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Background: Post-stroke behavioral disinhibition (PSBD) is common in stroke survivors and often presents as impulsive, tactless or vulgar behavior. However, it often remains undiagnosed and thus untreated, even though it can lead to a longer length of stay in a rehabilitation facility. The proposed study will aim to evaluate the clinical, neuropsychological and magnetic resonance imaging (MRI) correlates of PSBD in a cohort of stroke survivors and describe its 12-month course. Methods: This prospective cohort study will recruit 237 patients and will be conducted at the Neurology Unit of the Prince of Wales Hospital. The project duration will be 24  months. The patients will be examined by multiple MRI methods, including diffusion-weighted imaging, within 1  week after stroke onset. The patients and their caregivers will receive a detailed assessment at a research clinic at 3, 9 and 15  months after stroke onset (T1, T2 and T3, respectively). The disinhibition subscale of the Frontal Systems Behavior Scale (FrSBe) will be completed by each subject and caregiver, and scores ≥65 will be considered to indicate PSBD. A stepwise logistic regression will be performed to assess the importance of lesions in the regions of interest (ROIs), together with other significant variables identified in the univariate analyses. For patients with PSBD at T1, the FrSBe disinhibition scores will be compared between the groups of patients with and without ROI infarcts, using covariance analysis. The demographic, clinical and MRI variables of remitters and non-remitters will be examined again at T2 and T3 by logistic regression. Discussion: This project will be the first MRI study on PSBD in stroke survivors. The results will shed light on the associations of lesions in the orbitofrontal cortex, anterior temporal lobe and subcortical brain structures with the risk of PSBD. The obtained data will advance our understanding of the pathogenesis and clinical course of PSBD in stroke, as well as other neurological conditions. The findings are thus likely to be applicable to the large population of patients with neurological disorders at risk of PSBD and are expected to stimulate further research in this field. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE Current criteria for middle cerebral artery (MCA) stenosis by transcranial Doppler were mainly based on the flow velocity acceleration, ignoring other useful parameters. We tested the accuracy of new criteria using magnetic resonance angiography (MRA) as the confirmative method. METHODS A compositive score for each MCA was calculated according to following parameters: Velocity Scale (score 0-6 for peak systolic velocity <140 to ≥300 cm/second), Hemodynamic Scale (score 0-5 for diffuse or focal velocity increase; score 0-6 for differences between bilateral MCA; score 17 for damping velocity), and Spectrum Scale (score 0-2 for normal spectrum, turbulence, and musical murmurs). RESULTS The median scores in normal-mild, moderate, and severe groups on MRA differed significantly ( P < .001). The optimal cutoff score for <50% and ≥50% stenosis was 3 with the PPV of 72.3% (95% confidence interval [CI]: 65.3% to 78.5%) and negative predictive value (NPV) of 89.5% (95% CI: 85.9% to 92.3%), for moderate and severe stenosis was 6 with the PPV of 85.9% (95% CI: 76.7% to 92.0%) and NPV of 61.9% (95% CI: 50.6% to 72.1%). Both scores performed better than peak systolic or mean velocity. CONCLUSIONS This new method was feasible and reliable and showed some advantages over the velocity-only method. Further studies using digital subtraction angiography as the gold standard are needed to ameliorate the new criteria. [ABSTRACT FROM AUTHOR]