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IntroductionUnderlying pathological mechanisms of cerebral vessel damage in dementia patients have been suggested to increase the risk of intracranial haemorrhage following thrombolysis for acute ischaemic stroke. This has not been demonstrated in earlier literature. Our study compared the throm- bolysis outcomes of stroke patients with and without cognitive impairment.MethodsA retrospective cohort analysis of stroke patients receiving thrombolysis was conducted. Cognitive impairment was defined as: a diagnosis of dementia, mild cognitive impairment, or clinical evidence of mild cognitive impairment. Outcome measures included haemorrhagic complications, NIHSS and mRS scores, and mortality.ResultsStatistical analysis included data from 428 ischaemic stroke patients, 62 of whom had cognitive impairment. Following thrombolysis, cognitively impaired stroke patients had greater increments in dis- ability level, an increased risk of haemorrhagic complications, and a lower likelihood of 90-day survival. Logistic regression modelling revealed the main predictors of these poorer outcomes to be age, time to thrombolysis, and NIHSS on admission. Two thirds of the variance in stroke outcomes remained unex- plained by our models.ConclusionConfounding variables were the main predictors of poorer thrombolysis outcomes in cogni- tively impaired stroke patients. A large portion of these poorer outcomes remains unexplained, leaving potential for further investigation.

IntroductionMechanical thrombectomy is now in routine use for acute ischaemic stroke. This service audit examines outcomes and complications in the Sheffield regional centre.MethodsData was collected retrospectively for all patients undergoing mechanical thrombectomy at Sheffield Teaching Hospitals from March 2020 – February 2021 using case notes and digital records. The data was analysed for the whole group (n=33), and for the subgroup of patients (n=8) aged over 80.Results33 patients, aged 31-87, underwent mechanical thrombectomy. 88% had successful revasculari- sation (TICI grade 2b/3). 48% had a good functional recovery (modified Rankin scale 0-2).6 patients had haemorrhagic transformation, though none met the SITSMOST criteria for symptomatic intracerebral haemorrhage secondary to procedure. 6 patients (18%) did not survive to 90 days.In the group aged over 80, outcomes were significantly worse. In this group the rate of successful revas- cularisation was 63%, and good functional recovery (mRS 0-2) was 13%. 90 day mortality was 38%.ConclusionsOutcomes from mechanical thrombectomy at Sheffield teaching hospitals are good, with nearly half of patients having a good functional recovery. However, outcomes in the subgroup of patients aged over 80 were significantly poorer, with high complication and mortality rates; this warrants further study.

IntroductionReferrals to specialist memory clinics have increased out of proportion to the incidence of dementia. Time and financial pressures are consequently exerted on a service striving to deliver high quality care. We have developed a fully automated ‘Digital Doctor’ with the aim of providing pre-clinic risk stratification and ongoing monitoring for patients with memory concerns.MethodsWe recruited 15 participants with Functional Memory Disorder (FMD), Mild Cognitive Impairment (MCI) and Alzheimer’s disease each as well as 15 healthy controls. Participants answered 12 questions posed by the ‘Digital Doctor’. Audio and visual data is analysed using diarization and automatic speech recognition tools and machine learning classifiers.ResultsThe ‘Digital Doctor’ can distinguish between neuro-degenerative dementia and FMD with an accuracy of 95%. We will have results of a 4-way classification accuracy (HC, FMD, MCI & AD) at time of conference.DiscussionWe demonstrate the potential value of the ‘Digital Doctor’ as a stratification and triage tool. Accuracy will be improved with greater number of users and inclusion of fluency and picture description data. Patients at low risk could avoid the burden of a clinic appointment, whilst patients with higher risk could benefit from a more streamlined service.

The Acute neurology unit (ANU), located at the Royal Hallamshire Hospital, Sheffield is a regional centre for a population of approximately 1.5 million. We are unusual, as our neurologists manage both hyperacute stroke and hyperacute neurology. HASU is located within our ANU. We had 4026 neurology ward admissions, 3265 emergency cases and 761 elective cases last year. We receive acute admissions from Trust A and E, direct admissions from general practitioners and urgent transfers from DGHs.We provide 24 hour stroke thrombolysis and a weekday working hours thrombectomy service. Overnight thrombolysis is supervised through a regional ‘Telemedicine’ system. A 2 week survey in July 2017 showed that only 59% patients, who were referred with suspected stroke, had stroke/TIA. Neurological conditions, such as migraine, seizure, syncope, acute vestibulopathy, Bell’s palsy and medically unexplained symptoms were common ‘stroke mimics’. 46% of patients with ‘stroke mimic’ were discharged on the day of admission. Average length of stay was 3 days. A separate survey of acute neurology referrals showed that 58% of patients did not require admission and were managed through an ambulatory care pathway. Patient satisfaction regarding their rapid assessment and diagnosis was high. Co-location of ANU and HASU allows rapid and effective management of ‘stroke mimics’.

Background: Venous sinus disease must be excluded before diagnosing idiopathic intracranial hypertension but is found only rarely in typical cases. Magnetic resonance venography (MRV) is the technique of choice for investigating this, and provides images that are diagnostic and easy to interpret. However, recent work using more invasive techniques has documented pressure gradients and stenoses in the lateral venous sinuses in many cases of idiopathic intracranial hypertension. Objective: To examine the reason for this discrepancy and to establish whether there are characteristic appearances on MRV in idiopathic intracranial hypertension that are routinely overlooked in clinical practice. Methods: MRVs from 20 patients with idiopathic intracranial hypertension were reviewed, unblinded, by two neuroradiologists, and their appearances rated for focal narrowings and signal gaps. A control group of 40 asymptomatic volunteers, matched for age and sex with the patient group, was recruited prospectively for MRV, and their scans rated in the same way. Results: The lateral sinuses presented a range of appearances with quite different distributions in the two groups (p

Introduction Conversation Analysis (CA) can help with the differential diagnosis of seizure disorders. We investigated if CA could be used in the memory clinic to distinguish neurodegenerative (NDD) from functional memory disorders (FMD). Methods We recruited consecutive, patients newly referred to the Neurology-led memory Clinic. Consultations were video & audio recorded. All participants underwent detailed Neuropsychology testing and MRI. Results 111 patients of 178 approached were recruited (20 ND, 24 FMD, 87 other). We identified profiles of 14 interactional features that can distinguish NDD from FMD consultations based on encounters with 15 patients with NDD and 15 with FMD. Features of NDD included an inability to answer compound questions fully, inability to give detailed examples of memory failures, shorter length of turn and reduced complexity of replies. Prospective analysis of an additional 10 encounters proved that Conversation Analysts could use these features to predict the diagnoses of FMD and ND with high sensitivity and specificity. Conclusions Simple differences in the communication behaviour of patients can help to distinguish between ND and FMD, suggesting that a targeted observation of interactional features could improve screening for ND in primary or secondary or care settings.

The 2009 Dementia strategy promoted a ‘memory clinic in every town’. We investigated the patient mix seen in a neurology-led memory clinic. Retrospective review (2004, 2006, 2012) attendees to memory clinic. Prospective review memory clinic from October 2012–Dec 2013. Survey to neurologists in Specialist Interest Group in Cognition (ABN). Survey of local GPs. Results Percentage of attendees with benign memory complaints increased from 30% & 32% in 2004 and 2006 to 55% in 2012. Oct 2012–Dec 2013 >50% attendees do not have dementia or MCI. 9 responders: A mean of 27% of attendees of neurology-led memory clinics in the UK have ‘benign memory complaints’. The following terms were used: ▸ Attentional amnestic disorder, ▸ Attentional cognitive complaints, ▸ Worried well, ▸ Subjective memory complaints, ▸ Subjective memory impairment, ▸ Normal cognitive ageing, ▸ Hypocondrial, ▸ ‘Stress related.’ 4. GPs used; ‘worried well’, ‘benign senescent forgetfulness’, ‘Possible dementia’, ‘mild neurocognitive disorder’ and ‘late life forgetfulness’ & treated with antidepressants but also referred to psychology or memory clinic. People attending memory clinic frequently do not have dementia and currently there is no consensus for diagnostic label or treatment.

Clarification of the pathophysiological mechanisms of intra-arterial thromboembolism may lead to novel treatments for cerebrovascular disease. There is increasing evidence for the role of von Willebrand factor (VWF) cleaving protease (ADAMTS-13) in modulating the thrombotic cascade in high flow arterial settings. VWF multimers are rich in ultra large forms (ULVWF) which can rapidly bind its primary platelet receptor resulting in spontaneous aggregation of platelets. Under normal conditions, these ULVWF are regulated by rapid proteolysis converting them to smaller, less active forms. The protease responsible for cleavage of ULVWF is ADAMTS-13. We measured the ADAMTS-13 antigen and ADAMTS-13 activity levels in the plasma of consecutive patients with transient ischaemic attack (TIA), compared with nonstroke controls, in a hospital based TIA clinic. This was compared with VWF levels. Samples were analysed in the acute phase and at 3 months postevent. In our pilot study patients with partial anterior circulation type TIAs had significantly reduced ADAMTS-13 activity compared to controls (p=0.0394). No significant differences were seen between high- and low-risk ABCD2 scored patients. We did not observe any significant changes in VWF levels in our study sample. Our pilot study suggests a potential role for altered ADAMTS-13 activity in the pathophysiology of TIA.

Hormone Therapy and the Brain: a Clinical Perspective on the Role of Oestrogen. By v w henderson. (Pp 112, £28.00). Published by Parthenon Publishing Group, Carnforth, 2000. ISBN 1–85070–078–8. The role of sex steroids in neurological disease is a topic of importance in our aging population and very worthy of discussion. This book is set out in chapters focusing on different individual subspecialties, including dementia, vascular disease, and epilepsy, with an initial backdrop …