Transient ischemic attack evaluation models: hospitalization, same-day clinics, or rapid evaluation units.

Transient ischemic attack (TIA) has been well established as a risk factor for future stroke. Therefore, the diagnosis of TIA may serve as a golden opportunity for providing early time sensitive therapies to this high-risk group. Currently, there is no standardized algorithm for triaging suspected TIA, leading to errors in diagnosis, significant delays in evaluation and treatment, and greater morbidity and mortality. There are several proposed methods for triaging patients: hospitalization, same-day clinics, and rapid evaluation units. We review the benefits and limitations for each model, focusing on stroke risk reduction, costs, and feasibility.

Dietary intake is associated with neuropsychological impairment in women with HIV.

BACKGROUND: Diet is a modifiable risk factor that may influence cognition in people with HIV. OBJECTIVES: We examined the association between dietary intake and cognition in women with HIV (WWH) and HIV-seronegative women. METHODS: An 18-item dietary National Cancer Institute screener was completed by 729 WWH and 346 HIV-seronegative Women's Interagency HIV Study participants. Daily intake frequencies of processed meats, sweet beverages, fish, whole milk, and vegetables were calculated. Participants completed biennial neuropsychological (NP) testing. NP domains included attention/working memory, executive function, processing speed, memory, learning, fluency, and motor function. NP impairment was defined as demographically adjusted T-scores (mean = 50; SD = 10) ≤40 at ≥1 visit after completing the dietary screener. Multivariable logistic regression, stratified by HIV serostatus, examined associations between intake frequency tertile (referent = lowest intake) and NP performance. RESULTS: Dietary intake frequencies of individual food line items were similar between WWH and HIV-seronegative women, except for sweet beverages, for which HIV-seronegative women reported higher intake frequencies than WWH (P values < 0.05). In WWH, multivariable-adjusted models indicated higher odds of NP impairment with higher intake frequencies of processed meat [P = 0.006; ORupper tertile = 1.91 (95% CI: 1.23-2.95; P = 0.003); ORmiddle tertile = 1.66 (95% CI: 1.14-2.42; P = 0.01)], sweet beverages [P = 0.02; ORupper tertile = 1.75 (95% CI: 1.17-2.64; P = 0.007)], fish [P = 0.01; ORupper tertile = 1.70 (95% CI: 1.10-2.64; P = 0.02)], and whole milk [P = 0.029; ORupper tertile = 1.66 (95% CI: 1.14-2.42; P = 0.008)]. Lower odds of NP impairment [P = 0.005; ORupper tertile = 0.65 (95% CI: 0.45-0.95; P = 0.02); ORmiddle tertile = 0.42 (95% CI: 0.24-0.73; P = 0.002)] were associated with higher vegetable intakes. In HIV-seronegative women, multivariable-adjusted models did not show associations between food line items/diet quality score and NP outcomes. CONCLUSIONS: Intakes of processed meat, sweet beverages, whole milk, fish, and vegetables may be associated with NP functions among WWH. Associations among WWH are not directly comparable to those among HIV-seronegative women, because models were conducted on each group separately given controls for HIV-specific covariates in WWH. Further studies are needed using more rigorous dietary assessment methods and lengthier longitudinal follow-ups.

Leading with inclusion during the COVID-19 pandemic: Stronger together.

Inclusion is the deliberate practice of ensuring that each individual is heard, all personal traits are respected, and all can make meaningful contributions to achieve their full potential. As coronavirus disease 2019 spreads globally and across the United States, we have viewed this pandemic through the lens of equity and inclusion. Here, we discuss how this pandemic has magnified preexisting health and social disparities and will summarize why inclusion is an essential tool to traverse this uncertain terrain and discuss strategies that can be implemented at organizational and individual levels to improve inclusion and address inequities moving forward.

The utility of quantitative magnetic resonance angiography in the assessment of intracranial in-stent stenosis.

BACKGROUND AND PURPOSE: Noninvasive screening for intracranial in-stent stenosis is often limited by artifact because of the stent or associated coils. We aimed to determine the utility of quantitative MRA (QMRA) as a screening tool for detecting intracranial in-stent stenosis. METHODS: We reviewed 14 patients who had intracranial stent placement with follow-up QMRA and conventional angiography at our institution. Socio-demographic, medical, clinical, and imaging data were abstracted from medical charts. A blinded interventional neurologist reviewed all angiograms for presence of >50% in-stent stenosis. We tested QMRA (mL/min) at varying thresholds as a predictor of angiographic results. RESULTS: Among 14 patients (mean age, 62 years; 12 female, 2 male), 13 patients had Neuroform stents placed for wide-neck cerebral aneurysms and 1 patient had a Wingspan stent placement for atherosclerotic stenosis. Lesions were located in the intracranial internal carotid artery in 57.2% (n=8), the middle cerebral artery in 14.3% (n=2), and vertebrobasilar arteries in 28.6% (n=4). On follow-up angiography, 2 patients (14.3%) had >50% in-stent stenosis on angiography. Time-of-flight MRA was nondiagnostic in each case because of artifact from the stent or coils. A >20% reduction in vessel-specific blood flow by QMRA was associated with presence of >50% in-stent stenosis on angiography (P=0.033). As a screening tool to predict >50% angiographic in-stent stenosis, the sensitivity, specificity, positive predictive value, and negative predictive value of QMRA were 100%, 92%, 67%, and 100%, respectively. CONCLUSIONS: We found that QMRA is a promising screening tool to detect intracranial in-stent stenosis. Future prospective studies should focus on whether QMRA has a role in the detection of radiographic restenosis and prediction of clinical events.

Olive Oil Intake Associated with Increased Attention Scores in Women Living with HIV: Findings from the Chicago Women's Interagency HIV Study.

Women aging with human immunodeficiency virus (HIV) are particularly vulnerable to cognitive decline. Recent studies have highlighted the potential protective effects of olive oil on cognition in persons living without HIV. We sought to evaluate the association between olive oil consumption and domain-specific cognitive performance (dCog) t-scores (adjusted for age, race, education, reading level, practice effects) in women living with HIV (WLWH) and sociodemographically similar women living without HIV. A total of 166 women (113 WLWH and 53 women living without HIV) participating in the Cook County Women's Interagency HIV Study (WIHS) completed cognitive testing and a Block 2014 Food Frequency Questionnaire within 18 months. Use of olive oil was associated with a 4.2 point higher attention/concentration (p = 0.02), 4.0 point higher for verbal learning (p = 0.02), and 1.91 point higher for verbal memory (p = 0.05). Associations between using olive oil and attention/concentration cognitive domain were seen in WLWH but not in women living without HIV. Associations between olive oil and verbal learning and memory were only seen in women without HIV. Our data suggest that using olive oil as a primary cooking oil may contribute to differential effects in attention/concentration, verbal learning, and verbal memory between women living with and without HIV.

Neurosarcoidosis in a public safety net hospital: a study of 82 cases.

OBJECTIVE: To characterize clinical presentation, laboratory and imaging data, and treatment outcomes for neurosarcoidosis in an urban safety net hospital. METHODS: The research database of Cook County Health and Hospitals system was queried for all cases of sarcoidosis from 2006 to 2013. These cases plus those identified through a survey of neurology faculty were reviewed and flagged if suspected to be neurosarcoidosis. Data were extracted in a standardized fashion, upon review by two experienced neurologists; patients were classified as definite, probable or possible neurosarcoidosis. Disagreements on classification were resolved by consensus conference. RESULTS: 1706 cases of sarcoidosis were identified, with 82 (4.8%) classified as neurosarcoidosis. The cohort was predominantly African American (89%). Six were classified as definite, 34 as probable, and 42 as possible neurosarcoidosis. Neurosarcoidosis was the presenting symptom of sarcoidosis in 74% of cases. The most common presenting phenotype was myelopathy (21.7%), followed by optic nerve/chiasm involvement (16.0%) and epilepsy (11.3%). The facial nerve was involved in only 2% of cases. Chest x-ray showed abnormalities of sarcoidosis in 43.3% of cases, while chest CT did so in 78.6%. Corticosteroids were the initial treatment in 91% of cases, and outcomes were good in 53% of cases. CONCLUSION: Neurosarcoidosis remains a challenging diagnosis with the majority of patients without a previous diagnosis of systemic sarcoidosis. Chest imaging was supportive of the diagnosis in a majority of patients. Our cohort differs from others in the literature due to a low prevalence of facial nerve involvement. Prospective registry studies are needed.

Misdiagnosis of transient ischemic attacks in the emergency room.

BACKGROUND: To determine a pattern of symptoms and/or risk factors that distinguishes transient ischemic attack (TIA) from nonischemic causes of transient neurologic attacks (NI-TNA). METHODS: We reviewed demographic, clinical, and hospital data on 100 consecutive patients with transient focal neurologic episode(s) lasting less than 24 h and in whom the initial diagnosis was TIA. After inpatient evaluation and review, final diagnoses were made by two stroke neurologists. Using stepwise multivariable logistic regression, we estimated odds ratios (OR) for independent predictors of NI-TNA. p < 0.05 was considered significant. RESULTS: Of the 100 patients, 40 were confirmed to have TIA and 60 NI-TNA. Compared to TIA patients, those with NI-TNA were less likely to be male and white but more likely to have a history of prior unexplained TNA, gradual symptom onset, associated nonspecific symptoms, longer symptom duration, and delayed presentation. Other variables were similar between the two groups. In a multivariable logistic regression model, gradual symptom onset (adjusted OR 6.7, p = 0.002), prior history of unexplained transient neurologic attack (adjusted OR 10.6, p = 0.031), and presence of nonspecific symptoms (adjusted OR 4.2, p = 0.008) were independent predictors of the final diagnosis of NI-TNA. CONCLUSIONS: Distinguishing TIA from nonischemic causes is difficult in the emergency room, with 60% of suspected TIA patients having nonischemic causes on inpatient evaluation. We found 3 clinical features that may be useful in the emergency room triage of transient neurologic attacks. Further study is needed to develop tools that can accurately diagnose TIA.