Frontiers in Neurology

Dizziness after mild traumatic brain injury (mTBI) is commonly attributed to impairment within the vestibular system. However, oculomotor, mobility, and autonomic dysfunction can also contribute to patient-reported dizziness. The purpose of this preliminary study was to examine whether a multimodal battery of assessments could help explain patient-reported dizziness after mTBI. Twenty-three participants with concussion-related symptoms completed the Dizziness Handicap Inventory (DHI) to evaluate burden imposed by dizziness on daily activities and a battery of tests designed to incorporate domains that have been shown to contribute to dizziness (e.g., vestibular, oculomotor, balance and mobility, and autonomic dysfunction). Specific outcomes included quantitative variables obtained from: Vestibular Ocular Motor Screening (VOMS); standing for 30 seconds with feet together, eyes closed, with hands on their hips on both firm and foam surfaces; walking for one minute at a comfortable pace; and a Head-up Tilt (HUT) Test. Univariate associations between DHI and individual measures were assessed, and a backwards-stepwise regression model determined the multi-variable association. There were no strong associations and only a few moderate associations between individual functional measure and DHI total score. A total of eight variables had univariate correlation coefficients larger than 0.20 in magnitude. The final model from the backwards-stepwise procedure explained 69% of the variance in DHI and retained only three variables: peak turning speed from the one-minute walk; mean blood pressure (MBP) during the HUT; and the total VOMS score. Isolated assessments of individual domains of function have weak-to-moderate associations with post-mTBI dizziness. Conversely, a multivariable model that contained measures of mobility, autonomic function, and symptomatic complaints to vestibular and ocular provocation explained 69% of the variance in dizziness. These results suggest that dizziness is physiologically heterogeneous in nature and support the use of multi-domain assessments in patients with dizziness after mTBI.

ObjectiveTo study the pattern reversal visual evoked potential (PRVEP) in patients with post stroke cognitive impairment (PSCI) and to provide an objective and accurate basis for the neurophysiological assessment of cognitive function in stroke patients. MethodsFirst stroke patients admitted to the department of Rehabilitation Medicine of the Second Hospital of Jilin University between 01-10-2022 and 31-10-2023 were enrolled as subjects according to the inclusion criteria, exclusion criteria, shedding and exclusion criteria. They were screened for whole cognitive function using the Montreal Cognitive Assessment (MoCA), and were divided into a post-stroke cognitive impairment (PSCI) group (n=44) and a control group (post-stroke patients with normal cognitive function, n=25). The PSCI group was divided into three group including mild, moderate and severe PSCI patients according to the severity of their cognitive impairment. Clinical data of the above patients were collected, PRVEP examination was performed and index of P100 waves were calculated for both eyes. SPSS 25.0 statistical analysis was used to analyze data of patients. Results69 first-stroke patients completed the whole experiment, including 25 cases in control group, 14 cases in mild PSCI group, 14 cases in moderate PSCI group, and 16 cases in severe PSCI group. In patients with detectable VEP, the difference in latent period of P100 in both eyes of the PSCI group (n=20) was greater than that of the control group (n=19) (P<0.01), and the amplitude ratio of P100 waves on both sides in PSCI group was higher than that of the control group (P<0.05). Compared with PSCI patients with left-sided hemiplegia, PSCI patients with right-sided hemiplegia had a longer P100 latency in the right eye (P<0.05); Compared with PSCI patients without brainstem involvement, PSCI patients with brainstem involvement had an increased P100 latency in both eyes (P<0.01); Pearson correlation analysis showed that the binocular amplitude ratio in the VEP parameters in the PSCI group was correlated with the MoCA score (r=-0.624, P<0.01). The ROC curve showed that the difference in the latent period of P100 in both eyes and the ratio of P100 amplitude in both eyes had certain predictive value for the diagnosis of PSCI (AUC=0.875, 0.842; P<0.05). ConclusionPRVEP examination and VEP parameters can help to distinguish stroke patients with or without cognitive impairment. In first-stroke patients with detectable VEP, the difference in binocular P100 latency and the ratio of binocular P100 amplitude have certain predictive value for diagnosis of PSCI, which is worthy of further study and application.

Variable recovery in vestibular rehabilitation underscores the need for objective biomarkers to identify patients at risk of poor clinical outcomes. This study aimed to establish proof of concept for a multidimensional prognostic framework using structural cervical vestibular evoked myogenic potential (cVEMP) and functional modified Clinical Test of Sensory Interaction on Balance (mCTSIB) markers to predict therapeutic success. This prospective cohort study was conducted at a tertiary rehabilitation center between June 2023 and May 2025. Participants were adults with peripheral vestibular disorders, including unilateral vestibular dysfunction, Meniere disease, or superior semicircular canal dehiscence. All participants underwent a customized five-session vestibular rehabilitation protocol. Primary outcomes were subjective clinical success, defined as an 18-point reduction in Dizziness Handicap Inventory (DHI) score, and functional success, defined as a 3-point increase in Dynamic Gait Index score. Among 30 participants (mean age 60.8 years; 77% female), the rehabilitation protocol was associated with significant improvements in mean DHI (53.7 to 37.8; P = .003) and Dynamic Gait Index (19.5 to 22.1; P = .003) scores. While 83% of participants showed raw DHI improvement, only 37% achieved the 18-point minimal clinically important difference. Notably, no participants in the bilateral cVEMP absence group achieved subjective success, compared with 52.6% in the bilateral present group (P trend = .08). Multivariable logistic regression identified baseline DHI severity as an independent predictor of success (odds ratio, 1.05; 95% CI, 1.00-1.10; P = .04). Functional gait success was significantly correlated with baseline vestibular and visual preference ratios. These findings suggest that baseline otolithic structural integrity is a primary determinant of subjective recovery. Bilateral structural loss may represent a "structural floor" where meaningful relief is physiologically limited despite functional gains. These results support a precision-based model using structural and sensory biomarkers to tailor rehabilitation

IntroductionPersistent Postural-Perceptual Dizziness (PPPD), as an umbrella term for functional dizziness, encompasses a wide range of subjective symptoms affecting visual, vestibular, and motor functions. We developed the Athens-Lubeck Questionnaire (ALQ) as a bedside tool to differentiate specific symptom subtypes, which could inform more targeted research into the pathogenesis of the syndrome and facilitate tailored physiotherapeutic interventions. MethodsA total of 96 patients with primary or secondary PPPD were included in a prospective cross- sectional study conducted at two tertiary referral centers. All participants had unimpaired vestibular function, as verified by video head-impulse testing at the time of examination. Each participant completed the ALQ, an 8-item questionnaire divided into four symptom subtypes: ALQvis (visual intolerance), ALQstand (intolerance to quiet standing or sitting), ALQpass (passive motion intolerance), and ALQact (active motion intolerance). We assessed the reliability of the questionnaire, the prevalence of different symptom subtypes, and the presence of dominant symptom profiles. ResultsThe ALQ demonstrated good internal consistency, with a Cronbachs alpha of 0.813. Items within the same symptom domain showed strong inter-item correlations. Approximately two-thirds of the participants exhibited a predominant symptom subtype, with the majority classified under the ALQact phenotype. ConclusionThe 8-item ALQ is a valid tool for identifying distinct PPPD symptom subtypes. Its primary strengths lie in its brevity and ease of use in outpatient vertigo clinics, enabling the identification of predominant phenotypes that may be relevant for guiding tailored therapeutic interventions.

There remains a limited understanding of the characteristics of academic leaders within neurology departments, despite similar research in other fields. This investigation characterized the demographics, academic background, and scholarly productivity of United States (U.S.) neurology department chairs. Here, 131 chairs at Accreditation Council for Graduate Medical Education (ACGME)-certified neurology programs were identified. Publicly accessible demographic and academic data available online were collected in March 2021. Among the 131 neurology chairs analyzed, 84.7% were male. On average, these faculty were 60.5 years old and were appointed at a mean age of 52.0 years. 74.8% of chairs graduated from an American medical school, although a notable proportion of department heads received medical training internationally. A substantial cohort also acquired an additional graduate degree, of which Doctor of Philosophy (PhD; 22.1%) and masters degree (21.4%) were most common. 82.4% completed a post-residency fellowship, which were most frequently in vascular neurology (24.1%) and clinical neurophysiology (17.6%). The mean h-index, m-quotient, and lifetime NIH grant funding received were 39.2 {+/-} 29.4, 1.2 {+/-} 0.8, and $20,021,594 {+/-} $31,861,816, respectively. No between-gender differences were observed. Overall, neurology chairs are predominantly male, most often completing fellowships in vascular neurology or clinical neurophysiology. Research productivity is a notable component of these chairs careers, although certain programs place less emphasis on these metrics. Finally, substantial effort remains to address disparities in female representation at this leadership position. These findings serve as a benchmark to evaluate demographic trends among neurology department chairs.

ObjectivesAlthough the vagus nerve (VN) is easily observed by ultrasonography, few studies have evaluated the cross-sectional area (CSA) of the VN in healthy older individuals from East Asia. In this study, we aimed to report reference values for the CSA of the VN in community-dwelling elderly Japanese individuals and to identify any associated medical history and/or lifestyle factors. MethodsThe present study included 336 participants aged [&ge;] 65 years from a prospective cohort study conducted in Yahaba, Japan from October 2021 to February 2022. The CSA of the VN was measured bilaterally at the level of the thyroid gland by ultrasonography. Univariate and multivariable linear regression analyses were conducted to identify the associations between clinical and background factors and the CSA of the VN on each side. ResultsIn our cohort, the median CSA of the VN was 1.3 mm2 (interquartile range [IQR] 1.1- 1.6) on the right side and 1.2 mm2 (IQR 1.0-1.4) on the left side. Multivariable linear regression analysis showed that history of head injury ({beta} = -0.15, p < .01), history of convulsion ({beta} = 0.19, p < .01), and BMI ({beta} = 0.30, p < .01) were independently associated with the CSA of the VN on the left side. In contrast, there were no independent associations between any of the assessed variables and the CSA on the right side. ConclusionWe have reported reference VN CSA values for community-dwelling elderly Japanese individuals. In addition, we showed that the CSA of the VN on the left side was positively associated with a history of convulsive seizure and BMI and inversely associated with a history of head injury.

About 30% of adults suffer from some mild to severe vestibular dysfunction. Vestibular disorders can be expressed as acute vestibular syndrome (AVS), episodic vestibular syndrome. Only half of the sufferers can compensate for their dysfunction after three months after the onset, while the other half of them become chronic, the mechanisms behind this compensation remain unclear. Several behavioural studies have explored the role of the vestibulo-ocular reflex and saccades in the process, linking to the interaction between the superior colliculus and the cerebellum. Yet, despite cerebellar involvement in vestibular function and oculomotor adaptation, thus far, no studies have focused on the specific role of the cerebellum in the compensation process in vestibular dysfunction. In this study, we test the hypothesis that undiagnosed cerebellar dysfunction might hinder chronic vestibulopathy sufferers from compensating and recovering. We recruited 19 patients who had suffered from an acute peripheral vestibular syndrome (10 clinically recovered and 9 with chronic symptoms) and ten individuals with no history of vestibular alterations (controls). We assessed their implicit motor learning capacity with a visuomotor rotation task and measured by the angular aiming error, which showed an impaired implicit motor adaptation in chronic patients (7.04 {+/-} 1.6{o}) compared to recovered (11.06 {+/-} 1.94{o}, p = 0.007) and control groups (10.89 {+/-} 7.96{o}, p = 0.03). These findings indicate the involvement of the cerebellum in vestibular compensation and suggest that implicit motor adaptation of reaching movements could be potentially used as an early prognostic tool in unilateral peripheral vestibular dysfunction (UPVD) patients.

ObjectiveTo re-evaluate the longitudinal progression of stroke-induced homonymous visual field defects using strictly automated perimetry (Zeiss Humphrey Systems), rigorous inclusion/exclusion criteria, and quantitative analyses. MethodsA retrospective chart review of stroke patients diagnosed with "homonymous hemianopia", who underwent monocular Humphrey visual field (HVF) perimetry using the 24-2 SITA standard pattern from 2011-2019, was conducted at a large US academic medical center. Reliable tests (<20% fixation losses, false positives, and false negatives) were identified and analyzed with generalized estimating equations to extract temporal trends in perimetric mean deviation (PMD) and deficit area. ResultsOf 532 patients with "homonymous hemianopia", sequential, reliable HVFs were only available for 36 patients in the right eye, and 30 patients in the left eye, ranging from 7 days to 58 months post-stroke. Both PMD and deficit area improved early, within the first 3 months post-stroke; however, this was followed by a subsequent decline in performance >1 year post-stroke. Changes were similar between eyes. ConclusionWe discovered that a large portion of occipital stroke patients do not receive comprehensive ophthalmologic follow-up and, even then, only a fraction of HVFs performed are reliable enough for rigorous analysis. Nonetheless, reliable HVFs in such patients confirmed early visual improvement after stroke, consistent with prior reports. However, in contrast with prior, qualitative reports, there was no stability of the deficit beyond 6 months post-stroke; instead, gradual worsening erased the initial spontaneous improvement, especially >1 year post-stroke.

IntroductionVestibular migraine is a major cause of recurrent vertigo, yet its mechanisms and diagnostic markers remain limited. Abnormal vestibular-cervical integration and convergence insufficiency, reflected by impaired near point convergence (NPC),suggest multisensory dysfunction. This study tested whether cervical proprioceptive perturbation provokes vertigo and nystagmus in vestibular migraine and evaluated NPC as a predictor of these responses. MethodsFifty-one vestibular migraine patients and 12 controls underwent interictal vestibular testing. Peripheral function was assessed with vHIT. Participants received randomized 100-Hz cervical (proprioceptive) and mastoid (vestibular) vibration without visual fixation, with eye movements recorded via video Frenzel goggles and NPC measured using standard methods. Analyses included McNemars, Wilcoxon signed-rank, Mann-Whitney U, correlations, and multivariable logistic regression. ResultsNeck vibration provoked vertigo in all vestibular migraine patients and none of the controls, producing nystagmus in 76.5%. Horizontal, ipsiversive nystagmus predominated, while less frequent vertical responses showed higher velocities. Mastoid vibration elicited no nystagmus. NPC was the only independent predictor of nystagmus and correlated with slow-phase velocity and bilateral responses. Age correlated with drift velocity, whereas vestibulo-ocular reflex gain showed no association. DiscussionNeck vibration elicits vertigo and nystagmus in vestibular migraine, providing the first objective physiological marker. NPC predicts and correlates with nystagmus severity, highlighting its value as a surrogate of multisensory dysfunction. Together, these findings implicate abnormal cervical-vestibular integration and position NPC and neck-vibration testing as practical tools for diagnosis and phenotyping. Key pointsO_LIVestibular migraine affects [~]3% of population yet remains highly controversial. C_LIO_LIObjective measures reveal reproducible vertigo and nystagmus in vestibular migraine. C_LIO_LIImpaired convergence strongly predicts vibration-induced nystagmus in VM patients. C_LIO_LIFindings support sensory mismatch model linking cervical proprioception to vertigo. C_LI

The visual evoked potential (VEP) patterns of optic neuritis are known to often differ between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) but have been less reported in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). This study aimed to characterize the VEP pattern in MOGAD and evaluate its utility in distinguishing MOGAD from MS and NMOSD. We retrospectively reviewed the clinical manifestations and VEP findings in patients with MS (n = 29), NMOSD (n = 14), and MOGAD (n = 10). In eyes with acute visual impairment, VEP responses were detectable in all eyes with MOGAD but were undetectable in a significant percentage of eyes with MS (27.3%) and NMOSD (42.9%). In addition, VEP abnormalities in eyes without acute visual impairment were rare in MOGAD (23.1%) compared to MS (55.3%) and NMOSD (42.9%). Our results indicated that subclinical VEP abnormalities or undetectable VEP responses were less common in patients with MOGAD compared to patients with MS and NMOSD. VEP testing demonstrates potential diagnostic utility in distinguishing among these conditions.

Voluntary contraction anomalies of post-stroke survivors progress from flaccid paralysis to recovery of upper extremity motor function in the subacute phase. However, muscle weakness often persists, and it is unclear what changes or aberrations persist in neuromuscular function, particularly in motor unit behavior. Our objective was to characterize motor unit discharge behavior in hemiplegic stroke patients in the subacute phase. We tested seven subacute stroke patients at two time points (Timepoint 1 and Timepoint 2) a minimum of two weeks apart during the subacute phase. We used wireless surface electromyography to detect motor unit activities on both sides of our tested participants. Participants carried out two types of target force tracking tasks with isometric elbow flexion. We performed 2-way ANOVA between the time point and test side. The recruitment threshold force(RTF) of the Ramp task exhibited a significant interaction between the Timepoint and Test side (p < 0.00). The post hoc test showed the RTF of the affected side was not significantly lower than the contralateral side (p = 0.99) at Timepoint 1. On the other hand, the affected side at Timepoint 2 was significantly lower than the contralateral side (p < 0.00). The low recruitment threshold on the affected side may be more exacerbated than the contralateral side chronologically during the subacute phase of stroke. Our results suggest that the assessment of motor units in the subacute phase of stroke can contribute to the early detection of abnormal neuromuscular activity and, thereby, the establishment of effective rehabilitation. NEW & NOTEWORTHYThis study clarified altered chronological motor unit recruitment patterns in the subacute stroke. We revealed the neuromuscular physiological abnormalities on the affected side may persist from the subacute period to the chronic stage. To maximize recovery of motor function in stroke patients with prolonged symptoms, it is necessary to detect neuromuscular dysfunction in the subacute phase and establish early prevention. This study provided fundamental knowledge on preventive rehabilitation of persistent paresis during the subacute phase. Keywords: stroke; motor unit; surface electromyography; subacute; rehabilitation

BackgroundFactors early after stroke that are predictive of outcomes can help guide rehabilitation interventions. There is a growing understanding of the importance of sleep for recovery after stroke. ObjectivesTo explore factors at 10 days post stroke, including sleep health (SH), that may be associated with QOL at 60 days post stroke. MethodsData from 62 participants were collected at 10 and 60 days post stroke. Independent variables at 10 days post stroke were the NIHSS, Barthel Index (BI), Montreal Cognitive Assessment (MOCA), Patient Health Questionnaire (PHQ-9), gait speed, Berg Balance Scale, and SH. SH was measured by combining data from actigraphy and self-report to create a score that reflected regularity, satisfaction, alertness, timing, efficiency, and duration of sleep (S-Ru-SATED). The Stroke Impact Scale (SIS) at 60 days post stroke assessed quality of life. A multiple linear regression using a leave-one-out cross validation was employed to assess the association between the independent variables at 10 days and the SIS at 60 days. ResultsThe leave-one-out cross-validation analysis revealed that MOCA (p=0.0068), NIHSS (p=0.0181), BI (p=0.0028), and S-Ru-SATED (p=0.000155) at 10 days post stroke were significantly associated with the SIS at 60 days post stroke. ConclusionsParticipants with less stroke severity, higher cognition, better functional ability, and better SH early after stroke were more likely to have a higher QOL at 2 months post stroke. Research is needed to assess the impact of interventions to improve SH in conjunction with rehabilitation interventions after stroke.

Although animal research and some rare human case reports suggest that lesions of the dorsal pons yield saccadic and smooth pursuit eye movement deficits, little is known about the functional topology of the human pontine nuclei (PN) and whether limb movements are similarly affected as eye movements. Saccadic as well as SP eye and pointing movements were measured in six patients with lesions in the PN region. Five patients of the six exhibited dysmetric saccades, whilst smooth pursuit gain was reduced in four. Pontine lesions also alter the relationship between amplitude, velocity, and velocity skewness of saccadic eye movements. Limb movement trajectories were more curved in four patients. The results suggest that the lesions impair a general calibration mechanism that uses the parallel fiber-Purkinjecell synapse in the cerebellar cortex to adjust the timing of muscle innervation in visually guided oculomotor as well as limb movement tasks.

BackgroundThe role of the right hemisphere in language use and interpretive abilities has become clearer through studies describing sequelae in patients with right hemisphere stroke (RHS). Between 50% and 78% of stroke survivors with RHS experience communication disorders, a condition recently termed "apragmatism" by a group of experts. Apragmatism can negatively impact individuals personal lives and overall quality of life. ObjectiveTo develop and validate a bedside cognitive and communication screening tool for features of apragmatism in prospective patients with right stroke, called the Right Language Screening Test (R-LAST), which is simple, rapid, and suitable for emergency settings. Patients and methodsR-LAST consists of seven subtests and twelve items. We report its internal and external validity and inter-rater reliability. We validated the scale by prospectively administering it to 300 patients admitted to two stroke units with confirmed right stroke, as well as to 94 stabilized patients with and without cognitive-communication disorders, using the MEC B as a reference. ResultsInternal validity demonstrated no redundancy with a Pearson coefficient less than 0.8. The internal consistency of the 12 items was questionable, indicated by a Cronbachs alpha of 0.62. External validation against MEC B revealed a sensitivity of 0.84 and a specificity of 0.82. Inter-rater agreement was nearly perfect (ICC 0.993). The average time needed to complete R-LAST was 3 minutes and 52 seconds. ConclusionR-LAST could enable rapid and reliable detection of apragmatism in the acute phase of stroke, which could lead to timely referrals to speech-language therapists and ensure timely rehabilitation. This comprehensively validated cognitive-communication disorders rating scale is simple and rapid, making it a useful tool for bedside evaluation of acute stroke patients in routine clinical practice. Clinical Trial RegistrationUnique Identifier: NCT03622606 URL: https://clinicaltrials.gov/study/NCT03622606?term=R-LAST&rank=1

Background and ObjectivesVigilance towards balance has been proposed to underpin various chronic dizziness disorders, including Persistent Postural Perceptual Dizziness (PPPD). The objective of this study is to develop (through patient input) a validated balance-specific measure of vigilance that comprehensively assesses the varied ways in which this construct may manifest. MethodsWe developed the Balance Vigilance Questionnaire (Balance-VQ) through patient and clinician feedback, designed to assess vigilance towards balance. We then validated the questionnaire in 497 participants consisting of patients diagnosed with chronic dizziness disorders (including 97 individuals diagnosed with PPPD) and healthy controls. ResultsThe final 6-item Balance-VQ was shown to be a valid and reliable way to assess vigilance towards balance. Scores were significantly higher in individuals diagnosed with PPPD compared to controls. Although scores were also higher in the PPPD group compared to individuals with diagnosed vestibular disorders other than PPPD, Balance-VQ scores did not discriminate between the two groups when confounding factors were controlled for. ConclusionsOur findings confirm that the Balance-VQ is a valid and reliable instrument for assessing vigilance towards balance. As symptom vigilance has been identified as a key risk factor for developing chronic dizziness following an acute neuro-otological insult, we recommend using the Balance-VQ as a screening tool in people presenting with such symptoms. Key Messages- Vigilance towards balance has been proposed to underpin the development and maintenance of chronic dizziness disorders, such as Persistent Postural Perceptual Dizziness (PPPD). - Clinically assessing balance vigilance is difficult, as no validated assessment method exists. - Through feedback from patients and clinicians, we developed a new scale capable of assessing this construct: The Balance Vigilance Questionnaire (Balance-VQ). - Our findings confirm that the Balance-VQ is a valid and reliable instrument for assessing vigilance towards balance. - We recommend using the Balance-VQ as a screening tool in people at risk of developing, or currently presenting with, chronic dizziness.

BackgroundPrompt diagnosis of acute central retinal artery occlusion (CRAO) is crucial for therapeutic management and secondary prevention of associated neurological co-morbidities. However, most stroke centers lack on-site ophthalmic expertise prior to considering fibrinolytic treatments. We aimed to develop, train, and test a deep learning system (DLS) able to accurately detect hyper-acute CRAO on retinal color fundus photographs, during the critical treatment window of 4.5 hours after visual loss. We also evaluated the diagnostic performance of the DLS within 24 hours after visual loss, aiming to improve secondary prevention of stroke after CRAO. MethodsOur retrospective, multicenter, multiethnic study included 1,322 color fundus photographs from 771 patients with various causes of acute visual loss, including CRAO, central retinal vein occlusion, non-arteritic anterior ischemic optic neuropathy, and healthy controls. Photographs were collected from 9 expert neuro-ophthalmology centers in 6 countries, including 3 randomized clinical trials. Training was performed on 1,039 photographs (517 patients), followed by testing on two datasets to discriminate CRAO cases at (i) hyper-acute stage (54 photographs, 54 patients) and (ii) within 24 hours after visual loss (110 photographs, 109 patients). ResultsThe DLS achieved an area under the receiver operating characteristic curve (AUC) of 0.96 (95% confidence interval [CI], 0.95-0.98), a sensitivity of 92.6% (95% CI, 87.0-98.0), and a specificity of 85.0% (95% CI, 81.8-92.8) for detecting CRAO at hyper-acute stage, with similar results for CRAO diagnosis within 24 hours. The DLS outperformed neurologists on a subset of testing dataset at hyper-acute stage (120 photographs from 120 patients). ConclusionsA DLS can accurately detect hyper-acute CRAO on retinal photographs within a time-window compatible with urgent fibrinolysis. Delayed diagnosis (24h) did not alter the ability of the DLS to accurately identify CRAO. If further validated, such systems could improve patient selection for fibrinolytic trials and optimize secondary stroke prevention. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06390579.

While progress has been made toward understanding physical and mental fatigue, chronic fatigue has been under-studied and stigmatized. Unlike other fatigue states that can be relieved by rest, chronic fatigue is a common, debilitating symptom of many chronic conditions. Utilizing deidentified patient data from the Yale-New Haven Hospital System, we analyzed the overlap between diagnosed fatigue and 14 chronic conditions. Our results revealed a significantly lower overlap with fatigue than previous reports in all but one of the current diagnoses fields. The underreporting of disabling fatigue across chronic conditions restricts the translation between medical and basic scientific research. Accurate reporting of the prevalence of chronic fatigue can result in researchers refocusing their efforts toward uncovering targetable mechanisms and physicians consistently reporting and treating chronic fatigue.

BackgroundThe hyperintense acute reperfusion marker (HARM) sign is a hyperintense signal observed on postcontrast fluid-attenuated recovery inversion images and is strongly associated with cerebral ischemic insults. The clinical significance of the HARM sign in transient ischemic attack (TIA) has rarely been studied, unlike that in stroke. This study investigated the association between the HARM sign and clinical factors of diffusion-weighted imaging (DWI)-negative TIA, and the relationship between the HARM sign and recurrence of TIA and ischemic stroke. MethodsWe included 329 consecutive patients with DWI-negative TIA and divided them into two groups according to the HARM sign: 299 patients in the HARM(-) group and 30 patients in the HARM(+) group. Clinical information, brain imaging and follow-up data were collected from medical records and phone calls, and compared using HARM sign. ResultsThe HARM(+) patients were older and had higher systolic blood pressure, shorter symptom duration, and more frequent history of recent TIA or stroke and symptomatic artery stenosis or occlusion. Multivariate logistic regression revealed that recent TIA or stroke within 12 months (OR 6.623), symptom duration under 1 hour (OR 2.735), and relevant artery stenosis or occlusion (OR 2.761) were independently associated with the HARM sign. Cortical symptoms including aphasia were more prevalent in the HARM(+) group. During follow-up, HARM(+) patients showed higher recurrence rates of ischemic stroke (13.3% vs. 3.0%, p = 0.023). However, multivariate Cox analysis indicated that symptomatic stenosis or occlusion, rather than the HARM sign, was independently associated with stroke recurrence. ConclusionThe HARM sign in DWI-negative TIA patients is linked to older age, recent cerebrovascular events, shorter symptom duration, and large artery stenosis or occlusion. While the HARM sign correlates with higher recurrence of ischemic stroke, large artery stenosis or occlusion is the primary independent predictor.

ObjectiveThe flexion synergy and extension synergy are a representative consequence of a stroke and appear in the upper extremity and lower extremity. Since the ipsilesional corticospinal tract (CST) is the most influential neural pathway for both extremities in motor execution, damage by a stroke to this tract could lead to similar motor pathological features (e.g., abnormal synergies) in both extremities. However less attention has been paid to the inter-limb correlations in the flexion synergy and extension synergy across different recovery phases of a stroke. MethodsIn this study, we used results of the Fugl-Meyer assessment (FMA) to characterize those correlations in a total of 512 participants with hemiparesis post stroke from the acute phase to 1 year. The FMA provides indirect indicators of the degrees of the flexion synergy and extension synergy post stroke. ResultsWe found that generally, strong inter-limb correlations (r>0.65 with all p-values<0.0001) between the flexion synergy and extension synergy appeared in the acute-to-subacute phase (<90 days). But correlations of lower-extremity extension synergy with upper-extremity flexion synergy and extension synergy decreased (down to r=0.38) around 360 days after stroke (p<0.05). InterpretationThese results suggest that the preferential use of alternative neural pathways after damage by a stroke to the CST enhances inter-limb correlations between the flexion synergy and extension, however a recovery of the CST or/and the functional fragmentation (remodeling) of the alternative neural substrates in the chronic phase contribute to diversity in neural pathways in motor execution, eventually leading to reduced inter-limb correlations.

We demonstrate that low-frequency oscillations (LFOs) in cerebral hemodynamics, measured by frequency-domain functional near-infrared spectroscopy (FD-fNIRS), reflect altered cerebral hemodynamic oscillations in mild traumatic brain injury (mTBI). In a pilot study of two mTBI and 13 healthy subjects undergoing head-of-bed positional changes, we analyzed total hemoglobin concentration (THC), oxyhemoglobin (HbO), and deoxyhemoglobin (Hb) dynamics using spectral and time-frequency analyses. mTBI measurements exhibited significantly larger postural changes in THC ({Delta}THC = 9.49 {micro}M) compared to controls ({Delta}THC = 1.03 {micro}M). LFO power was consistently elevated in mTBI across all slow bands (0.01-0.2 Hz), particularly in the Slow-5 band (0.01-0.027 Hz), suggesting dysregulated cerebral vasomotion. Continuous wavelet transform (CWT) confirmed persistent LFO amplification during and after postural transitions. These findings indicate that THC-based LFO measures may serve as early, non-invasive biomarkers of cerebral autoregulatory impairment in mTBI.