Frontiers in Neurology

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.

IntroductionDespite first coming into view over two years ago, effective diagnostic and treatment pathways for Long COVID continue to evade the medical community. The overlap in neurological-based symptoms and neuroinflammatory origin indicates that the framework of post-concussion syndrome may provide insight into new diagnostics and treatment for patients with Long COVID. The objective of this investigation was to determine whether tools from the four common domains of concussion assessment were sensitive to differentiate between patients with Long COVID from a reference group who was infected with Sars-CoV-2 and does not have Long COVID. MethodsIn this prospective cohort design, each participant self reported their group (Acute, n=28) and Long COVID Group (n=33). Each participant underwent an examination in four assessment categories: symptoms, vestibular nystagmography, Automated Neuropsychological Assessment Metrics (ANAM), and a series of balance tasks. ResultsTotal Symptom scores were separated into functional classifications and showed clear success as a tool to differentiate between Acute and Long COVID. Five of the 33 people in the Long COVID had detectable central lesions, which increases the risk of developing long COVID by 64% (Relative Risk=1.64). A wide variety of objective and quantitative measures from post-concussion care are sensitive to the Long COVID condition. Prolonged latency during random saccades eye tracking was present (p<0.01, d=0.87) in the Long COVID group corresponding to the King-Devick rapid reading test, which was highly sensitive to Long COVID (p<0.01, d=1.34). ANAM reaction time subtests had similarly large effects (p<0.01, d=0.93-1.09). Balance performance with corrupted sensory feedback was also sensitive (p<0.01, d=0.96). DiscussionOur results indicate that long-standing and validated post-concussion symptom questionnaires may be used for quantifying the severity of Long COVID. Some of the most sensitive measures (especially the King-Devick rapid reading test) are easy to implement clinically and may be effective at tracking patient progress in the context of Long COVID treatment. The results point to wide deficits in motor integration and provide a rationale for treating the subset of Long COVID patients with similar rehabilitation strategies as patients with post-concussion syndrome.

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.

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.

Background: Dizziness is a frequent presenting complaint in the emergency department (ED), prompting extensive diagnostic evaluation. Non-contrast brain computed tomography (CT) is often utilized to rule out serious central pathologies, but its diagnostic yield is debated, leading to concerns about overuse. This study aimed to identify clinical predictors associated with abnormal brain CT findings in patients with acute dizziness to help refine imaging selection criteria. Methods: We conducted a retrospective analysis of 291 consecutive adult patients who presented with new-onset dizziness and underwent a non-contrast brain CT scan at Namazi Hospital, a tertiary referral center, between January 2019 and 2021. Patient data, including demographics, comorbidities, clinical symptoms, and hospital outcomes, were extracted from medical records. Statistical analyses were performed to determine associations between clinical variables and CT findings, with odds ratios (OR) and 95% confidence intervals (CI) calculated. Results: The diagnostic yield of brain CT was low, with a significant majority of scans (72.2%, n=210) revealing no acute pathology. Key clinical factors predicting abnormal CT findings included a history of diabetes mellitus, the presence of ataxic gait, and headache. Conversely, nausea and vomiting were significant predictors of normal findings, being associated with lower odds of central pathology. Conclusion: The diagnostic yield of routine brain CT in patients with acute dizziness is low. However, specific clinical indicators can effectively stratify risk. The presence of focal neurological signs like ataxia, headache, and certain comorbidities such as diabetes should heighten suspicion for central pathology and support the use of neuroimaging. In contrast, isolated vestibular symptoms like nausea and vomiting are associated with a lower probability of abnormal findings. These results could inform the development of clinical decision rules to optimize CT utilization, thereby reducing unnecessary radiation exposure and healthcare costs.

Cerebral cavernous malformations (CCMs) are neurological disorders that make individuals more susceptible to hemorrhagic stroke. The Mexican-Hispanic population has a higher prevalence of both CCMs and metabolic syndrome (MetS), which is also associated with hemorrhagic stroke. A study was conducted with 184 Mexican-Hispanic CCM subjects and age- and sex-matched Hispanic and non-Hispanic white controls. The CCM cohort had a higher proportion of epilepsy and hemorrhagic stroke but a lower proportion of MetS. Higher blood pressure and fasting glucose levels were observed in the CCM cohort. MetS and epilepsy were associated with increased odds of hemorrhagic stroke among elderly CCM patients, and increased systolic blood pressure was significantly linked to increased odds of hemorrhagic stroke in the CCM cohort. To minimize the risk of hemorrhagic stroke, it is important to manage blood pressure and comorbidities like MetS and epilepsy in CCM patients, particularly those older than 50. SUMMARUYO_ST_ABSWhat is already known about this subjectC_ST_ABSO_LIMetabolic Syndrome (MetS) is widely associated with cardiovascular conditions, including stroke, C_LIO_LIThe association between MetS and ischemic stroke is well established C_LIO_LIThe relationship between MetS and hemorrhagic stroke remains unclear C_LIO_LICurrently, one two studies explored the relationship between MetS and hemorrhagic stroke in CCM patients; one n sporadic CCM (sCCM) and one in familial CCM cases, with inconsistent results. C_LI What are the new findingsO_LIIn this study, a strong association was observed between systolic blood pressure (SBP) and hemorrhagic stroke in the CCM cohort, independent of obesity or fasting glucose levels. C_LIO_LIThis study also suggests that MetS is associated with hemorrhagic stroke among CCM patients, specifically in the older age group. C_LI How might it impact on clinical practice in the foreseeable futureO_LIThis study demonstrates many of the unique characteristics of symptomatic CCMs within the Mexican-Hispanic population C_LIO_LIOur results suggests that of Mexican-Hispanic CCM subjects are at a greater risk for hemorrhagic stroke and epilepsy than other ethnic groups. C_LIO_LIThis study highlights the importance of reducing blood pressure and managing comorbidities such as MetS and epilepsy in CCM patients, especially those who are older than 50 years to minimize the risk of hemorrhagic stroke among CCM subjects C_LI

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.

Relapsing-remitting multiple sclerosis is the most common type of multiple sclerosis characterized by periods of relapses and generating various motor symptoms. These symptoms are associated with the corticospinal tract integrity, which is quantified by means of corticospinal plasticity which can be probed via transcranial magnetic stimulation and assessed with motor threshold, motor evoked potential and central motor conduction time. Several factors, such as exercise and interlimb coordination, can influence corticospinal plasticity. Previous work in healthy and in stroke patients showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral arm exercises. Altered corticospinal plasticity due to bilateral cortical lesions is common in multiple sclerosis, yet, the impact of these type of exercises in this cohort is unclear. The aim of this concurrent multiple baseline design study is to investigate the effects of in-phase bilateral exercises on corticospinal plasticity and on clinical measures using transcranial magnetic stimulation and standardized clinical assessment, in five people with relapsing-remitting multiple sclerosis. The intervention protocol will last for 12 consecutive weeks (30-60 minutes /session x 3 sessions/week) and include in-phase bilateral movements of the upper limbs, adapted to different sports activities and to functional training. To define functional relation between the intervention and the results on corticospinal plasticity (i.e., resting motor threshold, motor evoked potential amplitude, latency) and on clinical measures (i.e., balance, gait, bilateral hand dexterity and strength, cognitive function), we will perform a visual analysis followed by multilevel modelling and the single case educational design-specific mean difference in order to estimate the magnitude of the effect size across cases. We assume that possible effects from our study, will introduce a type of exercise that will be effective during the disease progression.

Damage to the primary visual cortex causes homonymous visual impairments that appear to benefit from visual discrimination training. However, whether improvements persist without continued training remains to be determined and was the focus of the present study. After a baseline assessment visit, 20 participants trained twice daily in their blind-field for a minimum of six months (median=155 sessions), using a motion discrimination and integration task. At the end of training, a return study visit was used to assess recovery. Three months later, 14 of the participants returned for a third study visit to assess persistence of recovery. At each study visit, motion discrimination and integration thresholds, Humphrey visual fields, and structural MRI scans were collected. Immediately after training, all but four participants showed improvements in the trained discrimination task, and shrinkage of the perimetrically-defined visual defect. While these gains were sustained in seven out of eleven participants who improved with training, four participants lost their improvement in motion discrimination thresholds at the follow-up visit. Persistence of recovery was not related to age, time since lesion, number of training sessions performed, proportion of V1 damaged, deficit size, or optic tract degeneration measured from structural MRI scans. The present findings underscore the potential of extended visual training to induce long-term improvements in stroke-induced vision loss. However, they also highlight the need for further investigations to better understand the mechanisms driving recovery, its persistence post-training, and especially heterogeneity among participants.

Neuroimaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) have been widely adopted in the clinical diagnosis and management of traumatic brain injury (TBI), particularly at the more acute and severe levels of injury. Additionally, a number of advanced applications of MRI have been employed in TBI-related clinical research with great promise, and researchers have used these techniques to better understand underlying mechanisms, progression of secondary injury and tissue perturbation over time, and relation of focal and diffuse injury to later outcome. However, the acquisition and analysis time, the cost of these and other imaging modalities, and the need for specialized expertise have represented historical barriers in extending these tools in clinical practice. While group studies are important in detecting patterns, heterogeneity among patient presentation and limited sample sizes from which to compare individual level data to well-developed normative data have also played a role in the limited translatability of imaging to wider clinical application. Fortunately, the field of TBI has benefitted from increased public and scientific awareness of the prevalence and impact of TBI, particularly in head injury related to recent military conflicts and sport-related concussion. This awareness parallels an increase in federal funding in the United States and other countries allocated to investigation in these areas. In this article we summarize funding and publication trends since the mainstream adoption of imaging in TBI to elucidate evolving trends and priorities in the application of different techniques and patient populations. We also review recent and ongoing efforts to advance the field through promoting reproducibility, data sharing, big data analytic methods, and team science. Finally, we discuss international collaborative efforts to combine and harmonize neuroimaging, cognitive, and clinical data, both prospectively and retrospectively. Each of these represent unique, but related, efforts that facilitate closing gaps between the use of advanced imaging solely as a research tool and the use of it in clinical diagnosis, prognosis, and treatment planning and monitoring.

BackgroundStroke leads to both motor and cognitive impairments that can substantially limit daily activities and independence. Although these impairments are often treated separately in rehabilitation, growing evidence suggests they are interconnected. Understanding how cognitive and motor impairments relate to one another is essential for developing more effective, integrated rehabilitation strategies. ObjectiveThis longitudinal study addressed three key questions: (1) Do motor and cognitive impairments co-occur after stroke? (2) Does cognitive ability influence motor recovery? (3) Are cognitive and motor recovery trajectories associated? MethodsWe followed 148 individuals in the subacute phase of stroke, assessing them at 1 and 3 months post-stroke. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and the clock drawing test. Motor impairment was assessed using the Fugl-Meyer Assessment (FMA) and grip strength. Activity was evaluated using the Action Research Arm Test (ARAT), 10-Meter Walk Test (10MW), and Timed Up and Go (TUG). ResultsAt one month post-stroke, cognitive and motor impairment and activity levels were not correlated, although strong within-domain correlations were observed. Baseline cognitive ability did not predict motor impairment recovery. However, improvements in cognitive ability from 1 to 3 months were moderately correlated with gains in motor activity measures (r = 0.22-0.29, p < 0.05). ConclusionsAlthough cognitive and motor impairments may arise independently after stroke, their recovery processes appear partially linked. These findings underscore the importance of addressing both domains in rehabilitation and advancing understanding of shared mechanisms that support recovery across functional systems.

BackgroundTraumatic brain injury (TBI) remains a leading cause of morbidity and mortality worldwide, with secondary brain damage driven by inflammation and oxidative stress. Vitamin D is increasingly recognized for potential neuroprotective effects in TBI, while data regarding vitamin E remain limited. ObjectiveTo systematically review and meta-analyze the effects of vitamin D supplementation, and qualitatively review evidence for vitamin E, on clinical and functional outcomes after moderate to severe TBI. MethodsA comprehensive search was carried out in PubMed, Scopus, Embase, Web of Science, and Google Scholar up to January 2025. Studies reporting on vitamin D or E supplementation in clinical TBI were eligible. Risk of bias was assessed using JBI checklists. A meta-analysis of randomized controlled trials reporting pre- and post-treatment GCS scores following vitamin D supplementation was performed with a fixed-effect model. ResultsFrom 4,546 records, nine clinical studies met criteria; three RCTs on vitamin D (n=151 patients) were included in the meta-analysis, which found that vitamin D supplementation significantly improved GCS scores versus controls (SMD{square}= {square}1.02, 95% CI: 0.68-1.36, p{square}< {square}0.0001; I2{square}= {square}0%). Narrative analysis suggested that vitamin D may improve functional outcomes, reduce inflammatory biomarkers, and lower mortality in select studies. Evidence for vitamin E in TBI is currently limited to a small number of heterogeneous studies, with early data suggesting possible benefits for acute recovery and oxidative stress reduction, but insufficient for quantitative synthesis. ConclusionVitamin D supplementation may confer short-term improvement in neurological and functional outcomes following moderate to severe TBI. Existing evidence for vitamin E is insufficient to support robust conclusions. Larger, rigorously designed RCTs--particularly for vitamin E--are required to clarify effectiveness, optimal dosing, and long-term outcomes.

IntroductionThis study aimed to analyse disease characteristics and prognostic factors among a cohort of 407 patients with pontine infarction, focusing on the effect of branch atheromatous disease (BAD). Patients and MethodsA retrospective analysis of patients diagnosed with brainstem stroke at Baba Memorial Hospital from 2012 to 2022 was conducted. The study included patients with pontine stroke, excluding those with missing data, chronic or multiple cerebral infarctions, non-brainstem stroke, or without timely MRI. Patient analysis involved age, sex, Japan Coma Scale (JCS) score, medical history, symptoms at admission, and MRI findings. Prognostic groups were classified based on the modified Rankin Scale (mRS) and Functional Independence Measure (FIM) scores at admission and discharge. ResultsOf the 407 patients, 66.1% belonged to the good prognosis group (mRS 0-2) and 33.9% to the poor prognosis group (mRS 35). Younger patients tended to have a better prognosis. JCS scores correlated with prognosis severity. Significant differences in dysarthria, paralysis, and admission FIM scores were observed between patients with and without BAD. Logistic regression analysis identified the FIM score at admission as an independent predictor of prognosis. DiscussionBAD was not directly related to prognosis. The absence of differences in discharge FIM scores and similar prognoses to other stroke types suggested effective rehabilitation. However, due to the lack of pre-stroke FIM measurements and specific treatment details, further research is needed. ConclusionAge and JCS scores were significant prognostic factors, with BAD not directly affecting prognosis. There is need for investigation into treatment methods and detailed prognostic factors.

A growing body of evidence supports the link between eye movement anomalies and brain health. Indeed, the oculomotor system is composed of a diverse network of cortical and subcortical structures and circuits that are susceptible to a variety of degenerative processes. Here we show preliminary findings from the baseline measurements of an ongoing longitudinal cohort study in MS participants, designed to determine if disease and cognitive status can be estimated and tracked with high accuracy based on eye movement parameters alone. Using a novel gaze-tracking technology that can reliably and accurately track eye movements with good precision without the need for infrared cameras, using only an iPad Pro embedded camera, we show that several eye movement parameters significantly correlated with clinical outcome measures of interest. Eye movement parameters were extracted from fixation, pro-saccade anti-saccade, and smooth pursuit visual tasks, whereas the clinical outcome measures were the scores of several disease assessment tools and standard cognitive tests such as the Expanded Disability Status Scale (EDSS), Brief International Cognitive Assessment for MS (BICAMS), the Multiple Sclerosis Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT). Furthermore, multiple regression analyses show that a small set of oculomotor parameters can explain up to 74% of the variance of the clinical outcome measures. Taken together, these findings not only replicate previously known associations between eye movement parameters and clinical scores, this time using a novel mobile-based technology, but also the notion that interrogating the oculomotor system with a novel eye-tracking technology can inform us of disease severity and evolution, as well as the cognitive status of MS participants.

With ischemic strokes being one of the most pervasive medical issues globally, identifying methods for their accurate diagnosis is becoming increasingly crucial. Two common ischemic stroke subtypes are acute ischemic stroke (AIS) and transient ischemic attack (TIA). Although these two subtypes exhibit similar symptoms, AIS is far more severe than TIA. If AIS is misdiagnosed for TIA, this can lead to inadequate treatment and worse long-term outcomes for patients. Currently, stroke diagnosis relies heavily on patient medical history and imaging techniques, causing high rates of misdiagnosis. However, identifying protein biomarker concentrations associated with AIS and TIA is a promising new method for stroke diagnosis. In this meta-analysis, ten protein biomarkers were analyzed to determine whether or not they would serve as effective diagnostic tools for AIS and TIA. After collecting the mean concentration of each biomarker from 18,160 AIS patients and 3,410 TIA patients, means were compared between AIS and TIA patient groups, determining which biomarkers had a statistically significant difference in concentration between the two stroke subtypes. Biomarkers that yielded statistically significant results were S100B, sNfl, copeptin, IL-6, and MMP-9. MMP-9 yielded the highest difference in concentration between AIS and TIA patients (536.41 {+/-} 134.24 ng/mL in AIS patients vs. 0.11 {+/-} 0.03 ng/mL in TIA patients). A limitation to this study was the smaller sample size of TIA patients included. While this study establishes a baseline for promising protein biomarkers that can be utilized to differentiate AIS and TIA, future studies may want to further investigate each individual biomarker, establishing clear biomarker concentration ranges for AIS and TIA.

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.

Patient-reported outcomes importantly reflect the lived experiences of persons with multiple sclerosis (MS); however, given the broad array of MS symptoms, comprehensive evaluation can be burdensome, especially with lengthy questionnaires. The MS Impact Scale queries twenty different physical difficulties (MSIS-20). In 1150 patients with MS, evaluation of internal consistency indicated redundancy in the MSIS-20 (Cronbachs alpha: 0.96), but optimal internal consistency (0.90) of a six-item short form (MSIS-SF; first six MSIS items). The MSIS-20 and MSIS-SF showed comparably strong associations with objective physical disability. The MSIS-SF provides a psychometrically robust, less burdensome, and time-efficient option for assessing patient-reported physical disturbance.

BackgroundPresence of cerebral microbleeds (CMB) on MRI brain, increases risk of intracerebral haemorrhage in patients with atrial fibrillation (AF) who require anticoagulation. The retina shares similar embryological and pathological properties with cerebral vessels. Studying changes in retinal vasculature at capillary level associated with presence of CMB may provide complementary prognostic information to assess risk of anticoagulant-related intracerebral hemorrhage. We aimed to investigate changes in the retinal capillary network associated with presence of CMB in patients with AF using Optical Coherence Tomography-Angiography (OCT-A). MethodsPatients with AF were prospectively recruited to undergo both OCT-A and MRI brain. OCT-A metrics of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at macular region, along with the radial peripapillary capillary network at disc center were measured quantitatively by an automated image analysis program. Multivariable logistic regression and quasi-poisson regression were performed to investigate the association of OCT-A metrics with presence and burden of CMBs respectively. Significant OCT-A metrics were compared between patients with AF and healthy control subjects. ResultsAmong 99 patients with AF, 29 patients had CMB. A larger foveal avascular zone (FAZ) in SCP, also higher vessel diameter index (VDI) across SCP, DCP and disc center were significantly associated with presence and burden of CMB, after adjusting for age, diabetes mellitus, white matter hyperintensities ratio, image quality index, age, duration between OCT-A and MRI. A lower vessel density in SCP was associated with presence but not burden of CMB. Compared with healthy control, FAZ and VDI across SCP, DCP and disc area remained consistently different between patients with AF and control group. ConclusionsThis pilot study provides preliminary data supporting potential role of OCT-A to assist risk-stratification of bleeding-prone microangiopathy for patients with AF who require anticoagulation. Further studies with larger sample size and different ethnic groups are needed.

IntroductionThe use of electroacupuncture (EA) in post-ischemic stroke and rehabilitation has been the subject of numerous studies; however, the effect of EA on cholesterol metabolites has not been thoroughly investigated. The inflammatory response in stroke has been associated with serum cholesterol, low HDL-Cc, and high LDL-Cc levels, and early intervention has been linked to improved post-stroke rehabilitation. This study aimed to assess the impact of EA on early ischemic stroke as a modulator of total cholesterol, HDL-c, and LDL-c in the blood, its anti-inflammatory effect, and its effect on pain and stroke scales in patients in the first few days after the onset of stroke. Data Access StatementThe datasets generated during the current study are available from the corresponding author on reasonable request Material and MethodA total of 90 patients with acute ischemic stroke and a first-time diagnosis of stroke will be randomized into one of three groups: an EA group, a sham EA group, and a sensory control group. All patients will receive the interventions three times a week for a total of six sessions over two weeks. Outcome measurements will include blood tests for total cholesterol, triglycerides, HDL with HDL-c cholesterol, LDL and LDL-c cholesterol, along with Visual Analog Scale (VAS), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index (BI). Expected OutcomeThis study will help determine the effect of EA on ischemic stroke recovery, focusing on metabolic changes in patients with early stage stroke. EA treatment might modify risk indices (HDL-c), maintain or control (LDL-c), and generate localized reperfusion of the vascular areas involved in stroke. DiscussionThis randomized controlled trial will determine the ability of EA to support early stroke ischemic injury and neuro-endothelium damage, which could lead to a faster stroke recovery in stroke scales, and reveal whether the mechanism of EA is associated with a reduced inflammatory process via modulation of the levels of total cholesterol, HDL-c, LDL-c, and triglycerides. The results of this study will be of significant value in the treatment of ischemic stroke and could lead to more effective and personalized stroke rehabilitation therapies. Trial registryregistered study protocol on www.clinicaltrial.gov (NCT05734976)

BackgroundCompromised cerebral blood flow has been identified as a contributing risk factor for future ischemic events in patients with symptomatic carotid artery disease. Nevertheless, the hemodynamic impact of carotid stenosis is rarely evaluated. The aim of this observational cross-section study was to investigate how a reduced internal carotid artery (ICA) blood flow rate (BFR), rather than stenosis degree, relates to BFR in the cerebral arteries. MethodsFour-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI) was used to measure cerebral blood flow in 38 patients with symptomatic carotid stenosis ([&ge;]50%), being considered for carotid endarterectomy. The BFR in the cerebral arteries was compared between two subgroups that were based on the BFR in the symptomatic (ipsilateral) ICA: I. reduced ICA flow (<160 mL/min) i.e., 2 SD <normal ICA BFR; II. preserved ICA flow ([&ge;]160 mL/min). Furthermore, BFR laterality was defined as a difference in the paired ipsilateral-contralateral arteries within the groups. ResultsThe degree of stenosis was not significantly different between the two subgroups (72% vs. 80%; P=0.09). In the reduced group compared to the preserved ICA flow group, a reduced BFR was found in the ipsilateral middle cerebral artery (MCA) (108{+/-}32 vs. 136{+/-}24 mL/min; P<0.01) and anterior cerebral artery (A1 segment) (-6{+/-}47 vs. 81{+/-}27 mL/min; P<0.001), while the BFR was increased in the contralateral A1 segment (152{+/-}79 vs. 82{+/-}41 mL/min; P<0.001). There was also a reversed BFR in the posterior communicating artery and ophthalmic artery on the ipsilateral side in the group with reduced ICA flow. BFR laterality was observed in all paired arteries in the reduced ICA flow group (P<0.05), while there was no laterality in the preserved ICA flow group (P>0.05). Conclusions4D-PCMRI revealed compromised cerebral blood flow in patients with carotid stenosis, not possible to detect by solely analyzing the stenosis degree. In patients with reduced ICA flow, collateral recruitment was not sufficient to maintain symmetrical BFR distribution to the two hemispheres.