Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Stroke education: Engaging learners and the community to advance care for cerebrovascular disease","authors":"Joseph R. Geraghty MD, PhD , Fernando D. Testai MD, PhD , José Biller MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108152","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108152","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108152"},"PeriodicalIF":2.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between hyoid-carotid distance, hyoid position and morphology and degree of stenosis and associated stroke","authors":"Emmanuel Salaun-Penquer MD ,&nbsp;Sabine Laurent-Chabalier PhD ,&nbsp;Cassiana Trandafir MD ,&nbsp;Catalin Cosma MD ,&nbsp;Teodora Parvu MD ,&nbsp;Anne Wacongne MD ,&nbsp;Eric Thouvenot MD, PhD ,&nbsp;Dimitri Renard MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108106","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108106","url":null,"abstract":"<div><h3>Background</h3><div>Pressure on carotid artery by hyoid bone may influence plaque formation. We studied CTA-based hyoid-carotid anatomical interaction and its relationship with carotid stenosis degree and stenosis-related stroke.</div></div><div><h3>Methods</h3><div>We retrospectively analysed pre-operative CTA of 205 consecutive adults having undergone carotid endarterectomy (CEA) for asymptomatic or symptomatic stenosis. Radiological measurements were: degree stenosis, hyoid-carotid distance, carotid position in regard to hyoid, and hyoid morphology.</div></div><div><h3>Results</h3><div>In total, 410 carotids (including 114 symptomatic and 296 asymptomatic stenotic and non-stenotic carotids) from 205 CEA patients (median age 74, 72% men) were analysed. Median carotid stenosis was 61% (70% for symptomatic and 51% for asymptomatic carotids, p&lt;0.0001; 70% for CEA and 30.5% for non-CEA carotids, p&lt;0.0001). None of the other radiological parameters differed between asymptomatic/symptomatic carotids, between non-CEA/CEA carotids, or between asymptomatic/symptomatic patients. Median hyoid-carotid distance was 4.3mm, with 82% of carotids in posterolateral quadrant position in regard to the hyoid. There was no correlation between stenosis degree and hyoid-carotid distance (rho=-0.039), hyoid width (rho=-0.079), length (rho=0.007) or circumferential length (rho=-0.005), and stenosis degree was comparable between different carotid position quadrants (p=0.51).</div></div><div><h3>Conclusions</h3><div>Hyoid-carotid distance, hyoid position and morphology are not correlated with the degree of carotid stenosis or symptomatic carotid stenosis.</div></div><div><h3>Clinical Trial Registration-URL</h3><div><span><span>http://www.clinicaltrials.gov</span><svg><path></path></svg></span>: Unique identifier: NCT05349526</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108106"},"PeriodicalIF":2.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of diagnostic subtraction angiography for ischemic stroke (US DUTCH study) Regional variation and time-trend among medicare beneficiaries","authors":"Maxim J.H.L. Mulder MD, PhD ,&nbsp;Diederik W.J. Dippel MD, PhD ,&nbsp;James Burke MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108108","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108108","url":null,"abstract":"<div><h3>Introduction</h3><div>There are no guideline recommendations for DSA in the ischemic stroke work-up. We studied the rate of DSA in ischemic stroke, the recent time-trend, hospital variation and associated factors.</div></div><div><h3>Methods</h3><div>This is a retrospective cross-sectional study among Medicare fee-for-service beneficiaries with ischemic stroke admitted between 2016 and 2020 in the United States. ICD-10 codes were used to determine ischemic stroke diagnosis and procedure codes for thrombectomy and DSA. Hospital trends and factors associated with DSA performance were analyzed in hospitals with DSA capacity.</div></div><div><h3>Results</h3><div>7.373 (0.7 %) of the 1,085,644 ischemic stroke patients, had a DSA for diagnostic purposes. In the patients that were admitted to a hospital with DSA facility, the following factors showed the strongest association with DSA: younger age (aOR=0.81 [95 % confidence interval (CI):0.81-0.83]), thrombectomy rate in that hospital (aOR=2549 [95 %CI:610-10663]), transfer (aOR=1.41[95 %CI:1.34-1.50]) and carotid disease (aOR=5.8 [95 %CI:5.6-6.1]). There was large variation in the hospital DSA rate, varying from 0.07 % to 11.1 %. Of the variance of DSA rates, 15 % was attributed to the residual effect hospital propensity to perform DSA. The top decile of hospitals with the highest DSA rate, performed DSA's in &gt;2.3 % of patients, compared to the 0.6 % median. There was no change in DSA rates over time.</div></div><div><h3>Conclusion</h3><div>DSA is used infrequently in acute ischemic stroke patients and did not change between 2016 to 2020. Hospital variation in DSA use was however large, and not solely explained by patient and facility factors.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108108"},"PeriodicalIF":2.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CTP-Derived venous outflow profiles correlate with tissue-level collaterals regardless of arterial collateral status","authors":"Mouxiao Su ,&nbsp;Ying Zhou ,&nbsp;Xin Zou ,&nbsp;Shunyuan Zhang ,&nbsp;Zhonglun Chen","doi":"10.1016/j.jstrokecerebrovasdis.2024.108150","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108150","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Tissue-level collaterals (TLC), which quantify the state of arterial blood flow transiting through cerebral ischemic tissue, have been shown to be related to the clinical outcomes of acute ischemic stroke (AIS), regardless of the arterial collateral status on computed tomography angiography(CTA). Herein, we investigated whether venous outflow (VO) profiles on computed tomographic perfusion (CTP) were linked to TLC, regardless of the arterial collateral status.</div></div><div><h3>Methods</h3><div>Consecutive anterior circulation AIS patients with large vessel occlusion(LVO) undergoing thrombectomy in a retrospective cohort were evaluated between January 2021 and August 2023 at two comprehensive stroke centers. All patients underwent pretreatment noncontrast computed tomography (NCCT), computed tomography perfusion (CTP) and follow-up NCCT or head magnetic resonance imaging (MRI) within 72 h of endovascular treatment (EVT). The VO profile parameters were recorded based on time–density curve derived from the CTP, including the peak time of VO (PTV) and total VO time (TVT). As the quantitative index of TLC, hypoperfusion intensity ratio (HIR) ≦0.4 was considered favorable for TLC. The primary outcome was tissue-level collaterals (TLC), defined by the HIR. Logistic regression analysis was used to assess the association between VO characteristics and TLC, whereas receiver operating characteristic (ROC) analysis was used to evaluate the value of VO parameters in predicting favorable TLC.</div></div><div><h3>Results</h3><div>This study enrolled 221 eligible patients, among whom patients with favorable TLC were found to have a shorter PTV than patients with unfavorable TLC (12 s vs.16.5 s, <em>P</em> &lt; 0.001) in univariable analysis. A shorter PTV was significantly associated with a favorable TLC (odds ratio [OR], 0.811; 95% confidence interval [CI], 0.709 to 0.927; <em>P</em>=0.002). Multivariable binary logistic stepwise regression analysis revealed that PTV was negatively correlated with TLC, regardless of the arterial collateral status was good (Good: OR, 0.777; 95%CI, 0.660–0.914; <em>P</em>=0.002; Poor: OR,0.729; 95%CI, 0.569–0.932; <em>P</em>=0.012). ROC analysis revealed that the PTV threshold for predicting favorable TLC was ≤13s, with an area under the curve (AUC), sensitivity, and specificity of 0.754, 0.728, and 0.699, respectively. The comprehensive predictor combined with PTV had an optimal predictive ability for TLC with an AUC of 0.894 (sensitivity=0.839, specificity=0.864).</div></div><div><h3>Conclusion</h3><div>Cerebral VO profiles in patients with anterior circulation AIS with LVO were related to TLC regardless of arterial collateral status, while PTV≤13s was a good predictor of favorable TLC.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108150"},"PeriodicalIF":2.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Target door-to-needle time in acute stroke treatment via telemedicine versus in-person evaluation in a rural setting of the Midwest: a retrospective cohort study","authors":"Andrea Loggini MD MBA ,&nbsp;Jonatan Hornik MD ,&nbsp;Jessie Henson BSN RN ,&nbsp;Julie Wesler MSN RN ,&nbsp;Madison Nelson MD ,&nbsp;Alejandro Hornik MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108141","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108141","url":null,"abstract":"<div><h3>Objectives</h3><div>Telemedicine enables stroke specialists to treat patients with suspected acute stroke in facilities lacking in-person coverage. Studies have compared telemedicine in rural settings to in-person evaluation in urban areas, introducing biases of different infrastructure capabilities and ancillary staff. In this study, the authors provide a comparison of door-to-needle time (DTN) in the administration of thrombolytics in a rural stroke network, where the acute stroke care is provided by the same stroke specialists both in-person and via telemedicine.</div></div><div><h3>Methods</h3><div>This is a retrospective study analyzing DTN in patients treated with thrombolytics at a rural stroke network over five-year period. For each patient, demographics, medical history, clinical presentation, modality of evaluation, facilitator of telemedicine, and DTN were reviewed. Thrombolytic complications, mortality, and mRS at one month were noted.</div></div><div><h3>Results</h3><div>Out of 239 patients treated with thrombolytics, 142 were evaluated by telemedicine, and 97 in-person. In the telemedicine group, 108 evaluations were facilitated by nursing staff, while 34 by midlevel neurology providers (MNP). In-person group was associated with a faster median DTN (IQR), in minutes, (42 (35-54) vs. 55 (43-73), p&lt;0.01) and higher rate of DTN ≤60 minutes (76% vs. 60%, p=0.01). In a logistic regression model, after correcting for NIHSS, GCS, SBP, time of evaluation, and presence of family at bedside, in-person evaluation remained associated with better DTN time (OR:2.02, CI:1.06-3.81, p=0.03). There was no difference between the two groups in safety and short-term outcome. The presence of MNP as telemedicine facilitator improved both DNT (47 (35-53) vs. 42 (35-54)) and DTN≤60 minutes (85% vs. 76%) compared to in-person evaluation, p&gt;0.05 for both.</div></div><div><h3>Conclusions</h3><div>In our population, in-person evaluation provided faster DTN time compared to telemedicine. This trend reversed when a midlevel provider facilitated telemedicine. The faster DTN did not translate into increased safety or better short-term outcome.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108141"},"PeriodicalIF":2.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of endovascular thrombectomy for acute ischaemic stroke in patients aged ≥80 years: A Hong Kong stroke center experience","authors":"Long Hin Sin MBChB ,&nbsp;Yat Sing Lee MBBS ,&nbsp;Hin Yue Lau MBChB ,&nbsp;Wai Tat Chan MBBS ,&nbsp;Chi Wai Siu MBBS ,&nbsp;Chong Boon Tan MBBS","doi":"10.1016/j.jstrokecerebrovasdis.2024.108130","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108130","url":null,"abstract":"<div><h3>Background</h3><div>Elderly patients contribute to the large proportion of ischaemic stroke worldwide. Currently, treatment for elderly stroke remains aggressive, as the exact age cutoff for endovascular thrombectomy (EVT) has not been well established due to a lack of large-scale randomized control trials. In this study we investigate the difference in outcome after EVT in the octogenarian and above, compared to their younger counterparts.</div></div><div><h3>Methods</h3><div>EVT patients were divided into two groups, the octogenarian group and younger group (below age of 80). Primary outcome were the 90-days post-thrombectomy functional independence (modified Rankin scale), and Barthel index. Secondary and safety outcomes of post-thrombectomy were also analyzed, including reperfusion status (modified Thrombolysis in Cerebral Infarction (TICI) score), National Institutes of Health Stroke Scale (NIHSS), major complications and mortality rate.</div></div><div><h3>Results</h3><div>A total 340 patients were included from 2020 to 29 Feb 2024, and patients’ demographics were obtained. Poorer neurological outcome and functional independence were noted in octogenarian group compared with younger counterpart (OR 0.33; 95 % CI 0.14-0.51; p &lt; 0.001). A slightly higher trend of overall post-procedural death was also identified in elder group compared with the younger group (OR 1.48; 95 % CI 0.85-2.60, p = 0.08). Subgroup analysis with more advanced age cutoff at 90 took a step further and proposed that advanced age resulting in more devastating neurological outcome.</div></div><div><h3>Conclusion</h3><div>Outcomes after endovascular thrombectomy in the elder group were significantly worse than their younger counterparts. More than 80 % of elder group who were treated with EVT required moderate functional dependence, and one in four were dead within 90-days post-EVT.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108130"},"PeriodicalIF":2.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone pupillometry predicts ischemic penumbra in acute ischemic stroke","authors":"Anthony J. Maxin BS ,&nbsp;Bernice G. Gulek PhD ARNP ,&nbsp;Hunter Litz BS ,&nbsp;Zachary Brandt BS ,&nbsp;Graham M. Winston MD ,&nbsp;Lynn B. McGrath MD ,&nbsp;Isaac Joshua Abecassis MD ,&nbsp;Michael R. Levitt MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108143","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108143","url":null,"abstract":"<div><h3>Background</h3><div>Recent advances in time-sensitive treatment methods for large vessel occlusion (LVO), including medical and mechanical thrombectomy, have increased the importance of rapid recognition of acute ischemic stroke. The pupillary light reflex (PLR) is a biomarker for neurological status. We studied a portable smartphone-based quantitative pupillometry application that has been developed to quantify PLR metrics without requiring external hardware or extensive training to operate. We hypothesized that the PLR curve morphological metrics produced by the smartphone pupillometer could be used to predict the National Institutes of Health Stroke Scale (NIHSS) and CT Perfusion (CTP) core to penumbra volume ratio.</div></div><div><h3>Materials and Methods</h3><div>The PLR in patients with LVO in the emergency department of a comprehensive stroke center was recorded using a smartphone quantitative pupillometry application. Subjects with LVO were enrolled prior to thrombectomy or medical intervention. Collected data included volumetric measures of ischemic core and penumbra from CTP and presenting NIHSS. PLR curve morphological parameters were analyzed to determine their correlation with NIHSS or CTP core infarct to penumbra volume ratio (with a lower ratio indicating less core infarct relative to penumbra). This ratio was used instead of the mismatch ratio to account for patients without ischemic core. Initial alpha was set at 0.05, and a post-hoc Bonferroni correction was used to arrive at a corrected alpha of 0.004.</div></div><div><h3>Results</h3><div>Twenty-two patients with acute ischemic stroke from LVO were recruited, of whom 59 % were female and 21/22 (96 %) had anterior circulation occlusion. The median (± standard deviation) NIHSS was 20.5 ± 9, median ASPECTS was 9 ± 2, and mean CTP core to penumbra volume ratio was 1.02 ± 1.71. Before post-hoc Bonferroni correction, a significant negative correlation was seen between MAX (r = -0.49, p = 0.04), CHANGE (r = -0.74, p &lt; 0.001), and MCV (r = -0.5, p = 0.04) and the core infarct to penumbra volume ratio on CTP. In addition, before post-hoc Bonferroni correction, a significant negative correlation was seen between CHANGE (r = -0.43, p = 0.04) and MCV (r = -0.58, p = 0.005), and the NIHSS. A significant negative correlation between the core infarct to penumbra volume ratio on CTP for CHANGE (p &lt; 0.001) was observed after post-hoc Bonferroni correction.</div></div><div><h3>Conclusions</h3><div>Quantitative smartphone pupillometry metrics may predict cerebral ischemia and ischemic penumbra in acute ischemic stroke patients with large vessel occlusion prior to intervention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108143"},"PeriodicalIF":2.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gait assessment in the initial evaluation of posterior circulation stroke","authors":"Isaac Smith DO, MS ,&nbsp;Eduard Valdes MD ,&nbsp;Rubin Smith BS ,&nbsp;Rachel Bandler Cohen MD, PhD ,&nbsp;Jose Torres MD ,&nbsp;Albert Favate MD ,&nbsp;Kara R. Melmed M","doi":"10.1016/j.jstrokecerebrovasdis.2024.108138","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108138","url":null,"abstract":"<div><h3>Objectives</h3><div>Posterior circulation stroke (PCS) presents diagnostic challenges due to its diverse clinical presentations. Timely detection is crucial, yet a highly sensitive, non-invasive screening tool for PCS is lacking. This study explores gait assessment as a readily accessible diagnostic tool for ruling out PCS in acutely vertiginous patients.</div></div><div><h3>Materials and methods</h3><div>In this retrospective case-control study, we examined medical records of 311 acutely vertiginous patients from the Get with the Guidelines Database at an academic hospital in New York City. Of these, 40 were diagnosed with PCS and 271 did not have PCS based on imaging and clinical criteria. We used multivariable logistic regression models and ROC curves to evaluate the association between objective gait abnormality (OGA) and PCS.</div></div><div><h3>Results</h3><div>Objective gait abnormality (OGA) was observed in 38/40 (95 %) posterior circulation stroke (PCS) cases and 57/271 (21 %) controls (adjusted odds ratio 144, 95 %CI 24.4-855, p &lt; 0.0001). In a predictive model, objective gait abnormality (OGA) exhibited excellent discrimination between cases and controls (AUC 0.9599, sensitivity 95.0 %, specificity 75.6 %, positive predictive value 36.5 %, negative predictive value 99.0 %).</div></div><div><h3>Conclusions</h3><div>Gait assessment emerges as a highly-sensitive screening tool for ruling out posterior circulation stroke (PCS) in acutely vertiginous patients, enabling more efficient triage and patient management. Further prospective research is warranted to validate these findings in larger and more diverse patient populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108138"},"PeriodicalIF":2.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time is brain: detection of nonconvulsive seizures and status epilepticus during acute stroke evaluation using point-of-care electroencephalography","authors":"Kapil Gururangan MD ,&nbsp;Richard Kozak MD ,&nbsp;Parshaw J. Dorriz MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108116","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108116","url":null,"abstract":"<div><h3>Objectives</h3><div>Seizures are both a common mimic and a potential complication of acute stroke. Although EEG can be helpful to evaluate this differential diagnosis, conventional EEG infrastructure is resource-intensive and unable to provide timely monitoring to match the emergent context of a stroke code. We aimed to evaluate the real-world use and utility of a point-of-care EEG device as an adjunct to acute stroke evaluation.</div></div><div><h3>Materials and Methods</h3><div>We performed a retrospective observational cohort study at a tertiary care community teaching hospital by identifying patients who underwent point-of-care EEG monitoring using Rapid Response EEG system (Ceribell Inc., Sunnyvale, CA) during stroke code evaluation of acute neurological deficits during the study period from January 1, 2020 to December 31, 2020. We assessed the frequency of seizures and highly epileptiform patterns among patients with either confirmed strokes or stroke mimics.</div></div><div><h3>Results</h3><div>Point-of-care EEG monitoring was used in the wake of a stroke code in 70 patients. Of these, neuroimaging and clinical information resulted in a diagnosis of stroke in 38 patients (28 ischemic, 6 hemorrhagic, 4 transient ischemic attack; median NIHSS score of 6.5 [IQR 2.0-12.0]) and absence of any stroke in 32 patients. Point-of-care EEG detected seizures and highly epileptiform patterns in 6 (15.8 %) stroke patients and 11 (34.4 %) stroke-mimic patients, including 2 patients with persistent expressive aphasia due to repeated focal seizures.</div></div><div><h3>Conclusions</h3><div>Point-of-care EEG has utility for detecting nonconvulsive seizures in patients undergoing acute stroke evaluations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108116"},"PeriodicalIF":2.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A unique case of cerebellar infarcts: Investigating the intersection of Type II proatlantal artery arising from the common carotid artery and cardiac malformations","authors":"Allen Ye Fu ,&nbsp;Arevik Abramyan ,&nbsp;Emad Nourollah-Zadeh ,&nbsp;Gaurav Gupta ,&nbsp;Sudipta Roychowdhury ,&nbsp;Srihari Sundararajan","doi":"10.1016/j.jstrokecerebrovasdis.2024.108140","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108140","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108140"},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}