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Background: Cerebral microbleeds (CMBs) influence long‐term prognoses of stroke patients. Streptococcus mutans expressing the collagen‐binding protein Cnm induces cerebrovascular inflammation, impairing blood brain barrier integrity and causing cerebral bleeding. Here, we examine the association of Cnm‐positive S. mutans with CMBs. Methods: Acute stroke patients were selected from a single‐center registry database. Oral carriage of Cnm‐positive or Cnm‐negative S. mutans was determined using polymerase chain reaction assays. The associations of Cnm‐positive S. mutans with CMB number and specifically the presence of >10 CMBs were examined using quasi‐Poisson and logistic regression models, respectively. Results: This study included 3154 stroke patients, of which 428 patients (median [interquartile range] age, 73.0 [63.0–81.0] years; 269 men [62.9%]) underwent oral bacterial examinations. In total, 326 patients harbored S. mutans. After excluding four patients without imaging data, we compared patients with Cnm‐positive (n = 72) and Cnm‐negative (n = 250) S. mutans. Harboring Cnm‐positive S. mutans was independently associated with the presence of >10 CMBs (adjusted odds ratio 2.20 [1.18–4.10]) and higher numbers of deep and lobar CMBs (adjusted risk ratio 1.61 [1.14–2.27] for deep; 5.14 [2.78–9.51] for lobar), but not infratentorial CMBs, after adjusting for age, sex, hypertension, stroke type, National Institutes of Health Stroke Scale score, and cerebral amyloid angiopathy. Conclusions: Harboring Cnm‐positive S. mutans was independently associated with a higher number of CMBs in deep and lobar locations. Reducing Cnm‐positive S. mutans in the oral cavity may serve as a novel therapeutic approach for stroke. [ABSTRACT FROM AUTHOR]

A 37-year-old woman was hospitalized with fever and consciousness disturbance. She showed systemic inflammation with stress cardiomyopathy. Brain computed tomography showed diffuse brain edema. Cerebrospinal fluid (CSF) findings revealed markedly elevated cerebrospinal fluid pressure with pleocytosis, elevated protein, and elevated interleukin 6. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nicking enzyme amplification reaction test using a nasopharyngeal swab was positive, and the patient was diagnosed with SARS-CoV-2 infection. From the negative result of the CSF SARS-CoV-2 polymerase chain reaction test and no findings of bacterial or viral infection, we diagnosed meningoencephalitis by multisystem inflammation syndrome in adults (MIS-A). Intravenous methylprednisolone pulse therapy improved her symptoms and brain edema. There have been no cases of MIS-A with meningoencephalitis, and no initial treatment strategy has been established, especially in emergency cases of suspected MIS-A. The present case suggested Early intravenous methylprednisolone pulse with anti-coronaviral therapies after the exclusion of bacterial infection would be useful in suspected MIS-A with emergent meningoencephalitis cases. [ABSTRACT FROM AUTHOR]

Implantable loop recorders (ILRs) are useful for the detection of atrial fibrillation (AF) in patients with cryptogenic stroke (CS). P-wave terminal force in lead V1 (PTFV1) is associated with AF detection; however, data on the association between PTFV1 and AF detection using ILRs in patients with CS are limited. Consecutive patients with CS with implanted ILRs from September 2016 to September 2020 at eight hospitals in Japan were studied. PTFV1 was calculated by 12-lead ECG before ILRs implantation. An abnormal PTFV1 was defined as ≥ 4.0 mV × ms. The AF burden was calculated as a proportion based on the duration of AF to the total monitoring period. The outcomes included AF detection and large AF burden, which was defined as ≥ 0.5% of the overall AF burden. Of 321 patients (median age, 71 years; male, 62%), AF was detected in 106 patients (33%) during the median follow-up period of 636 days (interquartile range [IQR], 436–860 days). The median time from ILRs implantation to AF detection was 73 days (IQR, 14–299 days). An abnormal PTFV1 was independently associated with AF detection (adjusted hazard ratio, 1.71; 95% confidence interval [CI], 1.00–2.90). An abnormal PTFV1 was also independently associated with a large AF burden (adjusted odds ratio, 4.70; 95% CI, 2.50–8.80). In patients with CS with implanted ILRs, an abnormal PTFV1 is associated with both AF detection and a large AF burden. Clinical Trial Registration Information: UMIN Clinical Trials Registry 000044366. [ABSTRACT FROM AUTHOR]