Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: a multicentric observational study.

OBJECTIVES: The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV. METHODS: Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed. RESULTS: The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00-4.06): 102 (2.13% 95% CI 1.73-2.56) with stroke and 81 (1.68% 95% CI 1.33-2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet's disease (9.5%, 95% CI 5.79-14.37), polyarteritis nodosa (6.2%, 95% CI 3.25-10.61), and Takayasu's arteritis (6.0%, 95% CI 4.30-8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09-3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20-3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05-9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01-2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period. CONCLUSION: CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet's. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence.

Aphasia assessment: impact of material on naming performance.

BACKGROUND: Naming and lexical retrieval difficulties are common symptoms of aphasia. Naming abilities are usually evaluated by means of real objects or pictures or line drawings that are printed. OBJECTIVE: The aim of this study was to investigate whether the ability to name objects among individuals with aphasia is influenced by the dimensions of the visual stimuli and to understand whether the order of presentation of the stimuli, number of years of education and length of time post-onset are involved in the success of naming. METHODS: The naming abilities of healthy controls and patients with acute or chronic aphasia due to stroke were assessed through presentation of two sets of 24 stimuli consisting of real objects and color photographs of the same objects presented on a screen. The results obtained under these two conditions were compared by means of within-subject paired ANOVA, controlling for presentation order. RESULTS: 40 patients (62.4 ± 17.3 years old; 70% females; mean education level of 8.5 ± 5.3 years; and 60% evaluated within the first eight days after stroke) and 50 controls that were age, gender and education-matched were included. Object naming was significantly better than naming color photographs among the patients (p = 0.001), but no differences were observed among the controls. Age, education, length of time post-onset and presentation sequence did not have any impact on naming performance. CONCLUSION: These results suggest that use of digital color photographs for naming objects in assessment of aphasia may be associated with lower naming performance, compared with use of real objects. This needs to be taken into account when different forms of stimuli are presented in sequential aphasia evaluations.

Seizures after Ischemic Stroke: A Matched Multicenter Study.

OBJECTIVE: The purpose of this study was to identify risk factors for acute symptomatic seizures and post-stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. METHODS: We assessed the risk factors for post-stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging-confirmed ischemic stroke. We compared the risk of post-stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. RESULTS: In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large-artery atherosclerosis. Strokes caused by small-vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post-stroke epilepsy. Risk factors for post-stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large-artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post-stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post-stroke epilepsy or the risk of acute symptomatic seizures. INTERPRETATION: Post-stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post-stroke epilepsy. ANN NEUROL 2021;90:808-820.

Aphasia assessment: impact of material on naming performance / Avaliação da afasia: impacto do material no desempenho da nomeação

ABSTRACT Background: Naming and lexical retrieval difficulties are common symptoms of aphasia. Naming abilities are usually evaluated by means of real objects or pictures or line drawings that are printed. Objective: The aim of this study was to investigate whether the ability to name objects among individuals with aphasia is influenced by the dimensions of the visual stimuli and to understand whether the order of presentation of the stimuli, number of years of education and length of time post-onset are involved in the success of naming. Methods: The naming abilities of healthy controls and patients with acute or chronic aphasia due to stroke were assessed through presentation of two sets of 24 stimuli consisting of real objects and color photographs of the same objects presented on a screen. The results obtained under these two conditions were compared by means of within-subject paired ANOVA, controlling for presentation order. Results: 40 patients (62.4 ± 17.3 years old; 70% females; mean education level of 8.5 ± 5.3 years; and 60% evaluated within the first eight days after stroke) and 50 controls that were age, gender and education-matched were included. Object naming was significantly better than naming color photographs among the patients (p = 0.001), but no differences were observed among the controls. Age, education, length of time post-onset and presentation sequence did not have any impact on naming performance. Conclusion: These results suggest that use of digital color photographs for naming objects in assessment of aphasia may be associated with lower naming performance, compared with use of real objects. This needs to be taken into account when different forms of stimuli are presented in sequential aphasia evaluations.

RESUMO Antecedentes: As dificuldades de nomeação e de evocação lexical são sintomas comuns de afasia. A nomeação é geralmente avaliada por objetos reais, imagens ou desenhos de contorno, impressos. Objetivo: Este estudo visa investigar se a capacidade de nomear objetos em pessoas com afasia é influenciada pelas dimensões dos estímulos visuais e compreender se a ordem de apresentação dos estímulos, os anos de escolaridade e o tempo de evolução estão envolvidos no sucesso da nomeação. Métodos: A nomeação de pessoas saudáveis e pessoas com afasia, em fase aguda ou crónica, por AVC foi avaliada com dois conjuntos de 24 estímulos, objetos reais e fotografias a cores, dos mesmos objetos, apresentadas num ecrã. Os resultados obtidos nas duas condições foram comparados por uma ANOVA para amostras emparelhadas, controlando para a ordem de apresentação. Resultados: Foram incluídos 40 sujeitos com afasia (62,4±17,3 anos de idade, 70% mulheres, com uma escolaridade média de 8,5±5,3 anos, 60% avaliados nos primeiros 8 dias após o acidente vascular cerebral) e um grupo de controlo de 50 pessoas saudáveis, emparelhadas para a idade, sexo e escolaridade. A nomeação de objetos foi significativamente melhor do que a nomeação de fotografias a cores (p=.001), mas isso não se verificou nos controles. A idade, a escolaridade, o tempo de evolução e a sequência de apresentação não tiveram impacto na nomeação dos dois tipos de estímulos. Conclusão: Estes resultados sugerem que a utilização de fotografias digitais a cores para avaliar a nomeação de objetos na afasia pode ser associada a um pior desempenho quando comparada com objetos reais. Isto deve ser tido em conta quando são apresentadas diferentes formas de estímulos nas reavaliações.

Safety and Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation Stroke: Results From the Safe Implementation of Treatments in Stroke Registry and Meta-Analysis.

Background and Purpose- Posterior circulation stroke (PCS) accounts for 5% to 19% of patients with acute stroke receiving intravenous thrombolysis. We aimed to compare safety and outcomes following intravenous thrombolysis between patients with PCS and anterior circulation stroke (ACS) and incorporate the results in a meta-analysis. Methods- We included patients in the Safe Implementation of Treatments in Stroke Thrombolysis Registry 2013 to 2017 with computed tomography/magnetic resonance angiographic occlusion data. Outcomes were parenchymal hematoma, symptomatic intracerebral hemorrhage (SICH) per SITS-MOST (Safe Implementation of Thrombolysis in Stroke Monitoring Study), ECASS II (Second European Co-operative Stroke Study) and NINDS (Neurological Disorders and Stroke definition), 3-month modified Rankin Scale score, and death. Adjustment for SICH risk factors (age, sex, National Institutes of Health Stroke Scale, blood pressure, glucose, and atrial fibrillation) and center was done using inverse probability treatment weighting, after which an average treatment effect (ATE) was calculated. Meta-analysis of 13 studies comparing outcomes in PCS versus ACS after intravenous thrombolysis was conducted. Results- Of 5146 patients, 753 had PCS (14.6%). Patients with PCS had lower median National Institutes of Health Stroke Scale: 7 (interquartile range, 4-13) versus 13 (7-18), P<0.001 and fewer cerebrovascular risk factors. In patients with PCS versus ACS, parenchymal hematoma occurred in 3.2% versus 7.9%, ATE (95% CI): -4.7% (-6.3% to 3.0%); SICH SITS-MOST in 0.6% versus 1.9%, ATE: -1.4% (-2.2% to -0.7%); SICH NINDS in 3.1% versus 7.8%, ATE: -3.0% (-6.3% to 0.3%); SICH ECASS II in 1.8% versus 5.4%, ATE: -2.3% (-5.3% to 0.7%). In PCS versus ACS, 3-month outcomes (70% data availability) were death 18.5% versus 20.5%, ATE: 6.0% (0.7%-11.4%); modified Rankin Scale score 0-1, 45.2% versus 37.5%, ATE: 1.7% (-6.6% to 3.2%); modified Rankin Scale score 0-2, 61.3% versus 49.4%, ATE: 2.4% (3.1%-7.9%). Meta-analysis showed relative risk for SICH in PCS versus ACS being 0.49 (95% CI, 0.32-0.75). Conclusions- The risk of bleeding complications after intravenous thrombolysis in PCS was half that of ACS, with similar functional outcomes and higher risk of death, acknowledging limitations of the National Institutes of Health Stroke Scale for stroke severity or infarct size adjustment.

Improvement of sleep architecture in the follow up of a patient with bilateral paramedian thalamic stroke.

Normal sleep architecture and arousal require an intact thalamus. Thalamic vascular lesions, particularly in the paramedian region may cause arousal disturbances and hypersomnolence. Although hypersomnolence is one of the main characteristics of acute bilateral paramedian thalamic infarcts, there are only scarce reports in literature concerning polysomnographic follow-up of these patients. The few reported cases in literature show that sleep stages do not significantly change from the acute to chronic phase. We present a case report of a patient with a bilateral paramedian thalamic infarct in which a polysomnographic evaluation of sleep was performed four days and five months after stroke. In the acute phase, polysomnography showed an impairment of phase 2 NREM and absence of phase 3 and 4 NREM with absent sleep spindles. After the acute stroke phase, hypersomnolence improved and sleep spindles reappeared as well as phase 3 and 4 of NREM sleep. Our patient clear clinical and polysomnographic improvement makes us suppose that in this case the initial impairment could have been essentially due to a functional transitory impairment of the thalamocortical and corticothalamic connections. This case report is peculiar because it discloses a marked improvement of sleep architecture which to the best of our knowledge has not been clearly described before.