No clear relationship between circadian rhythm and cerebral perfusion parameters in pediatric and early adult populations.

Background: Recent literature suggests circadian rhythm influences cerebral perfusion parameters in adults experiencing an acute large vessel occlusion, but this has never been investigated in the pediatric and young adult populations.

Methods: We queried the United States RAPID Insights database (10/05/2018-09/29/2023) for unique patients between 2 and 25 years with computed tomography perfusion (CTP). Included scans had a minimum ischemic core volume (rCBF <30 %) of >0 cc and a Tmax volume of >0 cc.

Feasibility of a blood pressure telemedicine program in the virtual age.

Background: Despite strong evidence for maintaining blood pressure (BP) < 130/80 for secondary stroke prevention, there have been many barriers toward achieving this goal. The purpose of this pilot study was to assess the feasibility of a new physician-led BP telemedicine program on the improvement of BP and medication compliance in stroke survivors.

Methods: We prospectively enrolled patients with a history of stroke and hypertension into this BP telemedicine program where participants were paired with a physician for one-on-one counseling.

Telestroke Training: Considerations for Expansion of Vascular Neurology Program Requirements.

Telemedicine for stroke (Telestroke) has been a key component to efficient, widespread acute stroke care for many years. The expansion of reimbursement through the Furthering Access to Stroke Telemedicine Act and rapid deployment of telemedicine resources during the COVID-19 public health emergency have further expanded remote care, with practitioners of varying educational backgrounds, and experience providing acute stroke care via telemedicine (Telestroke). Some Telestroke practitioners have not had fellowship-level vascular neurology training and many are without training specific to virtual modalities.

Ischemic core volumes and collateral status have diurnal fluctuations - A retrospective cohort study of 18,137 patients.

Introduction: Recent observations suggest that circadian rhythms are implicated in the timing of stroke onset and the speed of infarct progression. We aimed to replicate these observations in a large, multi-center, automated imaging database.

Methods: The RAPID Insights database was queried from 02/01/2016 to 01/31/2022 for patients with perfusion imaging and automated detection of an ischemic stroke due to a presumed large vessel occlusion.

Nationwide diurnal pattern among intracerebral hemorrhage incidence and volume.

Introduction: Intracerebral hemorrhage (ICH) incidence follows both seasonal and diurnal patterns with greater severity reported in nighttime hemorrhages. These differences have been attributed to variations in the coagulation cascade, blood pressure, and sleep-wake cycle that all have their own rhythmicity. The purpose of this analysis was to validate these trends in a large nationwide database of automated ICH detection scans and evaluate for differences in hematoma volume by image acquisition time.

Decreasing false-positive detection of intracranial hemorrhage (ICH) using RAPID ICH 3.

Introduction: The prompt detection of intracranial hemorrhage (ICH) on a non-contrast head CT (NCCT) is critical for the appropriate triage of patients, particularly in high volume/high acuity settings. Several automated ICH detection tools have been introduced; however, at present, most suffer from suboptimal specificity leading to false-positive notifications.

Methods: NCCT scans from 4 large databases were evaluated for the presence of an ICH (IPH, IVH, SAH or SDH) of >0.

Safety and Feasibility of an Emergency Department-to-Outpatient Pathway for Patients With TIA and Nondisabling Stroke.

Background And Objectives: Evaluation of transient ischemic attack/nondisabling ischemic strokes (TIA/NDS) in the emergency department (ED) contributes to capacity issues and increasing health care expenditures, especially high-cost duplicative imaging.

Methods: As an institutional quality improvement project, we developed a novel pathway to evaluate patients with TIA/NDS in the ED using a core set of laboratory tests and CT-based neuroimaging. Patients identified as 'low risk' through a safety checklist were discharged and scheduled for prompt outpatient tests and stroke clinic follow-up.

Larger ischemic cores and poor collaterals among large vessel occlusions presenting in the late evening.

Background: Components critical to cerebral perfusion have been noted to oscillate over a 24-h cycle. We previously reported that ischemic core volume has a diurnal relationship with stroke onset time when examined as dichotomized epochs (i.e.

Infarct Core Growth During Interhospital Transfer For Thrombectomy Is Faster At Night.

Background: Preclinical stroke models have recently reported faster infarct growth (IG) when ischemia was induced during daytime. Considering the inverse rest-activity cycles of rodents and humans, faster IG during the nighttime has been hypothesized in humans.

Methods: We retrospectively evaluated acute ischemic stroke patients with a large vessel occlusion transferred from a primary to 1 of 3 French comprehensive stroke center, with magnetic resonance imaging obtained at both centers before thrombectomy.

Automated cerebral hemorrhage volume calculation and stability detection using automated software.

Introduction: The measurement of intracerebral hemorrhage (ICH) volume is important for management, particularly in evaluating expansion on subsequent imaging. However manual volumetric analysis is time-consuming, especially in busy hospital settings. We aimed to use automated Rapid Hyperdensity software to accurately measure ICH volume across repeated imaging.

Association of Soluble ST2 With Functional Outcome, Perihematomal Edema, and Immune Response After Intraparenchymal Hemorrhage.

Background And Objectives: Perihematomal edema (PHE) contributes to poor outcome after deep intraparenchymal hemorrhage (IPH), which is characterized by neuroinflammation and an influx of peripherally derived innate immune cells. We previously identified soluble ST2 (sST2) as a candidate for immune-mediated secondary brain injury. Leveraging prospectively collected cohorts from 2 centers, we sought to determine whether sST2 was associated with functional outcome, PHE, and the immune response following IPH.

Clinical Trial Publication Trends Within Neurology.

Timely dissemination of results from clinical studies is crucial for the advancement of knowledge and clinical decision making. A large body of research has shown that up to half of clinical trials do not publish their findings. In this study, we sought to determine whether clinical trial publication rates within neurology have increased over time.

Publication and Dissemination of Results in Clinical Trials of Neurology.

This review of interventional neurology trials registered in ClinicalTrials.gov classifies trials and compares publication rates and time to publication between 2007 and 2014.

Functional Improvement Among Intracerebral Hemorrhage (ICH) Survivors up to 12 Months Post-injury.

Background And Purpose: As survival rates have increased for intracerebral hemorrhage (ICH) patients, there is limited information regarding recovery beyond 3-6 months. This study was conducted to examine recovery curves using the modified Rankin Scale (mRS) and Barthel Index (BI) up to 12 months post-injury.

Methods: We prospectively enrolled 173 patients admitted with ICH who were subsequently evaluated using the mRS and BI at discharge as well as 3, 6, and 12 months.

Intracerebral Hemorrhage Location and Functional Outcomes of Patients: A Systematic Literature Review and Meta-Analysis.

Background And Purpose: Intracerebral hemorrhage (ICH) has the highest mortality rate among all strokes. While ICH location, lobar versus non-lobar, has been established as a predictor of mortality, less is known regarding the relationship between more specific ICH locations and functional outcome. This review summarizes current work studying how ICH location affects outcome, with an emphasis on how studies designate regions of interest.

TURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis.

Background And Purpose: Cerebral edema is associated with poor outcome after IV thrombolysis. We recently described the TURN score (Thrombolysis risk Using mRS and NIHSS), a predictor of severe outcome after IV thrombolysis. Our purpose was to evaluate its ability to predict 24-h cerebral edema.