Faculty Bibliography

The spatiotemporal structure of functional magnetic resonance imaging (fMRI) signals has provided a valuable window into the network underpinnings of human brain function and dysfunction. Although some cross-regional temporal correlation patterns (functional connectivity; FC) exhibit a high degree of stability across individuals and species, there is growing acknowledgment that measures of FC can exhibit marked changes over a range of temporal scales. Further, FC can co-vary with experimental task demands and ongoing neural processes linked to arousal, consciousness and perception, cognitive and affective state, and brain-body interactions. The increased recognition that such interrelated neural processes modulate FC measurements has raised both challenges and new opportunities in using FC to investigate brain function. Here, we review recent advances in the quantification of neural effects that shape fMRI FC and discuss the broad implications of these findings in the design and analysis of fMRI studies. We also discuss how a more complete understanding of the neural factors that shape FC measurements can resolve apparent inconsistencies in the literature and lead to more interpretable conclusions from fMRI studies.

Background and Aims: In this systematic review and individual patient data meta-analysis we aim to explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).
Method(s): A study was eligible if it enrolled AIS patients older than 18 years, with an LVO treated with either successful or unsuccessful EVT, and provided either individual or mean 24-hour systolic BP values after the end of the EVT procedure. Individual patient data from all studies were analyzed using a generalized linear mixed-effects model.
Result(s): A total of 5874 patients (mean age: 69+/-14 years, 50% women, median NIHSS on admission:16) from 7 published studies were included. Increasing mean systolic BP levels per 10 mm Hg during the first 24 hours after the end of the EVTwere associated with a lower odds of functional improvement (unadjusted common OR=0.82, 95%CI:0.80-0.85; adjusted common OR=0.88, 95%CI:0.84-0.93) and modified Ranking Scale score<=2 (unadjusted OR=0.82, 95%CI:0.79-0.85; adjusted OR=0.87, 95%CI:0.82-0.93), and a higher odds of all-cause mortality (unadjusted OR=1.18, 95%CI:1.13-1.24; adjusted OR=1.15, 95%CI:1.06-1.23) at 3 months. Higher 24-hour mean systolic BP levels were also associated with an increased likelihood of early neurological deterioration (unadjusted OR=1.14, 95%CI:1.07-1.21; adjusted OR=1.14, 95%CI:1.03-1.24) and a higher odds of symptomatic intracranial hemorrhage (unadjusted OR=1.20, 95%CI:1.09-1.29; adjusted OR=1.20, 95% CI:1.03-1.38) after EVT.
Conclusion(s): Increased mean systolic BP levels in the first 24 hours after EVT are independently associated with a higher odds of symptomatic intracranial hemorrhage, early neurological deterioration, threemonth mortality, and worse three-month functional outcomes

Background and aims: Epilepsy encompasses a group of neurological disorders characterized by an imbalance of electrical activity in the central nervous system (CNS) and recurrent seizures representing the principal clinical manifestation. Acetylcholine (ACh), serotonin, and norepinephrine (NE) may modulate neural activity via several mechanisms, mainly through its receptors/transporter activity and alterations in the extracellular potassium (K⁺) concentration via inwardly rectifying K⁺ (Kir) channels. Therefore, the aim of this study was to investigate the immunoreactivity pattern of these neurotransmitter, receptors/transporters and Kir channels in Pentylenetetrazol (PTZ)-kindling rat model, a well-established tool for studying chronic epilepsy.
Method(s): Kindling was chemically induced by intraperitoneally injections of PTZ for one month. Changes in the immunoreactivity of epileptogenesis-related neurotransmitter receptors/transporters (M2, 5-HT2B, and NE transporter) as well as Kir3.1 and Kir6.2 channels were determined in the cortex, hippocampus and medulla of adult Wistar rats by immunohistochemistry analyses.
Result(s): Increased immunoreactivity of the NE transporter, M2, and 5-HT2B receptors was witnessed in the cortex and medulla. While the immunoreactivity of the 5-HT2B receptor was found increased in the cortex and medulla, it was decreased in the hippocampus, with no changes observed in the M2 receptor in this region. Kir3.1 and Kir6.2 staining showed increase immunoreactivity in the cerebral cortex, but contrasting findings were found in the hippocampus and medulla.
Conclusion(s): Our data suggested significant changes in the neurotransmitter, receptors/transporters and ion channels, that may regulate neurotransmitter levels such as ACh, serotonin, and NE in the cortex, hippocampus, and medulla, thus contributing to epileptogenesis.
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Background and Aims: Knowledge about assumed causes and subsequent treatment in patients with atrial fibrillation (AF) and ischemic stroke despite anticoagulant therapy is limited.
Method(s): Retrospective analysis of patients with known AF and acute ischemic stroke despite therapy with vitamin-K-antagonists (VKA) or direct oral anticoagulants (DOAC). We determined probable stroke cause (s) as either (a)competing etiology other than AF (e.g. large artery atherosclerosis), (b)medication error (subtherapeutic DOAClevel or off-label DOAC-dosing/INR<2.0 or reported non-adherence) or (c)cardoembolic stroke despite anticoagulation (absence of medication error and competing etiology) and subsequent prevention therapies. The composite of recurrent ischemic stroke, intracranial hemorrhage, or allcause death was assessed at 3 months.
Result(s): We analyzed 2, 949 patients from 11 centers (age 81years, IQR [76-86], 48%Female, NIHSS 6, IQR[2-14], 57% DOAC, 913 with DOAClevels, median CHA2DS2-VASc score 4, IQR[4, 6]). Of those, 24% had competing etiology (DOAC vs VKA: 28% vs 20%, aOR1.3, 95%CI 0.96-1.7), 32% medication error (23% vs 43%, aOR0.5, 95%CI 0.4-0.6) and 44% cardoembolic stroke despite anticoagulation (49% vs 37%, aOR1.6, 95%CI 1.2-2.1). After index stroke, anticoagulant drug was changed in 45.8% of patients (1317/2877), antiplatelets were added in 7.1% (203/ 2873), 3.4% (94/2776) received carotid revascularization therapies and 1%(17/1764) underwent left atrial appendage occlusion. Eight centers collected 3-month outcome data (2, 084 patients). In those, stroke recurred in 4.6% (84/1844; completeness 88.5%). The composite outcome occurred in 27% (516/1908, completeness 91.6%), and no specific prevention strategy reduced its odds.
Conclusion(s): Stroke despite anticoagulation comprises heterogeneous causes with 1/3 of strokes potentially preventable and 1/4 attributable to competing etiologies. Recurrence rate is high and the optimal secondary prevention strategy needs to be determined. (Table Presented)

Background and Aims: We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world.
Method(s): Observational studies comparing characteristics, acute treatment delivery or hospitalization outcomes between stroke patients admitted during the COVID-19 pandemic and those admitted prior to the pandemic were identified by Medline, Scopus and Embase databases search. Random-effects meta-analyses were conducted for all outcomes.
Result(s): We identified 46 studies including 129, 494 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger [mean difference (MD)= -1.19, 95%CI: -2.05, -0.32; I²=70%] and more frequently male (OR=1.11, 95%CI:1.01, 1.22; I²=54%) compared to stroke patients admitted in the pre-pandemic era. Stroke patients admitted during the COVID-19 pandemic, also, had higher baseline NIH Stroke Scale (NIHSS) scores (MD=0.55, 95%CI:0.12, 0.98; I²=90%), higher probability for large vessel occlusion presence (OR=1.63, 95%CI: 1.07, 2.48; I²=49%) and higher risk for in-hospital mortality (OR=1.26, 95%CI:1.05, 1.52; I²=55%). Acute ischemic stroke patients admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy (EVT) treatment (OR=1.24, 95%CI:1.05, 1.47; I²=40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for EVT were detected.
Conclusion(s): Increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates were observed during the COVID-19 pandemic. Stroke patients admitted during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies

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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This study examined toddlers' autonomy- and connectedness-oriented behaviors and mothers' encouragement of autonomy and connectedness in two cohorts (1995 and 2008) in urban China. Observational data were collected from Chinese children and their mothers in a laboratory free play session. The results showed that compared with children in the 1995 cohort (207 children, 95 boys, Mage = 24.09 months), children in the 2008 cohort (281 children, 144 boys, Mage = 24.34 months) displayed fewer connectedness-oriented behaviors and spent more time on autonomous activities. Compared with mothers in the 1995 cohort (45% with a college education), mothers in the 2008 cohort (43.4% with a college education) were less likely to display involvement in children's activities and more likely to encourage child autonomy. The results suggest that macrolevel contexts may play an important role in shaping parenting and children's behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective/UNASSIGNED:Little is known about how symptom severity in the various neurologic domains commonly affected by multiple sclerosis (MS) varies by age, sex, and race/ethnicity. Methods/UNASSIGNED:This was a retrospective study of patients with MS attending 2 tertiary centers in the New York City metropolitan area, who self-identified as White, African American (AA), or Hispanic American (HA). Disability was rated with Patient-Determined Disability Steps (PDDS) and symptom severity, with SymptoMScreen (SyMS), a validated battery for assessing symptoms in 12 domains. Analyses comparing race, sex, and age groups were performed using analysis of variance models and Tukey honestly significant difference tests to control the overall type I error. A multivariable model was constructed to predict good self-rated health (SRH) that included demographic variables, PDDS, and SyMS domain scores. Results/UNASSIGNED:= 0.012), but similar total SyMS scores. Women reported higher fatigue and anxiety scores, whereas men had higher walking and dexterity scores. AAs and HAs had higher symptom domain scores than Whites in each of the 12 domains and worse SRH. In a multivariable logistic model, only pain, walking, depression, fatigue, and global disability (PDDS), but not sex or race/ethnicity, predicted good SRH. Conclusions/UNASSIGNED:AA and HA race/ethnicity was associated with higher overall disability, higher symptom severity in each of the 12 domains commonly affected by MS, and worse SRH relative to Whites. However, only symptom severity and disability, and not demographic variables, predicted good SRH.

Research has shown that sleep is beneficial for the long-term retention of memories. According to theories of memory consolidation, memories are gradually reorganized, becoming supported by widespread, distributed cortical networks, particularly during postencoding periods of sleep. However, the effects of sleep on the organization of memories in the hippocampus itself remains less clear. In a 3-d study, participants encoded separate lists of word-image pairs differing in their opportunity for sleep-dependent consolidation. Pairs were initially studied either before or after an overnight sleep period, and were then restudied in a functional magnetic resonance imaging (fMRI) scan session. We used multivariate pattern similarity analyses to examine fine-grained effects of consolidation on memory representations in the hippocampus. We provide evidence for a dissociation along the long axis of the hippocampus that emerges with consolidation, such that representational patterns for object-word memories initially formed prior to sleep become differentiated in anterior hippocampus and more similar, or overlapping, in posterior hippocampus. Differentiation in anterior hippocampal representations correlated with subsequent behavioral performance. Furthermore, representational overlap in posterior hippocampus correlated with the duration of intervening slow wave sleep. Together, these results demonstrate that sleep-dependent consolidation promotes the reorganization of memory traces along the long axis of the hippocampus.

BACKGROUND:The novel coronavirus 2019 (COVID-19) pandemic has transformed health care. With the need to limit COVID-19 exposures, telemedicine has become an increasingly important format for clinical care. Compared with other fields, neuro-ophthalmology faces unique challenges, given its dependence on physical examination signs that are difficult to elicit outside the office setting. As such, it is imperative to understand both patient and provider experiences to continue to adapt the technology and tailor its application. The purpose of this study is to analyze both neuro-ophthalmology physician and patient satisfaction with virtual health visits during the time of the COVID-19 pandemic. METHODS:Across three institutions (NYU Langone Health, Indiana University Health, and Columbia University Medical Center), telemedicine surveys were administered to 159 patients. Neuro-ophthalmologists completed 157 surveys; each of these were linked to a single patient visit. Patient surveys consisted of 5 questions regarding visit preparation, satisfaction, challenges, and comfort. The physician survey included 4 questions that focused on ability to gather specific clinical information by history and examination. RESULTS:Among 159 patients, 104 (65.4%) reported that they were satisfied with the visit, and 149 (93.7%) indicated that they were comfortable asking questions. Sixty-eight (73.9%) patients found the instructions provided before the visit easy to understand. Potential areas for improvement noted by patients included more detailed preparation instructions and better technology (phone positioning, Internet connection, and software). More than 87% (137/157) of neuro-ophthalmologists surveyed reported having performed an examination that provided enough information for medical decision-making. Some areas of the neuro-ophthalmologic examination were reported to be easy to conduct (range of eye movements, visual acuity, Amsler grids, Ishihara color plates, and pupillary examination). Other components were more difficult (saccades, red desaturation, visual fields, convergence, oscillations, ocular alignment, and smooth pursuit); some were especially challenging (vestibulo-ocular reflex [VOR], VOR suppression, and optokinetic nystagmus). Clinicians noted that virtual health visits were limited by patient preparation, inability to perform certain parts of the examination (funduscopy and pupils), and technological issues. CONCLUSIONS:Among virtual neuro-ophthalmology visits evaluated, most offer patients with appointments that satisfy their needs. Most physicians in this cohort obtained adequate clinical information for decision-making. Even better technology and instructions may help improve aspects of virtual health visits.