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Background Vertebrobasilar artery occlusion (VBAO) is a severe type of stroke. Multiple prediction models for outcome and symptomatic intracranial hemorrhage (sICH) of patients with acute ischemic stroke treated with endovascular treatment have been developed to improve patient management, but few are based on VBAO. This study aimed to provide an overview of published models to predict functional outcome and sICH as well as to validate their ability in patients with acute VBAO treated with endovascular treatment. Methods We performed a systematic search to identify models either developed or validated to predict functional outcomes or sICH after endovascular treatment. Models were externally validated in the Posterior Circulation Ischemic Stroke Registry (PERSIST) study (n = 2422). Outcome measures included the modified Rankin Scale (mRS) score at 90 days and sICH. Model performance was evaluated with discrimination (c‐statistic) and calibration (slope and intercept). Results A total of 65 models were included in overview. The most frequently used predictors were baseline National Institutes of Health Stroke Scale score (n = 57), age (n = 45), and glucose (n = 32). In the external validation cohort, 777 of 2353 patients (33.0%) achieved mRS score 0–2 at 90 days, 1061 of 2353 patients (45.1%) patients achieved mRS score 0–3 at 90 days, and sICH occurred in 170 of 2422 patients (7.0%). Finally, 27 models were included in external validation. For functional outcome models focusing on mRS score 0–2/3–6, discrimination ranged from 0.63 to 0.66 and best calibrated model was SC (Stroke Checkerboard) (intercept, −0.13 [95% CI, −0.27 to 0.01]; slope, 0.92 [95% CI, 0.67–1.17]). For functional outcome models focusing on mRS score 0–3/4–6, discrimination ranged from 0.64 to 0.74 and best calibrated model was modified Houston Intra‐Arterial Therapy 2 (mHIAT2) (intercept, −0.12 [95% CI, −0.31 to 0.07]; slope, 0.85 [95% CI, 0.65–1.04]). For sICH models, discrimination ranged from 0.53 to 0.83 and best calibrated model was Thrombolysis in Cerebral Infarction score, Alberta Stroke Program Early CT Score, and glucose (TAG) (intercept, 0.13 [95% CI, −0.25 to 0.51]; slope, 0.93 [95% CI, 0.63–1.23]). Conclusions The currently published models are inadequate for predicting functional outcomes and sICH in patients with acute VBAO undergoing endovascular treatment and, therefore, there is a need for more effective models specifically developed for VBAO conditions.

Background: Automated pupillometry (AP) is a handheld, non-invasive tool that is able to assess pupillary light reflex dynamics and is useful for the detection of intracranial hypertension. Limited evidence is available on acute ischemic stroke (AIS) patients. The primary objective was to evaluate the ability of AP to discriminate AIS patients from healthy subjects (HS). Secondly, we aimed to compute a predictive score for AIS diagnosis based on clinical, demographic, and AP variables. Methods: We included 200 consecutive patients admitted to a comprehensive stroke center who underwent AP assessment through NPi-200 (NeurOptics®) within 72 h of stroke onset and 200 HS. The mean values of AP parameters and the absolute differences between the AP parameters of the two eyes were considered in the analyses. Predictors of stroke diagnosis were identified through univariate and multivariate logistic regressions; we then computed a nomogram based on each variable’s β coefficient. Finally, we developed a web app capable of displaying the probability of stroke diagnosis based on the predictive algorithm. Results: A high percentage of pupil constriction (CH, p < 0.001), a low constriction velocity (CV, p = 0.002), and high differences between these two parameters (p = 0.036 and p = 0.004, respectively) were independent predictors of AIS. The highest contribution in the predictive score was provided by CH, the Neurological Pupil Index, CV, and CV absolute difference, disclosing the important role of AP in the discrimination of stroke patients. Conclusions: The results of our study suggest that AP parameters, and in particular, those concerning pupillary constriction, may be useful for the early diagnosis of AIS.

Abstract Compelling evidence suggest a key role of immune system in the development and progression of ischemic stroke. Although the balance between proinflammatory CD4 + T helper (Th)-1 lymphocytes, expressing T-bet transcription factor, and anti-inflammatory Th2 cells expressing GATA3 seems to influence the outcome in experimental stroke, the role of peripheral immune response in acute stroke patients is poorly understood. We aimed to evaluate the peripheral Th1/Th2 balance in acute atherothrombotic (ATHS) and cardioembolic stroke (CES) patients and in age- and sex-matched healthy subjects. Using flow cytometry, we analyzed the percentage of CD4 + T-bet + T cells and CD4 + GATA3 + T cells from peripheral blood of ATHS and CES patients (2,4 and 7 days after stroke onset). Patients and controls were screened for infectious conditions, autoimmune, inflammatory, or cancerous diseases. On day 2 circulating CD4 + T-bet + T cells were significantly higher in stroke patients compared to controls, and in ATHS compared to CES and controls. On day 7, we observed a significant increase of CD4 + T-bet + T cells in both ATHS and CES patients compared to baseline. No difference was observed in circulating CD4 + GATA3 + T cells among ATHS, CES patients, and controls. These data suggest that circulating CD4 + T-bet + T cells could be useful marker indicating atherothrombotic genesis of stroke and provide new insight into the peripheral adaptive immune response in acute stroke.

Climate change is a critical challenge of our era, and its effects on human well-being are undeniable. It may not be immediately apparent that its impacts can vary by gender. Drawing from lessons learned during the COVID-19 pandemic, it is clear that a shock can affect men and women differently, due to social norms and pre-existing gender differences. This paper reviews economic studies on how weather shocks—such as floods, droughts, and extreme temperatures—affect a broad spectrum of outcomes, ranging from endowments to economic opportunities and agency. Although specific physiological vulnerabilities exist (e.g. boys are more vulnerable to prenatal shocks, while girls and women are more vulnerable to heat), the most significant gendered impacts stem from pre-existing inequalities and societal responses to these shocks. In regions with a strong preference for boys, families facing resource shortages from shocks might prioritize boys for food and other resources, pull girls from school, marry them off young, or withdraw women from agricultural work so they can focus on household chores. Conversely, boys and men might leave school or migrate to seek alternative income sources during or after such shocks. Without gender-responsive climate policies, climate change is likely to exacerbate existing gender inequalities.

Background: Little evidence is available on the long-term efficacy and safety of edoxaban, mainly due to the recent release date. The primary objective of the study was to evaluate the safety of edoxaban, defined by the incidence of major bleedings. We then aimed to evaluate the incidence of thromboembolic events and the persistence of edoxaban therapy in the long-term. Methods: In this observational cohort study, we included ischemic stroke patients enrolled in a previous study to evaluate the safety and efficacy of long-term edoxaban treatment. Data were collected by a trained investigator through a structured telephone interview. Results: Sixty-three subjects (median age 81.0 (73.5–88.0) years, 38.1% male) were included in the study, with a mean follow-up of 4.4 ± 0.7 years (range: 3.2–5.5 years). Only one patient (1.6%, 0.4%/year) presented a major extracranial bleeding, and none had cerebral hemorrhage. Six thromboembolic events occurred in five patients (7.9%): three recurrent strokes, two transient ischemic attacks, and one myocardial infarction (2.2%/year). Over a follow-up period of more than three years, 13 patients discontinued edoxaban (20.6%). Conclusions: Edoxaban seems to be effective and safe in the long-term. The persistence rate of edoxaban therapy is optimal after more than three years of treatment.

We sought to verify the benefit of mechanical thrombectomy in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation and low National Institute of Health stroke scale score at presentation. The prospective database of our stroke center was screened for patients with acute ischemic stroke due to large vessel occlusion and a baseline National Institute of Health stroke scale score ≤5 that had undergone mechanical thrombectomy. Outcome measures were the modified Rankin Scale (mRS) score at 90 days, brain bleeding events and death at 90 days. Out of 459 patients, 17 (12 females, mean age 70 ± 14 years) with occlusion of M1 or M2 segment of middle cerebral artery and baseline National Institute of Health stroke scale score ≤5 underwent mechanical thrombectomy. Eight patients (47%) were treated within 6 hours from the onset, 5 (29%) were treated beyond 6 hours, and 4 (24%) were wake-up strokes. Effective mechanical thrombectomy was achieved in 16 patients (94%) and associated with excellent functional outcomes at 3 months (mRS 0–1) in 13 (76%). The asymptomatic brain-bleeding event was observed in one patient 4 days after effective mechanical thrombectomy concerning safety issues. One patient died 1 month after mechanical thrombectomy of a cause unrelated to stroke. Our findings favor a potential benefit of mechanical thrombectomy in patients with stroke due to large vessel occlusion and low National Institute of Health stroke scale score at presentation. These patients may also benefit from a prolonged time window for treatment.

Background: Automated pupillometry (AP) is a handheld, non-invasive tool that is able to assess pupillary light reflex dynamics and is useful for the detection of intracranial hypertension. Limited evidence is available on acute ischemic stroke (AIS) patients. The primary objective was to evaluate the ability of AP to discriminate AIS patients from healthy subjects (HS). Secondly, we aimed to compute a predictive score for AIS diagnosis based on clinical, demographic, and AP variables. Methods: We included 200 consecutive patients admitted to a comprehensive stroke center who underwent AP assessment through NPi-200 (NeurOptics®) within 72 h of stroke onset and 200 HS. The mean values of AP parameters and the absolute differences between the AP parameters of the two eyes were considered in the analyses. Predictors of stroke diagnosis were identified through univariate and multivariate logistic regressions; we then computed a nomogram based on each variable's β coefficient. Finally, we developed a web app capable of displaying the probability of stroke diagnosis based on the predictive algorithm. Results: A high percentage of pupil constriction (CH, p < 0.001), a low constriction velocity (CV, p = 0.002), and high differences between these two parameters (p = 0.036 and p = 0.004, respectively) were independent predictors of AIS. The highest contribution in the predictive score was provided by CH, the Neurological Pupil Index, CV, and CV absolute difference, disclosing the important role of AP in the discrimination of stroke patients. Conclusions: The results of our study suggest that AP parameters, and in particular, those concerning pupillary constriction, may be useful for the early diagnosis of AIS. [ABSTRACT FROM AUTHOR]

Introduction: We sought to verify the predicting role of a favorable profile on computed tomography perfusion (CTP) in the outcome of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing effective mechanical thrombectomy (MT). Methods: We retrospectively enrolled 25 patients with AIS due to LVO and with a CTP study showing the presence of ischemic penumbra who underwent effective MT, regardless of the time of onset. The controls were 25 AIS patients with overlapping demographics and clinical and computed tomography angiography features at admission who had undergone successful MT within 6 h from onset and without a previous CTP study. The outcome measure was the modified Rankin Scale (mRS) score at 90 days. Results: Sixty-four percent of the study patients had an mRS score of 0–1 at 90 days versus 12% of the control patients (p < 0.001). Patients of the study group had a more favorable distribution of disability scores (median mRS [IQR] score of 0 [0–2] vs. 2 [2–3]). Multivariate analysis showed that the selection of patients based on a favorable CTP study was strongly associated (p < 0.001) with a better neurological outcome. Conclusions: In our small-sized and retrospective study, the presence of ischemic penumbra was associated with a better clinical outcome in patients with AIS due to LVO after MT. In the future, a larger and controlled study with similar criteria of enrollment is needed to further validate the role of CTP in patient selection for MT, regardless of the time from the onset of symptoms.

Background: Seizures are a common complication of cerebral venous thrombosis. In this study, we intended to define clinical and neuroradiological factors associated with early and late seizures and predictors for seizure recurrence. Methods: The database of our high-volume tertiary stroke center was screened for patients diagnosed with cerebral venous thrombosis between April 2006 and July 2021. Demographics, clinical, imaging, and instrumental data were collected. Results: Out of a total of 80 patients, 30 had seizures, either within the first week after onset (22 patients) or after (8 patients). Speech impairment and intracerebral bleeding were statistically associated with seizures in univariate analysis, but in a logistic regression model, only brain damage with hemorrhagic infarct and/or presence of brain hematoma [OR 6.051; 95% CI 1.881–19.468] (p = 0.003) were predicting factors for seizures. Late seizures were significantly more frequent in younger age [OR 0.864; 95% CI 0.763–0.978] (p = 0.020). Early seizures resulted as protective factors for recurrence; an altered state of consciousness at baseline and late seizures resulted as predictive factors for relapses (0.0% vs. 81.0%, p = 0.005, and 100.0% vs. 19.0%, p < 0.005, respectively). Conclusions: Our study confirms brain bleeding as the strongest risk factor for seizures after cerebral venous thrombosis. Recurrence is unusual after early seizures, while the presence of late seizures seems to raise the risk of recurrence.

The essay proposes a critical analysis, based on an ethnographic approach, on the facial protection devices (mascherine) introduced at a global level to face the Covid pandemic19. While reflecting on how masks are redefining interpersonal relations on a decorporealized basis, on their symbolic dimension, on the relationship with the mask and masking, the contribution focuses on masks as "(s)objects". Seen in their materiality, the masks are in fact proposed as emblematic "agent-objects", invested of a "thing-power" (Bennet 2004), to influence our behaviour. But also as "acted-objects ", with reference to human agency, to the human capacity to manipulate them, to reinterpret them in ironic and subversive forms.