Descriptive Analysis of Health Disparities Between Black and White People With Multiple Sclerosis in the Deep South.

BACKGROUND: Black people with multiple sclerosis (MS) have a worse disease course and higher rates of progression than White people with MS. Contributing factors to health disparities are understudied. METHODS: Data were collected retrospectively from the electronic medical records of 500 people with MS treated between 2013 and 2022 at a university comprehensive MS center in a southern state. Multiple logistic regression analyses were used to determine the associations between 2 disability outcomes (ie, low vs high Expanded Disability Status Score [EDSS] and ambulatory assistance [AMB] requirements) and age, sex, body mass index (BMI), MS type, disease duration, hypertension status, diabetes status, smoking status, adjusted gross income, and health insurance type for Black people with MS and White people with MS. RESULTS: Of the cohort, 39.2% identified as Black people with MS and the rest were White people with MS. Approximately 80% of White people with MS had relapsing MS (RMS) vs almost 90% of Black people with MS. Black people with MS were more likely to have a higher EDSS (OR 5.0, CI 3.0-8.4) and AMB (OR, 2.8; 95% CI, 1.6-4.8) than White people with MS. Among White people with MS, women (OR, 0.5; 95% CI, 0.3-0.9) and people with RMS (OR, 0.13; 95% CI 0.06-0.3) were less likely to have higher EDSS scores. Among Black people with MS, neither female sex nor RMS status was associated with a lower risk of having a higher EDSS (OR, 0.685; P = .43 and OR, 0.394; P = .29, respectively). CONCLUSIONS: The disparity in disability outcomes between Black people with MS and White people with MS may be driven by more disabling courses for Black people with RMS and by female sex, though further study is needed to determine causes for this outcome.

The effects of stress hyperglycemia in diabetic and nondiabetic patients with large vessel occlusions undergoing mechanical thrombectomy.

INTRODUCTION: Diabetes and hyperglycemia are major risk factors that can increase infarction volume and contribute to poor functional status. Our study aim was to investigate the effect of stress hyperglycemia on various safety and efficacy outcomes in patients with large vessel occlusions (LVOs) undergoing mechanical thrombectomy (MT) with or without diabetes. METHODS: A retrospective analysis of consecutive LVO patient data treated with MT at a Comprehensive Stroke Center in the Mid-South was conducted. Adult patients with LVO on computed tomography angiography (CTA) and treated with MT within 24 h of symptom onset were included. The primary outcome was to determine if there was an association in collateral flow or infarct size in the setting of hyperglycemia. Secondary outcomes included National Institute of Health Sciences Score (NIHSS) and Modified Rankin Score (mRS). RESULTS: A total of 450 patients underwent MT, out of which 433 had baseline hemoglobin A1c recorded: mean age: 64 ± 15 years, 47% women, pretreatment NIHSS median 15 points (interquartile range 10-19), 323 (75%) with good collaterals grades >2 on multiphasic CTA, 326 (75%) were non-diabetic, and 107 (25%) were diabetic. Nondiabetics with stress hyperglycemia had a tendency toward higher pre-treatment NIHSS scores (mean 17.5 ± 7.6, P = 0.02) and at 24-h (12.9 ± 9.0, P = 0.02), poor collaterals (multiphasic CTA score ≥2; 21.4% vs. 34.5%, P = 0.02), larger infarct volumes (50.7 ± 63.6 vs. 24.4 ± 33.8 cc, P < 0.0001), and had poorer functional outcomes (good mRS 0-2 47.7% vs. good mRS 0-2 36.8%) when compared to nondiabetics without stress hyperglycemia. For every 1 mg/dL increase in admission blood glucose, there was a 0.3 cc increase in infarct volume (95% confidence intervals for ß =0.2-0.4; P < 0.0001) after adjusting for the final thrombolysis in cerebral infarction score. CONCLUSIONS: LVO patients with stress hyperglycemia without previously diagnosed diabetes had more severe strokes, developed larger infarct volumes, poorer collaterals, and had worse functional outcomes at 90 days post-MT. In addition, LVO patients with diabetes and stress hyperglycemia exhibited more passes during MT and worse functional outcomes.

Unusual Post-COVID-19 Presentation With Tetraventricular Hydrocephalus: A Case Report.

Objective: COVID-19 infection is suggested as one of the causes for hydrocephalus (HCP) of unknown etiology. COVID-19 infection may present with a range of neurologic symptoms given viral neurotropic and neuroinvasive properties. Postinfectious HCP is a severe complication as a potential sequela of COVID-19 infection. Methods: We identified a patient with a history of recent COVID-19 infection who presented with chronic progressive headaches with nausea, vomiting, and blurry vision over 2 weeks. Results: Neurologic examination showed bilateral papilledema. The head CT scan showed tetraventricular enlargement and marked fourth ventricular dilation. Cine MRI showed fourth ventricular turbulent CSF flow. The patient underwent external ventricular drain placement and exploratory suboccipital craniotomy, which revealed a subarachnoid web that was microsurgically resected. Reconstituted CSF flow resolved the patient's symptoms and prevented complications. Discussion: Fourth ventricular outlet obstruction is a rare cause of tetraventricular HCP. In most cases, it is associated with a history of inflammatory conditions or hemorrhage. In our case, a history of recent COVID-19 infection and normal imaging before COVID-19 make COVID-19 the most probable explanation for HCP. We suggest considering COVID-19 infection in the differential diagnosis of HCP of unclear etiology.