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BACKGROUND: The impact of different stroke types on specific activities of daily living (ADL) is unclear. OBJECTIVE: To investigate how differences between intracerebral hemorrhage (ICH) and cerebral infarction (CI) affect improvement of ADL in patients with stroke within a hospital by focusing on the sub-items of the Functional Independence Measure (FIM). METHODS: Patients with first-stroke hemiplegia (n = 212) were divided into two groups: ICH (86 patients) and CI (126 patients). Primary assessments included 13 motor and 5 cognitive sub-items of the FIM assessed at admission and discharge. Between-group comparisons and multiple regression analyses were performed. RESULTS: Upon admission, the ICH group exhibited significantly lower FIM scores than those of the CI group across various activities, including grooming, dressing (upper body and lower body), toileting, bed/chair transfer, toilet transfer, walking/wheelchair, and stairs. Age and FIM motor scores at admission influenced both groups' total FIM motor scores at discharge, whereas the duration from onset affected only the CI group. CONCLUSION: Several individual FIM motor items were more adversely affected by ICH than by CI. Factors related to ADL at discharge may differ depending on stroke type. Recognizing these differences is vital for efficient rehabilitation practices and outcome prediction. [ABSTRACT FROM AUTHOR]

Abstract Background Dilated perivascular spaces (DPVS), known as one of imaging markers in cerebral small vessel disease, may be found in patients with moyamoya disease (MMD). However, little is known about DPVS in MMD. The purpose of this study was to investigate the distribution pattern of dPVS in children and adults with MMD and determine whether it is related to steno-occlusive changes of MMD. Methods DPVS was scored in basal ganglia (BG) and white matter (WM) on T2-weighted imaging, using a validated 4-point semi-quantitative score. The degree of dPVS was classified as high (score > 2) or low (score ≤ 2) grade. The steno-occlusive changes on MR angiography (MRA) was scored using a validated MRA grading. Asymmetry of DPVS and MRA grading was defined as a difference of 1 grade or higher between hemispheres. Results Fifty-one patients with MMD (mean age 24.9 ± 21.1 years) were included. Forty-five (88.2%) patients had high WM-DPVS grade (degree 3 or 4). BG-DPVS was found in 72.5% of all patients and all were low grade (degree 1 or 2). The distribution patterns of DPVS degree in BG (P = 1.000) and WM (P = 0.767) were not different between child and adult groups. The asymmetry of WM-DPVS (26%) and MRA grade (42%) were significantly correlated to each other (Kendall’s tau-b = 0.604, P

This study aimed to explore the potential association between oxidative stress markers and Moyamoya Disease (MMD), a complex cerebrovascular disorder characterized by vascular constriction and collateral vessel formation. The study focused on thiol-disulfide homeostasis and ischemia-modified albumin (IMA) levels as indicators of oxidative stress. A total of 23 MMD patients and 23 control subjects were included in the study. Clinical assessments and comprehensive blood analyses were conducted to evaluate factors including age, gender, disease duration, treatment history, and biochemical parameters. Thiol-disulfide homeostasis parameters were measured using an automated method. Ischemia-modified albumin levels were also analyzed. Statistical analyses, including chi -square tests and ROC curve analysis, were performed to determine differences and potential diagnostic cut -off points. Elevated levels of native thiol, total thiol, and disulfide were observed in the MMD patient group compared to the control group, statistical ly significant. Ischemia-modified albumin levels were notably higher in the patient group, corroborating the association between oxidative stress and ischemic events. ROC curve analysis identified potential diagnostic cut-off points for these markers. The study also highlighted clinical differences, including BMI, CRP levels, and the frequency of various symptoms, between the patien t and control groups. Our study offers insights into the intricate interplay between oxidative stress and Moyamoya Disease. The statistically significant elevated levels of thiol-disulfide markers and ischemia-modified albumin suggest potential links to oxidative stress dynamics within MMD. These findings contribute to our understanding of oxidative stress in cerebrovascular diseases and open avenues for further research. [ABSTRACT FROM AUTHOR]

Alexei Antonov,1,* Anthony Terraciano,1,* Muhammed Amir Essibayi,2,3 Kainaat Javed,2 David J Altschul2,3 1Albert Einstein College of Medicine, Bronx, NY, USA; 2Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; 3Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA*These authors contributed equally to this workCorrespondence: David J Altschul, Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467, USA, Email daltschu@montefiore.orgAbstract: Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by the progressive narrowing and occlusion of the intracranial internal carotid arteries, leading to the formation of abnormal collateral vessels. MMD primarily affects the cerebrovascular system, and evidence suggests it is associated with various neuropsychiatric outcomes. This manuscript aims to provide an overview of the current understanding of MMD, including its epidemiology, pathophysiology, clinical manifestations, and diagnosis. Furthermore, it explores the emerging research on the neuropsychiatric sequelae of MMD, such as cognitive impairment, psychiatric disorders, and quality of life. The manuscript concludes with the challenges in managing MMD-related neuropsychiatric outcomes and potential avenues for future research.Keywords: moyamoya disease, neuropsychiatric outcomes, cerebrovascular disorder, cognitive impairment, psychiatric disorders

Abstract Background Carotid web (CaW) and carotid free-floating thrombus (CFFT) are rare yet critical causes of ischemic stroke in young adults. Case presentation A 54-year-old woman presented with a fluctuating right sensory-motor faciobrachial syndrome. A brain MRI scan revealed multiple small recent asynchronous cortico-subcortical ischemic foci in the vascular territory of the left internal carotid artery. A CT angiography identified a CFFT in the left internal carotid artery arising from an underlying CaW. The patient was treated with excellent clinical outcomes with carotid artery stenting and dual antiplatelet therapy. Conclusions We provide a structured pathophysiological rationale connecting CaW and CFFT and highlight pivotal therapeutic implications. Further studies are needed to investigate this relationship and guide assessment and treatment.

Background: Post-stroke depression is a major cause for poor functional and rehabilitation recovery. Aims and Objectives: The aims of the study were to determine risk factors causing depression in acute ischemic stroke. Materials and Methods: Prospective cohort study was conducted in acute ischemic stroke patients between January 2023 and April 2023 at Travancore Medical College, Kerala. They were divided into – ischemic stroke patients with depression and without depression. Variables studied – age, gender, marital, educational, occupation, socioeconomic status, national institute of health stroke scale (NIHSS) at admission, modified Rankin Scale (mRS) at 1 month, stroke lateralization, risk factors, and lobe and site. Results: Among 270 patients, 164 (60.7%) were male, 254 (94.1%) were above 50 years, 250 (92.6%) had marriage partner, 164 (60.7%) unemployed, 138 (51.1%) belonged to middle socioeconomic status, and 172 (63.7%) from rural areas. About 91 (33.7%) were in ischemic stroke patients with depression group. In univariate analysis, marriage, socioeconomic status, subcortical location, left hemisphere, severe NIHSS, and high mRS were associated with post-stroke depression. In multivariate analysis, socioeconomic status, subcortical location, and left hemisphere were significant risk factors. Strongest predictor was subcortical location. Conclusion: Early identification of following risk factors – socioeconomic and marital status, subcortical location, left hemisphere lesion, severe NIHSS, and high mRS in acute stroke patients may help to identify those who are vulnerable for post-stroke depression.

Background: Carotid web (CaW) and carotid free-floating thrombus (CFFT) are rare yet critical causes of ischemic stroke in young adults. Case presentation: A 54-year-old woman presented with a fluctuating right sensory-motor faciobrachial syndrome. A brain MRI scan revealed multiple small recent asynchronous cortico-subcortical ischemic foci in the vascular territory of the left internal carotid artery. A CT angiography identified a CFFT in the left internal carotid artery arising from an underlying CaW. The patient was treated with excellent clinical outcomes with carotid artery stenting and dual antiplatelet therapy. Conclusions: We provide a structured pathophysiological rationale connecting CaW and CFFT and highlight pivotal therapeutic implications. Further studies are needed to investigate this relationship and guide assessment and treatment. [ABSTRACT FROM AUTHOR]

Retinal blood vessels have become promising biomarkers for the early diagnosis and evaluation of systemic disorders, including myocardial infarction (heart disease) and cerebrovascular diseases. With an emphasis on current developments in retinal imaging techniques and their importance in identifying early vascular changes connected to both diseases, this review article explores the relationship between retinal blood vessels and these two significant systemic ailments. The benefits and drawbacks of several non-invasive imaging techniques for documenting retinal vascular changes, such as fundus photography, fluorescein angiography, and optical coherence tomography (OCT), are discussed. The study examines a variety of information that connects myocardial infarction risk, occurrence, and development to retinal vessel characteristics like calibre, tortuosity, and branching patterns. The underlying processes that might connect retinal vascular alterations to these systemic diseases are also perhaps investigated. In addition, common risk factors and systemic diseases that affect both the retinal and systemic vasculature are described as shared pathophysiological pathways. The promise of retinal vessel analysis as a non-invasive method for risk assessment, diagnosis, and monitoring of cardiovascular and cerebrovascular illnesses is highlighted by these findings. Retinal vascular analysis has the potential for improved patient outcomes through prompt interventions because of its affordability, accessibility, and non-invasive nature. To fully realize the clinical potential of this strategy, a number of issues, such as the standardization of imaging methods and the requirement for extensive longitudinal investigations, must be resolved. [ABSTRACT FROM AUTHOR]

Background: Post-stroke depression is a major cause for poor functional and rehabilitation recovery. Aims and Objectives: The aims of the study were to determine risk factors causing depression in acute ischemic stroke. Materials and Methods: Prospective cohort study was conducted in acute ischemic stroke patients between January 2023 and April 2023 at Travancore Medical College, Kerala. They were divided into – ischemic stroke patients with depression and without depression. Variables studied – age, gender, marital, educational, occupation, socioeconomic status, national institute of health stroke scale (NIHSS) at admission, modified Rankin Scale (mRS) at 1 month, stroke lateralization, risk factors, and lobe and site. Results: Among 270 patients, 164 (60.7%) were male, 254 (94.1%) were above 50 years, 250 (92.6%) had marriage partner, 164 (60.7%) unemployed, 138 (51.1%) belonged to middle socioeconomic status, and 172 (63.7%) from rural areas. About 91 (33.7%) were in ischemic stroke patients with depression group. In univariate analysis, marriage, socioeconomic status, subcortical location, left hemisphere, severe NIHSS, and high mRS were associated with post-stroke depression. In multivariate analysis, socioeconomic status, subcortical location, and left hemisphere were significant risk factors. Strongest predictor was subcortical location. Conclusion: Early identification of following risk factors – socioeconomic and marital status, subcortical location, left hemisphere lesion, severe NIHSS, and high mRS in acute stroke patients may help to identify those who are vulnerable for post-stroke depression. [ABSTRACT FROM AUTHOR]

The role of inherited thrombophilia in arterial disease is uncertain. We performed a systematic-review and meta-analysis of inherited thrombophilia in cerebrovascular (CVD), coronary heart (CHD), and peripheral artery disease (PAD) patients. MEDLINE and EMBASE were searched up to February 2022. Pooled prevalences (PPs) and odds ratios (ORs) with 95 % confidence intervals (95%CI) were calculated in a random-effects model. Factor V Leiden (G1691A), prothrombin (G20210A), MTHFR C677T/A1298C and PAI-1 4G/5G were evaluated. 377 studies for 98,186 patients (32,791 CVD, 62,266 CHD, 3129 PAD) and 108,569 controls were included. Overall, 37,249 patients had G1691A, 32,254 G20210A, 42,546 MTHFR C677T, 8889 MTHFR A1298C, and 19,861 PAI-1 4G/5G gene polymorphisms. In CVD patients, PPs were 6.5 % for G1691A, 3.9 % for G20210A, 56.4 % for MTHFR C677T, 51.9 % for MTHFR A1298C, and 77.6 % for PAI-1. In CHD, corresponding PPs were 7.2 %, 3.8 %, 52.3 %, 53.9 %, and 76.4 %. In PAD, PPs were 6.9 %, 4.7 %, 55.1 %, 52.1 %, and 75.0 %, respectively. Strongest ORs in CVD were for homozygous G1691A (2.76; 95 %CI, 1.83–4.18) and for homozygous G20210A (3.96; 95 %CI, 2.05–7.64). Strongest ORs in CHD were for homozygous G1691A (OR 1.68; 95%CI, 1.02–2.77) and G20210A (heterozygous 1.49 95%CI, 1.22–1.82; homozygous 1.54 95%CI, 0.79–2.99). The OR for PAI-1 4G/4G in PAD was 5.44 (95%CI, 1.80–16.43). Specific subgroups with higher PPs and ORs were identified according to age and region. Patients with arterial disease have an increased prevalence and odds of having some inherited thrombophilia. Some thrombophilia testing may be considered in specific subgroups of patients. [Display omitted] • Data on the role of inherited thrombophilia in arterial disease are heterogeneous. • G1691A, G20210A, MTHFR C677T/A1298C, and PAI-1 polymorphisms focused this study. • 377 studies included 98,186 patients with arterial disease and 108,569 controls. • Prevalence and odds of some polymorphisms were higher in arterial disease. • Some thrombophilia may be considered in specific subgroups of patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine the feasibility of using intraoperative contrast-enhanced ultrasound (CEUS) to assess subcortical hemodynamic changes in moyamoya disease patients who had undergone combined revascularization. It also aimed to investigate the correlation between quantitative CEUS parameters and post-operative neural functional recovery. Methods: This study included seventeen patients diagnosed with moyamoya disease, confirmed through cerebral angiography, who underwent combined revascularization. Intraoperative subcortical hemodynamics were assessed using CEUS before and immediately after cerebrovascular bypass. Hemodynamic parameters were calculated by analyzing the time-intensity curve generated from a defined region of interest in each CEUS video. Post-operative neurological symptoms, computed tomography records, and short-term modified Rankin Scale (mRS) scores were also recorded. Results: During the post-operative follow-up, 29.4 % of the patients experienced new neurological symptoms, including epilepsy, dyskinesia, and language impairment. Overall, CEUS quantitative parameters suggested that blood supply improved after surgery. And certain hemodynamic parameters exhibited a stronger correlation with the mRS scores, with correlation coefficients ranging up to 0.73 (p

Enteral feeding is very common following an acquired brain injury. However, no prognostic models for oral food intake have been developed for subacute rehabilitation. The aim of this study was to develop a prognostic model and online tool, coined "subacute prognosis of oral nutrition" (SPOON), for complete oral intake in tube-fed subjects with acquired brain injury. The model was developed using routinely gathered clinical data from a cohort of 1233 adult patients who were tube-fed at admission for sub-acute inpatient rehabilitation. Candidate predictors were included based on scientific evidence and their availability in the medical records within the first days following admission. The outcome was time until achieving complete oral food intake without any tube-feeding supplements. Time until complete oral intake was analyzed by discrete time-to-event analysis with logit-link and presented as daily odds ratios (OR) with 95% confidence intervals (CI). The following predictors of complete oral intake were included in the model: age, diagnosis, cuffed tracheostomy tube, days from injury to admission for rehabilitation, and the Early Functional Abilities (EFA) sum score. Multiple adjusted analyses were performed stratified by cuffed tracheostomy tube status. Some of the strongest predictors of complete oral intake were age 18–40 years, OR 1.99 (95%CI: 1.53; 2.59); 0–2 weeks since injury, OR 3.75 (95%CI: 2.72; 5.16); and EFA 61–100 (slight/no disturbance in function), OR 5.81 (95%CI: 4.47; 7.55). The online prognostic tool SPOON was evaluated in a usability study. Based on feedback from clinicians, the tool was further refined to enable extraction of data for prediction directly from medical records. The objective of SPOON is to complement the planning of rehabilitation initiatives and inform discussions to determine if a percutaneous endoscopic gastrostomy (PEG) tube should be inserted. SPOON is being implemented locally, but external validation based on appropriate data modeling is warranted before further clinical implementation. [ABSTRACT FROM AUTHOR]

Objectives: Moyamoya disease (MMD) leads to frequent ischemic/hemorrhagic manifestations. Our aim was to compare findings of arterial spin labeling (ASL) with dynamic susceptibility contrast (DSC) perfusion in patients of MMD. Materials and Methods: Patients diagnosed as MMD underwent magnetic resonance imaging with ASL and DSC perfusion sequences. Perfusion in bilateral anterior cerebral artery and middle cerebral artery territories at two levels (level of thalami and centrum semiovale) was graded as normal (score 1), or reduced (score 2) on DSC and ASL cerebral blood flow (CBF) maps by comparison with normal cerebellar perfusion. Time to peak (TTP) maps of DSC perfusion were also qualitatively scored as normal (score 1), or increased (score 2) similarly. Correlation between scores of ASL, CBF, DSC, CBF, and DSC, TTP maps was assessed by using Spearman's rank correlation. Results: Among the 34 patients, we did not find any significant correlation between the ASL CBF maps and DSC CBF maps (r = -0.028, P = 0.878), mean matching index 0.39 ± 0.31, whereas significant correlation was noted between the ASL CBF maps and DSC TTP maps (r = 0.58, P = 0.0003), mean matching index 0.79 ± 0.26. ASL CBF underestimated the perfusion compared to DSC perfusion. Conclusion: ASL perfusion CBF maps do not match the DSC perfusion CBF maps and rather match the TTP maps of DSC perfusion. This is explained by inherent problems in estimation of CBF in these techniques because of delay in arrival of label (in ASL perfusion) or contrast bolus (in DSC perfusion) due to the presence of stenotic lesions. [ABSTRACT FROM AUTHOR]

Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization.Design: Retrospective cohort study.Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020.Methods: The Falls Efficacy Scale-International was used to assess both patients’ and physical therapists’ perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated.Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers.Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.

Objective: Pre-eclampsia is a hypertensive complication of pregnancy that is associated with an increased risk of long-term cardiovascular and cerebrovascular disorders. Although the underlying mechanism of persistent susceptibility to cerebral complications after pre-eclampsia remains largely unclear, impaired blood-brain barrier (BBB) integrity has been suggested to precede several cerebrovascular diseases. In this study, we aimed to investigate the integrity of the BBB years after pre-eclampsia.Methods: This was an observational study of premenopausal formerly pre-eclamptic women and controls with a history of normotensive pregnancy who underwent cerebral magnetic resonance imaging (MRI) at ultra-high field (7 Tesla) to assess the integrity of the BBB. Permeability of the BBB was determined by assessing leakage rate and fractional leakage volume of the contrast agent gadobutrol using dynamic contrast-enhanced MRI. BBB leakage measures were determined for the whole brain and lobar white and gray matter. Multivariable analyses were performed, and odds ratios were calculated to compare women with and those without a history of pre-eclampsia, adjusting for potential confounding effects of age, hypertension status at MRI and Fazekas score.Results: Twenty-two formerly pre-eclamptic women (mean age, 37.8 ± 5.4 years) and 13 control women with a history of normotensive pregnancy (mean age, 40.8 ± 5.5 years) were included in the study. The time since the index pregnancy was 6.6 ± 3.2 years in the pre-eclamptic group and 9.0 ± 3.7 years in controls. The leakage rate and fractional leakage volume were significantly higher in formerly pre-eclamptic women than in controls in the global white (P = 0.001) and gray (P = 0.02) matter. Regionally, the frontal (P = 0.04) and parietal (P = 0.009) cortical gray matter, and the frontal (P = 0.001), temporal (P < 0.05) and occipital (P = 0.007) white matter showed higher leakage rates in formerly pre-eclamptic women. The odds of a high leakage rate after pre-eclampsia were generally higher in white-matter regions than in gray-matter regions.Conclusion: This observational study demonstrates global impairment of the BBB years after a pre-eclamptic pregnancy, which could be an early marker of long-term cerebrovascular disorders. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Abstract Background Robot-assisted rehabilitation for patients with stroke is promising. However, it is unclear whether additional balance training using a balance-focused robot combined with conventional rehabilitation programs supplements the balance function in patients with stroke. The purpose of this study was to compare the effects of Balance Exercise Assist Robot (BEAR) training combined with conventional inpatient rehabilitation training to those of conventional inpatient rehabilitation only in patients with hemiparetic stroke. We also aimed to determine whether BEAR training was superior to intensive balance training. Methods This assessor-blinded randomized controlled trial included 60 patients with first-ever hemiparetic stroke, admitted to rehabilitation wards between December 2016 and February 2019. Patients were randomly assigned to one of three groups, robotic balance training and conventional inpatient rehabilitation (BEAR group), intensive balance training and conventional inpatient rehabilitation (IBT group), or conventional inpatient rehabilitation-only (CR group). The intervention duration was 2 weeks, with assessments conducted pre- and post-intervention, and at 2 weeks follow-up. The primary outcome measure was a change in the Mini-Balance Evaluation Systems Test (Mini-BESTest) score from baseline. Results In total, 57 patients completed the intervention, and 48 patients were evaluated at the follow-up. Significant improvements in Mini-BESTest score were observed in the BEAR and IBT groups compared with in the CR group post-intervention and after the 2-week follow-up period (P

Background and Purpose: The cardiovascular risk in Parkinson's disease (PD) remains uncertain and controversial. Some studies suggest PD patients present an increased risk of cerebrovascular disease. We aimed to study the prevalence of neuroimaging cerebrovascular biomarkers in PD patients compared to controls, using an accurate and complete magnetic resonance (MR) imaging evaluation. Material and Methods: Neuroimaging sub-study within a larger cross-sectional case–control study. An enriched subgroup of PD patients (≤10 years since diagnosis) with at least a moderate cardiovascular mortality risk based on a Systematic COronary Risk Evaluation (SCORE) was compared to community-based controls regarding neuroimaging biomarkers. Patients underwent a high-resolution T1-weighted MR imaging sequence at 3.0 T to visualize neuromelanin. A 3D SWI FFE, sagittal 3D T1-weighted, axial FLAIR and diffusion-weighted image sequences were obtained. Results: The study included 47 patients, 24 with PD and 23 controls. PD patients presented a reduced area and signal intensity of the substantia nigra and locus coeruleus on neuromelanin-sensitive MR. The median SCORE was 5% in both groups. No significant differences regarding white matter hyperintensities (OR 4.84, 95% CI 0.50, 47.06), lacunes (OR 0.43, 95% CI 0.07, 2.63), microbleeds (OR 0.64, 95% CI 0.13, 3.26), or infarcts (0.95, 95% CI 0.12, 7.41) was found. The frequency of these neuroimaging biomarkers was very low in both groups. Conclusion: The present study does not support an increased prevalence of neuroimaging cerebrovascular biomarkers in PD patients. [ABSTRACT FROM AUTHOR]

Introduction: Transdural collaterals (TC) from the external carotid artery must be preserved when operating on patients with moyamoya vasculopathy. Several techniques have been used to identify the superficial temporal artery (STA) and middle meningeal artery (MMA) during surgery and prevent their damage. However, the use of neuronavigation for this specific purpose has never been described in the literature. We describe an operative case in which neuronavigation was used to preserve the TC (originating from the MMA), detailing our technique step by step and reviewing alternative methods previously reported. Case Presentation: A 6-year-old girl with moyamoya disease, who had developed marked bilateral TC from the MMA sparing the middle cerebral artery territory, underwent staged bilateral indirect revascularization surgery. Intraoperative neuronavigation was used to identify the STA and MMA with their main branches during skin incision, craniotomy, and dural opening. The neuronavigation matched the intraoperative findings exactly, and the target structures remained undamaged. The patient was discharged home after both surgeries with no neurological deficits. One year following surgery, the patient has excellent collateralization from both STAs and is asymptomatic and neurologically intact. Conclusion: With the use of intraoperative neuronavigation, the STA, MMA, and their main branches, as well as their relationship to the bone, can be identified and preserved. This approach can help in preventing undesirable injury to TC during surgery and may potentially prevent perioperative stroke in patients with moyamoya vasculopathy undergoing revascularization surgery. [ABSTRACT FROM AUTHOR]

Introduction: The benefits of performing open and endovascular procedures in a hybrid neuroangiography surgical suite include confirmation of treatment results and reduction in number of procedures, leading to improved efficiency of care. Combined procedural suites are infrequently used in pediatric facilities due to technical and logistical limitations. We report the safety, utility, and lessons learned from a single-institution experience using a hybrid suite equipped with biplane rotational digital subtraction angiography and pan-surgical capabilities. Methods: We conducted a retrospective review of consecutive cases performed at our institution that utilized the hybrid neuroangiography surgical suite from February 2020 to August 2021. Demographics, surgical metrics, and imaging results were collected from the electronic medical record. Outcomes, interventions, and nuances for optimizing preoperative/intraoperative setup and postoperative care were presented. Results: Eighteen procedures were performed in 17 patients (mean age 13.4 years, range 6–19). Cases included 14 arteriovenous malformations (AVM; 85.7% ruptured), one dural arteriovenous fistula, one mycotic aneurysm, and one hemangioblastoma. The average operative time was 416 min (range 321–745). There were no intraoperative or postoperative complications. All patients were alive at follow-up (range 0.1–14.7 months). Five patients had anticipated postoperative deficits arising from their hemorrhage, and 12 returned to baseline neurological status. Four illustrative cases demonstrating specific, unique applications of the hybrid angiography suite are presented. Conclusion: The hybrid neuroangiography surgical suite is a safe option for pediatric cerebrovascular pathologies requiring combined surgical and endovascular intervention. Hybrid cases can be completed within the same anesthesia session and reduce the need for return to the operating room for resection or surveillance angiography. High-quality intraoperative angiography enables diagnostic confirmation under a single procedure, mitigating risk of morbidity and accelerating recovery. Effective multidisciplinary planning enables preoperative angiograms to be completed to inform the operative plan immediately prior to definitive resection. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long-term cumulative risk and factors associated with fall-related fractures in stroke survivors discharged from convalescent rehabilitation wards. Design: Retrospective cohort study. Participants: A total of 786 stroke survivors discharged from a rehabilitation hospital. Methods: Data regarding fall-related fractures posthospital discharge were collected using self-reported questionnaires. The Kaplan–Meier method was used to calculate the cumulative incidence of fall-related fractures, and risk factors were analysed using Cox proportional hazard regression analysis. Results: Of 1,861 consecutive stroke survivors who had been discharged from hospital, 786 (42.2%) provided information concerning fall-related fractures. Duration from time of discharge to time of collection of questionnaires ranged from 1 to 6 years (mean 38.0 months). The cumulative incidence of fall-related fractures at 1-, 2-, 3-, 4-, and 5-years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. Cox proportional hazard regression analysis indicated that female sex (hazard ratio (HR) 1.69) and moderate lower limb paresis (HR 3.08) were significant risk factors. Conclusion: The cumulative risk of fall-related fractures in stroke survivors post-discharge from a rehabilitation hospital was notably high. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis. LAY ABSTRACT This study aimed to investigate the risk of fall-related fractures and associated factors in stroke survivors who had been discharged from rehabilitation wards. A questionnaire was sent by post to 1,861 post-discharge stroke survivors to investigate their experiences of fall-related fractures, to which 786 stroke survivors responded. The incidence of fall-related fractures at 1, 2, 3, 4, and 5 years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. The presence of moderate lower limb paresis and female sex were associated with 3.08- and 1.69-times higher risk of developing a fall-related fracture, respectively. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis following discharge from rehabilitation wards.

This study aimed to compare the time to emergence from general anesthesia with remimazolam versus propofol in patients undergoing cerebral endovascular procedures. A prospective, double-blind, randomized controlled, non-inferiority trial. An academic hospital. Adult patients scheduled for cerebral endovascular procedures. Patients were randomized at a 1:1 ratio to undergo surgery under general anesthesia with remimazolam (0.1 mg kg−1 for induction and 0.3–0.7 mg kg−1 h−1 for maintenance) or propofol (1–1.5 mg kg−1 for induction and 4–10 mg kg−1 h−1 for maintenance). The primary outcome was the time to emergence from anesthesia. The non-inferiority margin was −2.55 min in group difference. Major secondary outcomes included hypotension during induction, incidence of postoperative delirium and Modified Rankin Scale (mRs) at 30 days and 90 days after surgery. Of the 142 randomized patients, 129 completed the trial. In the modified intention-to-treat analysis, the mean time to emergence from anesthesia was 16.1 [10.4] min in the remimazolam group vs. 19.0 [11.2] min in the propofol group. The group difference was −2.9 min [95% CI -6.5, 0.7] (P = 0.003 for non-inferiority). The remimazolam group had lower rate of hypotension during induction (11.3% vs 25.4%, P = 0.03) and use of vasopressors during surgery (29.6% vs 62.0%, P < 0.001). The two groups did not differ in postoperative delirium and mRs at 30 and 90 days after surgery. In patients undergoing cerebral endovascular procedures, remimazolam did not increase the time from anesthesia vs propofol. [Display omitted] • Postoperative rapid emergence is crucial for neruosurgery. • Remimazolam would not prolong the emergence compared with propofol. • Remimazolam can provide more stable hemodynamics. • Remimazolam does not increase the incidence of postoperative delirium. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted rehabilitation for patients with stroke is promising. However, it is unclear whether additional balance training using a balance-focused robot combined with conventional rehabilitation programs supplements the balance function in patients with stroke. The purpose of this study was to compare the effects of Balance Exercise Assist Robot (BEAR) training combined with conventional inpatient rehabilitation training to those of conventional inpatient rehabilitation only in patients with hemiparetic stroke. We also aimed to determine whether BEAR training was superior to intensive balance training.Methods: This assessor-blinded randomized controlled trial included 60 patients with first-ever hemiparetic stroke, admitted to rehabilitation wards between December 2016 and February 2019. Patients were randomly assigned to one of three groups, robotic balance training and conventional inpatient rehabilitation (BEAR group), intensive balance training and conventional inpatient rehabilitation (IBT group), or conventional inpatient rehabilitation-only (CR group). The intervention duration was 2 weeks, with assessments conducted pre- and post-intervention, and at 2 weeks follow-up. The primary outcome measure was a change in the Mini-Balance Evaluation Systems Test (Mini-BESTest) score from baseline.Results: In total, 57 patients completed the intervention, and 48 patients were evaluated at the follow-up. Significant improvements in Mini-BESTest score were observed in the BEAR and IBT groups compared with in the CR group post-intervention and after the 2-week follow-up period (P < 0.05).Conclusions: The addition of balance exercises using the BEAR alongside conventional inpatient rehabilitation improved balance in patients with subacute stroke.Trial Registration: https://www.umin.ac.jp/ctr ; Unique Identifier: UMIN000025129. Registered on 2 December 2016. [ABSTRACT FROM AUTHOR]

Introduction: There is growing evidence supporting the relationship of vertical misperception and poor balance control with asymmetrical standing posture in patients with stroke. Although the vestibular system has been shown to be responsible for vertical misperception and balance disorders, the effect of galvanic vestibular stimulation (GVS) on both vertical misperception and postural asymmetry after stroke remains elusive. The aim of this study was to investigate the effects of GVS on visual verticality and postural asymmetry after stroke and to clarify whether the effects differ depending on the polarity of the stimulation and hemispheric lesion side. Methods: We measured the subjective visual vertical (SVV) and body weight distribution on each foot in an upright stance in 24 patients with a hemispheric stroke (10 with a left hemisphere lesion and 14 with a right hemisphere lesion) and nine age-matched healthy controls. During the measurements, bipolar GVS (1.5 mA) was applied over the bilateral mastoid processes in three stimulation conditions: contralesional-anodal and ipsilesional-cathodal vestibular stimulation, ipsilesional-anodal and contralesional-cathodal vestibular stimulation, and no stimulation. To examine whether GVS modulates visual verticality and standing posture, SVV and weight-bearing in the three conditions were analyzed. Results: During no stimulation, the SVV deviated to the contralesional side in patients with a right hemisphere lesion, while more weight-bearing was observed on the ipsilesional limb than on the contralesional limb in both patient groups than in the controls. The SVV was modulated by reversing the polarity of GVS in all the groups when the cathodal stimulus side was either ipsilateral or contralateral to the lesion while the ipsilesional-cathodal vestibular stimulation reduced weight-bearing asymmetry in only the patients with a right hemisphere lesion. Conclusions: These findings demonstrate that the effects of GVS on the SVV and standing posture differ depending on the polarity of GVS and the hemispheric lesion side. Patients with a right hemisphere lesion have difficulty maintaining their preferred standing posture under visual verticality modulation evoked by GVS. The application of GVS may clarify whether the vestibular system has neural redundancy after stroke to suppress any effects of the stimulation, including modulation of the visual verticality, on balance. [ABSTRACT FROM AUTHOR]

Introduction: There is growing evidence supporting the relationship of vertical misperception and poor balance control with asymmetrical standing posture in patients with stroke. Although the vestibular system has been shown to be responsible for vertical misperception and balance disorders, the effect of galvanic vestibular stimulation (GVS) on both vertical misperception and postural asymmetry after stroke remains elusive. The aim of this study was to investigate the effects of GVS on visual verticality and postural asymmetry after stroke and to clarify whether the effects differ depending on the polarity of the stimulation and hemispheric lesion side.Methods: We measured the subjective visual vertical (SVV) and body weight distribution on each foot in an upright stance in 24 patients with a hemispheric stroke (10 with a left hemisphere lesion and 14 with a right hemisphere lesion) and nine age-matched healthy controls. During the measurements, bipolar GVS (1.5 mA) was applied over the bilateral mastoid processes in three stimulation conditions: contralesional-anodal and ipsilesional-cathodal vestibular stimulation, ipsilesional-anodal and contralesional-cathodal vestibular stimulation, and no stimulation. To examine whether GVS modulates visual verticality and standing posture, SVV and weight-bearing in the three conditions were analyzed.Results: During no stimulation, the SVV deviated to the contralesional side in patients with a right hemisphere lesion, while more weight-bearing was observed on the ipsilesional limb than on the contralesional limb in both patient groups than in the controls. The SVV was modulated by reversing the polarity of GVS in all the groups when the cathodal stimulus side was either ipsilateral or contralateral to the lesion while the ipsilesional-cathodal vestibular stimulation reduced weight-bearing asymmetry in only the patients with a right hemisphere lesion.Conclusions: These findings demonstrate that the effects of GVS on the SVV and standing posture differ depending on the polarity of GVS and the hemispheric lesion side. Patients with a right hemisphere lesion have difficulty maintaining their preferred standing posture under visual verticality modulation evoked by GVS. The application of GVS may clarify whether the vestibular system has neural redundancy after stroke to suppress any effects of the stimulation, including modulation of the visual verticality, on balance.

Background & Aims: This study aimed to investigate the effects of low phase angle (PhA) on functional status and discharge disposition during the acute phase in older patients with acute stroke., Methods: We included consecutive patients who experienced acute stroke between October 2021 and December 2022. The exclusion criteria included: age<65 years, admission from other than home, death during hospitalization, inability to measure bioelectrical impedance analysis owing to implantation, and missing data. We defined low PhA (<5.28° for male and <4.62° for female) and categorized them into the low PhA group and normal group. The clinical outcomes were functional independence by the modified Rankin Scale (mRS) score (0-2, independence; 3-5, nonindependence) and discharge disposition (home or others). We used multivariate logistic regression analysis to examine the effect of low PhA on the mRS score at discharge and discharge disposition., Results: Ultimately, a total of 205 patients were included in this analysis. More patients in the low PhA group were unable to be independent (27.7% vs. 66.7%, P < 0.001) and were unable to be discharged home (53.4% vs. 82.5%, P < 0.001) than in the normal group. Logistic regression analysis of the mRS scores showed that baseline low PhA decreased the likelihood of functional independence (odds ratio [OR] = 0.275, P = 0.003) and home discharge (OR = 0.378, P = 0.044)., Conclusions: Low PhA is a risk factor for low functional status at hospital discharge; it decreases the likelihood of home discharge in older patients with acute stroke., Competing Interests: Declaration of competing interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Bleeding is a warning indication for many patients and persistent or recurrent hemorrhage leads to visit critical care facility. Brain computed tomography should be used to check for a ruptured aneurysm or an underlying SAH. The following are some of the methods for determining the underlying cause of SAH: Computed tomography angiography, magnetic resonance angiography and digital subtraction angiography are the 3 types of angiographies. A 36-years-old male was referred to the critical care department of our tertiary care teaching hospital with a complaint of severe frontal headache and vomiting from past 2 days. He had history of HTN and was not on any medication. Brain CT-SCAN was performed. Radiological finding of CT-SCAN shows Acute Sub-arachnoid Hemorrhage (SAH) in the in the split between the hemispheres, basal cistern, prepontine cistern, ambient cistern and small extension into bilateral sylvian cisternal spaces and along the tentorium in posterior aspect. The patient deceased after 27 days of admission. [ABSTRACT FROM AUTHOR]

Purpose: Androgen deprivation therapy (ADT), a mainstay of therapy for advanced prostate cancer (CaP), may raise patients' risk of cardiovascular disease (CVD) and related adverse events. The new androgen receptor (AR)-targeted agents are associated with hypertension and cardiovascular events. The most common non-CaP cause of death in men with CaP is CVD. The purpose of this review is to raise awareness of the metabolic and CV risks of ADT and to encourage proper monitoring of patients treated with hormonal agents.Materials and Methods: To review the cardiovascular and metabolic risk profiles of hormonal agents in managing patients with advanced CaP, the author searched PubMed, meeting abstracts, and clinicaltrials.gov from 1941 through early 2020 using search terms such as locally advanced CaP guidelines, gonadotropin-releasing hormone (GnRH) agonist/antagonist, ADT, CaP, CVD, abdominal obesity metabolic syndrome, and cerebrovascular disorder. The author ultimately selected 42 of the most relevant publications for inclusion in this paper.Results: Data regarding cardiovascular risk in patients with CaP on ADT are inconsistent, though there may be evidence of less risk in GnRH antagonists than GnRH agonists in men with pre-existing CVD. Observational post hoc studies generally show higher risks for GnRH agonists than GnRH antagonists. A review of 6 phase 3 trials found that patients treated with GnRH antagonists had lower cardiovascular risk than those treated with agonists during the first year of ADT, and these differences were especially significant among men with pre-existing CVD. Additionally, a small prospective randomized phase 2 study, as well as a large phase 3 trial, showed that there were significantly more major adverse cardiovascular events in patients treated with a GnRH agonist compared to a GnRH antagonist. In addition, the AR-targeted agents in conjunction with ADT have been shown to have more hypertension and/or cardiovascular risk than ADT plus placebo in numerous phase 3 trials.Conclusions: Whether there is a difference in CVD risk between GnRH agonists and antagonists is the subject of an ongoing phase 3 trial with cardiovascular endpoints. Addition of newer AR-targeted agents may confer additional risk over ADT alone. Clinicians treating advanced CaP should be aware of underlying comorbidities of their patients before choosing either conventional ADT or adding AR-targeted agents. Physicians should monitor patients for hypertension, diabetes, and cardiovascular side effects that may require intervention in order to minimize downstream adverse events and should communicate with other colleagues on the patient's health care team to ensure the best outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this systematic review was to determine the number of muscle synergies and the distribution of muscle weightings in stroke patients during gait. Material and Methods: This review is registered on PROSPERO (number: CRD42018088701) and is written following the PRISMA guidelines. A systematic search was conducted using following databases: PubMed, Web of Science, Naric, Cochrane and PEDro. Methodological quality was assessed by the Newcastle-Ottawa Scale and data extraction (subject characteristics, outcome measures and walking protocols) was performed by two independent researchers. The amount and structure of the muscle synergies were the two main outcome measures. Results: In total, ten studies were included in this review. While four synergies are common in healthy controls, stroke patients often showed less synergies during gait. Synergies were determined by the number of muscles measured which varied greatly between studies. Only Tibialis Anterior, Soleus, Gastrocnemius and Rectus Femoris were assessed in all studies. Conclusions: A consensus regarding the amount and composition of muscle synergies in stroke patients is difficult. The majority observed three to four muscle synergies. The decrease in amount of synergies can be explained by merging of synergies, often seen in hip/knee extensors with plantar flexors and hip/knee extensors with knee flexors. Muscle synergy analyses are a powerful tool for assessing and classifying neurological deficits. A decreased amount of muscle synergies is related to impaired motor function. Differences in coordinated muscle activity was seen in the paretic and non-paretic side. Merging was often seen in hip/knee extensors with plantar flexors and hip/knee extensors with knee flexors. [ABSTRACT FROM AUTHOR]

RNF213 is the major susceptibility factor for Moyamoya disease, a progressive cerebrovascular disorder that often leads to brain stroke in adults and children. Characterization of disease-associated mutations has been complicated by the enormous size of RNF213. Here, we present the cryo-EM structure of mouse RNF213. The structure reveals the intricate fold of the 584 kDa protein, comprising an N-terminal stalk, a dynein-like core with six ATPase units, and a multidomain E3 module. Collaboration with UbcH7, a cysteine-reactive E2, points to an unexplored ubiquitin-transfer mechanism that proceeds in a RING-independent manner. Moreover, we show that pathologic MMD mutations cluster in the composite E3 domain, likely interfering with substrate ubiquitination. In conclusion, the structure of RNF213 uncovers a distinct type of an E3 enzyme, highlighting the growing mechanistic diversity in ubiquitination cascades. Our results also provide the molecular framework for investigating the emerging role of RNF213 in lipid metabolism, hypoxia, and angiogenesis.

Introduction Circle of Willis is a large arterial anastomosis between internal carotid and vertebrobasilar arterial system. It is the principal collateral channel for constant blood flow to brain. Any changes in its morphology may cause vascular insufficiency of variable severity. Knowledge about its anomalies may elucidate occurrence of cerebrovascular disorders, its presentation, treatment, prognosis and prevention. Methods An observational study on 107 fresh cadavers was conducted at Maharajgunj Medical Campus from September 2016 to August 2017. After dissection of the scalp and removal of the vault and dura mater, the brain was obtained. Then the Circle of Willis was identified and observed for its completeness, symmetry, presence, origin and number of arteries forming it and the obtained data were documented, photographed and analyzed. Results Out of 107 cadavers, variations were noted among 15 (14%): out of which 10 were male and 5 female. Twelve cadavers had single variation while 3 had two variations. Accessory anterior cerebral artery was found in 7 (38.90%), fetal origin of right posterior communicating artery in 2 (11.10%), fetal origin of left posterior communicating artery in 4 (22.20%), early bifurcation of left posterior cerebral artery in 1 (5.60%), variant anterior communicating artery in 2 (11.10%), fused anterior cerebral artery in 1 (5.60%) and aneurysm in 1(5.60%) subjects were found. Conclusion Variations were noted among 15 cadavers (14%), 12 cadavers had single variation while 3 had two variations. The most common variation seen was accessory anterior cerebral artery found in 7 cadavers (38.90%). Most of the variations were found in midline anteriorly followed by right side. [ABSTRACT FROM AUTHOR]

We have previously reported that intravenous injection of l-citrulline, an α-amino acid isolated from watermelon juice, prevented the decrease in cerebral blood flow (CBF) during cortical spreading depression (CSD) in rats, a widely accepted animal model of migraine aura. However it is not clear whether oral l-citrulline administration improves CBF during CSD or not. For clinical application of l-citrulline against migraine aura, we evaluated the effect of oral l-citrulline administration on the parameters of CSD. Daily oral administration of l-citrulline for 8 consecutive days increased brain concentration of l-arginine as well as l-citrulline. Moreover, l-citrulline reduced the disturbance of CBF, monitored by laser Doppler flowmetry, with less effect on mean arterial pressure and heart rate during CSD. Although l-citrulline had no effect on CSD propagation velocity, it accelerated the recovery of CBF changes. These results suggest that l-citrulline has a clinically beneficial effect on migraine aura via regulation of CBF.

(1) Background: It is essential to increase the awareness of cardiovascular diseases’ symptoms and reduce treatment delays among women with hypertension (HTN). This study aimed to assess the knowledge of cardio-cerebrovascular diseases’ warning signs (KCVDs), according to awareness of their blood pressure levels (AoBP), and identify the factors associated with KCVDs and AoBP in women with HTN. (2) Methods: This study used the data from the Korea Community Health Survey of 2018. A total of 29,832 women with HTN were included in the final analysis. Data on sociodemographic characteristics, KCVDs, and AoBP were identified. A negative binomial regression was used to identify factors associated with KCVDs. (3) Results: Of the participants, 42.9% were not aware of their blood pressure level, and 9.1% did not have any knowledge of KCVD symptoms. Factors associated with KCVDs were AoBP (odds ratio (OR) = 1.121, p < 0.001), middle age (OR = 1.012, p = 0.008), employment (OR = 1.034, p < 0.017), and being married and living with a spouse (OR = 1.068, p < 0.001). Lower levels of education (OR = 0.931, p < 0.001) and regular walking (OR = 0.964, p = 0.015) were also associated with KCVDs. Health-related quality of life (HRQoL) and subjective health status were associated with increased AoBP. (4) Conclusions: AoBP was positively associated with KCVDs. It is necessary to include AoBP in public campaigns and regular policy support to improve KCVDs. In addition, findings in this study can serve as basic data for developing socio-cultural interventions, aimed at mitigating cardio-cerebrovascular diseases, by improving levels of KCVDs.

Objective: A systematic review to examine the effect of static or dynamic trunk training compared to standard care or control therapy on muscle activity and muscle thickness of the trunk and lower limb muscles in stroke survivors. Materials and methods: This review was registered on PROSPERO (no: CRD42017063771) and was written according to the PRISMA guidelines. The search strategy included studies from the first indexed article until September 2017 and was performed in the electronical databases PubMed, Web of Science, Cochrane Library, Ovid Medline and PEDro. Two independent reviewers screened, assessed risk of bias by means of the PEDro scale and extracted data. Results: Eight studies were included of which three investigated the effects of trunk training on muscle thickness, the remaining five investigated muscle activity. The following muscles were investigated: erector spinae, multifidi, paravertebralis, transversus abdominis, internal and external oblique abdominis, rectus abdominis, quadriceps femoris, hamstrings, soleus and tibialis anterior. Trunk exercises significantly improved the muscle activity of the internal oblique abdominis and increased muscle thickness of transversus abdominis. Conclusions: Trunk training is effective in restoring symmetry in muscle thickness to improve muscle strength. The gain in muscle thickness is specific to the applied exercise program, suggesting that therapeutic goal setting is of great importance. However, no conclusion could be made concerning changes in muscle activity due to a high risk of bias. Trunk training seems to be effective in restoring symmetry in trunk muscle thickness. Not all muscle groups benefit from specific trunk exercises. Patients suffering from chronic stroke are still capable of restoring muscle function. [ABSTRACT FROM AUTHOR]

Background and aims: Little data exist on the incidence of stroke in Australia. Our aim was to report age and sex disparities in hospital admission for stroke in Queensland, Australia's most populous northern state. Methods: We identified all patients admitted to hospital in Queensland with a diagnosis of stroke from January to December 2015. Results: Among 25,776 admissions with a diagnosis of stroke or TIA and related sequelae, stroke was the principal diagnosis in 11,072 cases of whom 5270 (47.60%) were first-ever stroke. Based on incidents per 100,000 population per year, the crude annual admission rate for first-ever strokes was 110 (95% CI, 107 to 113), 120 (95% CI, 115 to 124) for men and 101 (95% CI, 97 to 105) for women. The corresponding rates adjusted to the world population were 69 (95% CI, 52 to 85), and 88 (95% CI, 70 to 107) adjusted to the European population. Gender and age-adjusted incidence was greater for men than women in all age-groups, except those aged 30–34 years, where occurrence was 10 for men and 16 for women. Conclusions: Based on the outcomes, hospital admission for stroke occurs less frequently in Queensland than in other regions of Australia. Men generally show a higher rate of hospitalization than women, with the notable exception of women aged 30–34, for whom the trend reverses. [ABSTRACT FROM AUTHOR]

BACKGROUND: Functional autonomy and social inclusion are of key importance for stroke patient's rehabilitation. OBJECTIVE: To evaluate activity and participation of chronic stroke patients by means of basic (BADL), instrumental (IADL) and social (SADL) activities of daily living. METHODS: Forty individuals, 24 patients and 16 healthy individuals fill in a functional activities habits questionnaire. RESULTS: Regarding BADL, 25% of the patients did not get out of bed and 70.8% did not use toilet by themselves. Considering IADL, 29.2% of the patients did not dial the telephone, 70.8% did not wash dishes and clothes, 58.3% did not cook, 100% did not sew, 87.5% did not carry out repairs, 41.7% did not go to the bank, 54.2% did not shop and 45.8% did not write (all p < 0.05). Regarding SADL, 87.5% of the patients were not working professionally, 41.7% did not visit friends or relatives, 75% did not travel and go to the beach and 95.8% did not dance (all p < 0.05). CONCLUSIONS: Chronic stroke patients have limitations in activity and restrictions to participation, even after few years of stroke onset, particularly regarding applying knowledge, use of communication devices, domestic life, major life areas and community, social and civic life. [ABSTRACT FROM AUTHOR]

We offer here an observation written in 1866 by Jean-Martin Charcot, accompanied by drawings made during the autopsy of a patient who died of "cerebral softening." Focusing mainly on French medical progress at the time, our survey of the state of knowledge of cerebrovascular pathology indicates that Charcot completely explained the pathophysiology of cerebral infarction, describing the ulceration of an atheromatous plaque at the intima of an artery, on which a clot aggregates, blocks the vessel, or releases embolus downstream, causing cerebral ischemia and parenchymal lesions. Using the term "cholestérine" (cholesterin), the name of cholesterol at the time, he identified the biological nature of atheromatous plaques, and made detailed drawings. This observation, included in the famous thesis of Ivan Poumeau, indicates that Charcot did not neglect cerebrovascular pathology, ischemic in this case, but also pathology caused by hemorrhaging, as in the thesis of Charles Bouchard. This interest, which we see clearly during his first decade at Hôpital de la Salpêtrière, gradually turned toward other neurological pathologies that ensured his fame as a founder of neurology more enduringly and overshadowed the conceptual advances he made in the vascular domain. [ABSTRACT FROM AUTHOR]

Patients with subcortical ischemic vascular disease (SIVD) may exhibit a high risk of cognitive impairment (CI) by disruption of white matter (WM) integrity. Diffusion tensor imaging (DTI) is recommended as a sensitive method to explore whole brain WM alterations at an asymptomatic stage of the disease, which might be correlated with underlying cognitive disorders. We aim to investigate alterations in WM microstructures and evaluate the relationships between the mean values of diffusion metrics (FA, MD, AD, and RD) and cognitive assessments in SIVD patients. Fifty SIVD patients with (SVCI, N = 25) and without (pre-SVCI, N = 25) cognitive impairments and normal controls (NC, N = 23) underwent DTI and neuropsychological examinations. DTI data were analyzed via TBSS to detect significant changes in WM tracts. Spearman correlation analysis was performed to evaluate relationships between the mean values of diffusion indices and the cognitive assessments. In general, extensive symmetrically altered areas that involved approximately the entire cerebral WM were noted in the pre-SVCI group but were less distinct than that noted in the SVCI group compared with NCs. The genu of corpus callosum exhibited the most damaged WM fiber. Throughout WM, FA was decreased, whereas MD, AD, and RD were increased. Some specific WM tracts in patient groups were significantly correlated with the severity of white matter hyperintensity (WMH), cognitive assessments about executive functions and processing speed. WM integrity has already been damaged at the pre-SVCI stage, which would be associate with future cognitive dysfunction. DTI could potentially establish early biomarkers to detect underlying mechanisms of SIVD. [ABSTRACT FROM AUTHOR]

Purpose: Moyamoya disease is a chronic cerebrovascular disorder characterized by progressive stenosis of the circle of Willis with a compensatory collateral vessel network. Recent studies have identified the ring finger protein 213 gene (RNF213) as the unique susceptibility gene for moyamoya disease. The purpose of this study was to compare clinical features of moyamoya disease, especially angiographic findings, between patients with and without the RNF213 mutation.Methods: Blood samples from 35 patients with moyamoya disease were obtained between May 2016 and May 2017. Information on age at the time of diagnosis, sex, and initial symptom were obtained via retrospective chart review. Angiographic records were evaluated.Results: RNF213 variants were detected in the 28 of 35 patients (80%), including all pediatric patients (100%) and 18 of 25 adult patients (72%) in our cohort. Leptomeningeal collateral flow from posterior to anterior circulation was more frequent in the RNF213-negative group than in the RNF213-positive group (100% versus 38.9%; p = 0.020). Posterior cerebral arterial territorial involvement was more frequently observed in RNF213-positive patients than in RNF213-negative patients (50% versus 0%; p = 0.027).Conclusions: RNF213 may play a significant role in the development of collateral anastomoses. [ABSTRACT FROM AUTHOR]

Background Indirect revascularization is simple and safe, but it is not commonly used in adult moyamoya disease owing to its unreliable effect. This prospective study aimed to evaluate the effectiveness of indirect revascularization in treating adult moyamoya disease after refinement of the surgical technique and perioperative care. Methods Adult patients who underwent indirect revascularization as the primary treatment for moyamoya disease between November 2013 and January 2017 were studied. The indirect revascularization procedures included encephalo-duro-arterio-synangiosis and encephalo-myo-synangiosis in the temporal region and encephalo-pericranio-synangiosis in other hypoperfusion areas. The preoperative and postoperative clinical conditions, cerebral angiography findings, and time-to-peak prolongation areas on magnetic resonance perfusion studies were assessed to evaluate the revascularization effect. Refinements of the surgical technique included the selection of surgical area based on perfusion imaging, craniotomy size, and number of affected hemispheres, along with the inclusion of a dural flap in every procedure. Results Nineteen patients (17 females and 2 males), and a total of 31 cerebral hemispheres, were included. The mean patient age was 32.7 ± 11.4 years. After a mean follow-up of 38.6 ± 11.5 months, all patients showed clinical improvement or stabilization. Available postoperative angiography demonstrated Matsushima grade A or B in 19 of 21 hemispheres. The mean time-to-peak prolongation index of all 31 hemispheres improved from 24.09 ± 9.83% preoperatively to 12.82 ± 6.75% at 3–6 months after surgery (P < 0.001). The complication rate was 12.9%, and all complications were transient. Conclusions With refinements of surgical techniques and perioperative care, indirect revascularization is more reliable and can be a viable alternative treatment for adult moyamoya disease. In our cohort, outcomes were satisfactory, with mean 38.6-month follow-up. Highlights • Indirect revascularization can be a reliable treatment for adult moyamoya disease after refinements of surgical techniques. • Time-to-peak prolongation area measurement is a useful tool for preoperative planning and postoperative follow-up. • Dura is an important material for indirect revascularization. Duropexy should be performed in every craniotomy window. • In adult moyamoya patients, the addition of EPS and duropexy to EDAS is effective and important. [ABSTRACT FROM AUTHOR]