A simple, organized web-based system improved the transfer efficiency and patient outcomes for endovascular thrombectomy in regional stroke network.

BACKGROUND: Endovascular thrombectomy (EVT) is a time-sensitive treatment for acute ischemic stroke with large vessel occlusion. To optimize transfer efficiency, a web-based platform was introduced in the Tainan Stroke Network (TSN). We assessed its application and effectiveness in regional stroke care. METHOD: This new web-based platform containing a questionnaire-style interface was introduced on October 1, 2021. To assess the transfer efficiency and patient outcomes, acute stroke patients transferred from PSCs to CSC for EVT from April 01, 2020, to December 30, 2022, were enrolled. The patients were classified into the traditional transferal pathway (TTP) group and the new transferal pathway (NTP) group depending on mode of transfer. Patient characteristics, time segments after stroke onset and outcome were compared between groups. RESULT: A total of 104 patients were enrolled, with 77 in the TTP group and 27 in the NTP group. Compared to the TTP group, the NTP group had a significantly shorter onset-to-CSC door time (TTP vs. NTP: 267 vs. 198 min; p = 0.041) and a higher EVT rate (TTP vs. NTP: 18.2% vs. 48.1%, p = 0.002). Among EVT patients, those in the NTP group had a significantly shorter CSC door-to-puncture time (TTP vs. NTP: 131.5 vs. 110 min; p = 0.029). The NTP group had a higher rate of good functional outcomes at 3 months (TTP vs. NTP: 21% vs. 61.5%; p = 0.034). CONCLUSION: This new web-based EVT transfer system provides notable improvements in clinical outcomes, transfer efficiency, and EVT execution for potential EVT candidates without markedly changing the regional stroke care paradigm.

External validation of newly modified status epilepticus severity score for predicting mortality in patients with status epilepticus in a regional hospital in Taiwan.

PURPOSE: To evaluate and compare the performance of the status epilepticus severity score (STESS), modified STESS (mSTESS), and the newly modified STESS (nSTESS) in predicting mortality in patients with status epilepticus (SE) at a regional hospital in Taiwan. METHODS: Data were collected from 81 patients with SE, aged over 18 years at a regional medical hospital in Tainan from January 2012 to December 2022. SE were treated following the standard treatment protocol. Exclusion criteria included missing data, lack of adherence to the treatment protocol, and transfer to tertiary medical centers. Outcome measures included differences in characteristics between survivor and non-survivor groups, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of STESS, nSTESS, mSTESS. Receiver operating characteristic (ROC) curve and area under curve (AUC) of scales were generated. Calibration with Hosmer-Lemeshow test was built as well. RESULTS: The study found significant differences in seizure types (p = 0.015) and undergoing intubation (p = 0.017) between survivor and non-survivor groups. No significant differences were observed in age, gender, underlying diseases, or the category of antiseizure medications (ASMs) usage. The ROC curve for STESS, nSTESS and mSTESS showed similar predictive values of around 0.75, indicating moderate performance of prediction. The Hosmer-Lemeshow test showed no significant difference between real-world predictions and these three clinical scales. In the aspect of accuracy, sensitivity and specificity, nSTESS has similar overall accuracy as in STESS and mSTESS. CONCLUSION: This external validation study demonstrates the moderate performance of nSTESS in predicting mortality in SE patients at a regional hospital in Taiwan. These outcomes underscore the practical utility of these scales in clinical practice, with nSTESS demonstrating accuracy on par with the others. Further validation in larger, multicenter cohorts and other healthcare settings is necessary to fully confirm its predictive value.

Immunity, Ion Channels and Epilepsy.

Epilepsy is a common chronic neurological disorder in modern society. One of the major unmet challenges is that current antiseizure medications are basically not disease-modifying. Among the multifaceted etiologies of epilepsy, the role of the immune system has attracted considerable attention in recent years. It is known that both innate and adaptive immunity can be activated in response to insults to the central nervous system, leading to seizures. Moreover, the interaction between ion channels, which have a well-established role in epileptogenesis and epilepsy, and the immune system is complex and is being actively investigated. Some examples, including the interaction between ion channels and mTOR pathways, will be discussed in this paper. Furthermore, there has been substantial progress in our understanding of the pathophysiology of epilepsy associated with autoimmune encephalitis, and numerous neural-specific autoantibodies have been found and documented. Early recognition of immune-mediated epilepsy is important, especially in cases of pharmacoresistant epilepsy and in the presence of signs of autoimmune encephalitis, as early intervention with immunotherapy shows promise.

Predictive value of ankle-brachial index for long-term events of ischemic stroke in hemodialysis patients.

OBJECTIVES: The ankle-brachial index is a noninvasive modality to evaluate atherosclerosis and is a predictive role for future cardiovascular events and mortality. However, few studies have evaluated its relation to long-term future ischemic stroke in hemodialysis patients. Therefore, we examined the relationship between ankle-brachial index and ischemic stroke events among hemodialysis patients in a seven-year follow-up. METHODS: A total of 84 patients were enrolled. Ankle-brachial index was assessed in January 2009. Primary outcomes included ischemic stroke. An ankle-brachial index < 0.9 was considered abnormal and 1.4 ≥ ankle-brachial index ≥ 0.9 to be normal ankle-brachial index. RESULTS: Mean values for ankle-brachial index were 0.98 ± 0.21at study entrance. In addition, 28 patients encountered ischemic stroke in the seven-year follow-up. In univariate Cox regression analysis, old age (hazard ratio (HR): 1.065, 95% confidence interval (CI): 1.030-1.102, p < 0.001), low seven-year averaged serum phosphate levels (HR: 0.473, 95% CI: 0.306-0.730, p = 0.001), and abnormal ankle-brachial index (HR: 0.035, 95% CI: 0.009-0.145, p < 0.001) were risk factors for ischemic stroke. In multivariate Cox regression analysis for significant variables in univariate analysis, abnormal ankle-brachial index (HR: 0.058, 95% CI: 0.012-0.279, p < 0.001) and low seven-year averaged serum phosphate levels (HR: 0.625, 95% CI: 0.404-0.968, p = 0.035) remained the risk factors for ischemic stroke. The risk of ischemic stroke was 3.783-fold in patients with abnormal ankle-brachial index compared with patients with normal ankle-brachial index (HR: 3.783, 95% CI: 1.731-8.269, p = 0.001). CONCLUSIONS: These findings suggest that ankle-brachial index is an impressive predictor of future ischemic stroke among hemodialysis patients.

One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients.

BACKGROUND: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. METHODS: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0-49%; moderate to severe: 50-99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. RESULTS: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01-1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99-2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72-2.83), among patients with VBA occlusion after adjustment of potential confounders. CONCLUSIONS: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.

Low serum phosphate is associated with ischemic stroke in hemodialysis patients.

BACKGROUND: Hemodialysis patients have a high incidence of ischemic stroke. However, the association between serum phosphate levels and ischemic stroke is controversial among hemodialysis patients. The present study is used to evaluate whether serum phosphate levels are associated with ischemic stroke among patients undergoing hemodialysis. METHODS: A total of 84 hemodialysis patients were followed up for 8 years. Data collection included chart reviews and assessments of laboratory records. The ischemic stroke diagnosis was made on the basis of history, physical examination and neuroimaging (computed tomography and/or magnetic resonance imaging) by neurologists. Cox proportional hazard regression models were used to analyze the data. RESULTS: During the follow-up period, 29 patients experienced ischemic stroke. According to Cox proportional hazard regression analysis, the risk of ischemic stroke decreased by 45.5% for each 1-mg/dL increase in averaged serum phosphate (HR 0.545, p = 0.011). The risk of ischemic stroke increased by 4.3% for each 1-year increase in age (HR 1.043, p = 0.018). The risk of ischemic stroke increased by 1.1% increase for each 103/µL increase in averaged blood platelet (HR 1.011, p = 0.009). The risk of ischemic stroke in patients with averaged serum phosphate < 4.5 mg/dL increased 3.40-fold more than patients with averaged serum phosphate ≥ 4.5 mg/dL (HR 3.400, p = 0.025). CONCLUSIONS: Low serum phosphate is a risk factor for developing ischemic stroke in hemodialysis patients. The results suggest that managing serum phosphate ≥ 4.5 mg/dL among hemodialysis patients may reduce the risk of ischemic stroke.

Efforts to reduce the door-to-needle time of thrombolysis in acute ischemic stroke: video-assisted therapeutic risk communication.

BACKGROUND/PURPOSE: Explaining the risks and benefits of recombinant tissue-plasminogen activator (rtPA) to eligible patients with acute ischemic stroke (AIS) within a few minutes is important but difficult. We examined whether a new thrombolysis program can decrease the door-to-needle (DTN) time when treating patients with AIS. METHODS: A new rtPA thrombolysis program with video assistance was adapted for patients with AIS and their families. We retrospectively compared outcome quality before (2009-2011) and after (2012) the program began. Outcomes included DTN time, the percentage of rtPA thrombolysis within 3 hours of onset in all hospitalized patients with AIS who presented within 2 hours of onset (2 hr%) and the percentage of rtPA thrombolysis in all hospitalized patients with AIS (AIS%). RESULTS: We recruited patients with AIS who had undergone thrombolytic therapy before (n = 18) and after (n = 14) the initiation of the new program. DTN time decreased (93 ± 24 minutes to 57 ± 14 minutes, p < 0.001) and the AIS% increased (2% to 5%, p = 0.010) after the program. The 2 hr% marginally significantly increased (18% to 33%, p = 0.080). CONCLUSION: A thrombolysis program with video-assisted therapeutic risk communication decreased DTN time and increased the treatment rate of patients with AIS.

A nine-year population-based cohort study on the risk of multiple sclerosis in patients with optic neuritis.

Patients with optic neuritis (ON) are at an increased risk of developing multiple sclerosis (MS), an illness that may result in physical dysfunction and short life expectancy. Information on the conversion rate to MS of patients with ON is essential in determining the impact of ON on the incidence of MS. Previous Taiwanese studies on the risk of MS in patients with ON were all hospital based, thereby limiting the generalizability of the findings. We aimed to estimate the risk of MS in patients with ON using a nationally representative sample. A cohort of 2,741 patients who sought outpatient care for ON in 2000 was identified from Taiwan's National Health Insurance claims. The control group consisted of 27,330 age- and sex-matched subjects randomly selected from all beneficiaries in 2000. The person-year approach with Poisson assumption was used to estimate the incidence rate of MS from 2000 to 2008. The relative risk of outpatient visit or hospitalization for MS was estimated using the Cox proportional hazard model. The incidence rates of MS in the ON and control groups were 25.6 and 0.4, respectively, per 10,000 person-years; these values represent a relative risk estimate of 30.84 (95% confidence interval: 14.48 to 65.73) after the potential confounders were considered. Female or younger patients with ON were associated with a significantly elevated risk of developing MS. This study found that Taiwanese patients with ON are at a substantially high relative risk of developing MS. In addition to patients with ON, female and younger people should also receive intensive neurological care to further reduce their risk of developing MS.

Unilateral non-lesional temporal lobe epilepsy presenting as isolated ictal vertigo: a case report.

Temporal lobe epilepsy is the most common focal epilepsy syndrome and has a broad spectrum of presentations. Nevertheless, isolated vestibular symptoms without other symptoms typical of temporal lobe seizures are relatively rare. Here, we report one female patient who suffered from chronic refractory vertigo and had inappropriate pharmacotherapy for several years. Eventually, epileptic vertigo and dizziness (ictal vertigo) were accurately diagnosed by detailed history taking and serial examinations assisted by sphenoid electroencephalography. Awareness of this unique syndrome is important in the diagnosis of patients with epileptic vertigo and dizziness.

The Role of Glutamate Receptors in Epilepsy.

Glutamate is an essential excitatory neurotransmitter in the central nervous system, playing an indispensable role in neuronal development and memory formation. The dysregulation of glutamate receptors and the glutamatergic system is involved in numerous neurological and psychiatric disorders, especially epilepsy. There are two main classes of glutamate receptor, namely ionotropic and metabotropic (mGluRs) receptors. The former stimulate fast excitatory neurotransmission, are N-methyl-d-aspartate (NMDA), α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA), and kainate; while the latter are G-protein-coupled receptors that mediate glutamatergic activity via intracellular messenger systems. Glutamate, glutamate receptors, and regulation of astrocytes are significantly involved in the pathogenesis of acute seizure and chronic epilepsy. Some glutamate receptor antagonists have been shown to be effective for the treatment of epilepsy, and research and clinical trials are ongoing.

Effectiveness and Safety of Lacosamide, A Third-generation Anti-seizure Medication, for Poststroke Seizure and Epilepsy: A Literature Review.

Advances in stroke treatment have resulted in a dramatic reduction in stroke mortality. Nevertheless, poststroke seizures and epilepsy are issues of clinical importance affecting survivors. Additionally, stroke is the most common cause of epilepsy in older adults. Although numerous antiseizure medications exist, studies are needed to provide robust evidence of the efficacy and tolerability of these medicines for treating poststroke seizures and epilepsy. Crucially, the newer generations of antiseizure medications require testing. Lacosamide, a third-generation antiseizure medication approved for treating localization-related epilepsy, has a novel mechanism of selectively enhancing the slow inactivation of sodium channels. This literature review evaluated whether lacosamide is effective and safe for the treatment of poststroke seizures and epilepsy. This review critically analyzed studies published in major academic databases (Pubmed, Embase, and Cochrane Library) from inception through June 2022 regarding the interaction of lacosamide with poststroke seizures and epilepsy. We included clinical prospective, retrospective, and case studies on patients with poststroke seizure and epilepsy, lacosamide as a treatment for seizures, neuroprotection in animal models of seizures, and the safety of lacosamide when coadministering anticoagulants. Clinical studies revealed lacosamide to be an effective antiseizure medication with high efficacy and tolerability in patients with poststroke seizures and epilepsy. In animal models, lacosamide proved effective at seizure reduction and neuroprotection. Pharmacokinetic studies demonstrated the safety of lacosamide when coadministering conventional and new anticoagulants. The literature suggests that Lacosamide is a promising candidate antiseizure medication for patients with poststroke seizures and epilepsy.

Dementia with non-convulsive seizures: a case report.

Non-convulsive seizures (NCSs) are highly treatable, but appropriate management is usually delayed because of inaccurate diagnoses as a result of variable clinical presentations, including an altered mental state. It is difficult to detect NCSs in patients with dementia. We report a case of NCS superimposed on cognitive decline caused by Alzheimer's dementia. The patient's history was carefully recorded. An electroencephalogram was recorded with sphenoidal electrodes, which showed epileptiform discharges in the right mesial temporal lobe and focal, sharply contoured, slow wave activity in the left fronto-temporal area, suggesting an epileptic origin contributing to the patient's cognitive decline. After treatment with antiepileptic drugs, the patient's cognitive functioning gradually improved. An accurate diagnosis of NCS relies on performing a detailed inventory of a patient's history, thorough physical and neurological examinations, and electroencephalogram recordings. In patients with cognitive decline, testing for NCS should always be included in the differential diagnosis of cognitive impairment, even in the case of dementia. Early administration of antiepileptic drug therapy is the mainstay treatment for reversing the condition and for preventing prolonged insults from neurological sequelae.

Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure-A Hospital-Based Stroke Secondary Prevention Registry.

Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF. Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF. Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25-0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21-0.79 for severe DWMLs]. Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

Non-convulsive seizure clustering misdiagnosed as vertebrobasilar insufficiency.

Diagnosing non-convulsive seizures (NCSs) is a great challenge for most clinicians due to a wide spectrum of clinical presentations. The complexity of the disease course usually results in a delayed diagnosis or misdiagnosis so that timely and appropriate treatment is not given. Herein, we report a case with NCSs misdiagnosed as vertebrobasilar insufficiency (VBI), in which the patient suffered from episodes of prominent dizziness, vertigo, becoming transfixed, and worsening response within a day. Brain magnetic resonance image findings were unremarkable, however electroencephalography (EEG) showed rhythmic epileptiform discharges that appeared to originate from the right frontal area with ipsilateral hemispheric involvement. We prescribed intravenous valproate and the seizures ceased. Few studies have reported a patient with NCS misdiagnosed with VBI, a very different entity. It is thus important that clinicians should be aware of the trivial symptoms of NCSs, and to consider implementing early EEG studies and anti-epileptic drug therapy.

Nonketotic Hyperglycemia-related Seizures of Left Parieto-occipital Origin: A Case Report.

INTRODUCTION: Nonketotic hyperglycemia-related seizures are not uncommonly encountered in clinical practice. Their presentation varies, and they may cause serious consequences if they remain unnoticed. CASE: We report a case of nonketotic hyperglycemia-related seizures of unique left parieto-occipital origin and semiology, presenting as focal aware (simple partial) and impaired awareness (complex partial) seizures, including contralateral limb convulsion and apraxialike behavior. DISCUSSION: Nonketotic hyperglycemia-related seizures can present with a relatively unique semiology. Careful education to the patients and family regarding attention to the paroxysmal symptoms and an effort to maintain good glycemic control are mandatory in clinical practice.

Stimulus-induced rhythmic, periodic ictal discharges during funduscopic examination in a patient with status epilepticus.

Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs), an unusual pattern in electroencephalography, have been described in critically-ill encephalopathic patients in response to alerting stimuli. The phenomenon may be seen in patients with a broad range of aetiologies, including cerebral infarct, haemorrhage, anoxia, and degenerative diseases. Here, we report a unique case of status epilepticus presenting with SIRPIDs during funduscopic examination-induced focal to bilateral tonic-clonic seizures.

Pioglitazone, a PPAR-γ Activator, Stimulates BKCa but Suppresses IK M in Hippocampal Neurons.

Pioglitazone (PIO), a thiazolidinedone, was reported to stimulate peroxisome proliferator-activated receptor-γ (PPAR-γ) with anti-inflammatory, anti-proliferative, anti-diabetic, and antidepressive activities. However, whether this compound exerts any perturbations on Ca2+-activated K+ and M-type K+ currents in central neurons remains largely unresolved. In this study, we investigated the effects of PIO on these potassium currents in hippocampal neurons (mHippoE-14). In whole-cell current recordings, the presence of PIO (10 µM) increased the amplitude of Ca2+-activated K+ current [IK(Ca)] in mHippoE-14 cells. PIO-induced stimulation of IK(Ca) observed in these cells was reversed by subsequent addition of paxilline, yet not by TRAM-39 or apamin. In inside-out current recordings, PIO applied to the bath concentration-dependently increased the activity of large-conductance Ca2+-activated K+ (BKCa) channels with an EC50 value of 7.6 µM. Its activation of BKCa channels in mHippoE-14 cells was voltage-dependent and accompanied by both a lengthening in mean open time and a shortening in slow component of mean closed time. The activation curve of BKCa channels after addition of PIO was shifted to less depolarized potential without any change in the gating charge. PIO also suppressed the amplitude of M-type K+ currents inherently in mHippoE-14 neurons. Taken together, in addition to its agonistic action on PPAR-γ, PIO-induced perturbation of these potassium channels may be responsible for its widely pharmacological actions on hippocampal neurons.

Significant association of anti-platelet factor 4/heparin antibody with cardiovascular disease in hemodialysis patients: a longitudinal 7-year study.

BACKGROUND: Hemodialysis patients have a high incidence of anti-platelet factor 4/heparin antibody (PF4-H Ab) and are at a high risk of cardiovascular disease. This study determines the association between PF4-H Ab and cardiovascular events including coronary artery disease (CAD), ischemic stroke (IS), and native arteriovenous fistula thrombosis (AVFT), in a longitudinal 7-year follow-up. PATIENTS AND METHODS: 84 hemodialysis patients were enrolled. Data collection included chart reviews and assessments of laboratory records. PF4-H Ab was evaluated by ELISA and a titer ≥ 0.4 was defined to have PF4-H Ab. RESULTS: 30 patients were PF4-H Ab positive, 30 patients had CAD, 29 patients had IS, and 43 patients had AVFT. In Cox proportional hazard regression analysis, PF4-H Ab (HR 2.72, p = 0.01) was a significant risk factor for CAD. Age (HR 1.06, p = 0.003), PF4-H Ab (HR 4.53, p < 0.001), 7-year averaged serum phosphate levels (HR 0.53, p = 0.012), and 7-year averaged blood platelet count (HR 1.01, p = 0.029) were risk factors for IS. Age (HR 1.03, p = 0.047), PF4-H Ab (HR 3.57, p < 0.001), and 7-year averaged serum triglyceride levels (HR 1.01, p = 0.005) were risk factors for AVFT. In PF4-H Ab-positive groups, thrombocytopenia was not associated with CAD, IS, and AVFT by Fisher's test analysis. CONCLUSION: This study reveals that PF4-H Ab is a risk factor for developing CAD, IS, and AVFT among hemodialysis patients.

Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry.

The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160-200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41-2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11-1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76-8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.