Predicting cognitive decline in cognitively impaired patients with ischemic stroke with high risk of cerebral hemorrhage: a machine learning approach.

Background And Objective: Cognitive decline progresses rapidly in stroke patients, increasing risks of stroke recurrence. Predicting deterioration within a year in patients with poststroke cognitive impairment (PSCI) could guide targeted interventions for dementia prevention and better prognosis. In this PreventIon of CArdiovascular events in iSchemic Stroke patients with high risk of cerebral hemOrrhage for reducing cognitive decline substudy, machine learning on clinical and imaging data was used to predict cognitive decline over 9 months in PSCI patients.

Proximal and distal middle cerebral artery diameter ratio and lenticulostriate artery infarction.

Background: Lipohyalinotic degeneration (LD) and branch atheromatous disease (BAD) can contribute to subcortical infarctions in the lenticulostriate artery (LSA) territory. This study aimed to identify the association between the proximal and distal middle cerebral artery (MCA) diameter ratio and the two different pathomechanisms of LSA infarction.

Methods: Patients with acute LSA infarctions categorized as small vessel occlusive disease were included.

Deep learning to identify stroke within 4.5 h using DWI and FLAIR in a prospective multicenter study.

To enhance thrombolysis eligibility in acute ischemic stroke, we developed a deep learning model to estimate stroke onset within 4.5 h using diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) images. Given the variability in human interpretation, our multimodal Res-U-Net (mRUNet) model integrates a modified U-Net and ResNet-34 to classify stroke onset as < 4.

Serial changes and optimal imaging windows in vessel wall MRI for unruptured intracranial artery dissection.

We investigated serial changes in intracranial artery dissection (ICAD) from the baseline to 12 months on vessel wall MRI. This prospective study enrolled 17 participants with clear onset of 20 unruptured ICADs between April 2016 and May 2018, and underwent vessel wall MRI within 1 week, and at 1-, 3-, 6-, and 12-months following symptom onset. Detection rates of imaging features, imaging time showing stable morphology and measurements were assessed, and compared between 1- and 3-month using exact McNemar's and Wilcoxon signed-rank test.

Personalized Visual Perceptual Learning Digital Therapy for Visual Field Defects Following Stroke: A Randomized Clinical Trial.

Importance: Effective treatments for restoring visual field defects (VFDs) in patients with stroke necessitate validation through randomized clinical trials.

Objective: To evaluate the efficacy and safety of a personalized digital therapeutic based on visual perceptual learning for treating poststroke VFDs.

Design, Setting, And Participants: A multicenter randomized clinical trial was conducted from October 19, 2022, to November 8, 2023, at 12 hospitals in South Korea.

Genetic and imaging features of CADASIL patients with acute ischemic stroke.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), which is caused by mutations in the NOTCH3 gene, is associated with early-onset strokes. However, the specific genetic and imaging characteristics associated with acute ischemic stroke (AIS) in patients with CADASIL remain unclear. We reviewed CADASIL patients with NOTCH3 mutations, dividing them into two groups based on the presence of clinically relevant AIS lesions on diffusion-weighted imaging, observed at any time, regardless of the timing of CADASIL diagnosis.

Occipital cerebral microbleeds as a predictor of intracranial hemorrhage in posterior reversible encephalopathy syndrome.

Background And Objectives: Intracranial hemorrhage (ICH), which often occurs in cases of posterior reversible encephalopathy syndrome (PRES), is regarded as a significant predictor of poor disease outcomes. While ICH and cerebral microbleeds (CMBs) can occur due to uncontrolled hypertension, the relationship between these conditions remains unclear.

Methods: This retrospective case-control study categorized PRES patients according to the presence of ICH on the day of symptom onset.

Factors Associated With Silent Brain Infarcts After Middle Cerebral Artery Stenting or Balloon Angioplasty.

Background And Purpose: Silent brain infarcts (SBIs), which manifest as dot-like lesions on diffusion-weighted imaging (DWI) after endovascular procedures, are associated with an increased risk of stroke, dementia, and cognitive decline. We aimed to identify the factors associated with SBIs following middle cerebral artery (MCA) stenting or balloon angioplasty.

Methods: We retrospectively reviewed patients who underwent MCA stenting or balloon angioplasty, including those with symptomatic, atherosclerotic MCA stenosis of ≥50%.

Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source.

Background: Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up.

Methods: Patients with acute ischemic stroke classified as ESUS were included.

Narrative mobile video game-based cognitive training to enhance frontal function in patients with mild cognitive impairment.

Although cognitive training has been proposed as a possible therapeutic modality for mild cognitive impairment (MCI), most serious games focus on specific tasks. This study aimed to investigate the feasibility and efficacy of narrative video game-based cognitive intervention for MCI. A four-week (± 1-week) mobile game intervention was given to 17 MCI participants (mean age (SD) = 72.

Association Between the Timing of Atrial Fibrillation Detection and Functional Outcome Following Mechanical Thrombectomy.

Background: Atrial fibrillation detected after stroke (AFDAS) refers to the identification of newly diagnosed atrial fibrillation (AF) following an ischemic stroke in patients without known AF (KAF). The objective of this study was to compare the functional outcomes of patients diagnosed with AFDAS and those with KAF who underwent mechanical thrombectomy.

Methods And Results: We conducted a retrospective analysis of patients who underwent mechanical thrombectomy and with either new AF diagnosed during hospitalization or KAF.

Digital symbol-digit modalities test with modified flexible protocols in patients with CNS demyelinating diseases.

Cognitive impairment (CI) is prevalent in central nervous system demyelinating diseases, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). We developed a novel tablet-based modified digital Symbol Digit Modalities Test (MD-SDMT) with adjustable protocols that feature alternating symbol-digit combinations in each trial, lasting one or two minutes. We assessed 144 patients (99 with MS and 45 with NMOSD) using both MD-SDMT protocols and the traditional paper-based SDMT.

A Multimodal Ensemble Deep Learning Model for Functional Outcome Prognosis of Stroke Patients.

Background And Purpose: The accurate prediction of functional outcomes in patients with acute ischemic stroke (AIS) is crucial for informed clinical decision-making and optimal resource utilization. As such, this study aimed to construct an ensemble deep learning model that integrates multimodal imaging and clinical data to predict the 90-day functional outcomes after AIS.

Methods: We used data from the Korean Stroke Neuroimaging Initiative database, a prospective multicenter stroke registry to construct an ensemble model integrated individual 3D convolutional neural networks for diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR), along with a deep neural network for clinical data, to predict 90-day functional independence after AIS using a modified Rankin Scale (mRS) of 3-6.

Digital therapeutics using virtual reality-based visual perceptual learning for visual field defects in stroke: A double-blind randomized trial.

Introduction: Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs.

Distal normal vessel diameter might be associated with silent brain infarcts after stenting for symptomatic carotid stenosis.

Background: Carotid artery stenting (CAS) has been the standard treatment for carotid stenosis because it is less invasive; however, the risk of periprocedural thromboembolism is high. We investigated the predictors for silent brain infarcts (SBIs), focusing on embolic protection in CAS.

Methods: This study was single-center retrospective study, and we obtained baseline demographics and clinical, laboratory, and periprocedural variables of patients who underwent CAS.

Association between renal insufficiency and lesion characteristics of posterior reversible encephalopathy syndrome.

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by cerebral blood flow dysregulation and the blood-brain barrier (BBB) disruption. While renal insufficiency has been considered a factor in BBB fragility, the relationship between renal insufficiency and the PRES lesions volume remains unclear.

Methods: This observational study was performed retrospectively.

Early apixaban administration considering the size of infarction and functional outcome in acute ischemic stroke.

Background And Purpose: Atrial fibrillation-related stroke (AF-stroke) is associated with an adverse prognosis, characterized by a high incidence of progression, recurrence, and hemorrhagic transformation. Our study aims to investigate the potential benefits of stratified early administration of apixaban, taking into account infarct size during the acute phase, in order to enhance functional outcomes.

Methods: We conducted this study at a tertiary referral stroke center, enrolling acute AF-stroke patients who received apixaban during the acute phase.

Functional connectivity interacts with visual perceptual learning for visual field recovery in chronic stroke.

A reciprocal relationship between perceptual learning and functional brain changes towards perceptual learning effectiveness has been demonstrated previously; however, the underlying neural correlates remain unclear. Further, visual perceptual learning (VPL) is implicated in visual field defect (VFD) recovery following chronic stroke. We investigated resting-state functional connectivity (RSFC) in the visual cortices associated with mean total deviation (MTD) scores for VPL-induced VFD recovery in chronic stroke.

Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion.

Background And Purpose: The additive effects of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) remain unclear. We aimed to investigate the efficacy and safety of IVT prior to MT depending on the location of M1 occlusion.

Methods: We reviewed the cases of patients who underwent MT for emergent large-vessel occlusion of the M1 segment.

Time Window for Induced Hypertension in Acute Small Vessel Occlusive Stroke With Early Neurological Deterioration.

Background: Therapeutic-induced hypertension treatment (iHTN) is helpful for alleviating early neurological deterioration (END) in acute small vessel occlusive stroke. We examined the time parameters related to iHTN effectiveness in these patients.

Methods: We retrospectively reviewed patients with acute small vessel occlusive stroke who underwent iHTN for END, defined as an increase of ≥2 points in total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 point in motor items of NIHSS.

Association between arterial tortuosity and early neurological deterioration in lenticulostriate artery infarction.

Early neurological deterioration (END) in lenticulostriate artery (LSA) infarction is associated with perforating artery hypoperfusion. As middle cerebral artery (MCA) tortuosity may alter hemodynamics, we investigated the association between MCA tortuosity and END in LSA infarction. We reviewed patients with acute LSA infarction without significant MCA stenosis.