Cerebrovascular Diseases Extra最新文献

{"title":"Intracerebral Hemorrhage.","authors":"Tsong-Hai Lee","doi":"10.1159/000542566","DOIUrl":"10.1159/000542566","url":null,"abstract":"<p><strong>Background: </strong>Compared to ischemic stroke, intracerebral hemorrhage (ICH) has higher mortality and more severe disability. Asian such as Chinese and Japanese and Mexican Americans, Latin Americans, African Americans, Native Americans has higher incidences than do white Americans. So, ICH is an important cerebrovascular disease in Asia.</p><p><strong>Summary: </strong>ICH accounts for approximately 10-20% of all strokes. The incidence of ICH is higher in low- and middle-income than high-income countries and is estimated 8-15% in western countries like USA, UK, and Australia, and 18-24% in Japan, Taiwan, and Korea. The ICH incidence increases exponentially with age, and old age especially over 80 years is a major predictor of mortality independent of ICH severity. Females are older at the onset of ICH and have higher clinical severity than males. Modifiable risk factors include blood pressure, smoking, alcohol consumption, lipid profiles, use of anticoagulants, antiplatelet agents, and sympathomimetic drugs. Non-modifiable risk factors constitute old age, male gender, Asian ethnicity, cerebral amyloid angiopathy, cerebral microbleed, and chronic kidney disease. Blood pressure is the most important risk factor of ICH. Imaging markers may help predict ICH outcome, which include black hole sign, blend sign, iodine sign, island sign, leakage sign, satellite sign, spot sign, spot-tail sign, swirl sign, and hypodensities. ICH prognostic scoring system such as ICH scoring system and ICH grading scale scoring system in Chinese and Osaka prognostic score and Naples prognostic score has been used to predict ICH outcome. Early minimally invasive removal of ICH can be recommended for lobar ICH of 30-80 mL within 24 h after onset. Decompressive craniectomy without clot evacuation might benefit ICH patients aged 18-75 years with 30-100 mL at basal ganglia or thalamus. However, clinical studies are needed to investigate the effect of surgery on patients with smaller or larger ICH, ICH in non-lobar locations, and for older patients or patients with preexisting disability. Surgical treatment is usually associated with neurological sequels if survived. For medical treatment, blood pressure lowering should be careful titrated to secure continuous smooth and sustained control and avoid peaks and large variability in systolic blood pressure. Stroke and cancer are the most common causes of death in Asian ICH patients, compared to stroke and cardiac disease in non-Asian patients.</p><p><strong>Key messages: </strong>The incidence and outcome are different between Asian and non-Asian patients, and more clinical studies are needed to investigate the best management for Asian ICH patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Clinical Presentation of Women and Men Evaluated at a Comprehensive Stroke Center for Suspected Stroke.","authors":"Jordi Kühne Escolà, Bessime Bozkurt, Bastian Brune, Lennart Steffen Milles, Doreen Pommeranz, Philipp Dammann, Yan Li, Cornelius Deuschl, Michael Forsting, Clemens Kill, Christoph Kleinschnitz, Martin Köhrmann, Benedikt Frank","doi":"10.1159/000543835","DOIUrl":"10.1159/000543835","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding sex differences in the clinical presentation of patients with suspected stroke is important to reduce sex-related disparities and improve care. We aimed to characterize presenting symptoms in women and men with suspected stroke evaluated at our comprehensive stroke center.</p><p><strong>Methods: </strong>This was a retrospective analysis of consecutive patients with suspected stroke treated at the University Hospital Essen between January 2017 and December 2021. Patient characteristics, signs and symptoms as well as final diagnoses in women and men were compared. Logistic regression analysis was performed to assess the association of individual symptoms with a diagnosis of cerebrovascular disease.</p><p><strong>Results: </strong>We included 6,069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2,576/3,022) of women and 88.0% (2,681/3,047) of men (p = 0.002). Aphasia (31.4% vs. 27.7%, p = 0.002), neglect (15.5% vs. 12.8%, p = 0.003), gaze deviation (21.0% vs. 18.8%, p = 0.034), as well as nonfocal symptoms including impairments in consciousness (17.0% vs 14.6%, p = 0.012), orientation (42.5 vs. 36.4%, p < 0.001), and completion of tasks (31.2% vs. 26.0%, p < 0.001) were more common among women. Limb ataxia (8.1% vs. 11.2%, p < 0.001) and dysarthria (44.0% vs. 46.8%, p = 0.030) were less frequent in women. Neglect and gaze deviation were independent positive predictors of cerebrovascular disease in women but not in men.</p><p><strong>Conclusion: </strong>Although clinical presentation was similar in both sexes, cortical and nonfocal symptoms were more common among women with suspected stroke. Awareness of sex differences and acknowledgment of the full clinical picture are important to ensure optimal management for women and men with suspected stroke. Our findings might serve as a target for educational programs in order to improve preclinical stroke detection in patients with predominantly nonfocal or subtle symptoms.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"110-117"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Epidemiology in Asia.","authors":"Narayanaswamy Venketasubramanian","doi":"10.1159/000543399","DOIUrl":"10.1159/000543399","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major cause of death and disability globally, with different stroke burdens in different regions. This paper reviews the epidemiology of stroke in Asia.</p><p><strong>Summary: </strong>There is a wide range in age- and sex-standardised stroke incidence, highest in China, lowest in Bhutan. Geographically, incidence is highest in East Asia, lowest in South Asia. Stroke mortality is highest in Papua New Guinea, lowest in Singapore. There are variations in mortality within regions - in East Asia, it is higher in Mongolia and North Korea, lowest in Japan; in South Asia, it is higher in Bangladesh and Pakistan, lowest in Sri Lanka; in Southeast Asia, it is higher in Papua New Guinea and Indonesia, lowest in Singapore. Stroke disability-adjusted life years (DALYs) lost is highest in Papua New Guinea, lowest in Singapore. There is intra-regional variation - in East Asia, it is higher in Mongolia and North Korea, lowest in Japan; in South Asia, higher in Bangladesh and Pakistan, lowest in Sri Lanka; in Southeast Asia, it is highest in Papua New Guinea, lowest in Singapore. Among the stroke subtypes, ischaemic stroke (IS) has the highest incidence, intracerebral haemorrhage (ICH) is second, subarachnoid haemorrhage (SAH) is third. IS incidence is highest in China, lowest in Bhutan. The burden due to ICH is highest in Mongolia; ICH incidence is lowest in Sri Lanka, mortality and DALYs are lowest in Japan. SAH has a high incidence in Japan, Singapore, Brunei, and Republic of Korea. In hospital-based registries, the frequency of ICH was highest in Myanmar, low in Mongolia. Among IS, based on the Trial of Org 10,172 in Acute Stroke Treatment classification, large artery atherosclerosis (LAA) is more frequent in some countries (e.g., China, India, Indonesia, Japan, Pakistan, and Republic of Korea), but small artery occlusion (SAO) in most others (Bangladesh, Nepal, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam); cardioembolism is third. Of the stroke risk factors, hypertension is the most frequent, diabetes mellitus (DM) is usually second, with varying positions for hyperlipidaemia, smoking, and prior stroke or transient ischaemic attacks, obesity, and insufficient physical activity.</p><p><strong>Key messages: </strong>Asia carries a particularly heavy burden of stroke, higher in some countries. IS is the most common subtype. Among IS, the more common mechanisms are LAA and SAO. Hypertension and DM are the more common risk factors. A greater understanding of stroke epidemiology and risk factors will help in healthcare planning for the prevention and management of stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"81-92"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top-of-Basilar Artery Occlusion Thromboembolism in Arrhythmogenic Right Ventricular Cardiomyopathy Treated with Intravenous Thrombolysis and Mechanical Thrombectomy.","authors":"Amirul Asyraf Abdul Ghapar, Khairul Azmi Abd Kadir, Grace Sze Ern Chu, Mei Ling Sharon Tai, Mohamad Imran Idris, Ru Peng New, Imran Zainal Abidin, Khean Jin Goh, Kay Sin Tan","doi":"10.1159/000543418","DOIUrl":"10.1159/000543418","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This case report illustrates the complexities of arrhythmogenic right ventricular cardiomyopathy (ARVC) and its thromboembolic complications resulting in top-of-basilar artery syndrome. We discuss the case of a 37-year-old male with ARVC who presented with acute onset of dizziness, imbalance, and vomiting, leading to the diagnosis of a top-of-basilar artery occlusion (BAO) which was successfully treated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;This case highlights the diagnostic and acute treatment challenges in BAO due to its non-specific symptoms and emphasizes the critical role of CT angiography in detecting occlusive thrombi for timely intervention. With prompt endovascular thrombectomy and bridging intravenous thrombolysis, complete recanalization was achieved and the patient was discharged with modified Rankin Scale (mRS) of 1. Effective management strategies involve assessing ventricular function, detecting arrhythmias, identifying intracardiac thrombi, and implementing individualized stroke prevention measures, such as using direct oral anticoagulants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study illustrates the necessity of a multidisciplinary approach in optimizing patient outcomes in acute stroke care. Focusing on the rare condition of ARVC and the specific challenge of top-of-BAOs in this case underscores the intricate interplay between cardiovascular and cerebrovascular pathology leading to improved understanding and management of these conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This case report illustrates the complexities of arrhythmogenic right ventricular cardiomyopathy (ARVC) and its thromboembolic complications resulting in top-of-basilar artery syndrome. We discuss the case of a 37-year-old male with ARVC who presented with acute onset of dizziness, imbalance, and vomiting, leading to the diagnosis of a top-of-basilar artery occlusion (BAO) which was successfully treated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;This case highlights the diagnostic and acute treatment challenges in BAO due to its non-specific symptoms and emphasizes the critical role of CT angiography in detecting occlusive thrombi for timely intervention. With prompt endovascular thrombectomy and bridging intravenous thrombolysis, complete recanalization was achieved and the patient was discharged with modified Rankin Scale (mRS) of 1. Effective management strategies involve assessing ventricular function, detecting arrhythmias, identifying intracardiac thrombi, and implementing individualized stroke prevention measures, such as using direct oral anticoagulants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study illustrates the necessity of a multidisciplinary approach in optimizing patient outcomes in acute stroke care. Focusing on the rare condition of ARVC and the specific challenge of top-of-BAOs in this case underscores the intricate interplay between cardiovascular and cerebrovascular pathology leading to improved u","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"73-80"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focal Cerebral Arteriopathy of the Young: Clinical Profile, Outcomes, and Utility of High-Resolution Vessel Wall Imaging.","authors":"Ankith Bhasi, Naveen Kumar Paramasivan, Adarsh Anil Kumar, Rohith Maraludevanapura Govindaiah, Chandrasekharan Kesavadas, Jayadevan Enakshy Rajan, Sapna Erat Sreedharan, Padmavathy Narayanan Sylaja","doi":"10.1159/000545955","DOIUrl":"10.1159/000545955","url":null,"abstract":"<p><strong>Introduction: </strong>The data on focal cerebral arteriopathy (FCA) in young adults are limited to very few series, and the role of high-resolution magnetic resonance vessel wall imaging (MRVWI) has not been adequately explored.</p><p><strong>Methods: </strong>FCA was defined as unilateral, unifocal nonprogressive stenosis/irregularity of the distal internal carotid artery (ICA) or its proximal branches. All young patients aged 18-55 years admitted to our institute between 2010 and 2022 were retrospectively reviewed, and functional outcomes were quantified using the modified Rankin scale.</p><p><strong>Results: </strong>We identified 10 patients (9 males) with FCA giving an incidence rate of 2.8 per 1,000 person-years. Nine patients had an ischemic presentation (transient ischemic attacks = 5, minor strokes = 3, and major stroke = 1), while 1 patient had a cortical subarachnoid hemorrhage. The supraclinoid ICA and proximal middle cerebral artery (MCA) were the most common segments involved. Nine patients were treated with antiplatelets, and 3 received additional steroids. All cases underwent MRVWI, with concentric wall enhancement noted in most (80%). Follow-up imaging showed improvement in stenosis in 2 patients and a reduction in vessel wall enhancement in 3 patients. Except for the patient with a major stroke, all others had excellent short- and long-term outcomes with no recurrence of ischemic events. The presence of vessel wall enhancement did not predict short- or long-term outcomes.</p><p><strong>Conclusion: </strong>FCA is a rare cause of young stroke that preferentially involves the supraclinoid ICA and proximal MCA with excellent outcomes. MRVWI can be useful in ruling out mimics, but the presence of contrast enhancement did not predict outcome.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"137-142"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Individual Reproducibility of Early and Late C-Reactive Protein and Interleukin-6 in Patients with Non-Severe Ischaemic Stroke and Carotid Atherosclerosis.","authors":"Sarah Gorey, John J McCabe, Sean Collins, Karl McAuley, Rosanna Inzitari, Joe Harbison, Michael Marnane, David J Williams, Peter J Kelly","doi":"10.1159/000540773","DOIUrl":"10.1159/000540773","url":null,"abstract":"<p><strong>Introduction: </strong>Acute and late inflammatory markers including high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) are associated with future vascular events after stroke. However, few longitudinal studies exist examining the intra-individual reproducibility of inflammatory biomarker measures at different timepoints after atherosclerotic stroke. We sought to examine the reproducibility of hsCRP and IL-6 in a cohort of patients with minor stroke or transient ischaemic attack (TIA) caused by ipsilateral carotid atherosclerosis.</p><p><strong>Methods: </strong>Two observational cohort studies (DUCASS and BIOVASC) were pooled. Included patients had non-severe ischaemic stroke and ipsilateral internal carotid artery stenosis (≥50%). Patients had bloods drawn within 2 weeks of their index stroke/TIA event which was stored for later analysis. All patients included were followed up at 5 years, and repeat phlebotomy was performed. Bloods were analysed for hsCRP and IL-6 using high-throughput immunochemiluminescence. Difference between baseline and follow-up blood levels and intraclass correlation (ICC) was calculated.</p><p><strong>Results: </strong>Ninety-five participants were included, median age 69 (IQR: 63-77), and 51 (53.7%) had TIA as their presenting event. When biomarkers were dichotomised (for hsCRP <2 mg/L or ≥2 mg/L, and for IL-6 <7.5 pg/mL [median] or ≥7.5 pg/mL), 68.4% (IL-6) and 65.2% (hsCRP) of participants remained in the same risk category (high or low) over time. However, when analysed as a continuous variable, ICC coefficients were low: ICC for IL-6 0.14 (95% CI: -0.06 to 0.33), ICC for hsCRP 0.05 (95% CI: -0.14 to 0.25). ICC increased after removing outliers. Clinical characteristics and treatment were not associated with observed variability.</p><p><strong>Conclusion: </strong>Our results suggest that concordance between early- and late-phase inflammatory marker risk categories is modest, and absolute levels are not highly correlated at early and late timepoints, despite associations at both times with future vascular risk. Investigators should standardise timing of phlebotomy and analysis protocols in future studies of inflammatory biomarkers.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"19-29"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation Vasculopathy.","authors":"Hui Meng Chang, Narayanaswamy Venketasubramanian","doi":"10.1159/000546505","DOIUrl":"10.1159/000546505","url":null,"abstract":"<p><strong>Background: </strong>Cerebrovascular radiation-related vasculopathies can involve vessels of all sizes. Of these, extracranial carotid and vertebral artery (VA) radiation-induced atherosclerosis are the most commonly encountered radiation vasculopathy in Asia. This is because of the high incidence of oro-nasopharyngeal cancers in this region, where radiation therapy (RT) is the mainstay treatment.</p><p><strong>Summary: </strong>Radiation exposure induces the early and rapid development of atherosclerosis in the extracranial arteries. In retrospective studies, significant changes were demonstrated as early as 1 year after RT, using carotid intima media thickness measurements. Plaque development continued at an accelerated rate, with a four times increased risk compared to those without radiation exposure, and regardless of the presence or absence of traditional risk factors. In addition, radiation-induced plaques were often extensive, involving all cranial arteries exposed to radiation. They often have high-risk features, which included echolucent plaques with ulcerations, mobile components, and/or intraplaque hypoechoic foci. The risk of both ischaemic and haemorrhagic strokes are increased, with the highest risk seen in patients younger than 40 years old. Carotid blowout is a rare and potentially deadly complication, which could involve the common, internal or external carotid arteries. Both carotid endarterectomy and carotid artery stenting have been performed, but there is a preference for stenting because of a \"hostile neck,\" from underlying radiation dermopathy and fibrosis, or scarring from prior surgeries, both contributing to poor wound healing and difficult CEA. Favourable outcomes have been reported with transcarotid artery revascularisation, compared against CEA. Other radiation-related vasculopathies, intracranial aneurysms, intracranial disease or moyamoya syndrome, cavernomas, and microbleeds were less common and rarely encountered in Asian populations. Of this, radiation-related intracranial aneurysm has been described in <1% of Chinese patients who had head and neck radiation, with a long latency periods after radiation exposure, ranging from median lag time of 6-20 years.</p><p><strong>Key messages: </strong>Cerebrovascular radiation vasculopathies have a diverse phenotypic range, from small vessel to large vessel involvement, from extracranial to intracranial disease, intracranial aneurysms, cavernomas and microbleeds. In Asia, extracranial carotid and VA radiation-induced atherosclerosis was most commonly encountered and reported, due to the prevalence of oro-nasopharyngeal cancers in many parts of this region. Complications include atherosclerosis, stroke, and increased risk of carotid blowout syndrome.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"173-180"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of the Prehospital RACE Scale for Large Vessel Occlusion in Acute Stroke Patients.","authors":"Anh Tuan Le Truong, Hang Thi Minh Tran, Loc Dang Phan, Huong Bich Thi Nguyen, Trung Quoc Nguyen, Tra Vu Son Le, Duc Nguyen Chiem, Huy Nguyen, Thanh N Nguyen, Thang Huy Nguyen","doi":"10.1159/000543260","DOIUrl":"10.1159/000543260","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital stroke scales have been developed to identify anterior large vessel occlusion (LVO) in acute ischemic stroke (AIS) patients for direct transport to thrombectomy-capable hospitals. However, its performance in a Vietnamese population remains unknown. We aimed to evaluate the predictive value of the Rapid Arterial oCclusion Evaluation (RACE) scale for LVO detection in patients with ischemic stroke presenting within 24 h in Vietnam.</p><p><strong>Methods: </strong>This was a prospective study of patients with AIS admitted at People's 115 Hospital between May 2022 and October 2022. All patients were assessed with the RACE scale with five items: facial palsy (scored 0-2), arm motor function (0-2), leg motor function (0-2), gaze (0-1), and aphasia or agnosia (0-2). LVO was diagnosed by CTA or MRA. Receiver operating characteristic curve, sensitivity, specificity, and accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO.</p><p><strong>Results: </strong>There were 318 patients included. LVO was detected in 121/318 patients (37.6%). The higher the RACE score, the higher the proportion of patients with LVO (p < 0.001). Receiver operating characteristic curves showed capacity to predict LVO of the RACE scale with an area under the curve (AUC) of 0.767. The optimal RACE cutoff was ≥5 with sensitivity = 0.68, specificity = 0.79, positive predictive value = 0.67, negative predictive value = 0.80, and overall accuracy = 0.75. RACE ≥5 had higher sensitivity and same specificity for detecting LVO in AIS patients within 6-h versus 6-24-h window (AUC = 0.79 vs. 0.75, sensitivity = 0.74 vs. 0.65, specificity = 0.79 vs. 0.80, accuracy = 0.77 vs. 0.74).</p><p><strong>Conclusions: </strong>The RACE scale is a simple tool that can accurately identify AIS patients with LVO. This tool may be useful for early detection of LVO patients and should be validated in the prehospital setting in Vietnam.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"39-47"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke from Infection.","authors":"Aurauma Chutinet, Chutibhorn Charnnarong, Nijasri C Suwanwela","doi":"10.1159/000544986","DOIUrl":"10.1159/000544986","url":null,"abstract":"<p><strong>Background: </strong>Stroke related to infections represents a less common but significant cause, particularly in low- and middle-income countries. This review examines the pathophysiology of stroke from infections, involving both direct and indirect mechanisms.</p><p><strong>Summary: </strong>Bacterial infections such as tuberculous meningitis and infective endocarditis can directly cause strokes through local inflammation, arteritis, and septic embolism. Viral infections like Varicella zoster virus and HIV increase stroke risk through chronic immune activation, vasculopathy, and endothelial dysfunction. Parasitic infections, particularly malaria and neurocysticercosis, can cause strokes via vascular occlusion and inflammatory responses. Fungal infections like aspergillosis and mucormycosis can lead to strokes through vasculitis and direct invasion of the CNS.</p><p><strong>Key messages: </strong>Understanding the mechanisms by which various infectious agents contribute to stroke pathogenesis is essential for developing targeted therapeutic strategies and improving patient outcomes. Further research is needed to establish effective prevention and treatment for infection-related strokes, especially in low- and middle-income countries.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"118-129"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Identification of Stroke Thrombolysis Contraindications from Synthetic Clinical Notes: A Proof-of-Concept Study.","authors":"Bing Yu Chen, Fares Antaki, Marco Gonzalez, Ken Uchino, Samer Albahra, Scott Robertson, Sidonie Ibrikji, Eric Aube, Andrew Russman, Muhammad Shazam Hussain","doi":"10.1159/000545317","DOIUrl":"10.1159/000545317","url":null,"abstract":"<p><strong>Introduction: </strong>Timely thrombolytic therapy improves outcomes in acute ischemic stroke. Manual chart review to screen for thrombolysis contraindications may be time-consuming and prone to errors. We developed and tested a large language model (LLM)-based tool to identify thrombolysis contraindications from clinical notes using synthetic data in a proof-of-concept study.</p><p><strong>Methods: </strong>We generated 150 synthetic clinical notes containing randomly assigned thrombolysis contraindications using LLMs. We then used Llama 3.1 405B with a custom prompt to generate a list of thrombolysis contraindications from each note. Performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and F1 score.</p><p><strong>Results: </strong>A total of 150 synthetic notes were generated using five different models: ChatGPT-4o, Llama 3.1 405B, Llama 3.1 70B, ChatGPT-4o mini, and Gemini 1.5 Flash. On average, each note contained 241.6 words (SD 110.7; range 80-549) and included 1.5 contraindications (SD 1.1; range 0-5). Our tool achieved a sensitivity of 90.9% (95% CI: 86.3%-94.3%), specificity of 99.2% (95% CI: 98.8%-99.5%), PPV of 87.7% (95% CI: 82.7%-91.7%), NPV of 99.4% (95% CI: 99.1%-99.6%), accuracy of 98.7% (95% CI: 98.2%-99.0%), and an F1 score of 0.892. Among the false positives, 24 (86%) were due to the inclusion of irrelevant contraindications, and 4 (14%) resulted from repetitive information. No hallucinations were observed.</p><p><strong>Conclusion: </strong>Our LLM-based tool may identify stroke thrombolysis contraindications from synthetic clinical notes with high sensitivity and PPV. Future studies will validate its performance using real EMR data and integrate it into acute stroke workflows to facilitate faster and safer thrombolysis decision-making.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"130-136"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}