Neurology最新文献

{"title":"Adverse Effects of Post-Recanalization Hemorrhagic Transformation: Asymptomatic but Not Inconsequential.","authors":"Patrick D Lyden","doi":"10.1212/WNL.0000000000210164","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210164","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210164"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes Over Time in Short-Term Stroke Outcomes by Race-Ethnicity.","authors":"Lynda D Lisabeth, Devin L Brown, Darin B Zahuranec, Erin Case, Madeline Kwicklis, Melinda A Smith, Lewis B Morgenstern","doi":"10.1212/WNL.0000000000210033","DOIUrl":"10.1212/WNL.0000000000210033","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to quantify trends (2008-2019) in stroke outcomes by race-ethnicity.</p><p><strong>Methods: </strong>Patients with ischemic stroke from a population-based study were interviewed at 90 days to assess outcomes. Linear regression with multiple imputation and inverse probability weighting was used to model trends.</p><p><strong>Results: </strong>The median age was 66 years (n = 1,449); 61% were Mexican American (MA). QOL remained stable with no race-ethnic difference in trends (<i>p</i> for time*race-ethnicity interaction = 0.81). Neurologic outcomes improved for MA (<i>p</i> < 0.01) but not non-Hispanic White (NHW) persons with stroke (<i>p</i> = 0.23) with no race-ethnic difference in trends (<i>p</i> for interaction = 0.23). For functional outcomes, trends were stable and then improved in MA persons with stroke (<i>p</i> for interaction = 0.01), whereas trends were stable in NHW persons with stroke (<i>p</i> = 0.52). For cognitive outcomes, there was little change in NHW persons with stroke (<i>p</i> = 0.50); in MA persons with stroke, there was improvement followed by decline and then improvement (<i>p</i> = 0.03). No race-ethnic differences in trends in functional (<i>p</i> for interaction = 0.51) or cognitive (<i>p</i> for interaction = 0.21) outcomes were noted.</p><p><strong>Discussion: </strong>Outcome improvements were noted in MA but not NHW persons with stroke; race-ethnic differences were not present in 2019. Understanding factors contributing to favorable trends in MA persons may be informative for improving outcomes in all persons.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210033"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial Cell Senescence Effect on the Blood-Brain Barrier in Stroke and Cognitive Impairment.","authors":"Maria Guadalupe C Real, Sarina R Falcione, Roobina Boghozian, Michael Clarke, Raluca Todoran, Alexis St Pierre, Yiran Zhang, Twinkle Joy, Glen C Jickling","doi":"10.1212/WNL.0000000000210063","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210063","url":null,"abstract":"<p><p>Age is an important risk factor of stroke, cognitive decline, and dementia. Senescent endothelial cells (ECs) accumulate with advancing age through exposure to cellular stress, such as that exerted by hypertension and diabetes. These senescent ECs have altered characteristics, such as altered tight junction proteins, use of a more indiscriminate transcellular transport system, increased inflammation, and increased immune cell interactions. ECs are the main component of the blood-brain barrier (BBB), separating the brain from systemic circulation. As senescent ECs accumulate in the BBB, their altered functioning results in the disruption of the barrier. They have inadequate barrier-forming properties, disrupted extracellular matrix, and increased transcytosis, resulting in an overly permeable barrier. This disruption of the BBB can have important effects in stroke and cognitive impairment, as presented in this review. Besides increasing the permeability of the BBB, senescent ECs can also impair angiogenesis and vascular remodeling, which in ischemic stroke may increase risk of hemorrhagic transformation and worsen outcomes. Senescent ECs may also contribute to microvascular dysfunction, with disruption of cerebral perfusion and autoregulation. These may contribute to vascular cognitive impairment along with increased permeability. With an aging population, there is growing interest in targeting senescence. Several ongoing trials have been evaluating whether senolytics can slow aging, improve vascular health, and reduce the risk of stroke and cognitive decline.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210063"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Neurologic Disorder, <i>La Lésion Dynamique</i>: 2024 Wartenberg Lecture.","authors":"Mark Hallett","doi":"10.1212/WNL.0000000000210051","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210051","url":null,"abstract":"<p><p>Functional neurologic disorder is common and a significant cause of disability and stress in neurologic patients. The nature of this disorder has been unclear. Originally called hysteria, the disorder interested Charcot who postulated that a functional lesion, <i>la lésion dynamique</i>, was responsible. Recent studies of functional neurologic disorders now allow us to understand what <i>la lésion dynamique</i> is and identifies these disorders without ambiguity as arising from the brain. Functional neurologic disorders are best understood as a multifactorial process with a biopsychosocial model. There can be a genetic predisposition. Commonly there is early life trauma that leads to a developmental abnormality of the amygdala, including loss of inhibition. This abnormality can be considered a predisposing factor. When stressed, the amygdala becomes hyperactive, driving the limbic system to cause widespread network dysfunction in the brain. This dysfunction can improve, correlating with clinical improvement. Network dysfunction is becoming recognized as an important pathologic process in neurology and psychiatry, as real as any other pathology. We should be able to make progress in helping patients with functional neurologic disorders with this understanding of <i>la lésion dynamique</i>.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210051"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benign Enhancing Foramen Magnum Lesions.","authors":"Ryota Kogue, Masayuki Maeda, Seiya Kishi, Fumine Tanaka, Maki Umino, Hajime Sakuma","doi":"10.1212/WNL.0000000000210083","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210083","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210083"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Oxygen Metabolic Stress in Children and Adults With Large Vessel Vasculopathy Due to Sickle Cell Disease.","authors":"Yan Wang, Slim Fellah, Martin Reis, Kristin P Guilliams, Melanie E Fields, Karen Steger-May, Amy E Mirro, Josiah B Lewis, Chunwei Ying, Rachel A Cohen, Monica L Hulbert, Allison A King, Yasheng Chen, Jin-Moo Lee, Hongyu An, Andria L Ford","doi":"10.1212/WNL.0000000000210032","DOIUrl":"10.1212/WNL.0000000000210032","url":null,"abstract":"<p><strong>Background and objectives: </strong>Large vessel vasculopathy (LVV), or moyamoya syndrome, increases the risk of stroke in patients with sickle cell disease (SCD), yet effective treatments are lacking. In atherosclerotic carotid disease, previous studies demonstrated elevated oxygen extraction fraction (OEF) as a predictor of ipsilateral stroke. In a SCD cohort, we examined hemispheric hemodynamic and oxygen metabolic dysfunction as tissue-based biomarkers of cerebral ischemic risk in patients with LVV.</p><p><strong>Methods: </strong>Children and adults with SCD were recruited from a SCD clinic associated with a tertiary medical center and underwent prospective brain MRI and MR angiography. LVV was defined as ≥75% stenosis in a major anterior circulation artery, excluding occlusion or previous revascularization surgery. Baseline characteristics, cerebral blood flow (CBF), normalized OEF (nOEF), infarct volume, white matter microstructure, and brain volume were compared in hemispheres with vs without LVV. In a cross-sectional analysis, mixed-effects linear multivariable models examined the effect of LVV on: (1) CBF and nOEF, as tissue markers of hemodynamic and oxygen metabolic stress, respectively, and (2) endpoints of cerebral ischemic injury including infarct volume, white matter microstructure, and brain volume.</p><p><strong>Results: </strong>Of 155 patients (22 [12-31] years, 57% female), 33 (21%) had ≥25% stenosis, 22 (14%) had ≥50% stenosis, 14 (9%) had 75%-99% stenosis, and 5 (3%) had 100% occlusion. After excluding hemispheres with previous revascularization surgery, LVV was present in 16 hemispheres from 11 patients. Hemispheres with (N = 16) vs without (N = 283) LVV had lower CBF (25.2 vs 32.1 mL/100 g/min, <i>p</i> = 0.01) and higher nOEF (0.99 vs 0.95, <i>p</i> = 0.02). On multivariable analysis, CBF was nonsignificantly lower (β = -0.16, <i>p</i> = 0.07) while nOEF remained higher in hemispheres with LVV (β = 0.04, <i>p</i> = 0.03). Moreover, LVV was associated with greater hemispheric infarct volume, microstructural disruption, and atrophy.</p><p><strong>Discussion: </strong>Beyond greater infarct burden, LVV was associated with hemispheric atrophy and white matter microstructural injury. As an indicator of active hypoxia, elevated nOEF likely represents a compensatory response to flow-limiting stenosis in hemispheres with LVV. The study is limited by a small number of patients with severe stenosis. Future studies are needed to evaluate the potential of tissue-based CBF and nOEF in assessing stroke risk and guide timely treatment of vasculopathy in SCD.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210032"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Social Determinants of Health-Based Alternatives to Race-Based Cognitive Normative Models.","authors":"Andrea Lauren Christman Schneider, Anny Reyes, James A Henegan, Vidyulata Kamath, Lisa Wruck, James Russell Pike, Alden Gross, Keenan Walker, Anna Kucharska-Newton, Josef Coresh, Thomas H Mosley, Rebecca F Gottesman, Michael Griswold","doi":"10.1212/WNL.0000000000210030","DOIUrl":"10.1212/WNL.0000000000210030","url":null,"abstract":"<p><strong>Background and objectives: </strong>Race and ethnicity are proxy measures of sociocultural factors that influence cognitive test performance. Our objective was to compare different regression-based cognitive normative models adjusting for demographics and different combinations of easily accessible/commonly used social determinants of health (SDoH) factors, which may help describe cognitive performance variability historically captured by ethnoracial differences.</p><p><strong>Methods: </strong>We performed cross-sectional analyses on data from Black and White participants without mild cognitive impairment/dementia in the Atherosclerosis Risk in Communities Study who attended visit 5 in 2011-2013. Participants underwent a battery of 11 cognitive tests (3 domains: memory, executive function, language). We fit 6 separate normative models for each cognitive test, all including age and education, with different combinations of race, the Wide Range of Achievement Test (education quality proxy), and area deprivation index (neighborhood deprivation) associated with current residence. We compared model fits and calculated concordances/discordances between models using z-scores derived from each normative model and a z-score <-1.5 threshold for impairment.</p><p><strong>Results: </strong>Participants (n = 2,392) had a mean age of 74.4 years, 60.4% were female, and 17.1% were of self-reported Black race. The \"Full\" model with race alongside demographic and SDoH measures consistently outperformed other nested submodels (likelihood ratios ≥ 100) for all domains/tests except Delayed Word Recall. Models with education quality alone (\"WRAT\") generally outperformed models with neighborhood deprivation (\"ADI\") or race (\"Race\") alone for memory and language tests while \"Race\" models performed better for executive function tests. Adding neighborhood deprivation to education quality (\"WRAT + ADI\") did not improve models vs using \"WRAT\" alone. Across all domains/tests, the concordance compared with the \"Full\" model was lower for \"Education\" and \"ADI\" models than for other nested models. Although numbers were small, there was greater discordance among Black (range = 8.2%-23.2%) compared with White (range = 2.2%-3.4%) participants, particularly for Boston Naming Test and executive function tests.</p><p><strong>Discussion: </strong>Education quality outperformed neighborhood disadvantage as an additional/alternative SDoH measure in normative models and may be useful to collect in cognitive aging studies. While performance varied across cognitive domains and tests, routinely reported SDoH variables (education level, education quality, late-life neighborhood deprivation) did not fully account for observed ethnoracial variability; future work should evaluate SDoH across the lifespan in more ethnoracially diverse populations.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210030"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11567649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Conscious Sedation With Dexmedetomidine and Outcome in Stroke Patients Undergoing Thrombectomy in the DEVT and RESCUE-BT Trials.","authors":"Chen Gong, Jiacheng Huang, Zhongming Qiu, Meng Guo, Liyuan Chen, Hongfei Sang, Weilin Kong, Liping Huang, Pan Hu, Yangmei Chen, Fengli Li, Thanh N Nguyen, Chang Liu","doi":"10.1212/WNL.0000000000209953","DOIUrl":"https://doi.org/10.1212/WNL.0000000000209953","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although dexmedetomidine (DEX) is widely administered during endovascular treatment (EVT) to enhance procedural adherence of patients with acute ischemic stroke (AIS) with large vessel occlusion, there is limited research on the association of DEX and outcomes among these patients. Hence, this study aimed to explore the safety and outcomes of DEX during conscious sedation (CS) in a real-world setting among patients undergoing EVT.</p><p><strong>Methods: </strong>This study was an individual patient-level pooled analysis of 2 multicenter randomized clinical trials RESCUE-BT and DEVT. This study included patients who underwent EVT because of occlusion of the internal carotid artery or middle cerebral artery. The DEX group included those receiving intraprocedural DEX for CS, whereas the patients without intraprocedural DEX sedation were categorized into the non-DEX group. The primary outcome was functional independence (modified Rankin Scale score of 0-2 at 90 days). Adjusted odds ratio (aOR) and 95% CI were obtained by logistic regression models.</p><p><strong>Results: </strong>A total of 728 patients were included in this study, of whom 308 (42.3%) were female. The median (interquartile range) age was 69 (59-76) years; the median baseline NIH Stroke Scale score was 16 (12-19). Compared with the non-DEX group, the DEX group had a significantly lower rate of functional independence (40.3% vs 51.3%; aOR 0.66; 95% CI 0.46-0.93; <i>p</i> = 0.019). There was a significantly higher rate of unstable procedural hemodynamics in the DEX group (9.7% vs 2.3%; aOR 4.60, 95% CI 2.12-9.99, <i>p</i> < 0.001). In subgroup analysis, similar results were found in intraprocedural DEX-treated patients when compared with local anesthesia or intraprocedural midazolam-treated patients, respectively.</p><p><strong>Discussion: </strong>There was a negative association between procedural DEX administration during CS and functional outcomes in patients with AIS receiving EVT in a real-world setting. A larger cohort is warranted to validate our findings.</p><p><strong>Classification of evidence: </strong>This study provides Class II evidence that the use of DEX during EVT of AIS is associated with a worse outcome compared with other agents.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e209953"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ictal Involvement of the Pulvinar and the Anterior Nucleus of the Thalamus in Patients With Refractory Epilepsy.","authors":"Ryan McGinn, Erica Leah Von Stein, Anjali Datta, Teresa Wu, Zoe Lusk, Spencer Nam, Manveer Dilts-Garcha, Robert S Fisher, Vivek Buch, Josef Parvizi","doi":"10.1212/WNL.0000000000210039","DOIUrl":"10.1212/WNL.0000000000210039","url":null,"abstract":"<p><strong>Background and objectives: </strong>Deep brain stimulation (DBS) targeting the anterior nucleus of the thalamus (ANT) has been shown to be effective in treating some patients with medically refractory epilepsy. However, it remains unknown how seizures spread through the ANT relative to other thalamic nuclei. This study aimed to investigate, through simultaneous recordings from both ANT and pulvinar (PLV) nucleus, their roles in seizure propagation. Our goal was to determine whether the ANT is the primary site of seizure propagation in the human thalamus, especially for focal seizure originating in the medial temporal lobe.</p><p><strong>Methods: </strong>In a retrospective design, we studied EEGs and clinical notes of patients with refractory epilepsy who were implanted with stereo-EEG (sEEG) electrodes across cortical regions, some of which were extended to reach various sites of the thalamus (i.e., multisite thalamic recordings). We selected patients from the Stanford Comprehensive Epilepsy Center with both ANT and PLV electrodes and collected information about the timing and anatomy of seizure activity in the seizure onset zones, usually temporal, and the 2 thalamic sites.</p><p><strong>Results: </strong>We recruited 17 (5 female, mean age 32 years) adult patients with simultaneous ipsilateral ANT and PLV recordings. In all patients, the procedure was safe without any complications. In 100% of patients, the thalamus was involved during seizures (in 88% both ANT and PLV and in 82% first the PLV). In patients with confirmed hippocampal or amygdalar onset seizures, 62% had initial involvement and 100% had subsequent involvement of the PLV nucleus. Only 31% showed initial propagation to ANT. All focal-to-bilateral tonic-clonic seizures and most of the focal impaired awareness seizures had early involvement of both ANT and PLV, with rapid spread to the contralateral nuclei.</p><p><strong>Discussion: </strong>sEEG of thalamic nuclei simultaneously provides an opportunity to understand propagation patterns of seizures with respect to each thalamic subdivision at the individual level. The patterns of seizure propagation, as we report here, provide insights about the prominent involvement of the PLV nucleus during seizure propagation. This may motivate future prospective work in larger cohorts of patients to understand how thalamic propagation may predict response to resective/ablative surgery or whether personalization of DBS (for instance, PLV instead of, or together with, ANT) could improve clinical outcomes.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210039"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Vascular Risk With Severe vs Non-Severe Stroke: An Analysis of the INTERSTROKE Study.","authors":"Catriona Reddin, Michelle Canavan, Graeme J Hankey, Shahram Oveisgharan, Peter Langhorne, Xingyu Wang, Helle Klingenberg Iversen, Fernando Lanas, Fawaz Al-Hussain, Anna Czlonkowska, Aytekin Oğuz, Conor Judge, Annika Rosengren, Denis Xavier, Salim Yusuf, Martin J O'Donnell","doi":"10.1212/WNL.0000000000210087","DOIUrl":"10.1212/WNL.0000000000210087","url":null,"abstract":"<p><strong>Background and objectives: </strong>Acute stroke is associated with a spectrum of functional deficits. The objective of this analysis was to explore whether the importance of individual risk factors differ by stroke severity, which may be of relevance to public health strategies to reduce disability.</p><p><strong>Methods: </strong>INTERSTROKE is an international case-control study of risk factors of first acute stroke (recruitment 2007-August 2015) in 32 countries. Stroke severity was measured using the modified Rankin Scale (mRS) score within 72 hours of admission to hospital. Severe stroke is defined as mRS scores of 4-6 (and non-severe stroke, score of 0-3). We used multinomial logistic regression to estimate comparative odds ratios (ORs; 95% CIs) for severe and non-severe stroke and tested for heterogeneity (<i>p</i>_{heterogeneity}). We also conducted a matched case-case analysis (matched for age, sex, country, and primary stroke subtype) to determine whether the prevalence of risk factors differed significantly between severe and non-severe stroke. A significant difference in the association of a risk factor of severe stroke compared with non-severe stroke was defined as <i>p</i> < 0.05 for both <i>p</i>_{heterogeneity} and <i>p</i>_case-case.</p><p><strong>Results: </strong>Of patients with acute stroke (n = 13,460), 64.0% (n = 8,612) were reported to have mRS scores of 0-3 and 36.0% (n = 4,848) scores of 4-6. The mean age was 61.7 years for patients with non-severe stroke and 62.9 years for patients with severe stroke (<i>p</i> = 0.72). 38.1% (n = 3,278) of patients with non-severe stroke and 44.6% (n = 2,162) of patients with severe stroke were female. Hypertension (OR 3.21; 95% CI 2.97-3.47 for severe stroke, OR 2.87; 95% CI 2.69-3.05 for non-severe stroke; <i>p</i>_{heterogeneity} = 0.03; <i>p</i>_case-case < 0.001), atrial fibrillation (OR 4.70; 95% CI 4.05-5.45 for severe stroke, OR 3.61; 95% CI 3.16-4.13 for non-severe stroke; <i>p</i>_{heterogeneity} = 0.009; <i>p</i>_case-case < 0.001), and smoking (OR 1.87; 95% CI 1.72-2.03 for severe stroke, OR 1.65; 95% CI 1.54-1.77 for non-severe stroke; <i>p</i>_{heterogeneity} = 0.02; <i>p</i>_case-case < 0.001) had a stronger association with severe stroke, compared with non-severe stroke. The waist-to-hip ratio had a stronger association with non-severe stroke compared with severe stroke (<i>p</i>_{heterogeneity} < 0.001; <i>p</i>_case-case < 0.001).</p><p><strong>Discussion: </strong>Hypertension, atrial fibrillation, and smoking had a stronger magnitude of association with severe stroke (compared with non-severe stroke) while the increased waist-to-hip ratio had a stronger magnitude of association with non-severe stroke.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"103 11","pages":"e210087"},"PeriodicalIF":7.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}