Faculty Bibliography

OBJECTIVES/OBJECTIVE:Posterior circulation stroke (PCS) presents diagnostic challenges due to its diverse clinical presentations. Timely detection is crucial, yet a highly sensitive, non-invasive screening tool for PCS is lacking. This study explores gait assessment as a readily accessible diagnostic tool for ruling out PCS in acutely vertiginous patients. MATERIALS AND METHODS/METHODS:In this retrospective case-control study, we examined medical records of 311 acutely vertiginous patients from the Get with the Guidelines Database at an academic hospital in New York City. Of these, 40 were diagnosed with PCS and 271 did not have PCS based on imaging and clinical criteria. We used multivariable logistic regression models and ROC curves to evaluate the association between objective gait abnormality (OGA) and PCS. RESULTS:Objective gait abnormality (OGA) was observed in 38/40 (95 %) posterior circulation stroke (PCS) cases and 57/271 (21 %) controls (adjusted odds ratio 144, 95 %CI 24.4-855, p < 0.0001). In a predictive model, objective gait abnormality (OGA) exhibited excellent discrimination between cases and controls (AUC 0.9599, sensitivity 95.0 %, specificity 75.6 %, positive predictive value 36.5 %, negative predictive value 99.0 %). CONCLUSIONS:Gait assessment emerges as a highly-sensitive screening tool for ruling out posterior circulation stroke (PCS) in acutely vertiginous patients, enabling more efficient triage and patient management. Further prospective research is warranted to validate these findings in larger and more diverse patient populations.

Background and aims: Routine examinations for patients with stroke include clinical assessment using the National Institute of Health Stroke Scale (NIHSS). Although this score accurately predicts the outcome of stroke, the NIHSS is weighted for anterior circulation. No reliable clinical assessment tool has been established for predicting the functional outcome of posterior circulation ischemic stroke. We aimed to develop a stroke scale based on clinical assessment that can increase the yield of detection of posterior circulation ischemic strokes in acute settings, the Langone Augmented Posterior-fossa Stroke Scale (LAPSS).
Method(s): A retrospective, dual campus, single center record review of patients that have been diagnosed with posterior fossa circulation strokes between 12/2018-11 /2019 will be conducted. We will catalog the presenting symptoms, calculate their prevalence, and use this information to adjust the current proposed LAPSS. The validity of the LAPSS will then be tested by retrospectively applying it to all patients that presented with symptoms of posterior fossa ischemic strokes.
Result(s): We project 120 patients will fit the inclusion criteria. The sensitivity, specificity, positive predictive value, and negative predictive value of LAPSS will be calculated. Inter-rater reliability will be assessed using ANOVA to define an intraclass correlation coefficient. Primary clinical outcome in patients with suspected posterior fossa stroke will be independent functional outcome (mRS 2).
Conclusion(s): The NIHSS has been shown to detect <60% of posterior circulation strokes in previous studies. We anticipate that the LAPSS will increase the sensitivity of the NIHSS to increase the overall yield of detection of posterior circulation strokes.
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BACKGROUND AND PURPOSE/OBJECTIVE:Mechanical thrombectomy (MT) has helped many patients achieve functional independence. The effect of time-to-treatment based in specific epochs and as related to Alberta Stroke Program Early CT Score (ASPECTS) has not been established. The goal of the study was to evaluate the association between last known normal (LKN)-to-puncture time and good functional outcome. METHODS:We conducted a retrospective cohort study of prospectively collected acute ischemic stroke patients undergoing MT for large vessel occlusion. We used binary logistic regression models adjusted for age, Modified Treatment in Cerebral Ischemia score, initial National Institutes of Health Stroke Scale, and noncontrast CT ASPECTS to assess the association between LKN-to-puncture time and favorable outcome defined as Modified Rankin Score 0-2 on discharge. RESULTS:Among 421 patients, 328 were included in analysis. Increased LKN-to-puncture time was associated with decreased probability of good functional outcome (adjusted odds ratio [aOR] ratio per 15-minute delay = .98; 95% confidence interval [CI], .97-.99; P = .001). This was especially true when LKN-puncture time was 0-6 hours (aOR per 15-minute delay = .94; 95% CI, .89-.99; P = .05) or ASPECTS 8-10 (aOR = .98; 95% CI, .97-.99; P = .002) as opposed to when LKN-puncture time was 6-24 hours (aOR per 15-minute delay = .99; 95% CI, .97-1.00; P = .16) and ASPECTS <8 (aOR = .98; 95% CI, .93-1.03; P = .37). CONCLUSION/CONCLUSIONS:Decreased LKN-groin puncture time improves outcome particularly in those with good ASPECTS presenting within 6 hours. Strategies to decrease reperfusion times should be investigated, particularly in those in the early time window and with good ASPECTS.

Background and Aims: Contemplating the use of N-acetylcysteine as a neuroprotectant, with dextran as an antithrombotic for patients with NIHSS less than or equal to 5, we quantified treatment-relevant clinical characteristics of a sample of this patient population at a single stroke center over one year.
Method(s): Patients with NIHSSResult(s): One-hundred twenty-eight of 310 (41%) patients with ischemic stroke had NIHSSConclusion(s): Minor stroke symptoms may not be captured by the current NIHSS. This population rarely had renal or hepatic failure, making them good candidates for combination N-acetylcysteine and dextran

Background/UNASSIGNED:Scarce reports exist of permanent deployment of Solitaire FR™ devices for arterial steno-occlusive disease as it is primarily indicated for temporary deployment for thrombectomy in large-vessel, anterior-circulation ischemic strokes. Even more scarce are reports describing permanent deployment of the Solitaire device for posterior circulation strokes. Summary/UNASSIGNED:We present 2 cases where the Solitaire device was electrolytically detached to re-establish flow in an occluded or stenotic basilar artery in acutely symptomatic patients. In both cases, a 4 × 15 mm Solitaire device was positioned across the stenotic or occluded portion of the basilar artery and electrolytically detached to maintain vessel patency. Both cases had good clinical outcomes with a National Institutes of Health Stroke Scale (NIHSS) score of 1 (from 24) on 90-day follow-up and an NIHSS score of 2 (from 7) on 30-day follow-up. Key Messages/UNASSIGNED:Permanent deployment of the Solitaire device may potentially be a safe and effective means of maintaining vessel patency in an occluded or stenotic basilar artery.

Ischemic stroke is a heterogeneous multifactorial disorder recognized by the sudden onset of neurologic signs related directly to the sites of injury in the brain where the morbid process occurs. The evaluation of complex neurologic disorders, such as stroke, in which multiple genetic and epigenetic factors interact with environmental risk factors to increase the risk has been revolutionized by the genome-wide association studies (GWAS) approach. This article reviews salient aspects of ischemic stroke emphasizing the impact of neuroepidemiology and GWAS.