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Background and purpose: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance. Methods: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9‐point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts. Results: Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non‐invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed. Discussion and conclusion: Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility. [ABSTRACT FROM AUTHOR]

Background and purpose: Decompressive hemicraniectomy (DH) reduces mortality of large middle cerebral artery (MCA) territory infarcts. Survivors are at high risk of poststroke seizures (PSSs). This study aims to describe the incidence of PSSs, to identify associated factors, and to assess their impact on long‐term outcomes. Methods: We included consecutive patients who underwent DH for large MCA infarcts from May 2005 to December 2019 at Lille University Hospital. Patients were followed up at 3 months, 1 year, and 3 years. We analysed (i) the incidence and associated factors of early onset PSSs (EPSSs) with logistic regression models; (ii) the incidence and associated factors of late onset PSSs (LPSSs) in survivors at 7 days with a univariate Cox proportional hazard regression model for interval‐censored data; and (iii) the impact of PSSs (EPSSs and LPSSs) on mortality with univariate and multivariate Cox proportional hazard regression models and modified Rankin Scale at 1 and 3 years, with univariate and adjusted multivariate ordinal logistic regression analyses. Results: Of 248 patients (150 men, 60.5%; mean age = 50.4 ± 9.6 years), 106 (42.7%) presented PSSs (six inaugural seizures, 22 EPSSs, 78 LPSSs) during follow‐up. The PSS cumulative incidence was 12.3% at 7 days, 24.9% at 3 months, 49.8% at 1 years, and 54.8% at 3 years. No predictor was significantly associated with either EPSSs or LPSSs. PSSs did not significantly impact mortality and long‐term functional outcome. Conclusions: The incidence of PSSs after DH is high, reaching more than 50% 3 years after stroke, but PSSs did not influence long‐term mortality or functional outcome. [ABSTRACT FROM AUTHOR]

The clinical picture of moderate-to-severe thrombocytopenia and thrombotic complications at unusual sites occurring within 4-28 days of vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford/AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson) has been named vaccine-induced immune thrombotic thrombocytopenia (VITT), and several publications have followed the first case reports on 28 March 2021 [1-5]. However, there are similarities with the heparin-induced thrombocytopenia syndrome (HIT), and researchers have identified circulating platelet-activating platelet factor 4 antibodies in these patients. Cerebral venous sinus thrombosis associated with COVID-19 vaccine-induced thrombocytopenia: Improvement in mortality rate over time. [Extracted from the article]

Background and Purpose Methods Results Conclusions Decompressive hemicraniectomy (DH) improves survival and functional outcome in large middle cerebral artery (MCA) infarcts. However, long‐term cognitive outcomes after DH remain underexplored. In a cohort of patients with large right‐hemisphere MCA infarction undergoing DH, we assessed the rates of long‐term cognitive impairment over 3‐year follow‐up.We prospectively evaluated consecutive patients included in the Lille Decompressive Surgery Database (May 2005–April 2022) undergoing DH according to existing guidelines for large hemisphere MCA infarction. We included patients with right‐sided stroke and screened with the Mini‐Mental State Examination (MMSE) in at least one of the prespecified follow‐ups (3‐month, 1‐year, 3‐year). Cognitive impairment was defined as an MMSE score < 24. We included only right‐hemisphere strokes to avoid testing biases related to severe aphasia. We compared clinical and neuroimaging data in patients with and without cognitive impairment.Three hundred four patients underwent DH during the study period. Among 3‐month survivors, 95 had a right‐hemisphere stroke and underwent at least one cognitive screening (median age = 51 years, 56.8% men). Forty‐four patients (46.3%) exhibited cognitive impairment at least once during the 3‐year follow‐up. Baseline characteristics did not significantly differ between patients with and without cognitive impairment. Regarding long‐term temporal trends, cognitive impairment was observed in 23 of 76 (30.3%), 25 of 80 (31.3%), and 19 of 66 (28.8%) patients at 3‐month, 1‐year, and 3‐year follow‐up, respectively, and it was associated with higher rates of functional disability (all p < 0.05).The persistently high rates of cognitive impairment after DH highlight the importance of cognitive monitoring to improve the long‐term management of survivors. [ABSTRACT FROM AUTHOR]