BMJ Neurology Open最新文献

{"title":"Association between stroke and systemic inflammation response index (SIRI): a National Health and Nutrition Examination Survey (NHANES) Study 2015-2020.","authors":"Adib Valibeygi, Mohammadreza Fardaei, Sepideh Niknejad","doi":"10.1136/bmjno-2024-000718","DOIUrl":"10.1136/bmjno-2024-000718","url":null,"abstract":"<p><strong>Objectives: </strong>The present study aimed to compare the relationship between history of stroke and four different inflammatory indices, including high-sensitivity C reactive protein (hsCRP), inflammatory burden index (IBI), neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI).</p><p><strong>Methods: </strong>In this cross-sectional study, data from the National Health and Nutrition Examination Survey from 2015 to 2020 were used, yielding a sample of 25 531 participants. Individuals younger than 20, pregnant women, patients with cancer and missing cases were excluded. Baseline characteristics and inflammatory markers mentioned above were analysed. Logistic regression models assessed the association between inflammatory indices and the history of stroke.</p><p><strong>Results: </strong>Of the 7828 eligible cases, 271 (3.4%) had a history of stroke. Stroke was more prevalent among older subjects, smokers, patients with diabetes, hypertension and dyslipidaemia, and those less physically active. All inflammatory indices were elevated considerably in stroke survivors, according to crude analysis. After adjusting for covariates, hsCRP (p=0.519, 95% CI: 0.961 to 1.083), NLR (p=0.125, 95% CI: 0.947 to 1.565) and IBI (p=0.157, 95% CI: 0.991 to 1.060) did not reveal any significant difference between the stroke survivors and control subjects. SIRI was the only inflammatory index significantly associated with a history of stroke (p=0.005, 95% CI: 1.154 to 2.274).</p><p><strong>Conclusion: </strong>This study revealed that among the hsCRP, IBI, NLR and SIRI, SIRI is the only one independently associated with a history of stroke. Our findings, in conjunction with the pre-existing evidence from observational and experimental studies, highlight the role of monocytes as a component of SIRI in chronic inflammation, which may induce vascular thrombotic events, including stroke.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000718"},"PeriodicalIF":2.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558632","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":"Correction: ICAM-1 and CRP as biomarkers of 3-month outcome in acute ischaemic stroke.","authors":"","doi":"10.1136/bmjno-2023-000516corr1","DOIUrl":"10.1136/bmjno-2023-000516corr1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1136/bmjno-2023-000516.].</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000516corr1"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544383","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":"Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures.","authors":"Michael Valente, Mark Parsons, Bernard Yan, Chushuang Chen, Milanka Visser, Henry Ma, Andrew Bivard","doi":"10.1136/bmjno-2024-000939","DOIUrl":"10.1136/bmjno-2024-000939","url":null,"abstract":"<p><p>Vascular territory mapping (VTM) software estimates which intracerebral vessel provides peak arterial flow to a brain voxel. This observational study was performed to assess the hypothesis that the VTM algorithm may correlate to visual measurements of leptomeningeal grading and stroke outcome measures in acute middle cerebral artery (MCA) occlusion. VTM software assigned regions of the brain to an estimated feeding intracerebral vessel. Whole brain dynamic CT angiography was used to visually grade the extent of flow in either anterior or posterior cerebral leptomeningeal arteries. The final dataset included 115 patients with MCA occlusion. The median age was 74 years (IQR 62-82). The time from onset of symptoms to scan was a median of 129 min (IQR 85-241) and the median National Institutes of Health Stroke Scale (NIHSS) was 15 (IQR 12-19). Baseline imaging revealed a median ischaemic core of 19 mL (IQR 6-39) and perfusion lesion of 92 mL (IQR 68-122). Ischaemic core and posterior cerebral artery VTM volume were significantly associated with less robust posterior collateral flow on visual grading. VTM variables were not predictive of anterior collateral grade or stroke outcome measures. There did not appear to be a significant relationship between VTM volumes and visualised leptomeningeal collateral flow direction. The clinical utility and diagnostic value of VTM software in predicting collateral flow patterns remain to be elucidated, and further validation studies are warranted to determine the potential applications in acute stroke assessment.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000939"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558637","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":"Perfusion patterns as a tool for emergency stroke diagnosis: differentiating proximal and distal MCA occlusions.","authors":"Aglae Velasco Gonzalez, Liu Jingyu, Boris Buerke, Dennis Görlich, Joaquin Ortega-Quintanilla, Cristina Sauerland, Norbert Meier, Walter Heindel","doi":"10.1136/bmjno-2024-001001","DOIUrl":"10.1136/bmjno-2024-001001","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the effectiveness of a novel Perfusion Pattern (PP) scale in differentiating between proximal and distal middle cerebral artery (MCA) occlusions in patients with acute ischaemic stroke.</p><p><strong>Methods: </strong>This retrospective study included 201 patients with acute ischaemic stroke, categorised into two groups: those with M1 segment occlusions (n=114) and those with distal medium vessel occlusions (n=87). We analysed multimodal stroke CT imaging and clinical data, focusing on the occlusion site, hypoperfusion extent and basal ganglia involvement. Patients with tandem stenosis or multiple acute occlusions were excluded. Perfusion patterns were categorised into three types (PP-1, PP-2 and PP-3) based on the extent of hypoperfusion. Statistical analysis explored associations between the occlusion site, perfusion pattern and collateral status.</p><p><strong>Results: </strong>Among the 201 patients (mean age 75±14 years, 86 men), PP-1 was observed in 36.8% of patients (74/201), PP-2 in 27.4% (55/201) and PP-3 in 35.8% (72/201). The distribution of PP varied significantly by occlusion site (p<0.0001). Distal medium vessel occlusions were associated with PP-1 in 78.4% of cases (58/74), while PP-3 was most prevalent in M1 occlusions (90.3%, 65/72). The contingency coefficient revealed that occlusion location had a stronger association with the perfusion pattern (c=0.556) than collateral type (c=0.245). However, 21.6% of M1 occlusions (16/74) showed a PP-1 pattern and 9.7% of distal medium vessel occlusions (7/72) exhibited PP-3. Basal ganglia infarction presence was a reliable indicator of M1 occlusion with a 94% likelihood.</p><p><strong>Conclusions: </strong>Perfusion patterns can effectively differentiate between proximal and distal medium vessel MCA occlusions, aiding targeted assessment of CT angiography.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e001001"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544439","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":"Development of a diagnostic checklist to identify functional cognitive disorder versus other neurocognitive disorders.","authors":"Verónica Cabreira, Jane Alty, Sonja Antic, Rui Araujo, Selma Aybek, Harriet A Ball, Gaston Baslet, Rohan Bhome, Jan Coebergh, Bruno Dubois, Mark Edwards, Sasa R Filipovic, Kristian Steen Frederiksen, Thomas Harbo, Bradleigh Hayhow, Robert Howard, Jonathan Huntley, Jeremy Darryl Isaacs, Curt LaFrance, Andrew Larner, Francesco Di Lorenzo, James Main, Elizabeth Mallam, Camillo Marra, João Massano, Emer R McGrath, Isabel Portela Moreira, Flavio Nobili, Suvankar Pal, Catherine M Pennington, Miguel Tábuas-Pereira, David Perez, Stoyan Popkirov, Dane Rayment, Martin Rossor, Mirella Russo, Isabel Santana, Jonathan Schott, Emmi P Scott, Ricardo Taipa, Tiago Teodoro, Michele Tinazzi, Svetlana Tomic, Sofia Toniolo, Caroline Winther Tørring, Tim Wilkinson, Martin Zeidler, Lisbeth Frostholm, Laura McWhirter, Jon Stone, Alan Carson","doi":"10.1136/bmjno-2024-000918","DOIUrl":"10.1136/bmjno-2024-000918","url":null,"abstract":"<p><strong>Background: </strong>Functional cognitive disorder (FCD) poses a diagnostic challenge due to its resemblance to other neurocognitive disorders and limited biomarker accuracy. We aimed to develop a new diagnostic checklist to identify FCD versus other neurocognitive disorders.</p><p><strong>Methods: </strong>The clinical checklist was developed through mixed methods: (1) a literature review, (2) a three-round Delphi study with 45 clinicians from 12 countries and (3) a pilot discriminative accuracy study in consecutive patients attending seven memory services across the UK. Items gathering consensus were incorporated into a pilot checklist. Item redundancy was evaluated with phi coefficients. A briefer checklist was produced by removing items with >10% missing data. Internal validity was tested using Cronbach's alpha. Optimal cut-off scores were determined using receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>A full 11-item checklist and a 7-item briefer checklist were produced. Overall, 239 patients (143 FCD, 96 non-FCD diagnoses) were included. The checklist scores were significantly different across subgroups (FCD and other neurocognitive disorders) (F(2, 236)=313.3, p<0.001). The area under the curve was excellent for both the full checklist (0.97, 95% CI 0.95 to 0.99) and its brief version (0.96, 95% CI 0.93 to 0.98). Optimal cut-off scores corresponded to a specificity of 97% and positive predictive value of 91% for identifying FCD. Both versions showed good internal validity (>0.80).</p><p><strong>Conclusions: </strong>This pilot study shows that a brief clinical checklist may serve as a quick complementary tool to differentiate patients with neurodegeneration from those with FCD. Prospective blind large-scale validation in diverse populations is warranted.Cite Now.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000918"},"PeriodicalIF":2.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544435","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":"CSF oligoclonal bands in neurological diseases besides CNS inflammatory demyelinating disorders.","authors":"Jingru Ren, Jianchun Wang, Ran Liu, Jing Guo, Yan Yao, Hongjun Hao, Feng Gao","doi":"10.1136/bmjno-2024-000912","DOIUrl":"10.1136/bmjno-2024-000912","url":null,"abstract":"<p><strong>Objective: </strong>To understand the distribution characteristics and clinical significance of cerebrospinal fluid (CSF) oligoclonal bands (OCBs) in different nervous system diseases besides typical central nervous system (CNS) inflammatory demyelinating disorders.</p><p><strong>Material: </strong>A total of 2259 patients who underwent CSF examination for OCBs at Peking University First Hospital from January 2011 to December 2023 were tested. A cohort of 257 patients presenting with various types of OCBs but without CNS inflammatory demyelinating diseases was included in the analysis. Relevant medical history was collected from all patients.</p><p><strong>Results: </strong>OCBs were most common in patients with autoimmune encephalitis. OCB types II and III were most common in patients with autoimmune encephalitis and CNS infection, whereas OCB types IV and V were present in immune-mediated neuropathy mostly. The distribution of OCBs also varied among different disease subtypes. Other CSF characteristics varied between diseases with different OCBs.</p><p><strong>Conclusions: </strong>In addition to CNS inflammatory demyelinating diseases, OCBs also appear in other neurological diseases including cerebral angiopathy and neurodegenerative conditions, informing the potential immune background. Further research is still needed to determine the significance of OCBs in these diseases.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000912"},"PeriodicalIF":2.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574664","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":"Creutzfeldt-Jakob disease mimicking limbic encephalitis as a cause of rapid neurological deterioration.","authors":"Vinod Rajasingam, Donald P Peter Craig, Yun Hwang, Laveniya Satgunaseelan, Michael Buckland, Rodrigo Tomazini Martins","doi":"10.1136/bmjno-2024-000891","DOIUrl":"10.1136/bmjno-2024-000891","url":null,"abstract":"<p><strong>Background: </strong>A broad range of inflammatory and neurodegenerative conditions manifest with progressive cognitive and behavioural changes. A diagnostic challenge is the differentiation of limbic encephalitis (LE) from Creutzfeldt-Jakob disease (CJD). LE and CJD are distinct neurological conditions with distinct variations in their clinical course, with overlapping clinical presentations. LE can be subdivided into autoimmune paraneoplastic and non-paraneoplastic subtypes, under the umbrella of autoimmune LE. CJD is the most prevalent form of human prion disease and the subtype sporadic CJD (sCJD) the most common.</p><p><strong>Case presentation: </strong>This case study presents a 68-year-old man with a 6-week history of progressive cognitive decline and behavioural changes, ultimately leading to a dire clinical state. The initial symptoms included confusion, intermittent headaches and episodes of aggression towards his wife, preceded by 2 weeks of visual hallucinations. On examination, the patient displayed an ataxic gait, with signs of cerebellar dysfunction. The clinical course evolved, marked by myoclonic jerks, culminating in a decline in both his Glasgow Coma Scale (GCS) score and overall clinical status.</p><p><strong>Conclusion: </strong>The patient's rapidly deteriorating condition over 6 weeks was thought to be too rapid for sCJD, and the patient was treated initially as an LS. However, post-mortem biopsy findings confirmed CJD. Asymmetric periodic discharges on EEG, asymmetric neuroimaging changes and the manifestation of psychiatric symptoms should not preclude the diagnosis of sCJD. This case highlights the importance of recognising the potential rapid deterioration of sCJD, which would alert clinicians to earlier diagnosis and management.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000891"},"PeriodicalIF":2.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525233","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":"Immunoglobulin unresponsive Guillain-Barré syndrome: rinse or repeat? A systematic review.","authors":"Thomas Roe, Alex Gordon, Nicholas Gourd, Charlotte Thomas, James Ward, Chinar Osman, Ahilanandan Dushianthan","doi":"10.1136/bmjno-2024-000907","DOIUrl":"10.1136/bmjno-2024-000907","url":null,"abstract":"<p><strong>Introduction: </strong>Severe Guillain-Barré syndrome (GBS) patients may not show improvement after a single course of intravenous immunoglobulin (IVIg) therapy. Current treatment options include either a second course of IVIg or therapeutic plasma exchange (TPE). This systematic review aims to evaluate the current literature on the use of a second course of IVIg or TPE in patients who fail to show clinical improvement after the first IVIg course.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Medline databases up until 26 October 2023. Studies that evaluated adult patients with confirmed GBS who have failed one full course of IVIg and subsequently received either repeat IVIg or TPE were included. Risk of bias was performed using study-specific checklists. A narrative synthesis of results is presented.</p><p><strong>Results: </strong>A total of 37 articles were identified (1 randomised controlled trial (RCT), 3 observational and 33 case reports/series), consisting of 422 patients in total. 12 studies evaluated repeat IVIg and 24 studies evaluated TPE after IVIg. There was no superiority of a repeat course of IVIg or TPE in all clinical outcome measures.</p><p><strong>Conclusions: </strong>The evidence suggests with a low degree of certainty that there is no beneficial effect of further IVIg in unresponsive GBS. The quality of evidence regarding TPE after IVIg is insufficient to suggest any efficacy due to a lack of RCTs. We recommend standardised case reporting with consideration for a multinational case registry and RCTs to determine the efficacy of TPE after initial IVIg unresponsiveness.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000907"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416121","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":"Monitoring the neurological complications of chimeric antigen receptor (CAR) T-cell therapy in patients with sensory and physical impairments and non-native-speaking backgrounds using modified immune effector cell-associated encephalopathy (ICE) scores: a case series.","authors":"Christina Kazzi, Ty Simpson, Cassandra Abbott, Miriam Wronski, Nabil Seery, Tracie Huey-Lin Tan, Robb Wesselingh, Katherine Ko, Shu Min Wong, Shafqat Inam, Constantine Tam, Shaun Fleming, Terence J O'Brien, Rubina Alpitsis, Andrew Spencer, Charles Malpas, Mastura Monif","doi":"10.1136/bmjno-2024-000927","DOIUrl":"10.1136/bmjno-2024-000927","url":null,"abstract":"<p><strong>Background: </strong>Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common complication of chimeric antigen receptor (CAR) T-cell therapy. Current practice guidelines recommend the immune effector cell-associated encephalopathy (ICE) score for the assessment and monitoring of ICANS.</p><p><strong>Objective: </strong>To demonstrate modifications to ICE score to patients with vision and hearing impairments or who are who are from non-native-speaking backgrounds.</p><p><strong>Methods: </strong>We discuss five cases and the modifications made to adapt the ICE score to meet patients' needs.</p><p><strong>Results: </strong>Modifications to ICE score was feasible and it assisted with CAR T cell therapy outcome monitoring.</p><p><strong>Discussion: </strong>These cases highlight the need for flexible and patient-tailored strategies and the importance of collaboration between multidisciplinary teams and patients' families/caregivers when monitoring patients for ICANS after CAR T-cell therapy.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000927"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416122","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":"Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion.","authors":"Vivek Yedavalli, Hamza Adel Salim, Dhairya A Lakhani, Janet Mei, Licia P Luna, Yasmin Aziz, Vaibhav Vagal, Adam A Dmytriw, Adrien Guenego, Victor Urrutia, Elisabeth B Marsh, Aakanksha Sriwastwa, Raf Llinas, Hanzhang Lu, Risheng Xu, Dylan Wolman, Benjamin Pulli, Argye Hillis, Gregory W Albers, Max Wintermark, Kambiz Nael, Jeremy J Heit, Tobias D Faizy, Mona N Bahouth","doi":"10.1136/bmjno-2024-000974","DOIUrl":"10.1136/bmjno-2024-000974","url":null,"abstract":"<p><strong>Background: </strong>Acute ischaemic stroke (AIS) is a leading cause of mortality and disability globally, with volume contracted state (VCS), as indicated by an elevated blood urea nitrogen to creatinine (BUN/Cr) ratio, potentially influencing outcomes. This study investigates the association between VCS and clinical outcomes in patients with AIS due to large vessel occlusion (LVO).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving 298 patients with LVO-AIS from two comprehensive stroke centres. Patients were divided into two groups based on BUN/Cr ratio: ≤20 (n=205) and >20 (n=93). Primary outcomes included 90-day mortality and unfavourable functional outcomes, defined as a modified Rankin Scale score of 3-6. Secondary outcomes included the successful reperfusion, haemorrhagic transformation and National Institutes of Health Stroke Scale score at discharge.</p><p><strong>Results: </strong>Patients with a BUN/Cr ratio >20 had significantly higher 90-day mortality (35% vs 13%, p<0.001) and this association remained significant after adjusting for confounding factors (OR 2.20; 95% CI 1.11 to 4.39; p=0.024). However, VCS was not significantly associated with unfavourable functional outcomes at 90 days (OR 1.28; 95% CI 0.67 to 2.51; p=0.46). Age and initial stroke severity were more strongly associated with long-term functional outcomes.</p><p><strong>Conclusions: </strong>VCS is associated with higher odds of 90-day mortality in patients with LVO-AIS but not with unfavourable functional outcomes. These findings suggest the need for further research into the role of hydration management in improving survival in patients with AIS, potentially informing future treatment protocols.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000974"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257168","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}