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Stroke is a leading cause of death and disability. Some patients may present with atypical symptoms. One of the very rare presentations of stroke is initial neurogenic pain. Rare painful presentations include, amongst others, acute trigeminal neuralgia, atypical facial pain, hemi-sensory pain, and episodic pain. Based on the available literature, the pain at presentation may be episodic, transient, or persistent, and it may herald other debilitating stroke symptoms such as hemiparesis. Pain quality is often described as burning; less often as sharp. Patients often have accompanying focal symptoms and findings on neurological examination. However, in several of the reviewed cases, these were discrete or non-existent. In patients with pain located in the trunk and/or extremities, lesions may involve the thalamus, lateral medulla oblongata, insula, or parietal lobe. In patients with atypical facial or orbital pain (including the burning “salt and pepper” sensation), the stroke lesions are typically located in the pons. In this narrative review, we included studies/case series of patients who had pain at the time of onset, shortly before or within 24 h of stroke symptoms (on the day of admission). Cases with pain related to aortic or cervical vessel dissection, cerebral venous sinus thrombosis, subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, and CNS vasculitis were excluded. With this review, we aim to summarize the current knowledge on stroke presenting with acute pain.

Background Physical inactivity is highly prevalent after stroke, increasing the risk of poor health outcomes including recurrent stroke. Tailoring of exercise programs to individual preferences can improve adherence, but no tools exist for this purpose in stroke. Methods We identified potential questionnaire items for establishing exercise preferences via: (i) our preliminary Exercise Preference Questionnaire in stroke, (ii) similar tools used in other conditions, and (iii) expert panel consultations. The resulting 35-item questionnaire (SEPI-35) was administered to stroke survivors, along with measures of disability, depression, anxiety, fatigue and self-reported physical activity. Exploratory factor analysis was used to identify a factor structure in exercise preferences, providing a framework for item reduction. Associations between exercise preferences and personal characteristics were analysed using multivariable regression. Results A group of 134 community-dwelling stroke survivors (mean age 64.0, SD 13.3) participated. Analysis of the SEPI-35 identified 7 exercise preference factors (Supervision-support, Confidence-challenge, Health-wellbeing, Exercise context, Home-alone, Similar others, Music-TV). Item reduction processes yielded a 13-item version (SEPI-13); in analysis of this version, the original factor structure was maintained. Lower scores on Confidence-challenge were significantly associated with disability (p = 0.002), depression (p = 0.001) and fatigue (p = 0.001). Self-reported barriers to exercise were particularly prevalent in those experiencing fatigue and anxiety. Conclusions The SEPI-13 is a brief instrument that allows assessment of exercise preferences and barriers in the stroke population. This new tool can be employed by health professionals to inform the development of individually tailored exercise interventions.

Introduction: Thyroid hormones affect the cardiovascular system, but the precise mechanisms of their effects on the development of atherosclerosis are not entirely clear. The relationship between subclinical hypothyroidism, dyslipidemia and carotid atherosclerosis has been widely investigated, but the findings were controversial. The aim of the present study was to determine whether female subjects with subclinical hypothyroidism (SHypo) have increased carotid intima-media thickness (IMT) compared with euthyroid subjects, as well as to examine the association of SHypo, carotid atherosclerosis and dyslipidemia. Methods: This research included 100 women aged 30 to 70 years who were divided into two groups: the SHypo group including subjects with signs of subclinical hypothyroidism and the control group of euthyroid subjects. Carotid IMT thickness using B mode ultrasound was determined and its correlation with serum concentrations of fT4, TSH, CRP, and lipid profile including small dense LDL (sdLDL) was analysed. Results: Subjects with SHypo had significantly increased carotid IMT (IMT ≥ 75th centile) in all three measured segments of the right (p p = 0.001) carotid artery compared to the control group, with a significantly more frequent appearance of plaque (25% vs. 9%; p = 0.05). Significant positive correlations were found between higher TSH and higher IMT values. Increased age, LDL cholesterol, and TSH predicted thickening of the carotid artery IMT. Conclusions: It is important to screen people showing early, subclinical signs of thyroid gland dysfunction due to its impact on carotid atherosclerosis development.

Type 2 diabetes (Т2DM) both directly and indirectly impacts the development of morphological and functional changes of the central nervous system.The study was to determine clinical and neurophysiological patterns of cognitive impairment (CI) in patients with chronic cerebrovascular diseases (CCD) and Т2DM.We examined 132 patients with CCD. First group included 58 patients without Т2DM aged 64.5 [58; 72], second group 74 patients with CCD and Т2DM 63 [57; 70]. Clinical, neurological, neuropsychological, neurophysiological (cognitive evoked potentials (EP) and neurovisualisation (brain MRI) examination was carried out to all patients.Somatic and neurological characteristics of the patients were similar in both groups with the exception of more distinct metabolic changes in Т2DM patients. Neurovisualisation study of the brain MRI in Т2DM patients revealed more distinct changes in the form of white matter hyperintensity and subarachnoidal spaces enlargement. Neuropsychological examination in patients revealed the reduction of intellectual flexibility, constructive praxis disruption, optical spatial dysfunction and deteoration of delayed word recall. Significant disorders in the way of overall cognitive impairment, lobar dysfunction and impaired verbal associative productivity, proved by statistically lower amplitude and higher latency of P300 EP peak were noted in Т2DM patients. Correlation links were detected: for P300 amplitude and direct and inverse number listing test (r=0.366 and r=0.520; p=0.006 and p0.001 respectively); P300 latency and HbA1c (r=0.32; р0.05) in group 2 and glucose levels in both groups (r=0.30; p0.05); inverse relationship of latency with control functions evaluation (r=-0.34; p=0.008).CCD especially with Т2DM manifests with neurocognitive imbalance, including control functions disruption and are accompanied by neurophysiological and neurovisualistion changes.Обоснование. Сахарный диабет (СД) оказывает влияние на развитие морфологических и функциональных изменений центральной нервной системы. Цель. Определение клинико-нейрофизиологического паттерна когнитивных нарушений у пациентов с хроническими цереброваскулярными заболеваниями (ХЦВЗ) и СД 2. Материалы и методы. Обследовали 132 пациента с ХЦВЗ, в 1-ю группу вошли 58 человек без СД 2 в возрасте 64,5 [58; 72] года, во 2-ю 74 с сочетанием ХЦВЗ и СД 2 (63 [57; 70] года). Всем пациентам проводилось общеклиническое, неврологическое, нейропсихологическое, нейрофизиологическое (когнитивные вызванные потенциалы) и нейровизуализационное обследование (магнитно-резонансная томография головного мозга). Результаты. Общесоматическая и неврологическая характеристика обследованных значимо не различалась в группах. При исследовании вещества головного мозга у пациентов с СД 2 чаще отмечались более выраженные изменения гиперинтенсивности белого вещества, наличие лакунарных инфарктов и расширение ликворных пространств. Нейропсихологическое тестирование выявило снижение интеллектуальной гибкости, нарушение конструктивного праксиса, оптико-пространственные нарушения и ухудшение отстроченного воспроизведения слов. Нарушения когнитивных функций при СД 2 подтверждены изменением амплитуды и латентности пика когнитивных вызванных потенциалов Р300. Обнаружены корреляционные взаимосвязи: для амплитуды Р300 с тестом перечисления цифр в прямом и обратном порядке (r=0,366 и r=0,520; р=0,006 и р0,001 соответственно); латентности пика Р300 и уровня гликированного гемоглобина (r=0,32; р0,05) во 2-й группе и глюкозой плазмы в обеих группах больных (r=0,30; p0,05); обратная взаимосвязь латентности с оценкой управляющих функций (r=-0,34; p=0,008). Заключение. ХЦВЗ, особенно в сочетании с СД 2, проявляются нейрокогнитивным дисбалансом, включая нарушение управляющих функций, и сопровождаются нейрофизиологическими и нейровизуализационными изменениями.

Background: Vertigo is an uncommon symptom among acute stroke victims. Knowledge about the clinical profile, the brain location, and the early outcome in stroke patients with cerebrovascular diseases and vertigo remains limited. Objectives: In this study, the effects of vertigo on cerebral topography and early prognosis in cerebrovascular diseases were investigated. Methods: A comparative analysis in terms of demographics, risk factors, clinical characteristics, stroke subtypes, cerebral and vascular topography, and early outcome was performed between patients with presence or absence of vertigo on a sample of 3743 consecutive acute stroke patients available from a 24-year ongoing single-center hospital-based stroke registry. Results: Vertigo was present in 147 patients (3.9%). Multiple logistic regression analysis showed that variables independently associated with vertigo were: location in the cerebellum (OR 5.59, CI 95% 3.24–9.64), nausea or vomiting (OR 4.48, CI 95% 2.95–6.82), medulla (OR 2.87, CI 95% 1.31–6.30), pons (OR 2.39, CI 95% 1.26–4.51), basilar artery (OR 2.36, CI 95% 1.33–4.17), ataxia (OR 2.33, CI 95% 1.41–3.85), and headache (OR 2.31, CI 95% 1.53–3.49). Conclusion: The study confirmed that the presence of vertigo was not related with increased in-hospital mortality or poor prognosis at hospital discharge. Vertigo is mainly related to non-lacunar vertebrobasilar stroke with topographic localization in the cerebellum and/or brainstem.

Endothelial dysfunction is a universal pathological mechanism underlying or contributing to the development/progression of many diseases, including cerebrovascular disease and multiple sclerosis. Von Willebrand factor is a multimeric glycoprotein synthesized by endothelial cells and megakaryocytes that participates in a range of physiological and pathological processes, including primary hemostasis and coagulation. It also regulates secretion and transport of a variety of molecules, exerts a proinflammatory effect, modulates angiogenesis and smooth muscle mitotic activity, influences atherogenesis. In this review, we discuss the synthesis, secretion, and regulation of the von Willebrand factor within the context of endothelial dysfunction and other common mechanisms that play a significant role in brain tissue damage in cerebrovascular diseases and multiple sclerosis.

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.

Cerebral Cavernous Malformation (CCM) is a cerebrovascular disease of genetic origin affecting 0.5% of the population and characterized by abnormally enlarged and leaky capillaries that predispose to seizures, neurological deficits, and intracerebral hemorrhage (ICH). CCM occurs sporadically or is inherited as dominant condition with incomplete penetrance and highly variable expressivity. Three disease genes have been identified: KRIT1 (CCM1), CCM2 and CCM3. Previous results demonstrated that loss-of-function mutations of CCM genes cause pleiotropic effects, including defective autophagy, altered reactive oxygen species (ROS) homeostasis, and enhanced sensitivity to oxidative stress and inflammatory events, suggesting a novel unifying pathogenetic mechanism, and raising the possibility that CCM disease onset and severity are influenced by the presence of susceptibility and modifier genes. Consistently, genome-wide association studies (GWAS) in large and homogeneous cohorts of patients sharing the familial form of CCM disease and identical mutations in CCM genes have led to the discovery of distinct genetic modifiers of major disease severity phenotypes, such as development of numerous and large CCM lesions, and susceptibility to ICH. This review deals with the identification of genetic modifiers with a significant impact on inter-individual variability in CCM disease onset and severity, including highly polymorphic genes involved in oxidative stress, inflammatory and immune responses, such as cytochrome P450 monooxygenases (CYP), matrix metalloproteinases (MMP), and Toll-like receptors (TLR), pointing to their emerging prognostic value, and opening up new perspectives for risk stratification and personalized medicine strategies.

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.

A unique structure of care for neurological inpatients with significant palliative care (PC) needs was established in the Department of Neurology at the Charite-Universitatsmedizin Berlin in 2021: a specialized neuropalliative care (NPC) unit. After one year, we provide an overview of the concept and the patients' characteristics. Methods: We retrospectively analyzed the characteristics of patients treated in our NPC unit between February 2021-February 2022. Data were extracted from medical records and PC assessment including diagnosis, mode of admission and discharge, length of stay, and palliative symptoms. Data are presented as averages with a 95% confidence interval [lower limit; upper limit] or percentage (absolute number). Results: We included 143 patients (52% (75) female, 67.9 years [65.6; 70.2]). Patients were admitted from general wards (48%; 68), their homes (22%; 32), intensive care units (16%; 23) or emergency departments (14%; 20). The main diagnoses were tumors of the nervous system (39%; 56), neurodegenerative diseases (30%; 43), neurologic complications (13%; 19) and cerebrovascular diseases (12%; 17). Complaints most frequently rated as severely to overwhelmingly burdensome were motor- or fatigue-associated problems, problems communicating, dysphagia and pain. The average length of stay was 13.7 days [12.2; 15.2]. Forty-five percent (64) of patients were discharged without further PC, 17% (24) were referred to a hospice and 13% (18) were discharged with outpatient PC. Five percent (7) were referred to neurorehabilitation and 21% (30) of patients died. Conclusions: Our NPC unit is a new model of care for neurological patients with substantial PC needs especially within the structures of a highly specialized and individualized medicine.

Cerebrovascular disease is one of the leading causes of disability and death worldwide, and seeking a potential treatment is essential. Trilinolein (TriL) is a natural triacylglycerol presented in several plants. The effects of TriL on cerebrovascular diseases such as cerebral ischemia and carotid stenosis have never been studied. Accordingly, we investigated the protection of TriL on cerebral ischemia/reperfusion (I/R) and vascular smooth muscle cell (VSMC) migration in vivo and in vitro. The cerebral infarction area, the intima to media area (I/M ratio), and proliferating cell nuclear antigen (PCNA)-staining of the carotid artery were measured. Platelet-derived growth factor (PDGF)-BB-stimulated A7r5 cell migration and potential mechanisms of TriL were investigated by wound healing, transwell, and Western blotting. TriL (50, 100, and 200 mg/kg, p.o.) reduced: the cerebral infarction area; neurological deficit; TUNEL-positive apoptosis; intimal hyperplasia; and PCNA-positive cells in rodents. TriL (5, 10, and 20 µM) significantly inhibited PDGF-BB-stimulated A7r5 cell migration and reduced matrix metalloproteinase-2 (MMP-2), Ras, MEK, and p-ERK protein levels in PDGF-BB-stimulated A7r5 cells. TriL is protective in models of I/R-induced brain injury, carotid artery ligation-induced intimal hyperplasia, and VSMC migration both in vivo and in vitro. TriL could be potentially efficacious in preventing cerebral ischemia and cerebrovascular diseases.

Patients with intracranial artery stenosis show high incidence of stroke. Angiography reports contain rich but underutilized information that can enable the detection of cerebrovascular diseases. This study evaluated various natural language processing (NLP) techniques to accurately identify eleven intracranial artery stenosis from angiography reports. Three NLP models, including a rule-based model, a recurrent neural network (RNN), and a contextualized language model, XLNet, were developed and evaluated by internal–external cross-validation. In this study, angiography reports from two independent medical centers (9614 for training and internal validation testing and 315 as external validation) were assessed. The internal testing results showed that XLNet had the best performance, with a receiver operating characteristic curve (AUROC) ranging from 0.97 to 0.99 using eleven targeted arteries. The rule-based model attained an AUROC from 0.92 to 0.96, and the RNN long short-term memory model attained an AUROC from 0.95 to 0.97. The study showed the potential application of NLP techniques such as the XLNet model for the routine and automatic screening of patients with high risk of intracranial artery stenosis using angiography reports. However, the NLP models were investigated based on relatively small sample sizes with very different report writing styles and a prevalence of stenosis case distributions, revealing challenges for model generalization.

Objective: to analyze the diagnostic significance of clinical and phenomenological characteristics of affective disorders in patients with chronic somatic pathology.Patients and methods. The analysis included the results of a clinical evaluation of 131 patients with chronic somatic pathology, including 96 patients suffering from cardiovascular diseases and 35 patients with cerebral small vessel disease. Clinical assessment included Primary care evaluation of mental disorders (PRIME-MD) and Hamilton Depression Rating Scale.Results and discussion. Despite the significant frequency and transparent clinical symptoms, general practitioners diagnosed mental disorders in only 30% of patients with depression. We observed a higher prevalence of somatic rather than psychological complaints during the clinical survey. According to the screening using PRIME-MD, 74% of patients were diagnosed with mood disorders, anxiety, and somatoform disorders. We also noted their significant comorbidity with a predominance of a depression and anxiety combination (p < 0.001). Hypertensive patients had the highest depression prevalence (87%) and severity. Moderate depression was the most frequent diagnosis in the study participants, corresponding to major depressive disorder (61.5%).Conclusion. In general, the symptoms of anhedonia, depression, and anxiety were most pronounced in patients with affective disorders. The high prevalence of somatic symptoms complicates depression evaluation. It is possible to highlight depression and anhedonia as significant symptoms for the detection of depression in patients with somatic disorders.

Resumen: Introducción: El cannabis y sus análogos sintéticos corresponden actualmente a las sustancias ilícitas de mayor consumo a nivel mundial. Resultan múltiples las alteraciones con las cuales se ha relacionado su consumo, y dentro de estas se encuentra la enfermedad cerebrovascular (ECV) o ictus, cuya asociación con esta sustancia se ha fundamentado principalmente a través de la hipótesis de vasoconstricción transitoria, la cual explica una amplia proporción de los casos descritos. Sin embargo, los estudios epidemiológicos realizados no han desarrollado un análisis individual en los pacientes sin otros factores de riesgo cardiovascular, lo que puede limitar la estimación del riesgo que confiere por sí mismo el consumo de esta droga. Desarrollo: Se realizó una revisión sistemática de la literatura a través de Medline, EBSCOhost, EMBASE, Lilacs y Scielo hasta el 13 de mayo de 2016 considerando estudios de tipo «Caso clínico» que presentaran pacientes con diagnóstico de ECV o ataque isquémico transitorio e historia de consumo de cannabinoides sin otros factores de riesgo cardiovascular. Se utilizaron palabras clave como ictus; enfermedad cerebrovascular; cannabis; marihuana, entre otras. Finalmente, de las 566 referencias encontradas fueron seleccionados 18 casos clínicos. Conclusiones: Existe una amplia variedad de publicaciones de ictus asociado a consumo concomitante de cannabis en pacientes sin otros factores de riesgo, destacando una presentación a edad joven y una alta temporalidad, lo que, en concordancia con los estudios epidemiológicos y fisiopatológicos en esta área, ubica a esta sustancia como un potencial factor de riesgo para esta población. Abstract: Introduction: Cannabis and its synthetic analogues are currently the most widely consumed illicit substances worldwide. Multiple alterations have been linked to its use, including cerebrovascular disease (CVD) or stroke, whose association with the substance has been based mainly on the hypothesis of transient vasoconstriction, which explains a large proportion of the cases reported. However, epidemiological studies have not performed an individual analysis of patients without other cardiovascular risk factors, which may limit the estimation of the risk of stroke associated with cannabis use alone. Development: A systematic literature review was conducted through Medline, EBSCOhost, EMBASE, Lilacs, and Scielo to gather case reports published before 13 May 2016 presenting patients with a diagnosis of CVD or transient ischaemic attack, a history of cannabinoid use, and no other cardiovascular risk factors. Key words such as stroke, cerebrovascular disease, cannabis, and marijuana, among others, were used. A total of 18 case reports were selected from the 566 references found. Conclusions: There is a wide variety of reports of stroke associated with cannabis use in patients with no other risk factors. Noteworthy findings were presentation at young age and a strong temporal association, which place cannabis use as a potential risk factor for this population in line with the epidemiological and pathophysiological studies in this area.

Vascular diseases of the brain are one of the most important problems of modern neurology. Increasing prevalence, high mortality, deep disability in cerebral strokes determines the medical and social significance of this pathology. In Kyrgyzstan, the relevance is times greater due to high mortality and disability rates. According to the WHO, stroke is the second most common cause of death. Acute disorders of cerebral circulation reduce the duration of the upcoming life of more than half of patients who have suffered from it, and those who survived remain severely disabled, completely deprived of the ability to self-care. The article presents epidemiological indicators of cerebral strokes in residents of the city of Osh.

According to the World Health Organization (WHO), particulate matter (PM) contamination causes around 800,000 premature deaths per year, ranking 13th in the world in terms of mortality. However, several findings revealed that the correlation is much stronger and more complicated than previously believed. PM is an element of emissions comprised of very small, acidic, organic compounds, metals, and particulate soil or dust particles or fluid droplets. The most consistent air quality component linked to human illness is PM, which is categorized by size. PM is likely to develop cardiovascular and cerebrovascular disorders due to the mechanisms of inflammation, overt and indirect coagulation activation, and direct translocation to the systemic circulation. The evidence on the cardiovascular system that shows a PM effect is strong. Coronary incidence and mortality rates in populations prone to long-term PM toxicity were significantly higher. Short-term acute emissions increase coronary incidence rates subtly within days of the pollution peak. While some evidence and associated mechanisms show a smaller outcome, the findings for PM’s cortical disease symptoms are not as promising. Respiratory infections are aggravated by exposure to PM. More analysis is needed to clarify the effects of structure, chemistry, and PM for vulnerable groups. The existing research indicates that PM toxicity causes a minor but significant increase in human morbidity and mortality. Air conditioners and particulate matter filters reduced internal heating, and cooking combustion and smoking cessation will reduce indoor PM exposure. These fundamental improvements can be beneficial to patients with acute and chronic cardiovascular and respiratory symptoms. This article provides an overview of the effects of atmospheric airborne suspended particulate matter on population morbidity and mortality. This critical review concludes with public health recommendations based on a summary of the published literature’s findings.

Today, chronic cerebral ischemia (CCI) is the most common diagnosis in our country, both in neurological and general medical practice. The high frequency of comorbid conditions and diseases predisposing to the development of CCI, and the association with the risk of stroke and dementia, which increase patient disability, make CCI an urgent medical and social problem. Proper diagnosis of CCI allows the prescription of effective treatment, prevents the disease progression, and the development of strokes and dementia. The article deals with the treatment principles for elderly and senile patients with headache and CCI in outpatient practice. It discusses the causes of headache in CCI patients and its treatment methods. It also covers in depth the spectrum of therapeutic effects of Neurox ® (ethylmethylhydroxypyridine succinate) and Neupilept ® (citicoline) in this category of patients.

COVID-19 worsens the course of cerebrovascular diseases (CVD), including chronic cerebral ischaemia (CCI). The Actovegin drug, which has long been widely used in CCI treatment, has an antioxidant and endothelium protective effect. It makes sense to study the effect of Actovegin therapy on the clinical manifestations of CCI in patients with a recent experience of COVID-19.Objective: to evaluate Actovegin efficacy in the treatment of CCI in patients with a recent experience of COVID-19.Patients and methods. The study included 440 patients (234 female; 206 male) with a recent experience of COVID-19, suffering from CCI, their average age being 67.8 years (from 54 to 85 years). All patients were broken down into two groups of 220 people (the patients in Group 1 were administrated Actovegin, the ones in Group 2 – were not). All patients were followed up for 90 days; their condition was assessed by the severity of clinical manifestations of CCI, using special scales and questionnaires.Results and discussion. After 90 days of follow-up, the frequency of complaints of cognitive impairment, sleep disorder, dizziness, fatigue, emotional disorders, and headache in Group 1 was significantly lower than in Group 2 (pConclusion. The observational study demonstrated the efficacy of Actovegin in the treatment of main clinical manifestations of CCI in patients with recent COVID-19 experience.

Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke.

Acute spontaneous intracerebral hemorrhage (ICH) is the most severe stroke subtype, with a high risk of death, dependence, and dementia. Knowledge about the clinical profile and early outcomes of ICH patients with lobar versus deep subcortical brain topography remains limited. In this study, we investigated the effects of ICH topography on demographics, cerebrovascular risk factors, clinical characteristics, and early outcomes in a sample of 298 consecutive acute ICH patients (165 with lobar and 133 with subcortical hemorrhagic stroke) available in a single-center-based stroke registry over 24 years. The multiple logistic regression analysis shows that variables independently associated with lobar ICH were early seizures (OR 6.81, CI 95% 1.27–5.15), chronic liver disease (OR 4.55, 95% CI 1.03–20.15), hemianopia (OR 2.55, 95% CI 1.26–5.15), headaches (OR 1.90, 95% CI 1.90, 95% IC 1.06–3.41), alcohol abuse (>80 gr/day) (OR 0–10, 95% CI 0.02–0,53), hypertension (OR 0,41, 95% CI 0.23–0–70), sensory deficit (OR 0.43, 95% CI 0.25–0.75), and limb weakness (OR: 0.47, 95% CI 0.24–0.93). The in-hospital mortality was 26.7% for lobar and 16.5% for subcortical ICH. The study confirmed that the clinical spectrum, prognosis, and early mortality of patients with ICH depend on the site of bleeding, with a more severe early prognosis in lobar intracerebral hemorrhage.

Ischemic stroke seems to be one of the most serious neurologic complications in patients with COVID-19 infection. Herein, we report a series of 10 ischemic stroke patients with concomitant COVID-19 disease. Out of 10, 8 had large infarcts (3 massive middle cerebral artery, 2 basilar artery, 2 posterior cerebral artery, and 1 internal carotid artery infarct territory). Two had cardiogenic embolic stroke due to atrial fibrillation. Almost half of our patients did not have a vascular risk factor. Nine did not have fever and were diagnosed with COVID-19 upon admission for stroke. Stroke occurred in the first week of respiratory symptoms with moderate pulmonary involvement. Most Patients did not have hypoxia and did not establish respiratory failure or acute respiratory distress syndrome. The blood pressures were low and hemorrhagic transformation did not occur even after antiplatelet or anticoagulant therapy. Patients had markedly increased levels of lactate dehydrogenase, C-reactive protein, and D-dimer. Three patients died. It seems that ischemic strokes in COVID-19 patients tend to occur as large infarct and can be seen in patients with mild to moderate pulmonary involvement.

Purpose To assess whether an asymmetry exists in the prevalence of carotid artery intraplaque hemorrhage (IPH) between right- and left-sided arteries. Materials and methods The records of all patients with atherosclerotic carotid artery disease that underwent neck magnetic resonance angiography imaging with high-resolution plaque sequences between 2017 and 2020 at our institution were retrospectively reviewed. The prevalence of stenosis and IPH was determined for all patients and compared between the left and right carotid arteries of those with unilateral anterior circulation ischemic strokes. Multiple regression analysis was performed to determine potential independent associations of IPH laterality with ischemic strokes. Results A total of 368 patients were included overall and 241 were male (65.4%). There were a total of 125 asymptomatic patients and 211 patients with unilateral anterior circulation ischemic strokes. Of patients with ischemic strokes, 55.5% had left-sided strokes compared with 44.5% who had right-sided strokes ( p = 0.03). Patients with left-sided strokes had a higher prevalence of ipsilateral IPH than those with right-sided strokes (64.1% versus 36.2%, p Conclusions Left-sided plaques more frequently have IPH and may be more likely to result in ipsilateral ischemic strokes compared with right-sided plaques. The underlying mechanism of asymmetric distribution of IPH between right and left carotids remains unclear.

It is essential to know whether COVID-19 patients have a history of cerebrovascular disease, as it may be predictive of prognosis and useful for allocation of limited medical resources. This meta-analysis was performed to assess the incidence of cerebrovascular disease as a comorbidity in COVID-19 patients. The PubMed, Cochrane Library, Embase, CNKI, WFSD, and VIP databases were systematically searched. The pooled analysis of relevant data was conducted using RevMan 5.3 software. The primary outcome was incidence of cerebrovascular disease as a comorbidity. Forty-seven studies involving 16,143 COVID-19 patients were included in this analysis. The incidences of a history of cerebrovascular disease and hypertension in COVID-19 patients were estimated to be 3.0% (95% CI, 2.0%-4.0%; P

Purpose Dorsal arachnoid web (DAW) is a rare intradural abnormality which is associated with progressive myelopathy. Our objective was to review multi-modality imaging techniques demonstrating the scalpel sign appearance in evaluation of DAW. Methods We retrospectively reviewed various imaging modalities of patients found to have DAW at our institution during January 2015 to February 2020. Five patients underwent surgical decompression with pathological correlation. The remaining patients were presumptively diagnosed based on the characteristic finding of scalpel sign. Clinical data were evaluated and correlated to imaging findings. All imaging modalities demonstrated the characteristic scalpel sign. Results Sixteen patients (10 females, and six males) with multi-imaging modalities were evaluated. Their mean age was 52 year (range 23–74 years). Fifteen patients underwent conventional spine MRI. Further high-resolution MR imaging techniques, e.g. 3D T2 myelographic sequence, were utilized with two patients. MRI spine CSF flow study was performed to evaluate the flow dynamic across the arachnoid web in one patient. Eight patients were evaluated with CT myelogram. Syrinx formation was discovered in seven (44%) patients; five (71%) of them underwent surgical resection and decompression. Two patients underwent successful catheter-directed fenestration of the web with clinical improvement. We found a statically significant positive correlation between the degree of cord displacement and compression with syrinx formation (r = 0.55 and 0.65 with p-value of 0.03 and 0.009, respectively). Conclusion DAW has characteristic scalpel sign independent of imaging modality. Multi-modality imaging evaluation of DAW is helpful for evaluation and surgical planning.

Objectives: Evidences from either small series or spontaneous reporting are accumulating that SARS-CoV-2 involves the Nervous Systems. The aim of this study is to provide an extensive overview on the major neurological complications in a large cohort of COVID-19 patients. Methods: Retrospective, observational analysis on all COVID-19 patients admitted from February 23rd to April 30th, 2020 to ASST Papa Giovanni XXIII, Bergamo, Italy for whom a neurological consultation/neurophysiological assessment/neuroradiologic investigation was requested. Each identified neurologic complication was then classified into main neurologic categories. Results: Of 1760 COVID-19 patients, 137 presented neurologic manifestations that manifested after COVID-19 symptoms in 98 pts and was the presenting symptom in 39. Neurological manifestations were classified as: (a) cerebrovascular disease [53 pts (38.7%)] including 37 ischemic and 11 haemorrhagic strokes, 4 transient ischemic attacks, 1 cerebral venous thrombosis; (b) peripheral nervous system diseases [31 (22.6%)] including 17 Guillain–Barrè syndromes; (c) altered mental status [49 (35.8%)] including one necrotizing encephalitis and 2 cases with RT-PCR detection of SARS-Cov-2 RNA in CSF; (d) miscellaneous disorders, among whom 2 patients with myelopathy associated with Ab anti-SARS-CoV-2 in CSF. Patients with peripheral nervous system involvement had more frequently severe ARDS compared to patients with cerebrovascular disease (87.1% vs 42%; difference = 45.1% 95% CI 42.0–48.2; χ2= 14.306; p < 0.0002) and with altered mental status (87.1% vs 55.6%; difference = 31.5% 95% CI 27.5–37.5%; χ2= 7.055; p < 0.01). Conclusion: This study confirms that involvement of nervous system is common in SARS-CoV-2 infection and offers clinicians useful information for prevention and prompt identification in order to set the adequate therapeutic strategies.

Основными факторами риска развития цереброваскулярных заболеваний, так же как и возникновения когнитивных нарушений, являются артериальная гипертония, поражение церебральных артерий (атеросклероз, васкулит), сахарный диабет, гиперхолестеринемия, гипергомоцистеинемия, курение и наследственная отягощенность по сосудистым и нейродегенеративным заболеваниям. Большинство этих факторов поддаются контролю и требуют ранней профилактики и своевременной диагностики, а наличие нескольких факторов риска усиливает их неблагоприятное воздействие на когнитивные функции. В обзоре приводятся данные многочисленных исследований, в которых изучались особенности развития когнитивных нарушений на фоне цереброваскулярных заболеваний, и даются рекомендации по использованию препаратов, улучшающих мозговой кровоток и метаболизм, а также воздействующих на общие патогенетические механизмы повреждения головного мозга при патологии сосудов., High blood pressure, cerebral arteries damage (atherosclerosis, vasculitis), diabetes mellitus, hypercholesterolemia, hyperhomocysteinemia, smoking, and family history of vascular and neurodegenerative disorders are the main risk factors for cerebrovascular diseases, as well as cognitive impairment. Most of these risk factors are controllable and require early prevention measures and timely diagnosis, while simultaneous presence of multiple risk factors enhances their negative effects on cognitive functions. This review includes data from multiple studies focused on the features of the development of cognitive impairment in cerebrovascular diseases, and provides guidelines on the use of drugs that improve cerebral blood flow and metabolism, as well as influence the general pathogenic mechanisms of brain damage in vascular disorders.

Objective: Post-stroke epilepsy (PSE) is one of the most common causes of acquired epilepsy and accounts for about 10-15% of all newly diagnosed epilepsy cases. However, evidence about the clinical profile of antiseizure medications in the PSE setting is currently limited. Brivaracetam (BRV) is a rationally developed compound characterized by high-affinity binding to synaptic vesicle protein 2A. The aim of this study was to assess the 12-month effectiveness and tolerability of adjunctive BRV in patients with PSE treated in a real-world setting. Methods: This was a subgroup analysis of patients with PSE included in the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). The BRIVAFIRST was a 12-month retrospective, multicentre study including adult patients prescribed adjunctive BRV. Effectiveness outcomes included the rates of seizure response (≥50% reduction in baseline seizure frequency), seizure‐freedom, and treatment discontinuation. Safety and tolerability outcomes included the rate of treatment discontinuation due to adverse events (AEs) and the incidence of AEs. Results: Patients with PSE included in the BRIVAFIRST were 75 and had a median age of 57 (interquartile range, 42-66) years. The median daily doses of BRV at 3, 6, and 12 months from starting treatment were 100 (100-150) mg, 125 (100-200) mg and 100 (100-200) mg, respectively. At 12 months, 32 (42.7%) patients had a reduction in their baseline seizure frequency by at least 50%, and the seizure freedom rates was 26/75 (34.7%). During the 1-year study period, 10 (13.3%) patients discontinued BRV. The reasons of treatment withdrawal were insufficient efficacy in 6 (8.0%) patients and poor tolerability in 4 (5.3%) patients. Adverse events were reported by 13 (20.3%) patients and were rated as mild in 84.6% and moderate in 15.4% of cases. Significance: Adjunctive BRV was efficacious and generally well-tolerated when used in patients with PSE in clinical practice. Adjunctive BRV can be a suitable therapeutic option for patients with PSE.

Objective To describe cerebrovascular manifestations in patients hospitalized for treatment of severe COVID-19, highlighting the comorbidities observed, and those that may play a relevant role as risk factors for severe outcomes. Methods This case series retrospective analyzed, from June to November, 2020, ten patients admitted to the emergency department, with positive nasopharyngeal swab polymerase chain reaction assay for SARS-CoV-2, presenting with neurological symptoms and positive findings at brain imaging studies. Results In this sample, the clinical severity of the symptoms varied from mild to critical. Ischemic stroke was observed in four patients, hemorrhagic events occurred in five cases. Three patients evolved with large parenchymal hemorrhage, and one presented petechial bleeding foci. In one case, we observed subarachnoid hemorrhage associated with bilateral hypodensity in both globus pallidus. Typical posterior reversible encephalopathy syndrome findings were observed in one patient on brain computed tomography. Conclusion Patients with neurovascular complications related to COVID-19 had positive findings in brain imaging and neurological symptoms. The pathological entities observed drew attention to the neurological risk of patients with SARS-CoV-2 infection, including worse outcomes in individuals whose medical history includes clinical comorbidities, especially hypertension and obesity.

Цереброваскулярные заболевания являются одной из ведущих причин смертности во всем мире, но вопросы патогенетической терапии с учетом многофакторности сосудистых нарушений и разнообразия молекулярных патогенетических мишеней до конца не решены. Доступные лекарственные средства обеспечивают только частичное патогенетическое воздействие, поэтому монотерапия отдельными группами нейропротекторов часто является менее эффективной по сравнению с комбинацией препаратов. Перспективным считается использование комплексных лекарственных средств, содержащих в своем составе ≥2 компонентов с различным механизмом действия. Брейнмакс – это янтарно-кислый координационный комплекс, компоненты которого связаны между собой нековалентными связями, что обеспечивает лучшее взаимодействие с рецепторами и более выраженный фармакологический и терапевтический эффекты, подтвержденные в ряде клинических исследований., Cerebrovascular diseases are one of the leading causes of death worldwide, but the issues of pathogenetic therapy have not been fully resolved, taking into account the multifactorial nature of vascular diseases and variety of molecular pathogenetic targets. Available drugs provide only a partial pathogenetic effect, so monotherapy with individual groups of neuroprotectors is often less effective than a combination of drugs. The use of complex medicines containing two or more components with different mechanisms of action is considered promising. Brainmax is a succinic acid coordination complex, the components of which are interconnected by noncovalent bonds, providing better binding to the receptors and more pronounced pharmacological and therapeutic effects, confirmed by a number of clinical studies.

Лечение основных проявлений астенического синдрома (АС) является актуальной задачей в клинической практике врачей первичного звена. Было спланировано и проведено многоцентровое контролируемое рандомизированное клиническое исследование ТОНУС, целью которого явилась оценка эффективности и безопасности терапии Милдронатом у пациентов с АС на фоне различных соматических заболеваний, включая перенесенные инфекционные заболевания. В 2 параллельные ветви исследования ТОНУС было отобрано 4076 пациентов с АС. В ТОНУС-1 были включены пациенты без сопутствующей соматической патологии и рандомизированы в 2 группы – основную, в которой к терапии поливитаминами был добавлен Милдронат 500 мг/cут в течение 14 дней, и контрольную, в которой применяли комплекс витаминов в стандартной суточной дозе. В ТОНУС-2 были включены пациенты с сердечно-сосудистыми или цереброваскулярными заболеваниями, которым в основной группе был назначен Милдронат в дозе 1000 мг/cут в течение 42 дней в дополнение к базовой терапии основного заболевания, а в контрольной – только базовая терапия сердечно-сосудистых или цереброваскулярных заболеваний. В случае выявления связи симптомов астении с перенесенным инфекционным заболеванием пациентам ТОНУС-2 основной и контрольной групп к вышеописанной терапии были добавлены поливитамины. Эффективность терапии оценивалась по шкале оценки астении (MFI-20), таблицам Шульте и шкале общего клинического впечатления (CGI). К окончанию наблюдения во всех группах исследования ТОНУС было отмечено улучшение состояния пациентов по сравнению с 1-м визитом. Однако клинически значимая редукция астенических симптомов, оцененная по шкале MFI-20, была отмечена только в группах пациентов, получавших Милдронат, причем как в ветви ТОНУС-1, так и в ветви ТОНУС-2. В группах контроля достоверное снижение количества баллов по шкале MFI-20 в основном наблюдалось только к 3-му визиту и было почти в 3 раза менее выраженным в сравнении с основными группами. Во всех группах пациентов, получавших Милдронат, было отмечено достоверное улучшение характеристик внимания и работоспособности, определенное по таблицам Шульте, а для пациентов с сердечно-сосудистыми или цереброваскулярными заболеваниями, перенесших инфекционное заболевание, было дополнительно выявлено достоверное улучшение показателей психической устойчивости (р < 0,011) и врабатываемости (р < 0,018). В исследовании ТОНУС во всех группах пациентов, получавших Милдронат, отмечена значимая положительная динамика и регресс основных проявлений АС в сравнении с группами контроля. При этом была отмечена низкая частота нежелательных явлений, связанных с приемом препарата Милдронат, не повлекших прекращения терапии; серьезных побочных эффектов ни в одной из групп зафиксировано не было., Treatment of the main symptoms of chronic fatigue syndrome (CFS) presents a challenging task in primary care clinical practice. TONUS, a multicenter randomized controlled clinical trial, was designed and conducted. Its aim was to evaluate the efficacy and safety of Mildronate therapy in patients with CFS occurring in various somatic diseases, including post-infectious CFS. 4076 patients with CFS were selected for two parallel subgroups of the TONUS trial. TONUS-1 included patients without any somatic comorbidities who were then randomly assigned to two groups – the main group, in which Mildronate 500 mg daily was added to multivitamin therapy for 14 days, and the control group, where only multivitamin therapy was used in a defined daily dose. TONUS-2 included patients with cardiovascular or cerebrovascular diseases who were treated with Mildronate 1000 mg daily for 42 days in addition to the basic therapy for the underlying medical condition in the main group, and only basic therapy for cardiovascular or cerebrovascular diseases in the control group. If a connection between symptoms of asthenia and previous infectious disease had been established, multivitamins were added to the above-mentioned therapy for TONUS-2 patients of the main and control groups. The efficacy of therapy was evaluated using Multidimensional Fatigue Inventory (MFI-20), Schulte tables, and the Clinical Global Impression (CGI) scale. At the end of the observation period, an improvement in the patients’ condition relative to the baseline visit was detected in all groups of the TONUS study. However, a clinically significant reduction in asthenic symptoms measured with the MFI-20 scale was observed only in groups treated with Mildronate, both in the TONUS-1 and in the TONUS-2 subgroups. In the control groups, a significant decrease in the MFI-20 score was mainly observed only at the third visit, and was almost three times lower than in the main groups. In patients treated with Mildronate, we observed a significant improvement in attention and performance evaluated with the Schulte tables, and for patients with cardiovascular or cerebrovascular diseases with a history of an infectious disease, a significant improvement in mental stability (p < 0.011) and workability (p < 0.018) was also noted. In the TONUS trial, in all patient groups treated with Mildronate, a significant positive dynamic and regression of the main manifestations of CFS were observed in comparison with the control groups. At the same time, low incidence of adverse events associated with Mildronate therapy was noted, which did not result in therapy discontinuation. No serious adverse effects were observed in any of the groups.

В 2019 г. человечество столкнулось с новой коронавирусной инфекцией, которая в итоге приобрела черты пандемии. Коронавирус, первично вызывающий преимущественно респираторную инфекцию, способен поражать в том числе нервную систему. Неврологические симптомы инфекционного заболевания представлены широким спектром клинических проявлений – от аносмии и агевзии до инфаркта мозга и когнитивных нарушений. Среди основных механизмов нарушения функций нервной системы выделяют прямое проникновение вируса в клетки и воспалительно-опосредованное поражение. Для понимания связанного с SARS-CoV-2 повреждения нервной системы необходимы повышение осведомленности о потенциальных механизмах нейротропности коронавируса, дальнейшее изучение соответствующей патофизиологии и анализ эффективности различных способов лечения., In 2019 the humanity was faced with new coronavirus infection that finally became a pandemic. Coronavirus, which primarily causes a respiratory infection, can also affect the nervous system. The neurological symptoms of this infectious disease are represented by a wide range of clinical manifestations, varying from anosmia and ageusia to stroke and cognitive impairments. The crucial mechanisms of nervous system dysfunction include direct viral entry into cells and inflammatory-mediated injury. It is necessary to improve the awareness about potential mechanisms of coronavirus neurotropicity, perform further investigation of corresponding pathophysiology, and analyze the efficacy of different treatment options to understand the nervous system damage associated with SARS-CoV-2.

В статье представлены результаты отечественного клинического исследования ЭКВИЛИБРИСТ, целью которого являлась оценка клинического профиля действия, эффективности и безопасности применения препарата Брейнмакс в комплексном лечении пациентов с цереброваскулярными заболеваниями (ЦВЗ). В исследование было включено 60 пациентов с дисциркуляторной энцефалопатией (ДЭ), которых разделили на 2 группы по критерию наличия или отсутствия вестибулоатактических расстройств. Все пациенты наряду с базовой терапией принимали Брейнмакс по 1 капсуле 2 раза в сутки в течение 1,5 мес. Длительность периода наблюдения составляла 3 мес. Анализ результатов нейровизуализации, проведенной в группах, позволил установить, что общая выраженность цереброваскулярной патологии по данным магнитно-резонансной томографии достоверно коррелировала с тяжестью когнитивных и постуральных расстройств у пациентов с ДЭ. Применение препарата Брейнмакс позволило значимо улучшить когнитивные функции и снизить выраженность статодинамических нарушений у пациентов с ДЭ через 2 мес от начала лечения. Кроме того, применение препарата Брейнмакс оказало положительное влияние на купирование тревожного синдрома, проявлений астении, дневной сонливости. Показано, что терапия препаратом Брейнмакс характеризуется высоким профилем безопасности и хорошей переносимостью. По результатам исследования препарат Брейнмакс рекомендован для широкого клинического применения у пациентов с ЦВЗ., The article represents the results of Russian clinical study EQUILIBRIST aimed at assessing the clinical action profile, efficacy, and safety of Brainmax drug application in a complex treatment of patients with cerebrovascular diseases (CVDs). The research involved 60 patients with small vessel disease (SVD) divided into 2 groups depending on the presence or absence of vestibulo-atactic disorders. All patients administered Brainmax at a dose of 1 capsule twice daily for 1.5 months along with the background therapy. The duration of follow-up period was 3 months. According to the results of neurovisualization in groups, it was found that the overall degree of cerebrovascular pathology referring to magnetic resonance imaging data statistically correlated with the severity of cognitive and postural disorders in SVD patients. The application of Brainmax allowed significantly improving the cognitive abilities and decreasing the severity of static and dynamic disorders in SVD patients after 2 months from treatment initiation. Furthermore, the application of Brainmax demonstrated a positive influence on the relief of anxiety, asthenia, and daytime drowsiness. It was shown that treatment with Brainmax was characterized by high safety profile and favorable tolerability. Using the study results, Brainmax was recommended for wide clinical application in CVD patients.

Background White-matter lesions (WMLs) are frequently found in magnetic resonance imaging (MRi), and the WML load tends to be higher in patients affected by cervical internal carotid artery (cICA) stenosis. Purpose This study aimed to investigate whether and how WMLs influence cerebral networking in patients with asymptomatic cICA stenosis eligible for carotid endarterectomy (CEA) by exploiting the connectometry technique. Methods The study was designed as a cross-sectional exploratory investigation, and 28 patients with cICA stenosis eligible for CEA were enrolled. All patients received an MRI scan, including a T1-weighted, a FLAIR and a diffusion-weighted (DW) sequence. The T1 and FLAIR sequences were analysed for quantification of WML burden (WMLB) and total number of WMLs (TNWMLs). The DW data were reconstructed in the MNI space using q-space diffeomorphic reconstruction, and were grouped to create a connectometry database. The connectometry analysis evaluated the influence of both the WMLB and TNWMLs to local connectivity in a multiple regression model that included age, WMLB and TNWMLs, adopting three different T-score thresholds (1, 2 and 3). A p-value corrected for false discovery rate of Results The connectometry analysis identified several white-matter bundles negatively correlated with WMLB; no statistically significant correlation was found for TNWMLs. Conclusion Results of our study suggest that WMLs influence brain connectivity measured by the connectometry technique in patients with cICA stenosis eligible for CEA. Further studies are warranted to understand the role of WMLs better as a marker of disease in patients with cICA stenosis.

Background Though flow diverter is a safe and efficient modality, some patients can experience delayed aneurysmal rupture. The mechanism of delayed rupture is still obscure to us. Methods We performed a systematic search in the PubMed database for patients with delayed rupture of intracranial aneurysms after flow diverter placement. Results A total of 36 articles reporting on 60 patients were included in the final analysis. Of the 49 patients with description of presenting symptoms, six (12.2%) patients were incidentally diagnosed, 39 (87.8%) patients were admitted for aneurysmal rupture or mass effect. Multiple flow diverters were used in 38.3% (18/47) of the patients. Coil assistance was applied in 13.0% (7/54) of the patients. Delayed aneurysmal rupture led to intracranial hemorrhage or carotid–cavernous sinus fistula (CCF) in 76.8% (43/56) and 23.2% (13/56) of the patients, respectively. Of the 55 patients with description of outcome, 14 (25.5%) patients achieved good recovery, one (1.8%) patient was severely disabled, 40 (72.7%) patients died. All of the patients in the CCF group survived and experienced good recovery. Conclusion Increased intra-aneurysmal pressure, destabilization of the aneurysm wall by intra-aneurysmal thrombus, persistent residual intra-aneurysmal flow, characteristics of the specific aneurysm, and mechanical injury by the flow diverter might conjointly contribute to the final delayed rupture. There has been no established preventive measure to decrease the incidence of delayed rupture yet. The treatment and outcome depend on the presentation of delayed rupture. Patients presenting with aneurysm-related intracranial hemorrhage have a dismal outcome. Those presenting with CCFs usually have a satisfactory recovery.

Background and purpose Low-profile self-expandable stents have increased the number of intracranial aneurysms treated by endovascular means. The new low-profile visible intraluminal support device LVIS EVO (Microvention), the successor of LVIS Jr, is a self-expandable and retrievable microstent system, designed for implantation into intracranial arteries with a diameter up to 2.0 mm. In this retrospective study we aimed to elucidate the technical feasibility and clinical safety of the novel LVIS EVO stent for stent-assisted coil embolisation of intracranial aneurysms. Materials and methods A single centre technical report of the first six consecutive cases of stent-assisted coil embolisation with the novel LVIS EVO stent for the treatment of unruptured or recanalised intracranial aneurysms. Records were made of basic demographics, aneurysmal characteristics, device properties and related technical details, adverse events, clinical outcomes and occlusion rates on available radiological follow-up. Results Six LVIS EVO devices were successfully implanted in all subjects to treat a total number of six intracranial aneurysms. No device-related intraprocedural complications were seen. At early clinical follow-up six out of six (100%) patients had a modified Ranking score of 0–1. Early angiographic and cross-sectional radiological follow-up, available in five out of six (83.3%) of the patients confirmed unchanged aneurysmal occlusion rates. A minor, transitory neurological deficit was recorded in one of the six (16.6%) patients. Mortality was 0%. Conclusions Preliminary experience in this subset of our patients confirms a notably improved technical behaviour of the novel LVIS EVO stent system when compared to its ancestor LVIS Jr. The enhanced visibility of the stent and the refined delivery/retrieval capabilities of the stent further increase the safety margins of the devices profile, especially in cases of tortuous anatomy.

Objective The conventional arteriovenous malformation (AVM) Onyx embolization technique is the extrusion Onyx injection technique, with blood-flow control after a certain distance casting through the head end of the microcatheter. This method has elevated periprocedural AVM bleeding complications. In this study, the authors reported safety and efficacy of an updated ante-grade drifting Onyx injection for plexiform AVM embolization. Methods Between January 2016 and December 2018, 101 consecutive patients with plexiform AVMs were treated with ante-grade drifting Onyx injection. The patients’ clinical status was classified using the modified Rankin Scale (mRS). To measure associations, logistic univariate or multivariate regression analyses were used. Results Complete AVM obliteration was achieved in 51.2% (52/101) of patients. Two (2/101, 2.0%) arterial perforations occurred without causing neurological deficits. In univariate and multivariate logistic regression analyses, younger patient age (odds ratio (OR) = 1.06, 95% confidence interval (CI) 1.01–1.12, p = 0.014), haemorrhagic presentation at admission (OR = 7.14, 95% CI 1.52–33.33, p = 0.013) and low Spetzler–Martin grade (OR = 10.00, 95% CI 3.45–25.00, p Conclusions With ante-grade drifting Onyx injection, it was possible to prevent serious bleeding complications and elevated complete embolization rate in plexiform AVMs. Younger patient age, haemorrhagic presentation at admission and low AVM Spetzler–Martin grade were significantly correlated with complete obliteration. Although there is not enough statistical power to show that the pretreatment mRS and the arterial perforation complication have a significant correlation, but its OR value is large, and there may be more data in the future to obtain further conclusion.

Central nervous system involvement in severe acute respiratory syndrome caused by coronavirus disease 2019 (COVID-19) has increasingly been recognised in the literature, and possible mechanisms of neuroinvasion, neurotropism and neurovirulence have been described. Neurological signs have been described in 84% of COVID-19 intensive care unit patients, and haemostatic abnormalities in such patients may play an important role, with a broad spectrum of neuroimaging findings. This report describes the magnetic resonance imaging neurovascular findings in an acutely ill patient with COVID-19, including perfusion abnormalities depicted in the arterial spin labelling technique.

In acute ischemic stroke (AIS) patients, eligibility for endovascular intervention is commonly determined through computed tomography perfusion (CTP) analysis by quantifying ischemic tissue using perfusion parameter thresholds. However, thresholds are not uniform across all analysis methods due to dependencies on patient demographics and computational algorithms. This study aimed to investigate optimal perfusion thresholds for quantifying infarct and penumbra volumes using two post-processing CTP algorithms: Vitrea Bayesian and singular value decomposition plus (SVD+). We utilized 107 AIS patients (67 non-intervention patients and 40 successful reperfusion of thrombolysis in cerebral infarction (2b/3) patients). Infarct volumes were predicted for both post-processing algorithms through contralateral hemisphere comparisons using absolute time-to-peak (TTP) and relative regional cerebral blood volume (rCBV) thresholds ranging from +2.8 seconds to +9.3 seconds and –0.23 to –0.56 respectively. Optimal thresholds were determined by minimizing differences between predicted CTP and 24-hour fluid-attenuation inversion recovery magnetic resonance imaging infarct. Optimal thresholds were tested on 60 validation patients (30 intervention and 30 non-intervention) and compared using RAPID CTP software. Among the 67 non-intervention and 40 intervention patients, the following optimal thresholds were determined: intervention Bayesian: TTP = +4.8 seconds, rCBV = –0.29; intervention SVD+: TTP = +5.8 seconds, rCBV = –0.29; non-intervention Bayesian: TTP = +5.3 seconds, rCBV = –0.32; non-intervention SVD+: TTP = +6.3 seconds, rCBV = –0.26. When comparing SVD+ and Bayesian post-processing algorithms, optimal thresholds for TTP were significantly different for intervention and non-intervention patients. rCBV optimal thresholds were equal for intervention patients and significantly different for non-intervention patients. Comparison with commercially utilized software indicated similar performance.

Introduction Endovascular treatment of high-flow vascular lesions with onyx may be very dangerous due to premature occlusion of the vein resulting from high flow-induced migration of this embolic substance without occlusion of the feeding vessels and the nidus. It is also dangerous because of the risk of occlusion of the normal vessels around the lesion. Inducing temporary cardiac arrest using adenosine may be helpful in limiting and minimizing these risks. However anaesthetic management of this procedure in children suffering from high-flow vascular lesions is difficult and challenging. Methods We report three paediatric patients with high-flow cerebrospinal vascular lesions that underwent endovascular treatment under general anaesthesia and temporary cardiac arrest with adenosine. Adenosine was administered in escalating doses to induce a few seconds of cardiac standstill and the onyx injection was synchronized with the onset of adenosine-induced cardiac standstill, the fistula being occluded by onyx. Results There were no complications in peri-procedural treatment in all three cases. Post-embolization angiography revealed complete obliteration of the lesion, and the patients’ neurological status progressively improved at follow-up. Conclusion Adenosine-induced temporary cardiac standstill was successfully used to facilitate safe and controlled endovascular onyx embolization of high-flow central nervous system vascular lesions.

Objective Acute hemorrhagic cerebral artery dissection may show a subtle stenosis and bulge on an angiogram, for which diagnosis and treatment are difficult. This report describes seven cases of acute hemorrhagic cerebral artery dissection treated by endovascular techniques. Patients and methods From January 2018 to April 2019, seven patients (22–76 years old) were diagnosed with subarachnoid hemorrhage caused by cerebral artery dissection. Six patients were treated by low-profile visualized intraluminal support stent-assisted coiling and there was a sacrifice of the posterior cerebral artery in one patient. Cerebral angiography results were obtained immediately after intervention and at follow-up. Clinical outcome was evaluated by a modified Rankin Scale score. Results Four dissections were angiographic changes of subtle stenosis and small bulges; three were apparent angiographic changes of stenosis or fusiform morphologies. All seven aneurysms were completely obliterated, a low-profile visualized intraluminal support stent was used in six patients and coil occlusion of the parent artery in one patient. Complications occurred in two cases of proximal posterior cerebral artery dissection. One bleeding complication was observed intra-procedure and one ischemic complication was observed after stent-assisted coiling. The angiographic and clinical follow-up was obtained at 3–8 months in five patients. Good recovery was achieved for six patients (modified Rankin Score 0); one patient who presented Weber syndrome caused by ischemic complication had a modified Rankin Score of two at 8 months follow-up. Conclusion Hemorrhagic cerebral artery dissection may show subtle stenosis, small bulges or fusiform morphologies on angiograms. Treatment of proximal posterior cerebral artery dissection is challenging. Endovascular reconstruction with a low-profile visualized intraluminal support stent was effective depending on the angiographic morphology.

Several recent randomised control trials have shown adjunctive endovascular mechanical thrombectomy to be an effective and safe treatment for acute stroke superior to medical therapy alone. Despite this, questions remain over certain groups of patients that have been excluded from these studies, such as pregnant women. We believe this is a topic of increasing clinical significance with minimal data in the literature. In this article we discuss stroke in pregnancy and highlight the important technical considerations of endovascular mechanical thrombectomy, including minimising radiation exposure to the mother and fetus.

MicroRNAs have been implicated as critical regulatory molecules in many cerebrovascular diseases. Recent studies demonstrated miR-22 might provide a potential neuroprotective effect. However, the neuroprotective effect of miR-22 in ischemia/reperfusion (I/R) injury has not been thoroughly elucidated. In this study, the PC12 cells were subjected to 4 h oxygen and glucose deprivation (I) and 24 h reoxygenation (R). The PC12 cells were pre-transfected with miR-22 or anti-miR-22 or siRNA-mediated downregulation of p53-upregulated-modulator-of-apoptosis (PUMA)(PUMA siRNA) or their controls at 24 h prior to exposure to I/R. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Western blot were employed to analyze mRNA and protein expression. PI and Annexin V assays and terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) assay were used to quantify the rate of apoptosis. We found that miR-22 expression was significantly downregulated in the PC12 cells subjected to I/R. Loss of function of miR-22 increased PC12 apoptosis after I/R, and overexpression of miR-22 decreases PC12 apoptosis after I/R. PUMA protein was upregulated in the I/R group as compared with the sham group. The increased PUMA protein expression and apoptosis induced by I/R was reversed by transfection with PUMA siRNA. We concluded that I/R enhanced apoptosis and PUMA expression in PC12 cells via downregulation of miR-22. Enhanced miR-22 expression reversed both PUMA expression and apoptosis induced by I/R in PC12 cells. miR-22/PUMA axis has important implications for their clinical applications., Graphical Abstract

Darii I. V. Structural changes of the vascular wall in patients with chronic cerebral ischemia depending on the presence of the metabolic syndrome and the concentration of the vasculoendothelial growth factor. Journal of Education, Health and Sport. 2019;9(12):275-281. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2019.09.12.028 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2019.09.12.028 http://dx.doi.org/10.5281/zenodo.3832398 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 16.12.2019. Revised: 23.12.2019. Accepted: 28.12.2019. STRUCTURAL CHANGES OF THE VASCULAR WALL IN PATIENTS WITH CHRONIC CEREBRAL ISCHEMIA DEPENDING ON THE PRESENCE OF THE METABOLIC SYNDROME AND THE CONCENTRATION OF THE VASCULOENDOTHELIAL GROWTH FACTOR I. V. Darii State Institution "Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine Abstract Background. Chronic inflammation and enhancement of free-radical oxidation follow metabolic syndrome. Nowadays, much attention is paid to vasculoendothelial growth factor, one of the most important factors of endothelial dysfunction. There is an evidence of its possible involvement in degenerative and atherosclerotic vascular processes. The objective: to determine changes in the structure of the vascular wall in patients with chronic cerebral ischemia, depending on the presence of metabolic syndrome and the concentration of vasculoendothelial growth factor. Materials and methods. In a prospective study 49 patients with chronic cerebral ischemia were examined. The patients were randomized into 2 groups: the main group consisted of 27 patients with chronic cerebral ischemia with metabolic syndrome. There were 22 patients with chronic cerebral ischemia without metabolic syndrome in the comparison group. The severity of atherosclerotic lesions of the arteries of the head and neck was investigated taking into account the structural changes of the vascular wall, the presence of intraluminal formations, as well as their ultrasonic characteristics. In the serum of the studied patients the concentration of vasculoendothelial growth factor was measured by enzyme-linked immunosorbent assay. Results. At the concentration of vasculoendothelial growth factor >300 pg/l, differentiation into layers of the intima-media complex was more often lost in patients of the main group than in patients of the comparison group: 35.7% and 0% of the examined, respectively. At this biomarker concentration, excess thickness of the intima-media complex of the common carotids (≥0.9 mm) was observed in 36.4% of patients in the main group versus 13.4% in patients in the comparison group. Also at a concentration of vasculoendothelial growth factor >300 pg/l in patients of the main group the presence of plaques was observed in 33.3%, while in patients in the comparison group plaques were not observed. Conclusions. Early and late manifestations of atherosclerotic structural vascular lesions in chronic cerebral ischemia with metabolic syndrome may have another quantitative biomarker of vascular endothelial damage. In these patients, the manifestations of the atherosclerotic process at all stages occur at a concentration of vasculoendothelial growth factor >300 pg/l, while atherosclerotic changes in patients without metabolic syndrome are minimal at this concentration. Key words: chronic cerebral ischemia; cerebrovascular diseases; metabolic syndrome; ultrasound; vasculoendothelial growth factor; intima-media complex; atherosclerotic plaques.

Objectives Patients with complex cerebral aneurysms can now be treated intravascularly with the help of flow-diverting stents. The primary purpose of this article is to document the clinical and angiographic outcomes in 80 patients who were treated with the Pipeline flow-diverting stent (PFS; Medtronic, Dublin, Ireland) and the obliteration mechanism was discussed. Patients and methods Between October 2015 and October 2019, 80 patients with 90 complex (undefined neck, large/giant, blood blister–like, and recurrent side-wall) cerebral aneurysms treated with the PFS were retrospectively reviewed. Forty-five patients were women and 35 were men, with a mean age of 52 years. Large or giant aneurysms were defined as 10 mm or larger and small aneurysms were defined as less than 10 mm at the largest diameter measured on angiogram. Results Forty-one aneurysms (45.6%) were large or giant, 41 (45.6%) were small, four (4.4%) were recurrent side-wall aneurysms and four (4.4%) were blood blister–like aneurysms. In total, 87 PFSs were placed in 80 patients with 90 aneurysms. In six patients, coexisting proximal stenosis of parent artery was also covered with PFS without balloon angioplasty. Adjunct coils were placed in 31 aneurysms (34%). One patient died of intracerebral hematoma after thrombolysis. There was one intrastent occlusion at six-month follow-up without any symptoms. The morbidity and the mortality rate is 0% and 1.3% (95% confidence interval (CI), 0%–3.7%). Control angiography was available in 74 (92.5%) patients with 83 aneurysms, and the aneurysm occlusion rate was 98.8% (95% CI, 96.5%–100%) in 6 to 12 months. Conclusion For wide-necked saccular, large/giant, blood blister–like aneurysms and recurrent side-wall aneurysms, PFS is a valid and safe treatment option.

Background Flow diverters (FDs) with flared ends (FEs) or straight ends (SEs) are used either alone or when overlapped to treat complex intracranial aneurysms. We evaluated filament inadequate wall apposition (IWA) of the FEs and SEs of FDs in vivo. Methods A total of 24 FDs with FEs and SEs were placed in an overlapping manner in the abdominal aortae of six rabbits (two sets per rabbit). Digital subtraction angiography was performed immediately after stent insertion and three months later. The anatomical and histopathological aortic features at FEs and SEs were evaluated. Results Angiography revealed no significant difference in terms of changes in arterial diameter between the FE and SE groups ( p = 0.877). Gross anatomical evaluation revealed IWA of the different ends of FDs but no thrombi or bleeding, showing that the metallic filaments were not in touch with the vessel wall and nor had they penetrated the vessel wall. The filaments’ IWA rates of FEs and SEs were 8.33% and 8.85%, respectively. The IWA rate at overlapping ends was lower than that at non-overlapping ends. The maximum neo-intimal thickness at FEs was greater than that at SEs (149.4 ± 48.9 and 98.6 ± 26.6 µm, respectively; p Conclusions Both the FEs and SEs of FDs can exhibit IMA. IWA events are reduced at the overlapped regions. On pathological evaluation, FEs increased neo-intimal thicknesses more than SEs did, but hyperplasia was minimal on angiography.

Objective To assess the usefulness of diffusion tensor imaging and its fractional anisotropy map along with conventional T2-weighted imaging in evaluating the anisotropic water diffusion variations of annulus fibres involved in herniation disc pathology. Materials and methods Seventy-five patients with previous medical ethics committee approval and informed consent experiencing low back pain were selected for this prospective randomised blinded trial. Lumbar disc fractional anisotropy maps were obtained acquiring diffusion tensor sequences on a 3T machine. The matrix of nucleus pulposus and structures of annulus fibres were analysed using fractional anisotropy textural features to highlight any presence of lumbar disc herniation. Observer variability and reliability between two neuroradiologists were evaluated. The χ2 test, two-tailed t test and linear regression analysis were used to focus differences in patients’ demographic data and magnetic resonance imaging findings. Results Annular fissures with extrusions were identified using diffusion tensor imaging in 10 out of 17 discs (study group) previously assessed as bulging discs using conventional magnetic resonance imaging. Eighteen extrusions out of 39 (study group) disc levels were identified on diffusion tensor imaging compared to eight extrusions highlighted on T2-weighted imaging ( P 0.01). Conclusions The addition of diffusion tensor imaging sequences and fractional anisotropy mapping to a conventional magnetic resonance imaging protocol could be useful in detecting annular fissures and lumbar disc herniation.

Diagonal earlobe crease (DELC) or Frank's sign is a diagonal crease in the earlobe that extends diagonally from the tragus to the edge of the auricle with an angle of approximately 45°. Although its presence increases with advancing age, several studies have shown an independent association between DELC and cardiovascular diseases as well as peripheral vascular diseases. DELC has also been demonstrated to increase the risk of cerebrovascular events (mostly ischaemic stroke), probably through atherosclerotic mechanisms. A systematic literature search was conducted using PubMed and Embase to identify studies investigating the relationship between DELC and the occurrence of cerebrovascular diseases. We identified 5 articles (1469 subjects included). Since the presence of DELC can be easily evaluated, patients with the Frank's sign should undergo a diagnostic workup to detect vascular risk factors and implement preventative therapies.

Nurses play an important role in healthcare, and the Nursing Outcomes Classification is a key tool for the standardization of care. This study aims to validate the nursing outcome “Neurological Status” for patients with cerebrovascular diseases. A methodological study was performed in four phases. In Phase 1, the relevance of the indicators was evaluated by seven specialists and the modified kappa coefficient and content validity index were calculated. In Phase 2, conceptual and operational definitions were formulated. In addition, their content was validated with a focus group in Phase 3. In Phase 4, the results were applied in clinical practice and convergence with the National Institute of Health Stroke Scale was verified. The reliability was measured by Cronbach’s alpha. Of the 22 initial indicators, 6 were excluded. The focus group suggested changes in the definitions and the exclusion of two indicators. In Phase 4, only 13 indicators were validated due to the impossibility of measuring intracranial pressure. A strong correlation between the two scales and agreement among all the indicators were observed. Following the specialists’ review, the nursing outcome was reliable and clinically validated with 13 indicators: consciousness, orientation, language, central motor control, cranial sensory and motor function, spinal sensory and motor function, body temperature, blood pressure, heart rate, eye movement pattern, pupil size, pupil reactivity, and breathing pattern.

Objective: The Chernobyl nuclear power plant (ChNPP) disaster that happened in Ukraine on the 26th of April 1986 still represents the most severe nuclear accident in human history. Its consequences, especially those involving mental health are increasingly emerging as long-term detrimental effects. Therefore, the aim of the present paper was to review the results of some of authors’ studies and their personal reflections on this topic. Method: The authors selected and commented on the findings mainly derived from their contributions on the prevalence of long-term psychopathological symptoms and neuropsychiatric disorders in diferent groups of exposed and non exposed individuals, including the workers at the NPP the so-called liquidators (CUWs), the most exposed group, evacuees and people living in more or less contaminated areas. Results: The main findings derived from a series of studies carried out by the authors throughout the following decades after the disaster indicate the high prevalence of cerebrovascular diseases, organic mental and depressive disorders, cognitive impairment and even dementia that increase with the irradiation dose mainly amongst the liquidators. The organic disorders are probably related to a peculiar effect of radiation on left, dominant brain hemisphere. Interestingly, recent studies revealed abnormalities of the serotonin transporter and other genes disorders possibly at the basis of depression of exposed individuals. Conclusions: The high prevalence of neuropsychiatric disorders amongst irradiated subjects following the ChNPP disaster highlights the impact of radiation exposure on the lifelong onset of neuropsychiatric disorders, for too long neglected by international agencies. Such findings require to be deepened in the future possibly within the frame of the so-called “ecological psychiatry”.

Emotional distress (depression, anxiety, and PTS) and unhealthy lifestyle factors (e.g., smoking, alcohol consumption, poor diet, limited physical activity, medication adherence) are common in hemorrhagic stroke (HS) survivors and may increase risk for recurrence, morbidity, and mortality. Emotional distress and unhealthy lifestyle factors tend to be interdependent between survivors and their informal caregivers (e.g., family and friends who provide unpaid care; together called dyads), such that one partner’s lifestyle and coping behaviors influence the other’s behaviors, yet no research has closely examined this relationship in HS dyads over time. We will conduct a mixed methods study to quantitatively and qualitatively understand the longitudinal relationship between emotional distress and lifestyle factors across time in this population (HS dyads) to identify treatment targets to prevent emotional distress chronicity and stroke recurrence. In aim 1, we will assess emotional distress (i.e., depression, anxiety, and PTS) and lifestyle factors (smoking, alcohol consumption, poor diet, limited physical activity medication adherence/blood pressure control) in dyads of survivors of HS and their caregivers (N = 80), at three separate time points (hospitalization in the Neuro-ICU, 1, and 3 months later). We hypothesize that 1) lifestyle factors and emotional distress will be interrelated within and across time for both survivors and caregivers, and 2) lifestyle factors and emotional distress will be interdependent between survivors and caregivers. We also aim to explore the nuanced interplay between lifestyle factors and emotional distress and gain in depth information on barriers and facilitators for a dyadic intervention to optimize lifestyle behaviors and emotional functioning in HS dyads. Eligible patients will be adults who have a caregiver also willing to participate. Patients will be referred for study participation by the nursing team who will ensure that they are cognitively able to meaningfully participate. Multilevel dyadic modeling (i.e., actor-partner interdependence model; APIM) with distinguishable dyads will be used to determine influences of these factors onto each other over time. In Aim 2, we will conduct live video qualitative dyadic interviews (N = 20 or until theme saturation) at all time points from the same participants with and without emotional distress and at least one lifestyle risk factor, to understand the nuanced relationships between emotional distress and lifestyle behaviors, and barriers and facilitators to engagement in a skills-based psychosocial intervention. Interviews will be analyzed using inductive and deductive approaches. The present study is currently ongoing. So far, we enrolled 2 participants. Recruitment will end October 2022 with plans to analyze data by December 2022. The findings from this study will be used to further develop psychosocial interventions and inform novel treatments for survivors of HS and their informal caregivers.