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Background: In a recent Italian study, 30% of patients with reversible cerebral vasoconstriction syndrome (RCVS) presented without thunderclap headache (TCH), and tended to present more severe forms of RCVS than patients with TCH. We aimed to analyze the risk for complications of RCVS in patients with and without TCH at onset. Methods: In a pooled cohort of 345 French patients with RCVS, we compared patients with and without TCH at onset regarding rates of neurological complications, and the functional outcome at 3 months. Results: As compared to the 281 patients with TCH at onset, the 64 patients without TCH had a higher risk for any neurological complication (61% vs. 24%, OR 4.9, 95% CI 2.8–8.7, p < 0.001). The association was strongest for cervical artery dissections (28% vs. 5%, OR 8.1, 95% CI 3.7–17.6, p < 0.001), followed by posterior reversible encephalopathy syndrome (17% vs. 3%, OR 7.1, 95% CI 2.7–18.4, p < 0.001), seizures (9% vs. 2.5%, OR 4.1, 95% CI 1.3–12.5, p = 0.019), and subarachnoid hemorrhage (41% vs. 16%, OR 3.5, 95% CI 1.9–6.3, p < 0.001). In multivariable analysis, the risk for any neurological complication remained significantly elevated in the absence of TCH (OR 3.5, 95% CI 1.8–6.8, p < 0.001). The functional outcome was equal in both groups, with a modified Rankin scale score of 0–1 in ≥90% of patients. Conclusions: Absence of TCH at onset might predict a higher risk of complications in RCVS. Our results warrant further multicentric studies to prove this finding. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim of this study was to determine the differences in life expectancy and causes of death after primary intracerebral hemorrhage (ICH) relative to general population controls. Methods: In a population‐based setting, 963 patients from Northern Ostrobothnia who had their first‐ever ICH between 1993 and 2008 were compared with a cohort of 2884 sex‐ and age‐matched controls in terms of dates and causes of death as extracted from the Causes of Death Register kept by Statistics Finland and valid up to the end of 2017. Results: Of our 963 patients, 781 died during the follow‐up time (mortality 81.1%). Cerebrovascular disease was the most common cause of death for these patients, 37.3% compared with 8.2% amongst the controls. The most common reasons for cerebrovascular mortality in the ICH patients were late sequelae of ICH in 12.8% (controls 0%) and new bleeding in 10.6% (controls 1.0%). The long‐term survivors had a smaller ICH volume (median 12 ml) than those patients who died within 3 months (median 39 ml). The mortality rate of ICH patients during a follow‐up between 12 and 24 years was still higher than that of their controls (hazard ratio 2.08, 95% confidence interval 1.58–2.74, p < 0.001). Conclusions: Very long‐term ICH survivors have a constant excess mortality relative to controls even 10 years after the index event. A significantly larger proportion of patients died of cerebrovascular causes and fewer because of cancer relative to the controls. [ABSTRACT FROM AUTHOR]

Background and purpose: Women may receive stroke care less often than men. We examined the contribution of clinical care on sex differences and health‐related quality of life (HRQoL) after stroke. Methods: We included first‐ever strokes registered in the Australian Stroke Clinical Registry (2010–2014) with HRQoL assessed between 90 and 180 days after onset (EQ‐5D‐3L instrument) that were linked to hospital administrative data (up to 2013). Study factors included sociodemographics, comorbidities, walking ability on admission (stroke severity proxy) and clinical care (e.g. stroke unit care). Responses to the EQ‐5D‐3L were transformed into a total utility value (−0.516 'worse than death' to 1 'best' health). Quantile regression models, adjusted for confounding factors, were used to determine median differences (MD) in utility scores by sex. Results: Approximately 60% (6852/11 418) of stroke survivors had an EQ‐5D‐3L assessment (median 139 days; 44% female). Compared with men, women were older (median age 77.1 years vs. men 71.2 years) and fewer could walk on admission (37.9% vs. men 46.1%, P < 0.001). Women had lower utility values than men, and the difference was explained by age and stroke severity, but not clinical care [MDadjusted = −0.039, 95% confidence interval: −0.056, −0.021]. Poorer HRQoL was observed in younger men (aged <65 years), particularly those with more comorbidities, and in older women (aged ≥75 years). Conclusions: Stroke severity and comorbidities contribute to the poorer HRQoL in young men and older women. Further studies are needed to understand age–sex interaction to better inform treatments for different subgroups and ensure evidence‐based treatments to reduce the severity of stroke are prioritized. [ABSTRACT FROM AUTHOR]

Background and purpose: Infections with coronaviruses are not always confined to the respiratory tract and various neurological manifestations have been reported. The aim of this study was to perform a review to describe neurological manifestations in patients with COVID‐19 and possible neuro‐invasive mechanisms of Sars‐CoV‐2. Methods: PubMed, Web of Science and COVID‐dedicated databases were searched for the combination of COVID‐19 terminology and neurology terminology up to 10 May 2020. Social media channels were followed up between 15 March and 10 May 2020 for postings with the same scope. Neurological manifestations were extracted from the identified papers and combined to provide a useful summary for the neurologist in clinical practice. Results: Neurological manifestations potentially related to COVID‐19 have been reported in large studies, case series and case reports and include acute cerebrovascular diseases, impaired consciousness, cranial nerve manifestations and autoimmune disorders such as the Guillain–Barré syndrome often present in patients with more severe COVID‐19. Cranial nerve symptoms such as olfactory and gustatory dysfunctions are highly prevalent in patients with mild to moderate COVID‐19 even without associated nasal symptoms and often present in an early stage of the disease. Conclusion: Physicians should be aware of the neurological manifestations in patients with COVID‐19, especially when rapid clinical deterioration occurs. The neurological symptoms in COVID‐19 patients may be due to direct viral neurological injury or indirect neuroinflammatory and autoimmune mechanisms. No antiviral treatments against the virus or vaccines for its prevention are available and the long‐term consequences of the infection on human health remain uncertain especially with regard to the neurological system. [ABSTRACT FROM AUTHOR]

Both the European Stroke Organization and the American Heart Association/American Stroke Association guidelines regarding EVT treatment for minor stroke patients acknowledge the lack of high-quality data within this patient subgroup [[3]]. Keywords: cerebrovascular diseases; neurological disorders; stroke; stroke thrombectomy EN cerebrovascular diseases neurological disorders stroke stroke thrombectomy 292 293 2 12/19/22 20230101 NES 230101 We sincerely thank Dr Malhotra and colleagues for their interest in our article, "Minor stroke in large vessel occlusion: A matched analysis of patients from the German Stroke Registry-Endovascular Treatment (GSR-ET) and patients from the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR)" [[1]]. Patients from the GSR-ET reflect the reality of daily life care for EVT patients; thus, we do not have more structured information regarding patient selection for EVT. [Extracted from the article]

Background and purpose: Leptomeningeal collateral (LMC) status governs the prognosis of large artery occlusive stroke, although factors determining LMC status are not fully elucidated. The aim was to investigate metrics affecting LMC status in such patients by using computational fluid dynamics (CFD) models based on computed tomography angiography (CTA). Methods: In this cross‐sectional study, patients with recent ischaemic stroke or transient ischaemic attack attributed to atherosclerotic M1 middle cerebral artery (MCA) stenosis (50%–99%) were recruited. Demographic, clinical and imaging data of these patients were collected. Ipsilesional LMC status was graded as good or poor by assessing the laterality of anterior and posterior cerebral arteries in CTA. A CFD model based on CTA was constructed to reflect focal hemodynamics in the distal internal carotid artery, M1 MCA and A1 anterior cerebral artery. Pressure gradients were calculated across culprit MCA stenotic lesions in CFD models. Predictors for good LMC status were sought in univariate and multivariate analyses. Results: Amongst the 85 patients enrolled (mean age 61.5 ± 10.9 years), 38 (44.7%) had good ipsilesional LMC status. The mean pressure gradient across MCA lesions was 14.8 ± 18.1 mmHg. Advanced age (P = 0.030) and a larger translesional pressure gradient (P = 0.029) independently predicted good LMCs. A lower fasting blood glucose level also showed a trend for good LMCs (P = 0.058). Conclusions: Our study suggested a correlation between translesional pressure gradient and maturation of LMCs in intracranial atherosclerotic disease. Further studies with more exquisite and dynamic monitoring of cerebral hemodynamics and LMC evolution are needed to verify the current findings. [ABSTRACT FROM AUTHOR]

Background and purpose: Dementia in Parkinson's disease (PD) is common and disabling. Identification of modifiable risk factors for it is essential. Vascular risk factors (VRFs) may be associated with cognitive decline in early PD. Biomarkers that serve as surrogates of the long‐term effect of VRFs on PD are needed. To that end, we aimed to quantitate white matter hyperintensities (WMH) in early PD, measure associations with VRFs and examine relationships between WMH and longitudinal cognition. Methods: Participants in the Parkinson's Progression Markers Initiative study (141 patients with PD, 63 healthy controls) with adequate baseline structural brain magnetic resonance imaging data were included. Hypertension and diabetes history, and body mass index were combined to create a vascular risk score. WMH were quantitated via automated methods. Cognition was assessed annually with a comprehensive test battery. Results: In the PD group, vascular risk score was associated with WMH for total brain (β = 0.210; P = 0.021), total white matter (β = 0.214; P = 0.013), frontal (β = 0.220; P = 0.002) and temporal (β = 0.212; P = 0.002) regions. Annual rate of change in global cognition was greater in those with higher vascular risk score (β = −0.040; P = 0.007) and greater WMH (β = −0.029; P = 0.049). Higher temporal WMH burden was associated with great decline over time in verbal memory (β = −0.034; P = 0.031). Conclusions: In early PD, modifiable VRFs are associated with WMH on brain magnetic resonance imaging. Temporal WMH burden predicts decline in verbal memory. WMH may serve as a surrogate marker for the effect of VRFs on cognitive abilities in PD. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Poststroke emotional and behavior impairment: A narrative review," by JM Ferro and colleagues is presented.

A response by Silvia Koton and colleagues to a letter to the editor on their article "Cerebral artery calcification in patients with acute cerebrovascular diseases: determinants and long-term clinical outcome" in the 2012 issue is presented.

A letter to the editor is presented in response to the article "Metabolic syndrome and cerebral vasomotor reactivity," by S. Giannopoulos and colleagues.

A letter to the editor is presented describing a case in which the authors concluded that dysproteinemia in case of protein-losing enteropathy may be considered a rare differential diagnosis in the pathogenesis of cerebral ischemia if there is a prothrombotic state.