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Liying Sun, Xuhui Ye, Junping Yu, Linlin Wang, Yan Wu, Jing Cui, Lihua Dai Intensive Care Unit, Shidong Hospital, Shanghai, People’s Republic of ChinaCorrespondence: Lihua Dai, Intensive Care Unit, Shidong Hospital, Yangpu District, Shanghai, 200438, People’s Republic of China, Tel +86 18917059757, Email gg790516@163.comPurpose: Previous studies have reported that lymphocyte-to-monocyte ratio (LMR) is associated with the prognosis of patients with acute ischemic stroke (AIS); however, the relationship between LMR and early neurological deterioration (END) in AIS patients has not been elucidated.Patients and Methods: Patients were divided into two groups according to LMR by using receiver operating characteristic (ROC) curve analysis. Patients with END were confirmed as the National Institutes of Health Stroke Scale (NIHSS) increased ≥ 4 points between hospital days 0 and 5. Multivariate logistic regression analysis was used to analyze the factors independently related to END in patients with AIS.Results: In total, 202 patients diagnosed with AIS were enrolled in this retrospective study. Using ROC curve analysis, patients were divided into two groups according to LMR: low LMR group (LMR < 3.24, n = 95) and high LMR group (LMR ≥ 3.24, n = 107). The frequencies of END were significantly higher in the low LMR group compared to the high LMR group (41.05 vs.15.89%, p < 0.001). Multivariate logistic regression showed that age (OR = 1.03, 95% CI 1.01– 1.06, p = 0.04), infarct volume (OR = 1.01, 95% CI 1.00– 1.02, p = 0.001), neutrophil count (OR = 1.17, 95% CI 1.03– 1.33, p = 0.018), and LMR (OR = 2.49, 95% CI 1.01– 9.11, p = 0.018) were independently associated with END in AIS patients.Conclusion: A peripheral LMR levels at admission were significantly associated with END and LMR < 3.24 is an independent predictive factor of END in patients with AIS.Keywords: lymphocyte-to-monocyte ratio, acute ischemic stroke, early neurological deterioration, national institutes of health stroke scale

Abstract In this hospital-based cross-sectional analytic study, we retrospectively reviewed clinical data of patients with acute ischemic stroke (AIS) between January 2017 and April 2023. Atrial cardiopathy was defined as any presence of the following: left atrial diameter ≥ 52 mm (males) or ≥ 47 mm (females), elevated P-wave terminal force in V1 > 5000 μV ms, or serum N terminal pro B type natriuretic peptide > 250 pg/ml. Initial stroke severity was defined by the National Institutes of Health Stroke Scale (NIHSS; moderate-to-severe, ≥ 5; and severe, ≥ 15). Univariate and multivariate binary logistic regression analyses were performed to assess the association between atrial cardiopathy and stroke severity. Among 662 AIS patients (mean age 70 years [interquartile range 61–78], 31.3% women), 303 (45.8%) had atrial cardiopathy. Multivariable logistic regression analysis showed that the presence of atrial cardiopathy was significantly associated with a higher odd of moderate-to-severe stroke (adjusted odds ratio [OR] 2.16, 95% confidence interval [CI] 1.46–3.20, p

We wanted to evaluate if optical coherence tomography angiography OCTA findings could predict the functional outcome in extracranial carotid artery atherosclerotic disease (ECAD) associated stroke. This exploratory study was performed on adults with acute ischaemic stroke due to ECAD at 3–6 weeks following stroke onset with risk factor matched controls without carotid artery stenosis. Twenty-three stroke patients (cases) and 23 controls were enrolled. There was significant difference between cases and controls in deep vessel density at the macula (p =.0007) and in radial peripapillary capillary perfusion density (RPCPD) at the optic nerve head (ONH) (p =.0007). Statistically significant difference was noted in the total superficial vessel density (SVD) at the macula (SVD within 1 standard deviation [SD] versus SVD beyond 1 SD of control data) in the ipsilateral eye and functional outcome at 3 months (poor versus very good outcome, modified Rankin scale [mRS] 0–1 versus mRS 2–6, respectively; p =.0361). There was statistically insignificant correlation between the RPCPD at the ONH and the National Institutes of Health Stroke Scale score at admission, mRS at discharge, and mRS at 3 months following stroke onset (r =.33, r =.35, r =.39; p =.11, p =.09, p =.06, respectively). The findings of this exploratory study suggested that OCTA findings may predict 3 month outcomes in cases of ECAD-related stroke and could be useful in decision making in future intervention studies as to whether intervene or not in patients having critical or non-critical ECAD for preventing stroke. [ABSTRACT FROM AUTHOR]

In this hospital-based cross-sectional analytic study, we retrospectively reviewed clinical data of patients with acute ischemic stroke (AIS) between January 2017 and April 2023. Atrial cardiopathy was defined as any presence of the following: left atrial diameter ≥ 52 mm (males) or ≥ 47 mm (females), elevated P-wave terminal force in V1 > 5000 μV ms, or serum N terminal pro B type natriuretic peptide > 250 pg/ml. Initial stroke severity was defined by the National Institutes of Health Stroke Scale (NIHSS; moderate-to-severe, ≥ 5; and severe, ≥ 15). Univariate and multivariate binary logistic regression analyses were performed to assess the association between atrial cardiopathy and stroke severity. Among 662 AIS patients (mean age 70 years [interquartile range 61–78], 31.3% women), 303 (45.8%) had atrial cardiopathy. Multivariable logistic regression analysis showed that the presence of atrial cardiopathy was significantly associated with a higher odd of moderate-to-severe stroke (adjusted odds ratio [OR] 2.16, 95% confidence interval [CI] 1.46–3.20, p < 0.001) and severe stroke (adjusted OR 4.89, 95%CI 2.45–9.76, p < 0.001). This association remained significant in a sensitivity analysis excluding those with atrial fibrillation or coronary artery disease. Findings of the current study revealed that the association of atrial cardiopathy was with initial stroke severity independent of atrial fibrillation and was even confirmed in patients without atrial fibrillation; future studies to explore improved stroke prevention strategies for patients with atrial cardiopathy are needed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the incidence of pressure ulcers (PUs) in patients treated for acute ischaemic stroke (AIS) and to evaluate comorbid/confounding factors. Method: The study included patients treated for AIS who were divided into three treatment groups: those receiving intravenous tissue plasminogen activator therapy (tPA); patients receiving mechanical thrombectomy (MT); and those receiving both tPA and MT. PUs were classified according to the international classification system and factors that may influence their development were investigated. Results: A total of 242 patients were included in this study. The incidence of PUs in patients treated for AIS was 7.4%. Most PUs were located on the sacrum (3.7%), followed by the gluteus (3.3%) and trochanter (2.9%). With regards to PU classification: 29% were stage I; 34% were stage II; and the remainder were stage III. Age was not a significant factor in the development of PUs (p=0.172). Patients in the tPA group had a lower PU incidence (2.3%) than patients in the tPA+MT group (15.7%) and MT group (12.1%) (p=0.001). Patients with PUs had a longer period of hospitalisation (18.5±11.92 days) than patients without a PU (8.0±8.52 days) (p=0.000). National Institute of Health Stroke Scale (NIHSS) scores at admission were higher in patients with PUs than in patients without a PU (14.33±4.38 versus 11.08±5.68, respectively; p=0.010). The difference in presence of comorbidities between patients with and without PUs (p=0.922) and between treatment groups (p=0.677) were not statistically significant. The incidence of PUs was higher in patients requiring intensive care, but this difference was not statistically significant (p=0.089). Conclusion: In this study, patients treated for AIS with high NIHSS scores at admission and/or receiving MT were at higher risk for PUs, and so particular attention should be given to these patients in order to prevent PU development. [ABSTRACT FROM AUTHOR]

Background Multicenter electronic health records can support quality improvement and comparative effectiveness research in stroke. However, limitations of electronic health record–based research include challenges in abstracting key clinical variables, including stroke severity, along with missing data. We developed a natural language processing model that reads electronic health record notes to directly extract the National Institutes of Health Stroke Scale score when documented and predict the score from clinical documentation when missing. Methods and Results The study included notes from patients with acute stroke (aged ≥18 years) admitted to Massachusetts General Hospital (2015–2022). The Massachusetts General Hospital data were divided into training/holdout test (70%/30%) sets. We developed a 2‐stage model to predict the admission National Institutes of Health Stroke Scale, obtained from the GWTG (Get With The Guidelines) stroke registry. We trained a model with the least absolute shrinkage and selection operator. For test notes with documented National Institutes of Health Stroke Scale, scores were extracted using regular expressions (stage 1); when not documented, least absolute shrinkage and selection operator was used for prediction (stage 2). The 2‐stage model was tested on the holdout test set and validated in the Medical Information Mart for Intensive Care (2001–2012) version 1.4, using root mean squared error and Spearman correlation. We included 4163 patients (Massachusetts General Hospital, 3876; Medical Information Mart for Intensive Care, 287); average age, 69 (SD, 15) years; 53% men, and 72% White individuals. The model achieved a root mean squared error of 2.89 (95% CI, 2.62–3.19) and Spearman correlation of 0.92 (95% CI, 0.91–0.93) in the Massachusetts General Hospital test set, and 2.20 (95% CI, 1.69–2.66) and 0.96 (95% CI, 0.94–0.97) in the MIMIC validation set, respectively. Conclusions The automatic natural language processing–based model can enable large‐scale stroke severity phenotyping from the electronic health record and support real‐world quality improvement and comparative effectiveness studies in stroke.

Abstract Background Acute ischemic stroke (AIS) is one of the most common cerebrovascular diseases which accompanied by a disruption of aminothiols homeostasis. To explore the relationship of aminothiols with neurologic impairment severity, we investigated four aminothiols, homocysteine (Hcy), cysteine (Cys), cysteinylglycine (CG) and glutathione (GSH) in plasma and its influence on ischemic stroke severity in AIS patients. Methods A total of 150 clinical samples from AIS patients were selected for our study. The concentrations of free reduced Hcy (Hcy), own oxidized Hcy (HHcy), free reduced Cys (Cys), own oxidized Cys (cysteine, Cyss), free reduced CG (CG) and free reduced GSH (GSH) were measured by our previously developed hollow fiber centrifugal ultrafiltration (HFCF-UF) method coupled with high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The concentration ratio of Hcy to HHcy (Hcy/HHcy), Cys to Cyss (Cys/Cyss) were also calculated. The neurologic impairment severity of AIS was evaluated using National Institutes of Health Stroke Scale (NIHSS). The Spearman correlation coefficient and logistic regression analysis was used to estimate and perform the correlation between Hcy, HHcy, Cys, Cyss, CG, GSH, Hcy/HHcy, Cys/Cyss and total Hcy with NIHSS score. Results The reduced Hcy and Hcy/HHcy was both negatively correlated with NIHSS score in AIS patients with P = 0.008, r=-0.215 and P = 0.002, r=-0.249, respectively. There was no significant correlation of Cys, CG, GSH, HHcy, Cyss, Cys/Cyss and total Hcy with NIHSS score in AIS patients with P value > 0.05. Conclusions The reduced Hcy and Hcy/HHcy, not total Hcy concentration should be used to evaluate neurologic impairment severity of AIS patient.

Abstract Background Acute ischemic stroke (AIS) is the second leading cause of disability and death worldwide. Micro-RNA (miRNA)-223 was first identified as a regulator of hematopoietic lineage differentiation. Later, its diverse roles were discovered in a wide spectrum of pathological conditions. The present study aimed to assess the clinical and prognostic significance of miR-223 in patients with acute ischemic stroke (AIS). The study included 93 patients with AIS diagnosed on the basis of clinical and radiological findings. In addition, there were 50 healthy subjects who served as controls. Patients were classified into two categories: Those with favorable functional outcome (modified Rankin Scale (mRS): 0–2) and others with unfavorable functional outcome (mRS: 3–6) at 6 months post-stroke. Results The present prospective longitudinal study included 93 patients with AIS. They included 60 males (64.5%) and 33 females (35.5%) with an age of 64.5 ± 12.4 years. At the end of 6-month follow up, 44 patients (47.3%) had favorable outcome while the remainder 49 patients (52.7%) had unfavorable outcome. Patients with favorable outcome had significantly lower baseline miR-223 levels [median (IQR): 4.4 (2.0–6.3) versus 8.4 (4.5–14.9), p

Introduction: Stroke is the second leading cause of mortality and disability worldwide. A large proportion of stroke survivors are left with significant disability. Assessing stroke severity and predicting morbidity and mortality is essential for treatment decisions and counseling. Traditionally used tools like the National Institutes of Health Stroke Scale (NIHSS) are not reliable in predicting mortality. Studies have shown that B-type Natriuretic Peptide (BNP) and N-terminal pro Brain Natriuretic Peptide (NT-proBNP) are elevated in acute stroke. Aim: To assess the prognostic importance of NT-proBNP in stroke. Materials and Methods: A prospective cohort study was conducted at Sri Devaraj URS Medical College (SDUMC), SDUAHER, Kolar, Karnataka, India involving 64 consecutive stroke patients from July 2018 to September 2019. Serum NT-proBNP levels were measured on both the day of admission and on day 7. Stroke severity was assessed using the NIHSS on admission day, and functional disability was determined using the Barthel Index (BI) at the 3-month mark. Data were entered into MS Excel for statistical analysis, where a p-value of

Background: Acute ischemic stroke (AIS) is one of the most common cerebrovascular diseases which accompanied by a disruption of aminothiols homeostasis. To explore the relationship of aminothiols with neurologic impairment severity, we investigated four aminothiols, homocysteine (Hcy), cysteine (Cys), cysteinylglycine (CG) and glutathione (GSH) in plasma and its influence on ischemic stroke severity in AIS patients. Methods: A total of 150 clinical samples from AIS patients were selected for our study. The concentrations of free reduced Hcy (Hcy), own oxidized Hcy (HHcy), free reduced Cys (Cys), own oxidized Cys (cysteine, Cyss), free reduced CG (CG) and free reduced GSH (GSH) were measured by our previously developed hollow fiber centrifugal ultrafiltration (HFCF-UF) method coupled with high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The concentration ratio of Hcy to HHcy (Hcy/HHcy), Cys to Cyss (Cys/Cyss) were also calculated. The neurologic impairment severity of AIS was evaluated using National Institutes of Health Stroke Scale (NIHSS). The Spearman correlation coefficient and logistic regression analysis was used to estimate and perform the correlation between Hcy, HHcy, Cys, Cyss, CG, GSH, Hcy/HHcy, Cys/Cyss and total Hcy with NIHSS score. Results: The reduced Hcy and Hcy/HHcy was both negatively correlated with NIHSS score in AIS patients with P = 0.008, r=-0.215 and P = 0.002, r=-0.249, respectively. There was no significant correlation of Cys, CG, GSH, HHcy, Cyss, Cys/Cyss and total Hcy with NIHSS score in AIS patients with P value > 0.05. Conclusions: The reduced Hcy and Hcy/HHcy, not total Hcy concentration should be used to evaluate neurologic impairment severity of AIS patient. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Patients with acute ischaemic stroke are more likely to develop refeeding syndrome due to increased need for nutritional support when suffering alterations of consciousness and impairment of swallowing. This study aimed to evaluate the incidence, risk factors and outcomes of refeeding syndrome in stroke patients.This was a retrospective observational study, using the prospective stroke database from hospital, included all consecutive acute ischaemic stroke patients who received enteral nutrition for more than 72 h from 1 January 2020 and 31 December 2022. Refeeding syndrome was defined as occurrence of new‐onset hypophosphataemia within 72 h after enteral feeding. Multiple logistic regression analysis was conducted to evaluate risk factors and relationships between refeeding syndrome and stroke outcomes.338 patients were included in the study. 50 patients (14.8%) developed refeeding syndrome. Higher scores on National Institutes of Health Stroke Scale and Nutritional Risk Screening 2002, albumin <30 g/L and BMI <18.5 kg/m2 were risk factors for refeeding syndrome. Moreover, refeeding syndrome was independently associated with a 3‐month modified Rankin Scale score of >2 and 6‐month mortality.Refeeding syndrome was common in stroke patients and higher baseline National Institutes of Health Stroke Scale, higher Nutritional Risk Screening 2002, albumin <30 g/L and BMI <18.5 kg/m2 were independent risk factors of refeeding syndrome. Occurrence of refeeding syndrome was significantly associated with higher 3‐month modified Rankin Scale and 6‐month mortality. [ABSTRACT FROM AUTHOR]

Introduction: Strokes rank among the leading causes of death and disability worldwide, with acute ischemic stroke (AIS) on the rise in Iran. Thrombolytic drugs constitute a primary treatment for ischemic stroke. However, due to limited studies in Iran, there exists hesitation among physicians regarding their administration. This study aims to assess the efficacy of these drugs on AIS patients. Methods: In a clinical trial, 80 patients with ischemic stroke were divided into treatment and control groups. Both groups were assessed upon admission and 72 hours later using the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) scores at discharge. The treatment group received Alteplase (0.9mg/kg), while the control group received standard care. Statistical analysis was performed using SPSS 20. Results: The mean NIHSS ± SD scores at admission and 72 hours later in the treatment group were 10.0±3.51 and 4.55±8.75, respectively, compared to 8.53±3.52 and 7.88±9.21 in the control group, showing a significant difference in favor of the treatment group (P < 0.001). Similarly, the mean mRS± SD score in the treatment group was 1.68±1.79, significantly lower than the control group's 3.15±1.61 (P < 0.001). Conclusion: Intravenous Alteplase administration proved effective in treating patients with ischemic stroke, significantly reducing neurological complications and disabilities compared to standard medical care. [ABSTRACT FROM AUTHOR]

Background: Acute ischemic stroke (AIS) is the second leading cause of disability and death worldwide. Micro-RNA (miRNA)-223 was first identified as a regulator of hematopoietic lineage differentiation. Later, its diverse roles were discovered in a wide spectrum of pathological conditions. The present study aimed to assess the clinical and prognostic significance of miR-223 in patients with acute ischemic stroke (AIS). The study included 93 patients with AIS diagnosed on the basis of clinical and radiological findings. In addition, there were 50 healthy subjects who served as controls. Patients were classified into two categories: Those with favorable functional outcome (modified Rankin Scale (mRS): 0–2) and others with unfavorable functional outcome (mRS: 3–6) at 6 months post-stroke. Results: The present prospective longitudinal study included 93 patients with AIS. They included 60 males (64.5%) and 33 females (35.5%) with an age of 64.5 ± 12.4 years. At the end of 6-month follow up, 44 patients (47.3%) had favorable outcome while the remainder 49 patients (52.7%) had unfavorable outcome. Patients with favorable outcome had significantly lower baseline miR-223 levels [median (IQR): 4.4 (2.0–6.3) versus 8.4 (4.5–14.9), p < 0.001], lower HbA1c levels (5.6 ± 1.0 versus 6.2 ± 1.2, p = 0.006) and lower C-reactive protein (CRP) levels [median (IQR): 8.9 (5.1–26.7) versus 15.2 (6.2–39.3) mg/dL, p = 0.02]. Multivariate binary logistic regression analysis recognized high baseline miR-223 [OR (95% CI) 1.13 (1.06–1.24), p = 0.011], infarct size [OR (95% CI) 2.58 (1.66–4.77), p = 0.001] and National Institutes of Health Stroke Scale (NIHSS) [OR (95% CI) 2.11 (1.74–3.09), p = 0.004] as significant predictors of unfavorable outcome in the studied patients. Conclusions: Elevated baseline miR-223 levels are associated with high NIHSS and larger infarct size at baseline and can effectively predict patients' outcome at 6-months post-stroke. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is the second leading cause of mortality and disability worldwide. A large proportion of stroke survivors are left with significant disability. Assessing stroke severity and predicting morbidity and mortality is essential for treatment decisions and counseling. Traditionally used tools like the National Institutes of Health Stroke Scale (NIHSS) are not reliable in predicting mortality. Studies have shown that B-type Natriuretic Peptide (BNP) and N-terminal pro Brain Natriuretic Peptide (NT-proBNP) are elevated in acute stroke. Aim: To assess the prognostic importance of NT-proBNP in stroke. Materials and Methods: A prospective cohort study was conducted at Sri Devaraj URS Medical College (SDUMC), SDUAHER, Kolar, Karnataka, India involving 64 consecutive stroke patients from July 2018 to September 2019. Serum NTproBNP levels were measured on both the day of admission and on day 7. Stroke severity was assessed using the NIHSS on admission day, and functional disability was determined using the Barthel Index (BI) at the 3-month mark. Data were entered into MS Excel for statistical analysis, where a p-value of <0.05 was considered statistically significant. Results: The average age of the subjects was 62.36 years with a standard deviation of 12.15 years. The average NIHSS on the day of admission was 12.81 (7), and it was 20.2 (5.882) among deceased patients. The mean NT-proBNP on admission was 776.70 (1023.6) pg/mL, significantly elevated in deceased patients at 2014.65 (1320.546) compared to survivors at 328.94 (239.353). NT-proBNP is strongly associated with stroke severity (NIHSS) (R2=0.522; Spearman's correlation coefficient=0.843, p-value <0.001) and functional outcome (BI) (R2=0.824; Spearman's correlation coefficient -0.923, p-value <0.001) at three months. On Receiver Operating Characteristic (ROC) analysis, a serum NT-proBNP level of 960 pg/mL had a sensitivity and specificity of 94.1% and 97.9% in predicting mortality, and a value of 435.1 pg/mL had a sensitivity and specificity of 90% and 81% in predicting disability. Conclusion: Serum NT-proBNP was significantly elevated in patients after stroke and was strongly associated with stroke severity and functional outcome at three months. Measuring serum NT-proBNP on the day of admission can predict mortality and functional dependence after acute ischaemic stroke. [ABSTRACT FROM AUTHOR]

Objectives: Resistive index (RI) and pulsatility index (PI) assessed on carotid Doppler assess the hemodynamic status of cranial vasculature. They are related to the severity of stroke and help determine the overall outcome. This study was done to compare the hospital stay and stroke severity with RI and PI of both internal carotid arteries. Materials and Methods: Patients >18 years of age presenting within 48 h of anterior circulation stroke (either ischemic or hemorrhagic) were included. They were divided into two groups based on their length of stay (LOS). They were assessed clinically on days 1, 3, and 5, and underwent a carotid Doppler study on the same days. The Doppler parameters were correlated with the LOS and stroke severity for possible associations. Results: One hundred and one patients were included. Forty-seven patients had a favorable outcome based on LOS. In this group, significant decrease in RI and PI scores was seen from days 1 to 3. In patients with unfavorable outcome, there was a significant increase in PI on days 1-3 and days 1-5. The National Institutes of Health Stroke Scale decreased significantly from days 1 to 5 in favorable group Conclusion: For those with an unfavorable outcome and prolonged LOS, PI continues to increase suggesting a failure of autoregulation. Carotid Doppler can be a simple bedside tool to predict outcome in patients with acute stroke. [ABSTRACT FROM AUTHOR]

Background Prior studies have shown benefit for endovascular therapy (EVT) in patients with large‐vessel occlusion and severe deficits, as captured by the National Institutes of Health Stroke Scale (NIHSS). However, the benefit of EVT in patients with NIHSS score of

Introduction: The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria. Methods: In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates. Results: The error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (P < 0.001). For dysphasia phrases and dysarthria words, the error rates were low and there were no differences in error rates between the original and alternative items. Conclusion: There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by the high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable version of the NIHSS for English-speaking subjects in Singapore. [ABSTRACT FROM AUTHOR]

Abstract Background National institutes of health stroke scale (NIHSS) is used, since its appearance in analysis of stroke in any national or international single center or multicenter study. It is also the golden standard assessment scale for stroke patients whether by emergency medical services on the way to hospital or by emergency room staff and by neurologists whether juniors or senior consultants. Yet, it is not capable of identifying all stroke cases. Along the current case report a relatively rare case of cortical deafness is presented highlighting its rarity and its vascular mechanism as well as how defective is NIHSS in recognizing it. Case presentation 72-year-old female patient presented with sudden episodic less than 60 min duration of bilateral deafness; initial imaging showed right hemispheric encephalomalacia of old stroke. Patient was initially managed as psychogenic case especially that her NIHSS was zero. On returning again to emergency room she was administered thrombolysis and regained full hearing power. Follow-up imaging revealed a new ischemic stroke along her left auditory cortex explaining her cortical deafness. Conclusion Cortical deafness might be missed especially that NIHSS does not detect it. NIHSS role as the only golden standard scale for diagnosing and following up stroke cases ought to be revised.

Objective: The preventability of strokes treated by mechanical thrombectomy is unknown. The purpose of this study was to analyze stroke preventability for patients treated with mechanical thrombectomy for large vessel occlusion. Methods: We conducted retrospective analyses of 300 patients (mean ± SE age 69 ± 0.9 years, range 18-97 years; 53% male) treated with mechanical thrombectomy for large vessel occlusion from January 2008 to March 2019. We collected data including demographics, NIH Stroke Scale (NIHSS) at onset, and (beginning in 2015) classified 90-day outcome by modified Rankin Scale (mRS). Patients were evaluated using a Stroke Preventability Score (SPS, 0 to 10 points) based on how well patients had been treated given their hypertension, hyperlipidemia, atrial fibrillation, and prior stroke history. We examined the relationship of SPS with NIHSS at stroke onset and with mRS outcome at 90 days. Results: SPS was calculated for 272 of the 300 patients, with mean ± SE of 2.1 ± 0.1 (range 0-8); 89 (33%) had no preventability (score 0), 120 (44%) had low preventability (score 1-3), and 63 (23%) had high preventability (score 4 or higher). SPS was significantly correlated with age (r = 0.32, p < 0.0001), while NIHSS (n = 267) was significantly higher (p = 0.03) for patients with high stroke preventability vs. low/no preventability [18.8 ± 0.92 (n = 62) vs. 16.5 ± 0.51 (n = 205)]. Among 118 patients with mRS, outcome was significantly worse (p = 0.04) in patients with high stroke preventability vs. low/no preventability [4.7 ± 0.29 (n = 28) vs. 3.8 ± 0.21 (n = 90)]. The vast majority of patients with high stroke preventability had inadequately treated atrial fibrillation (85%, 53/62). Conclusions: Nearly one quarter of stroke patients undergoing mechanical thrombectomy had highly preventable strokes. While stroke preventability showed some relationship to stroke severity at onset and outcome after treatment, preventability had the strongest association with age. These findings emphasize the need for improved stroke prevention in the elderly.

We investigated the associations among neurological severity, activities of daily living (ADLs), and clinical factors in patients with ischemic stroke in convalescent rehabilitation outcome. The study sample included 723 patients with ischemic stroke (484 men and 239 women; mean age, 73.2 ± 8.5 years) for inpatient convalescent rehabilitation. National Institutes of Health Stroke Scale (NIHSS) was used to measure the neurological severity, and Functional Independence Measure (FIM) was used to assess ADLs at discharge. Leukoaraiosis was graded based on periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) on magnetic resonance imaging. The correlations between NIHSS scores and total FIM scores were significant but relatively mild (r = -0.684, P < 0.001). Multiple regression analysis revealed that age and PVH grade significantly decreased their total FIM scores and affected the discrepancies between NIHSS scores at discharge (P < 0.001), but DWMH scores did not affect these results. Factors such as positive history of heart disease (P = 0.008) and bilateral infarction (P = 0.038) additionally decreased their total FIM scores and affected the discrepancies between NIHSS scores. These findings suggest that age, PVH, history of heart disease positive, and bilateral infarction in patients with ischemic stroke affected their performance of ADLs and the discrepancies between their neurological severities in convalescent rehabilitation outcomes, probably because the pathophysiological background of leukoaraiosis and these factors strongly decrease their ADL performance in post-phase ischemic stroke. [ABSTRACT FROM AUTHOR]

Assessment and prognostic value of serum uric acid (SUA) and neuron-specific enolase (NSE) on the efficacy of intravenous thrombolytic therapy in cerebral infarction. A retrospective analysis was performed on clinical data of 159 patients with acute cerebral infarction who received rt-PA intravenous thrombolytic therapy from 2015 to 2020 and patients with an mRS>2 points were assigned to the poor prognosis group and with mRS=2 to the good prognosis group. The receiver operating characteristic curve (ROC) was used to examine the prognostic value of SUA and NSE in intravenous thrombolytic therapy for acute cerebral infarction, and logistic regression analysis was utilized to elucidate the predictive features. SUA levels were adversely correlated with prognosis, whereas NSE was positively correlated with prognosis (r=0.465 and -0.501, P=0.000 and 0.000). The ROC curve showed that the predictive accuracy of SUA was 77.4% and of NSE was 71%. SUA=337.5 mmol/l and NSE=24.50 ng/ml are considered viable criteria to predict the curative effect and prognostic value of intravenous thrombolytic therapy for acute cerebral infarction. SUA and NSE demonstrate great potential to accurately predict the therapeutic effect and prognosis of intravenous thrombolytic therapy for acute cerebral infarction. [ABSTRACT FROM AUTHOR]

Background & Objective: Data about outcomes of endovascular treatment (EVT) in basilar artery occlusion (BAO) are limited. The aim of this study is to evaluate the predictors of functional outcome and to investigate the benefit of bridging intravenous thrombolysis (IVT) and the impact of first-pass effect (FPE) on prognosis. Methods: A total of 57 consecutive BAO patients who received EVT at our tertiary stroke center between January 2018 and March 2021 were retrospectively analyzed. The primary outcome was to evaluate excellent prognosis (mRS 0-1) and mortality (mRS 6) at day 90. The secondary outcome was to define the benefit of bridging IVT and the impact of FPE on prognosis. The safety outcome was symptomatic intracranial hemorrhage (sICH). National Institutes of Health Stroke Scale (NIHSS) at admission and at 24 hours, collateral scores, successful recanalization, asymptomatic ICH, embolization, malignant infarction and decompression were also evaluated. Results: The mean age of the patients was 64.1 ± 14.5 years. Male-to-female ratio was 1.7. Hypertension (HT) was the most common risk factor. Bridging IVT was performed in nine patients (15.8%). The FPE rate was 56.1%. NIHSS scores at admission and at 24 hours were found to be statistically significant predictors of prognosis (P=0.023 and P<0.001, respectively). Bridging IVT, FPE, successful recanalization and collateral status did not significantly predict outcome. Conclusion: Lower NIHSS scores at admission and at 24 hours were significantly associated with excellent prognosis. NIHSS scores at admission and at 24 hours were significantly higher in mortality group. sICH did not predict mortality. [ABSTRACT FROM AUTHOR]

Background: The challenge for neuroscience in patients with stroke is to provide an accurate prediction of functional impairment poststroke, to aid therapy and help early recovery. The sensitivity of diffusion tensor imaging (DTI) metrics to predict the clinical outcome using the modified Rankin Scale and Barthel score in early stroke was the objective of the study. Materials and Methods: A prospective observational study was conducted between October 2019 and October 2021 involving 86 patients with stroke. DTI sequences were taken on day 2–day 10 after the stroke. The National Institutes of Health Stroke Scale (NIHSS) was obtained at the time of the scan. The modified Rankin Score (MRS) and Barthel index scoring were used to do the clinical assessment and were done on day 7, day 30, and day 90. Results: There was a weak positive correlation between the NIHSS and Fractional Anisotropy (FA) and the NIHSS and axial diffusivity curve. There was a strong positive correlation between the NIHSS and voxels (infarct), and this correlation was statistically significant (rho = 0.75 and P ≤ 0.001. There was a weak positive correlation between the relative Average Diffusion Coefficient (rADC) and MRS of day 7, day 30, and day 90. There was a strong positive correlation between the voxels and NIHSS, and this correlation was statistically significant (rho = 0.75 and P ≤ 0.001). Conclusions: The NIHSS is a well-known clinical indicator to classify the severity of stroke. DTI metrics – FA and relative Fractional Anisotropy (rFA) are surrogate markers to predict the long-term motor outcome in stroke patients.

Background and Aim: The World Health Organization estimated that 15 million people throughout the world suffer stroke every year. Only 5%–10% of all acute ischemic stroke (AIS) patients presenting to emergency departments (EDs) are eligible for and receive thrombolytic therapy. This study was conducted to assess and compare the efficacy and safety profile of thrombolysis with tenecteplase (TNK) with that of alteplase among patients with AIS who were eligible for thrombolysis. Materials and Methods: This was a hospital-based prospective observational study. All the patients who presented with AIS within the time window period of ≤4.5 h to ED of Sher-i-Kashmir Institute of Medical Sciences, Soura, from September 2018 to March 2021, were screened for eligibility of thrombolysis by TNK. A total of 76 patients were enrolled; among which 42 were thrombolysed with TNK and 34 patients were thrombolysed with alteplase. These data were compared with departmental data of patients thrombolysed by alteplase during July 2015–July 2017. Inclusion and exclusion criteria used in the study were as per the American Heart Association/American Stroke Association guidelines for thrombolysis. Efficacy and safety were assessed and compared of the two drugs. Results: After 24 h of thrombolysis, early neurological improvement occurred in 62% of TNK patients compared to only 35% of patients from alteplase group, which was significant statistically (P < 0.05). An excellent functional outcome, defined as the Modified Rankin Scale (mRS) of 0–1 at 3 months of discharge, was seen in 67.6% of TNK and 48.5% of alteplase group. A poor recovery, defined as the mRS of 4–6 at 3 months of follow-up, was seen in 16% and 21% in TNK and alteplase group patients, respectively. Conclusion: TNK appears to be characterized by a better safety and efficacy profile than alteplase; however, further multicenter studies and randomized controlled trials are required to confirm our preliminary findings.

Objective To evaluate the application effect of modified prehospital acute stroke severity scale（mPASS） in acute cerebral infarction due to large artery occlusion. Methods In this retrospective study, 112 patients with acute cerebral infarction were recruited and assigned into the occlusion （n = 59） and non-occlusion groups （n = 53） according to the presence of acute cerebral infarction due to large artery occlusion. The neurological functional scores at admission were collected： National Institutes of Health Stroke Scale （NIHSS）, PASS and mPASS scores. The Modified Rankin Scale （mRS） score was calculated to evaluate clinical prognosis. The predictive value of each score was expressed by the area under the receiver operating characteristic （ROC） curve （AUC）. The sensitivity and specificity were calculated. Youden index was utilized to assess the optimal cut-off value. The relationship between large artery occlusion and the sub-items of the mPASS was assessed by logistic regression analysis. Results The neurological functional and mRS scores in the occlusion group were significantly higher than those in the non-occlusion group （both P < 0.01）. The AUC, sensitivity, specificity, Youden index and accuracy of mPASS score were significantly higher compared with those of PASS score. Logistic regression analysis indicated that the cortical symptom-gaze yielded the most reference significance （P < 0.001）. The mRS score was positively correlated with the sub-items of mPASS （mRS score=0.554+0.037 consciousness level +1.965 gaze+0.206 limb movement+0.193 language function, F = 25.361, P < 0.001）. Conclusion Compared with NIHSS and PASS, mPASS is a more effective tool for identifying acute cerebral infarction due to large artery occlusion.

Background: Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied. Aim: The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation. Material and Methods: On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression. Results: 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized. Conclusion: The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%. [ABSTRACT FROM AUTHOR]

Background: The challenge for neuroscience in patients with stroke is to provide an accurate prediction of functional impairment poststroke, to aid therapy and help early recovery. The sensitivity of diffusion tensor imaging (DTI) metrics to predict the clinical outcome using the modified Rankin Scale and Barthel score in early stroke was the objective of the study. Materials and Methods: A prospective observational study was conducted between October 2019 and October 2021 involving 86 patients with stroke. DTI sequences were taken on day 2-day 10 after the stroke. The National Institutes of Health Stroke Scale (NIHSS) was obtained at the time of the scan. The modified Rankin Score (MRS) and Barthel index scoring were used to do the clinical assessment and were done on day 7, day 30, and day 90. Results: There was a weak positive correlation between the NIHSS and Fractional Anisotropy (FA) and the NIHSS and axial diffusivity curve. There was a strong positive correlation between the NIHSS and voxels (infarct), and this correlation was statistically significant (rho = 0.75 and P ≤ 0.001. There was a weak positive correlation between the relative Average Diffusion Coefficient (rADC) and MRS of day 7, day 30, and day 90. There was a strong positive correlation between the voxels and NIHSS, and this correlation was statistically significant (rho = 0.75 and P ≤ 0.001). Conclusions: The NIHSS is a well-known clinical indicator to classify the severity of stroke. DTI metrics - FA and relative Fractional Anisotropy (rFA) are surrogate markers to predict the long-term motor outcome in stroke patients. [ABSTRACT FROM AUTHOR]

Background: National institutes of health stroke scale (NIHSS) is used, since its appearance in analysis of stroke in any national or international single center or multicenter study. It is also the golden standard assessment scale for stroke patients whether by emergency medical services on the way to hospital or by emergency room staff and by neurologists whether juniors or senior consultants. Yet, it is not capable of identifying all stroke cases. Along the current case report a relatively rare case of cortical deafness is presented highlighting its rarity and its vascular mechanism as well as how defective is NIHSS in recognizing it. Case presentation: 72-year-old female patient presented with sudden episodic less than 60 min duration of bilateral deafness; initial imaging showed right hemispheric encephalomalacia of old stroke. Patient was initially managed as psychogenic case especially that her NIHSS was zero. On returning again to emergency room she was administered thrombolysis and regained full hearing power. Follow-up imaging revealed a new ischemic stroke along her left auditory cortex explaining her cortical deafness. Conclusion: Cortical deafness might be missed especially that NIHSS does not detect it. NIHSS role as the only golden standard scale for diagnosing and following up stroke cases ought to be revised. [ABSTRACT FROM AUTHOR]

Background Insight into outcome variation between hospitals could help to improve quality of care. We aimed to assess the validity of early outcomes as quality indicators for acute ischemic stroke care for patients treated with endovascular therapy (EVT). Methods and Results We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. Random effect linear and proportional odds regression were used to analyze the effect of case mix on between‐hospital differences in 2 early outcomes: the National Institutes of Health Stroke Scale (NIHSS) score at 24 to 48 hours and the expanded thrombolysis in cerebral infarction score. Between‐hospital variation in outcomes was assessed using the variance of random hospital effects (tau2). In addition, we estimated the correlation between hospitals' EVT‐patient volume and (case‐mix–adjusted) outcomes. Both early outcomes and case‐mix characteristics varied significantly across hospitals. Between‐hospital variation in the expanded thrombolysis in cerebral infarction score was not influenced by case‐mix adjustment (tau 2=0.17 in both models). In contrast, for the NIHSS score at 24 to 48 hours, case‐mix adjustment led to a decrease in variation between hospitals (tau 2 decreases from 0.19 to 0.17). Hospitals' EVT‐patient volume was strongly correlated with higher expanded thrombolysis in cerebral infarction scores (r=0.48) and weakly with lower NIHSS score at 24 to 48 hours (r=0.15). Conclusions Between‐hospital variation in NIHSS score at 24 to 48 hours is significantly influenced by case‐mix but not by patient volume. In contrast, between‐hospital variation in expanded thrombolysis in cerebral infarction score is strongly influenced by EVT‐patient volume but not by case‐mix. Both outcomes may be suitable for comparing hospitals on quality of care, provided that adequate adjustment for case‐mix is applied for NIHSS score.

Background: Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen – a key component of the coagulation pathway, is controversial. Objective: To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke. Design: Single-centre prospective observational study. Methods: 141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome. Results: Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], P =.046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], P <.001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], P <.001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], P <.001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], P =.020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], P =.038). Conclusion: The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background and Aim: The World Health Organization estimated that 15 million people throughout the world suffer stroke every year. Only 5%-10% of all acute ischemic stroke (AIS) patients presenting to emergency departments (EDs) are eligible for and receive thrombolytic therapy. This study was conducted to assess and compare the efficacy and safety profile of thrombolysis with tenecteplase (TNK) with that of alteplase among patients with AIS who were eligible for thrombolysis. Materials and Methods: This was a hospital-based prospective observational study. All the patients who presented with AIS within the time window period of =4.5 h to ED of Sher-i-Kashmir Institute of Medical Sciences, Soura, from September 2018 to March 2021, were screened for eligibility of thrombolysis by TNK. A total of 76 patients were enrolled; among which 42 were thrombolysed with TNK and 34 patients were thrombolysed with alteplase. These data were compared with departmental data of patients thrombolysed by alteplase during July 2015-July 2017. Inclusion and exclusion criteria used in the study were as per the American Heart Association/American Stroke Association guidelines for thrombolysis. Efficacy and safety were assessed and compared of the two drugs. Results: After 24 h of thrombolysis, early neurological improvement occurred in 62% of TNK patients compared to only 35% of patients from alteplase group, which was significant statistically (P < 0.05). An excellent functional outcome, defined as the Modified Rankin Scale (mRS) of 0-1 at 3 months of discharge, was seen in 67.6% of TNK and 48.5% of alteplase group. A poor recovery, defined as the mRS of 4-6 at 3 months of follow-up, was seen in 16% and 21% in TNK and alteplase group patients, respectively. Conclusion: TNK appears to be characterized by a better safety and efficacy profile than alteplase; however, further multicenter studies and randomized controlled trials are required to confirm our preliminary findings. [ABSTRACT FROM AUTHOR]

Background: Stroke is the 2nd largest cause of mortality world over. In the intensive care unit (ICU), severity scales are crucial adjuncts of treatment for anticipating patient outcomes, comparing quality of care, and stratification for clinical studies. They are an important aspect of making better health-care judgments and identifying people with unusual outcomes. This study was conducted to assess and compare Acute Physiology and Chronic Health Evaluation II (APACHE II) score and National Institutes of Health Stroke Scale (NIHSS) score as predictors of mortality in cerebrovascular accident (CVA) patients admitted in medical intensive care unit (ICU) of tertiary care center, Rewa. Aims and Objectives: To evaluate APACHE II score, NIHSS score and APACHE II + NIHSS score as a predictor of short term mortality in CVA patients. Materials and Methods: This was a cross-sectional, analytical study conducted in the Department of Medicine, Sanjay Gandhi Memorial Hospital, associated with Shyam Shah Medical College, Rewa (M.P), between January 2020 and June 2021. The APACHE II score, NIHSS score, and APACHE II+NIHSS scores were calculated for each patient on day of admission and patients were followed up for a maximum period of 7 days. The area under receiver operating characteristic (ROC) curve was used to measure the ability of these scoring systems to forecast the prognosis, to find the best dividing value. Results: Out of 154 patients of CVA, 102 were male and 52 were female. In both sexes, the highest frequency of CVA was seen in those over 55 years of age. The mean age of the participants in the study was 62.70±12.62 years while it was 61.98±12.83 years for males and 64.13±12.19 years for females. The mean APACHE II score in death group was 29.45±10.095, mean NIHSS score in death group was 32.45±6.486, and the mean of both scores combined in death group was 61.91±14.017 and the mean of APACHE II score in survival group was 12.92±6.478, mean NIHSS score in survival group was 14.09±8.099, and the mean of both scores combined in survival group was 27.76±14.090. The APACHE II score had an area under the curve (AUC) of 0.919 which is slightly more than the NIHSS score which had the AUC of 0.913 and the sum of the two scores had the highest area under the ROC curve which is 0.947. According to Youden’s index, the dividing value for the APACHE II score is 21, the NIHSS score is 22, and APACHE II+NIHSS score was 42. Conclusions: Application of APACHE II and NIHSS scores provides an objective method to decide prognosis and plan management of CVA patients. It also helps in deciding whether the patient needs to manage in neurology ward or ICU depending on the dividing value. Both the scores have good ability to predict the short-term prognosis of CVA patients and the combination of these two can provide an even better measure of mortality.

Background: To investigate the relationship between irisin levels in serum and classification of subtype of acute ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Score (mRS) at the time of discharge from the hospital in Turkish patients who had their first acute ischemic stroke (AIS). Methods: Serum irisin levels were measured using enzyme linked immunosorbent assay (ELISA) 180 patients who applied to emergency department with the diagnosis of AIS from May 2021 to November 2021. Results: A significant relationship was found between serum irisin levels and ischemic stroke aetiological factors (TAOST) (p=0.017). Increased serum irisin levels were detected in patients without neurological deficits with localization value than those with it (p

Background and Aim: The association of atrial fibrillation (AF) with the ischemic stroke has emerged as an area of clinical research. The purpose of the present study is to investigate possible correlations between the severity, progress, and outcome of ischemic stroke and the presence of AF. Materials and Methods and Results: The clinical assessment of patients was based on the neurological status at the time of diagnosis utilizing the National Institutes of Health Stroke Scale (NIHSS), the neurological semiology during hospitalization (improvement, deterioration, and without differentiation), and the final outcome at the end of the treatment optimizing the modified Rankin scale (mRS). A total of 344 patients diagnosed with an ischemic stroke were enrolled in the study. The presence of AF was found to be associated with higher severity, poorer progress, and more adverse clinical outcomes of the ischemic stroke. Furthermore, a lower frequency of transient ischemic attacks was observed in patients with AF. Finally, patients with AF presented higher incidence of middle cerebral artery occlusion and were more frequently found with a lesion on the left brain hemisphere. Conclusion: AF was found to be highly associated with higher severity and poorer prognosis of ischemic strokes, independently from the presence of other cardiovascular risk factors.

During a stroke, a series of biochemical and metabolic changes occur which eventually lead to the death of cells by necrosis or apoptosis. This is a multi-stage process involving oxidative stress and an inflammatory response from the first signs of occlusion of a blood vessel until the late stages of regeneration and healing of ischemic tissues. The purpose of the research was to assess the concentration of pro-inflammatory cytokines IL-6 and TNF-α in the blood serum of patients with ischemic stroke (AIS) and to investigate their role as new markers in predicting functional prognosis after thrombolytic therapy. The researches have shown that the concentrations of the measured biomarkers were higher compared to the control group. Serum levels of IL-6 and THF-α before the initiation of intravenous thrombolysis were lower in the subgroup of patients with a favourable functional result (mRS: 0–2 pts) compared to the group of patients with an unfavourable functional result (mRS: 3–6 pts). A positive correlation was found between the concentration of IL-6 and TNF-α in patients with AIS during <4.5 h and on one day after the onset of stroke, which means that the concentration of IL-6 increases with the increase in TNF-α concentration. It has also been shown that higher levels of IL-6 in the acute phase of stroke and on the first and seventh days, and TNF-α during onset, were associated with poorer early and late prognosis in patients treated with intravenous thrombolysis. A relationship was found between the level of IL-6 and TNF-α in the subacute AIS and the severity of the neurological deficit. It has been shown that the investigated biomarkers may be a prognostic factor in the treatment of thrombolytic AIS. [ABSTRACT FROM AUTHOR]

• Plasma levels of IL-17A, TNF-α and VEGF-A were measured at multiple time points after cerebral infarction. • The change trend and correlation of these three cytokines after cerebral infarction were analyzed. • The correlation between cytokines and GCS score /NIHSS score at different time periods was analyzed. • To investigate the possible role of IL-17A, TNF-α and VEGF-A in cerebral infarction. Interleukin 17A (IL-17A), vascular endothelial growth factor A (VEGF-A) and tumour necrosis factor alpha (TNF-α) are important cytokines detected mostly within two weeks after stroke in previous clinical studies. Longer clinical studies investigating these cytokines are lacking. We aimed to explore the roles of these cytokines in patients within 35 days after cerebral infarction. Thirty patients with cerebral infarction and 30 healthy individuals were enrolled. Venous blood was collected from each patient at specific times and from each healthy individual only once. Coma and neurological functional deficits of the patients were evaluated by the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS), respectively. Three cytokines were measured. The correlations among the three cytokines and between each cytokine and the GCS/NIHSS scores were analysed. IL-17A and TNF-α began to increase on day 1 after cerebral infarction, peaked on day 4, then decreased, and increased again on day 18. IL-17A returned to normal on day 35, but TNF-α remained higher than normal on day 35. VEGF-A began to increase on day 1, peaked on day 7, and returned to normal on day 35. From days 18 to 35, IL-17A was positively correlated with the GCS scores, and both IL-17A and VEGF-A were negatively correlated with the NIHSS scores. After cerebral infarction, VEGF-A from the acute phase and IL-17A from the early stage of recovery may be important for nerve protection and repair; TNF-α plays a complex role within 35 days. [ABSTRACT FROM AUTHOR]

Background: Multicenter electronic health records can support quality improvement and comparative effectiveness research in stroke. However, limitations of electronic health record-based research include challenges in abstracting key clinical variables, including stroke severity, along with missing data. We developed a natural language processing model that reads electronic health record notes to directly extract the National Institutes of Health Stroke Scale score when documented and predict the score from clinical documentation when missing., Methods and Results: The study included notes from patients with acute stroke (aged ≥18 years) admitted to Massachusetts General Hospital (2015-2022). The Massachusetts General Hospital data were divided into training/holdout test (70%/30%) sets. We developed a 2-stage model to predict the admission National Institutes of Health Stroke Scale, obtained from the GWTG (Get With The Guidelines) stroke registry. We trained a model with the least absolute shrinkage and selection operator. For test notes with documented National Institutes of Health Stroke Scale, scores were extracted using regular expressions (stage 1); when not documented, least absolute shrinkage and selection operator was used for prediction (stage 2). The 2-stage model was tested on the holdout test set and validated in the Medical Information Mart for Intensive Care (2001-2012) version 1.4, using root mean squared error and Spearman correlation. We included 4163 patients (Massachusetts General Hospital, 3876; Medical Information Mart for Intensive Care, 287); average age, 69 (SD, 15) years; 53% men, and 72% White individuals. The model achieved a root mean squared error of 2.89 (95% CI, 2.62-3.19) and Spearman correlation of 0.92 (95% CI, 0.91-0.93) in the Massachusetts General Hospital test set, and 2.20 (95% CI, 1.69-2.66) and 0.96 (95% CI, 0.94-0.97) in the MIMIC validation set, respectively., Conclusions: The automatic natural language processing-based model can enable large-scale stroke severity phenotyping from the electronic health record and support real-world quality improvement and comparative effectiveness studies in stroke.

Saffron (Crocus sativus L.) has been widely used in traditional medicine as a treatment of nervous disorders. Saffron as an antioxidant can be considered effective for treatment of oxidative stress in ischemia stroke. Therefore, the aim of the present study was to investigate the role of aqueous extract of saffron in reducing oxidative stress in ischemic strokes patients. Forty patients with acute ischemic stroke were randomly divided into two groups including control group and saffron group. During 4 days of experiment, control group received routine stroke care and saffron group received routine care plus capsule of saffron 400 mg/day (200 mg twice per day). Then, two groups were compared using the National Institute of Health Stoke Scale (NIHSS) and serum oxidative stress biomarkers, at the time of hospital admission and 4 days later as well. On the fourth day after ischemic stroke onset, antioxidant enzymes activities and glutathione (GSH) and total antioxidant capacity (TAC) levels were higher in the saffron group compared to the control group, while malondialdehyde (MDA) level was lower. In addition, the severity of stroke, based on the NIHSS scores, was significantly reduced after 4 days in the saffron group. The severity of stroke was negatively correlated with the levels of GSH and TAC and positively correlated with MDA level. Saffron has modulatory effects on ischemic-induced oxidative stress due to its free radical scavenging and antioxidant properties. Thus, saffron extract can be considered as a potential candidate therapy of the ischemic brain. [ABSTRACT FROM AUTHOR]

Abstract Background Stroke is a major cause of mortality and morbidity. Also, free radicals and oxidative stress are deleterious factor in the stroke progression. We aimed to evaluate the association between oxidative stress markers and odds of having risk factor for stroke or developing stroke. Methods The present case-control study was conducted on 556 participants in Imam-Reza hospital, Tabriz, Iran. Subjects were divided into three group, including individuals with acute ischemic stroke, those who were at risk of stroke, and healthy controls. All enrolled participants except for controls underwent neurological examinations and brain magnetic resonance imaging (MRI). Stroke-related disability and stroke severity were evaluated by modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS), respectively. Serum malondialdehyde (MDA) level and total antioxidant capacity (TAC) were measured within 48 h of the initiation of stroke. One-way ANOVA and Chi-square tests were used for comparing characteristics between groups. Multivariable logistic regression was implemented for odds of stroke based on MDA and TAC quartiles. Also, Spearman’s correlation was utilized. Results Serum MDA, systolic and diastolic blood pressure, cholesterol, and triglyceride were significantly higher in the stroke group than controls. High levels of MDA were associated with increased development of stroke (P-value

Traditionally, gastrodin extracted from Rhizoma Gastrodiae has been used to treat various neurological diseases. The objective of this systematic review with meta-analysis is to evaluate the potential benefits of gastrodin as an adjuvant therapy for the treatment of acute stroke. Relevant literature from multiple medical databases was searched until October 12, 2023, to identify randomised controlled trials investigating the use of gastrodin as an adjuvant therapy for acute stroke treatment. The total response rate and marked improvement rate were defined as >18% and >45% improvement in National Institutes of Health Stroke Scale score, respectively. A total of 12 randomised controlled trials, including 1 174 stroke patients, were identified. Compared to conventional treatment alone, the combination of gastrodin and conventional treatment significantly improved the total response rate (risk ratio 1.24; 95% CI 1.15–1.34) and marked improvement rate (risk ratio 1.37; 95% CI 1.18–1.59). Adjuvant treatment with gastrodin also resulted in a reduction in the National Institutes of Health Stroke Scale score (weighted mean difference [ WMD ] −3.08 points; 95% CI −3.75 to −2.41), haematoma volume (WMD −3.57 cm3; 95% CI −4.26 to −2.87), and blood neuron-specific enolase level (WMD −3.81 μg/l; 95% CI −6.21 to −1.41), as well as an increase in blood brain-derived neurotrophic factor level (WMD 0.81 ng/ml; 95% CI 0.50–1.12). Gastrodin, when used as an adjuvant therapy, may yield additional beneficial effects in patients with acute stroke. However, future high-quality trials are necessary to further support this evidence. • Adjuvant treatment with gastrodin improved 24% total response rate. • Adjuvant treatment with gastrodin improved 37% marked improvement rate. • Addition of gastrodin to the usual treatment led to a decrease of 3.08 points in National Institutes of Health Stroke Scale. • Gastrodin as adjuvant therapy can increase neuroprotective effect in acute stroke patients. • The benefits of gastrodin may be linked to its anti-inflammatory and antioxidant effects. [ABSTRACT FROM AUTHOR]

Background: Stroke is the 2nd largest cause of mortality world over. In the intensive care unit (ICU), severity scales are crucial adjuncts of treatment for anticipating patient outcomes, comparing quality of care, and stratification for clinical studies. They are an important aspect of making better health-care judgments and identifying people with unusual outcomes. This study was conducted to assess and compare Acute Physiology and Chronic Health Evaluation II (APACHE II) score and National Institutes of Health Stroke Scale (NIHSS) score as predictors of mortality in cerebrovascular accident (CVA) patients admitted in medical intensive care unit (ICU) of tertiary care center, Rewa. Aims and Objectives: To evaluate APACHE II score, NIHSS score and APACHE II + NIHSS score as a predictor of short term mortality in CVA patients. Materials and Methods: This was a cross-sectional, analytical study conducted in the Department of Medicine, Sanjay Gandhi Memorial Hospital, associated with Shyam Shah Medical College, Rewa (M.P), between January 2020 and June 2021. The APACHE II score, NIHSS score, and APACHE II+NIHSS scores were calculated for each patient on day of admission and patients were followed up for a maximum period of 7 days. The area under receiver operating characteristic (ROC) curve was used to measure the ability of these scoring systems to forecast the prognosis, to find the best dividing value. Results: Out of 154 patients of CVA, 102 were male and 52 were female. In both sexes, the highest frequency of CVA was seen in those over 55 years of age. The mean age of the participants in the study was 62.70±12.62 years while it was 61.98±12.83 years for males and 64.13±12.19 years for females. The mean APACHE II score in death group was 29.45±10.095, mean NIHSS score in death group was 32.45±6.486, and the mean of both scores combined in death group was 61.91±14.017 and the mean of APACHE II score in survival group was 12.92±6.478, mean NIHSS score in survival group was 14.09±8.099, and the mean of both scores combined in survival group was 27.76±14.090. The APACHE II score had an area under the curve (AUC) of 0.919 which is slightly more than the NIHSS score which had the AUC of 0.913 and the sum of the two scores had the highest area under the ROC curve which is 0.947. According to Youden's index, the dividing value for the APACHE II score is 21, the NIHSS score is 22, and APACHE II+NIHSS score was 42. Conclusions: Application of APACHE II and NIHSS scores provides an objective method to decide prognosis and plan management of CVA patients. It also helps in deciding whether the patient needs to manage in neurology ward or ICU depending on the dividing value. Both the scores have good ability to predict the short-term prognosis of CVA patients and the combination of these two can provide an even better measure of mortality. [ABSTRACT FROM AUTHOR]

To review the literature for randomized control trials (RCTs) and prospective cohort studies investigating the safety and efficacy of tirofiban and eptifibatide in patients with acute ischemic stroke (AIS). PubMed, Embase, and the Cochrane library were searched for available papers published up to September 2021. The efficacy was evaluated based on the 3-month favorable outcome [modified Rankin scale (mRS) = 0–1], functional outcome (mRS = 0–2), and the last available National Institutes of Health Stroke Scale (NIHSS) score measured in each study. Twelve studies (two RCTs and 10 prospective cohorts) and 2926 patients were included. Treatment with tirofiban or eptifibatide had no effects on the favorable outcome (RR = 1.09, 95% CI 0.89–1.35, P = 0.411), functional outcome (RR = 1.12, 95% CI 0.98–1.28, P = 0.010), and last available NIHSS (WMD = − 2.32, 95% CI − 5.14 to 0.50, P = 0.106), but might increase mortality (RR = 0.84, 95% CI 0.71–0.99, P = 0.121). The sensitivity analyses showed that the meta-analyses were robust. There was no significant publication bias. Tirofiban did not increase the risk of ICH (P = 0. 423) and sICH (P = 0. 990) but increased the risk of fatal ICH (RR = 3.59, 95% CI 1.62–7.96, P = 0.002). Thrombolysis/thrombectomy did not influence any of the outcomes. Adding tirofiban or eptifibatide to thrombolysis/thrombectomy was not significantly associated with a favorable outcome (mRS = 0–1) nor functional outcome (mRS = 0–2) in patients with AIS at 3 months, but might be associated with mortality, possibly due to fatal ICH. The NIHSS was also not significantly different between the intervention and control groups after treatments. [ABSTRACT FROM AUTHOR]

Background & Objective: Acute ischemic stroke is defined as the development of sudden neurological deficits resulting from a focal injury due to vascular occlusion in the central nervous system. Intravenous tissue plasminogen activator (t-PA) therapy in these patients is an internationally accepted, evidence-based effective treatment. Previous data suggest that increased serum bilirubin may reflect the intensity of oxidative stress associated with stroke severity. This study aimed to investigate the effect of bilirubin levels on early neurological improvement after intravenous t-PA treatment and whether bilirubin is a determinant in in-hospital mortality. Methods: The determinant role of admission bilirubin levels in the severity of stroke, in-hospital mortality and early neurological improvement after intravenous t-PA was investigated. An independent association of bilirubin with mortality and neurological improvement were identified by multivariate logistic regression analysis. Results: A total of 184 ischemic stroke patients who received intravenous t-PA were included in the study. Serum direct bilirubin, indirect bilirubin, and total bilirubin of patients in the group without early improvement were significantly higher than the group with improvement (p= 0.041, p= 0.030, p= 0.026, respectively). Also, in binary logistic regression analysis, total bilirubin was found to be an independent predictor for early neurological improvement (OR 6.257, 95%CI 1.482-26.413, p=0.013). Conclusions: There was a significant relationship between the severity of the stroke and in-hospital mortality and increased serum bilirubin levels in our study. Again, there was a significant relationship between the lack of early neurological improvement after intravenous t-PA and increased serum bilirubin levels, and serum direct bilirubin levels were independent predictor of neurological improvement. [ABSTRACT FROM AUTHOR]

ImportanceAlthough patients with acute stroke are routinely evaluated for potential treatment (ie, treatability of the stroke), preventability of the presenting stroke is generally not seriously considered.ObjectiveTo systematically analyze stroke preventability.Design, setting, and participantsWe evaluated medical records of 274 consecutive patients discharged with a diagnosis of ischemic stroke between December 2, 2010, and June 11, 2012, at the University of California Irvine Medical Center. Mean (SE) patient age was 67.2 (0.8) years. Data analysis was conducted from July 3, 2014, to August 4, 2015.ExposuresMedical records were systematically examined for demographic information, stroke risk factors, stroke severity, and acute stroke treatment.Main outcomes and measuresWe defined stroke preventability as the degree to which the patient's presenting stroke was preventable. Using variables easily determined at onset of stroke, we developed a 10-point scale (0, not preventable; 10, most preventable) to classify the degree of stroke preventability. Our focus was effectiveness of treatment of hypertension (0-2 points), hyperlipidemia (0-2 points), and atrial fibrillation (0-4 points), as well as use of antithrombotic treatment for known prior cerebrovascular and cardiovascular disease (0-2 points).ResultsTotal risk scores ranged from 0 to 8 (mean [SE], 2.2 [0.1]), with 207 patients (75.5%) exhibiting some degree of preventability (score of 1 or higher). Seventy-one patients (25.9%) had scores of 4 or higher, indicating that the stroke was highly preventable. Severity of stroke as determined by the National Institutes of Health Stroke Scale score was not related to preventability of stroke. However, 21 of 71 patients (29.6%) whose stroke was highly preventable were treated with intravenous or intra-arterial acute stroke therapy while these treatments were provided for only 13 of 67 patients (19.4%) with scores of 0 (no preventability) and 19 of 136 patients (14.0%) with scores of 1 to 3 (low preventability) (P = .03).Conclusions and relevanceMost patients with acute stroke exhibited some degree of preventability. Preventability and treatment of stroke were significantly associated, indicating that the most preventable strokes paradoxically were more likely to receive acute treatment.

Background: Time spent in the prehospital phase of acute stroke care is multifactorial and has an effect on the possibilities for acute treatment. Communication between paramedics and the in-hospital stroke team directly affects time to treatment. A mutual stroke scale such as the National Institutes of Health Stroke Scale (NIHSS) may improve communication quality. The Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) was a stepped-wedge, randomized trial of stroke screening using NIHSS in the ambulance where the intervention was training paramedics in stroke and the NIHSS, with the use of NIHSS made into a mobile app to guide the examination and facilitate communication with the in-hospital stroke team. Objective: The aim of this study was to validate the digital training model from the ParaNASPP clinical trial. Methods: In total, 24 paramedics were recruited from Oslo University Hospital in Norway to complete the ParaNASPP training model; 20 exclusive videos with predefined NIHSS scores were recorded; and 4 stroke physicians from Oslo University Hospital were included for reference. Bland-Altman plots with 95% limits of agreement (LoA) were calculated--first comparing paramedics and stroke physicians to the predefined scores and then with each other. The predefined LoA were set to 3 points. To align with clinical practice, NIHSS scores were also dichotomized into 2 categories: from 0-5 (minor stroke) or =6 (moderate and major stroke), and agreement was calculated using Cohen κ. Results: The videos (n=20) had a median (range) NIHSS score of 7 (0-31). The paramedics' scores were slightly higher than the predefined scores with a mean difference of -0.38 and the LoA ranging from -4.04 to 3.29. The paramedics scored higher than the stroke physicians with a mean difference of -0.39, with the LoA ranging from -4.58 to 3.80. When the NIHSS scores were dichotomized, Cohen κ was 0.89 between the predefined scores and paramedics, 0.92 between the predefined scores and stroke physicians, and 0.81 between the paramedics and stroke physicians, all indicating very good agreement. Conclusions: The paramedics scored higher than both the predefined scores and stroke physicians' scores, hence the predefined LoA were not met. However, the width of the LoA was smaller than seen when experienced neurologists are compared. When the NIHSS scores were dichotomized, the paramedics achieved very good agreement with both the predefined scores and stroke physicians' scores. This study demonstrates the possibilities for the transfer of clinical competence in digital simulation training. [ABSTRACT FROM AUTHOR]

Reduction in the mortality and disability resulting from acute ischemic stroke translates into restoration of blood flow to ischemic penumbra or tissue-at-risk. Reopening occluded large intracranial arteries is currently possible by timely institution of endovascular mechanical thrombectomy. In this topic, we discuss the physiologic basis of thrombectomy, technical steps and future directions in a concise yet eminently readable manner.

Cattle encephalon glycoside and ignotin (CEGI) injection is a compound preparation formed by a combination of muscle extract from healthy rabbits and brain gangliosides from cattle, and it is generally used as a neuroprotectant in the treatment of central and peripheral nerve injuries. However, there is still a need for high-level clinical evidence from large samples to support the use of CEGI. We therefore carried out a prospective, multicenter, randomized, double-blind, parallel-group, placebo-controlled study in which we recruited 319 patients with acute cerebral infarction from 16 centers in China from October 2013 to May 2016. The patients were randomized at a 3:1 ratio into CEGI (n = 239; 155 male, 84 female; 61.2 ± 9.2 years old) and placebo (n = 80; 46 male, 34 female; 63.2 ± 8.28 years old) groups. All patients were given standard care once daily for 14 days, including a 200 mg aspirin enteric-coated tablet and 20 mg atorvastatin calcium, both taken orally, and intravenous infusion of 250–500 mL 0.9% sodium chloride containing 40 mg sodium tanshinone IIA sulfonate. Based on conventional treatment, patients in the CEGI and placebo groups were given 12 mL CEGI or 12 mL sterile water, respectively, in an intravenous drip of 250 mL 0.9% sodium chloride (2 mL/min) once daily for 14 days. According to baseline National Institutes of Health Stroke Scale scores, patients in the two groups were divided into mild and moderate subgroups. Based on the modified Rankin Scale results, the rate of patients with good outcomes in the CEGI group was higher than that in the placebo group, and the rate of disability in the CEGI group was lower than that in the placebo group on day 90 after treatment. In the CEGI group, neurological deficits were decreased on days 14 and 90 after treatment, as measured by the National Institutes of Health Stroke Scale and the Barthel Index. Subgroup analysis revealed that CEGI led to more significant improvements in moderate stroke patients. No drug-related adverse events occurred in the CEGI or placebo groups. In conclusion, CEGI may be a safe and effective treatment for acute cerebral infarction patients, especially for moderate stroke patients. This study was approved by the Ethical Committee of Peking University Third Hospital, China (approval No. 2013-068-2) on May 20, 2013, and registered in the Chinese Clinical Trial Registry (registration No. ChiCTR1800017937).

Objective: To investigate the effect of hospital working hours on outcomes of patients with acute ischemic stroke 3 months after receiving alteplase intravenous thrombolysis., Methods: A retrospective analysis was performed on 254 individuals with acute ischemic stroke who received alteplase intravenous thrombolysis between January 2018 and December 2020 either during peak hospital working hours (08:00-17:59; Group A) or off-peak hours (18:00-07:59 the following day; Group B). Patients were also categorized according to which of four peak/off-peak-hour periods they received treatment in: Group 1 (08:00-11:59), Group 2 (12:00-17:59), Group 3 (18:00-21:59), Group 4 (22:00-07:59 the following day). Baseline data and 3-month prognosis were compared across groups. Logistic regression analysis was used to investigate the correlation between hospital working hours and 3-month prognosis., Results: There were no significant differences in door-to-needle time, onset-to-needle time, 24-hour National Institutes of Health Stroke Scale (NIHSS) score, 7-day NIHSS score or Modified Rankin Score between Groups 1 to 4 or between Groups A and B. Whether treatment was administered during peak or off-peak hours did not significantly affect 3-month prognosis., Conclusion: At this hospital, differences in the time at which stroke patients were treated were not associated with outcomes., Competing Interests: Declaration of conflicting interestsThe authors declare that there is no conflict of interest.