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Background: Quantitative lesion net water uptake (NWU) has been described as an imaging biomarker reflecting vasogenic edema as an early indicator of infarct progression. We hypothesized that edema formation measured by NWU is higher in children compared to adults but despite this functional outcome may be better in children. Methods: This study analyzed children enrolled in the Save ChildS Study who had baseline and follow‐up computed tomography available and the data were compared to adult patients. Results: Some 207 patients, of whom 13 were children and 194 were adults, were analyzed. Median NWU at baseline was 7.8% (IQR: 4.3–11.3), and there were no significant differences between children and adults (7.5% vs. 7.8%; p = 0.87). The early edema progression rate was 3.0%/h in children and 2.3%/h in adults. Median ΔNWU was 15.1% in children and 10.5% in adults. Children had significantly more often excellent (mRS 0–1; children 10/13 = 77% vs. adults 28/196 = 14%; p < 0.0001) and favorable clinical outcomes (mRS 0–2, 12/13 = 92% vs. 39/196 = 20%; p < 0.0001). Conclusions: In this study, clinical outcomes in children with large vessel occlusion strokes were better than in adults despite similar clinical and imaging characteristics and similar edema formation. This may be impacted by the generally better outcomes of children after strokes but may demonstrate that the degree of early ischemic changes using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and edema progression rate may not be a reason for exclusion from endovascular thrombectomy. [ABSTRACT FROM AUTHOR]

Background: In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied. Aim: This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion. Methods: In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0–2 at day 90). Results: A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25–16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9–5.8). Conclusion: PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes. [ABSTRACT FROM AUTHOR]

Objective: The N. accumbens (NAc) is a key relay in the mesolimbic dopaminergic reward system, also connected to the amygdala, dorsomedial thalamus and hippocampus. As such, it is a promising target for deep brain stimulation (DBS) in patients with psychiatric diseases. In the present study, we aimed to reconstruct the neural projections connecting the NAc with the ventral tegmental area (VTA) and the medial prefrontal cortex (mPFC) using probabilistic fiber tractography based on diffusionweighted MR imaging (DWI). Methods: MR data (T1-MPRAGE; FLAIR; DWI: 1.6 mm isotropic resolution, 60 gradient directions) for 11 healthy subjects were acquired in two sessions on a Siemens Magnetom Prisma 3T MRI scanner. For each subject, the bilateral NAc, mPFC, and VTA were manually segmented based on the T1 and FLAIR data and transformed to the session-specific DWI space for probabilistic fiber tractography. The results were subject to detailed visual inspection to assess their validity in terms of anatomical plausibility by comparing them with the relevant literature. To quantitatively assess the reliability of the reconstructions, the fiber density maps corresponding to the individual tracts (NAc ↔ VTA and NAc ↔ mPFC) were transformed to a study template constructed from the T1 data before correlation analysis. Results: Using MRI data from 11 healthy subjects, we were able to reconstruct neural projections connecting the NAc with the mPFC and the VTA. The connectivity patterns formed by the obtained fibers were in good concordance with the literature (anatomical tracer studies). The reliability assessment yielded moderate to high correlations, which were higher for projections between NAc and mPFC (r = 0.85) than for those between NAc and VTA (r = 0.696). Conclusion: In the present work, we assessed the feasibility and reliability of the in vivo reconstruction of neural fibers connecting the human NAc with the mPFC and the VTA from high-resolution DWI data using probabilistic fiber tractography. In clinical practice, the presented procedure may guide selective electrical stimulation of the mesolimbic fibers using directional lead technology. Compared to undirected neuromodulation of the entire NAc, this could improve the efficacy of DBS for the treatment of mental disorders, such as addiction and obesity compulsive disorder. [ABSTRACT FROM AUTHOR]