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Sudden catastrophic events such as terror attacks have clear and immediate consequences for the people who are directly affected. However, less is known about the impact on the physical health of local community members (online supplemental available from Dryad [doi.org/10.5061/dryad.bcc2fqz9t][1] for further discussion). Acute psychological stress may cause a parallel physiologic response increasing risk of cardiovascular events.1–3 On March 15, 2019, a gunman shot and killed 51 people praying at the Al Noor and Linwood mosques in Christchurch city, New Zealand. We observed an increase in ischemic stroke reperfusion treatments in the week starting Monday, March 18, 3 days after the terror attack. We hypothesized that this observation could have occurred because of either an effect of the attack on the total number of ischemic strokes and/or the severity of these strokes, or coincidence. We investigated these possibilities by analyzing the association between the terror attack and rate of stroke reperfusion treatment, proven intracranial large vessel occlusion (LVO), and total stroke admissions at Christchurch hospital and the national stroke data set. [1]: https://doi.org/10.5061/dryad.bcc2fqz9t

Background and Purpose: Left atrial appendage (LAA) is the likely embolic source in atrial fibrillation (AF)–related cardioembolic strokes. We sought to determine the prevalence of LAA thrombus on hyperacute stroke imaging and its association with AF. Methods: We retrospectively examined the clinical and radiological features of patients assessed through the hyperacute stroke imaging pathway over a 12-month period at Christchurch Hospital. The LAA was included in the computed tomography angiogram scan-range as part of the multimodal imaging protocol. Two radiological readers blinded to clinical information independently assessed for the presence of LAA thrombus. The association between AF and LAA thrombus was determined by multivariable logistic regression analysis. Results: Of 303 patients included in the analysis, the overall prevalence of LAA thrombus was 6.6% and 14.9% in patients with known AF. Patients with LAA thrombus were older (85 versus 75 years, P P P =0.01), and was associated with intracranial large vessel occlusion (65% versus 39%, P =0.02). In the multivariable model, AF (odds ratio, 3.71 [95% CI, 1.25–11.01] P =0.02) was independently associated with LAA thrombus after adjusting for age and congestive heart failure. Interrater reliability was moderate (kappa=0.56). Conclusions: LAA thrombus is a potential radiological marker of AF and can be assessed as a part of hyperacute stroke imaging.

Background: Multimodal stroke imaging (Non-contrast CT, CT perfusion and CT angiogram) is essential to acute stroke assessment, there is currently no benchmark for this key process from real world data. Methods: Retrospective review of the turnaround time of consecutive multimodal imaging performed for acute stroke assessment at two high volume stroke centers in Australasia from July to September 2019.Results: 252 imaging studies were included from both sites. The overall median time from acquisition to imaging availability was 13 minutes (IQR 11- 16). The median for Christchurch and Box Hill were 11 minutes (IQR 10 – 12) and 15 minutes (IQR 13 – 19) respectively. Conclusions: Multimodal stroke imaging turnaround time of 11 minutes is a reasonable benchmark.