnetic resonance imaging (MRI) scans at baseline and after 6 years (cohorts 8.7 μg/m3had on average an annual shrinkage of total brain tissue volume of 0.22 (95% CI, −0.43 to −0.01) and an annual increase of 0.25 (95% CI, 0.07–0.43) of the white matter hyperintensities as compared with participants exposed to PM2.5

Stroke, Ahead of Print. BACKGROUND:The most common cause of arterial ischemic stroke in healthy children, focal cerebral arteriopathy (FCA), can progress rapidly over days with worsening brain injury. A 2017 retrospective Swiss study of corticosteroid treatment for FCA changed practice. To assess its impact, we compared the FCA cohorts from the 2 VIPS (Vascular Effects of Infection in Pediatric Stroke) prospective cohort studies.METHODS:The VIPS II study prospectively enrolled 205 children (29 days to 18 years) with arterial ischemic stroke at 22 centers, December 2016 to January 2022. The local team measured 12-month outcomes using the pediatric stroke outcome measure. A neuroradiologist and pediatric vascular neurologist independently reviewed all clinically obtained imaging and clinical data to classify the cause of arterial ischemic stroke. The neuroradiologist measured the FCA Severity Score on vascular imaging performed at any time poststroke. We compared the VIPS II FCA cohort to the previously published FCA cohort from VIPS I (2010–2014; 37 centers).RESULTS:Of 75 children with definite arteriopathy enrolled in VIPS II, 32 (43%) had FCA, compared with 41 of 127 (32%) of definite arteriopathy cases in VIPS I. The median age was 11.3 years (56% male) in VIPS I and 11.4 years (55%) in VIPS II. Treatment with intravenous corticosteroids increased from 2 of 41 (5%) of FCA patients in VIPS I to 18 of 32 (56%) in VIPS II. The VIPS II FCA cases were more severe at baseline (median FCA Severity Score 6 versus 4;P=0.006). There were no significant differences in either the change in FCA Severity Score (baseline to maximum) or the 12-month neurological outcomes.CONCLUSIONS:Treatment of FCA with corticosteroids increased dramatically between the VIPS I and VIPS II studies. VIPS II cases were more severe at baseline, but we observed no significant difference in disease progression or neurological outcomes. Given the low level of evidence supporting corticosteroid therapy, pediatric stroke centers should enroll FCA patients into ongoing FCA corticosteroid treatment trials.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifiers: NCT04873583 and NCT06040255.

Stroke, Ahead of Print. BACKGROUND:Carotid web is a rare and likely underrecognized cause of ischemic stroke, particularly in young patients. Given the high risk of recurrence, diagnostic delays may have serious consequences. This study aimed to assess the incidence and impact of delayed carotid web diagnosis after a first ischemic event.METHODS:We conducted a retrospective analysis using data from the French ongoing multicenter prospective CAROWEB (Carotid Web registry). We included patients with a first-ever ischemic stroke or transient ischemic attack in the anterior circulation, attributed to an ipsilateral carotid web with no other identifiable cause, between September 2013 and April 2023. Patients with missing data on the date of the first ischemic event or carotid web diagnosis, or with prior stroke history, were excluded. Participants were categorized into early diagnosis (≤30 days) and delayed diagnosis ( >30 days) groups. Factors associated with diagnostic delay were investigated through univariable and multivariable analyses. Stroke recurrence was evaluated using Kaplan-Meier survival analysis.RESULTS:Of 280 patients in the registry, 225 met the inclusion criteria. A delayed diagnosis occurred in 57 patients (25.3%). Independent predictors of diagnostic delay included lower initial National Institutes of Health Stroke Scale score (odds ratio, 0.92;P=0.002), stroke occurring before 2019 (odds ratio, 0.19;P

Stroke, Ahead of Print. BACKGROUND:The outcomes of endovascular therapy (EVT) across sexes for large infarcts remain unclear. This study aimed to evaluate the impact of sex on the outcomes of EVT or medical management for patients with large infarcts.METHODS:In this secondary analysis of the ANGEL-ASPECT (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core) randomized controlled trial conducted at 46 stroke centers across China between October 2, 2020, and May 18, 2022, we compared baseline characteristics and clinical outcomes between males and females, and each cohort further divided into EVT and medical management groups. The primary outcome was the 90-day modified Rankin Scale score distribution. Safety outcomes included symptomatic intracranial hemorrhage within 48 hours and mortality within 90 days.RESULTS:There were 176 of 455 patients enrolled in the ANGEL-ASPECT trial who were female. There were 54.0% (95/176) of females and 48.4% (135/279) of males who underwent EVT. The treatment effect of EVT did not vary in both sexes with large infarcts (allP >0.05 for interaction). Compared with medical management, EVT improved 90-day functional outcomes for both males (3 [2–5] versus 4 [3–5]; common odds ratio, 1.94 [95% CI, 1.27–2.97];P=0.002) and females (4 [3–6] versus 5 [4–6]; common odds ratio, 2.50 [95% CI, 1.41–4.45];P=0.002). The symptomatic intracranial hemorrhage rate was not different in both treatment groups across both sexes (males, 5.2% versus 2.8%; odds ratio, 2.05 [95% CI, 0.56–7.50];P=0.278; females, 7.4% versus 2.5%; odds ratio, 2.89 [95% CI, 0.55–15.14];P=0.210).CONCLUSIONS:In patients with large ischemic core, the treatment effect of EVT did not differ between females and males, with better outcomes with EVT versus medical management, without an increased risk of symptomatic intracranial hemorrhage. These findings emphasize the need for equal attention and care for both sexes with large infarcts in clinical practice.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT04551664.

Stroke, Ahead of Print. BACKGROUND:In symptomatic carotid stenosis, treatment decisions are currently primarily based on stenosis degree. We developed a clinical prediction model (Individualized Magnetic Resonance Imaging–Based Stroke Prediction Score Using Plaque Vulnerability for Patients With Symptomatic Carotid Artery Disease [IMPROVE]) incorporating the strong predictor, intraplaque hemorrhage on magnetic resonance imaging, stenosis degree, and risk factors to identify patients with high stroke risk.METHODS:IMPROVE was developed on data from 5 cohorts of 760 patients with symptomatic carotid disease on optimal medical treatment. Inclusion criteria included a recent transient ischemic attack/stroke (

Stroke, Ahead of Print. BACKGROUND:Evidence about the impact of multiple metal exposure on brain neuroimaging metrics remains limited. We aim to investigate the effects of single and mixed metal exposure on white matter hyperintensities (WMHs).METHODS:This cross-sectional study included 1183 subjects without stroke history from the META-KLS (Multi-modality Medical Imaging Study Based on Kailuan Study), which is an existing prospective cohort in Tangshan, China. Plasma metal levels, including Mg, Ca, V, Mn, Co, Ni, Cu, Zn, As, Se, Rb, Cs, Tl, Pb, and Cd, were measured using an inductively coupled plasma mass spectrometer. Ordinal and binary logistic regression models were used to examine the effects of metal exposure on the WMH burden, deep white matter hyperintensity, and periventricular white matter hyperintensity. All metal concentrations were naturally log-transformed to reduce skewness and were analyzed as both continuous and tertile forms. Weighted quantile sum regression, quantile-based g-computation model, and Bayesian Kernel Machine Regression were used in the metal mixture analysis.RESULTS:Compared with the first tertile, the adjusted odds ratios and 95% CIs for the WMH burden in the third tertile were 1.57 (1.05–2.34) for As, 2.01 (1.28–3.18) for Cu, 1.68 (1.14–2.50) for V, 1.61 (1.07–2.44) for Cs, and 1.56 (1.04–2.34) for Tl (allPfor trend

Introduction
Approximately 70% of patients with stroke experience varying degrees of cognitive impairment, which imposes a substantial direct and indirect socioeconomic burden. Previous studies have shown that scalp acupuncture (SA) or repetitive transcranial magnetic stimulation (rTMS) in combination with other therapies is effective for poststroke cognitive impairment (PSCI). Limited by interstudy heterogeneity and the limited number of included studies, there is insufficient evidence of the efficacy of rTMS in combination with SA in treating PSCI. Therefore, this protocol aims to investigate the effectiveness of rTMS in conjunction with SA for patients with PSCI through a comprehensive meta-analysis.

Methods and analysis
This study will undertake a comprehensive search across nine distinct databases (Web of Science, Embase, Cochrane Library, PubMed, China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, China Biology Medicine and SCOPUS). The primary outcome will encompass the Montreal Cognitive Assessment and the Mini-Mental State Examination. The secondary outcomes are the modified Barthel Index, the Rivermead Behavioral Memory Test and the Digit Span Test. The bias risk assessment tool from the Cochrane Handbook for Systematic Reviews of Interventions will be used to evaluate bias risk, and the GRADE will be applied to gauge the quality of evidence. Furthermore, we plan to perform an analysis of subgroups to investigate the heterogeneity, employ the leave-one-out approach for sensitivity evaluation and use funnel plots and Egger’s test to determine publication bias, respectively.

Ethics and dissemination
Ethical approval is not required in systematic review and meta-analysis. The review will be published in a peer-reviewed journal.

PROSPERO registration number
CRD42024571762.

Introduction
The aetiology of sudden sensorineural hearing loss (SSNHL) is not certain in a significant number of cases. In 8%–31% of posterior fossa infarctions, acute hearing or vestibular loss precedes neurological symptoms. Also, several retrospective cohort analyses have indicated a higher chance of experiencing a stroke after SSNHL compared with the general population. This higher incidence of stroke suggests vascular involvement in the pathophysiology of SSNHL. The aim of this study is to evaluate the association of cardiovascular disease and idiopathic SSNHL (iSSNHL) by investigating the presence of cardiovascular risk factors and cerebral small vessel disease (CSVD), in patients with iSSNHL and compare this to controls.

Method and analysis
In this multicentre cross-sectional study, the ROSALIE study, 205 patients aged 50 years or higher diagnosed with iSSNHL, and 205 controls who are either suspected of trigeminus neuralgia, hemifacial spasm, vestibular paroxysmia or have a cerebellopontine angle neoplasm will be included. The primary outcome is the difference in CSVD, measured by the degree of white matter hyperintensities according to the Fazekas scale and the presence of brain infarctions on MRI, between patients with iSSNHL and controls. The secondary outcome is the difference in prevalence of the cardiovascular risk factors: hypertension, hypercholesterolaemia, smoking status, body mass index and cardiovascular comorbidities; diabetes, stroke and myocardial infarction, between both cohorts.

Ethics and dissemination
Ethics approval has been obtained by the institutional review boards of all participating hospitals. The Medical Research Involving Human Subjects Act does not apply to this study, as has been declared by the regional review board at Leiden University Hospital, registration number 22-3060.
Patients will receive the standard diagnostic protocol for iSSNHL in the Netherlands, which consists of pure tone audiometric assessment before and after treatment with corticosteroids and an MRI of the cerebellopontine angle displaying the entire cerebrum. The data will not be available publicly but might be shared on a reasonable request.

Introduction
Acute pneumonia (AP) remains a leading cause of death in the older population. Excess risk of death after AP is partly due to cardiovascular (CV) events. We aim to evaluate whether aspirin at a preventive dose (100 mg daily) introduced at the acute phase of AP reduces 90-day mortality.

Methods and analysis
The ASPirin for Acute Pneumonia in the elderlY study is a phase III multicentre randomised double-blind, placebo-controlled, superiority clinical trial, which will investigate the efficacy and safety of aspirin in older patients with AP hospitalised in a French university and non-university hospitals. Patients will be randomised in a 1:1 ratio between two groups receiving daily either 100 mg of aspirin or a placebo, within 84 hours following radiologically proven AP diagnosis for 90 days. This study aimed at assessing the efficacy of aspirin on all-cause mortality after AP at 90 days (D90) (primary objective), D30 and D120 after randomisation, CV mortality, major adverse CV events (MACE) (ie, myocardial infarction, stroke, heart failure, new atrial fibrillation and pulmonary embolism, CV death and sudden death) incidence, length of intensive care unit and hospital stay, unscheduled rehospitalisation, dependence, overall and MACE-free survival, as well as safety outcomes (bleeding incidence). The sample size, calculated considering a 90-day mortality of 25% and a reduction of 10% in the aspirin group, a two-sided alpha risk at 5% and power of 80%, is 500 patients to prove the superiority of aspirin over placebo. To account for screening failures and consent withdrawals, 600 patients (300 per arm) will be included.

Ethics and dissemination
This study has full approval from an independent Ethics Committee. Participants will sign a written informed consent ahead of participation. Findings will be published in peer-reviewed journals and conference presentations.

Trial registration number
EU CTIS: 2024-510811-32-00.