research magnet Research Magnet news Medical News

View research about

Essential mixed cryoglobulinemia Dentist Paediatric Cardiology Autoimmune dysautonomia Pain Medicine Fitness Inclusion body myositis (IBM) Juvenile myositis (JM) Pathology Sarcoma Colorectal Cancer Alopecia areata Pemphigus Vascular Surgery Cleft Lip Gall Bladder Cancer Dementia Dermatomyositis Progesterone dermatitis Transverse myelitis Sports Medicine Medical Charity ADHD Foot & Ankle Orthopaedics Cosmetic Surgery Interstitial cystitis (IC) Brain Tumor Primary Biliary Cholangitis Endocrinology Subacute bacterial endocarditis (SBE) Leukodystrophy Procedural Dermatology Molecular Genetic Pathology Autoimmune retinopathy Heart Failure Coronary Artery Disease Narcolepsy Peripheral neuropathy Malignant Hypertension Implantology Angina Paediatric Dentistry Transplant Heamatology Pure red cell aplasia (PRCA) Castleman disease (CD) Nephrology Autoimmune encephalomyelitis Chronic Lymphocytic Leukaemia Orthopaedic Surgery Bile Duct Cancer Undifferentiated connective tissue disease (UCTD) Dressler’s syndrome Dermatology Hyperlipidaemia Cold agglutinin disease Musculoskeletal Oncology Cardiothoracic Surgery Doctor Optic neuritis Epilepsy Parkinson’s Disease Surgical Oncology Ocular cicatricial pemphigoid Overactive Bladder Devic’s disease (neuromyelitis optica) Anti-GBM/Anti-TBM nephritis Autoimmune myocarditis Polymyalgia rheumatica Lower GI Guillain Barre Syndrome Temporal arteritis/Giant cell arteritis Low Back Pain Lung Cancer Hand Surgery Paediatric Surgery Hypertriglyceridemia Perivenous encephalomyelitis Neuroendocrine Tumors Antiphospholipid syndrome Spinal Cord Injury Upper GI Biochemical Genetics Microbiology Reflex sympathetic dystrophy COVID-19 Henoch-Schonlein purpura (HSP) Chronic inflammatory demyelinating polyneuropathy (CIDP) Polyglandular syndromes type I, II, III Paediatric ICU Maternal & Fetal Medicine Cancer Hypogammalglobulinemia Endovascular surgery Discoid lupus Hip & Knee Osteoarthritis Asthma Rheumatic fever Parry Romberg syndrome Pediatrics Obesity & Bariatrics Pancreatic Cancer Prediabetes Syncope & Collapse Microscopic polyangiitis (MPA) Hospice And Palliative Medicine Urology Behcet’s disease General Medicine / Internal Medicine Granulomatosis with Polyangiitis Spina Bifida Thoracic Surgery Neonatal & Perinatal Medicine Bladder Cancer Hepatology Ophthalmology Podiatrist Traumatic Brain Injury Coronavirus Transplant Hepatology Clinical Pharmacology Autoimmune orchitis Specialist In Training Chronic recurrent multifocal osteomyelitis (CRMO) Occupational & Environmental Medicine Liver Cancer Vaginal Cancer Clinic Ankylosing spondylitis Neurosurgery Schmidt syndrome General Surgery Hidradenitis Suppurativa (HS) (Acne Inversa) Evans syndrome Obstetrics And Gynecology Chiropractor Dermatological Immunology Pulmonology Stem Cell Research Pyoderma gangrenosum Psychiatry Immunology & Allergy Amyloidosis Critical Care Ulcerative colitis (UC) Retroperitoneal fibrosis Autoimmune inner ear disease (AIED) Peripheral Vascular Disease Depression Undersea & Hyperbaric Medicine Mona Vale ED Acute Myeloid Leukaemia Thyroid eye disease (TED) Herpes gestationis or pemphigoid gestationis (PG) Psoriasis Lupus Macular Degeneration Pernicious anemia (PA) Head & Neck Surgery Geriatric Psychiatry Cardiology Pharmacy Reactive Arthritis Melanoma Psychosomatic Medicine Linear IgA disease (LAD) Chronic Kidney Disease Palliative Medicine Bullous pemphigoid Clinical Cytogenetics Mitochondrial Myopathies Chronic Ischaemic Heart Disease Audiologist Congenital heart block Tropical Medicine Adolescent Medicine Otology Neurotology Dermatitis herpetiformis Juvenile diabetes (Type 1 diabetes) Muscular Dystrophy Clinical Paediatric Genetics Moya Moya Disease Prostate Cancer Myelin Oligodendrocyte Glycoprotein Antibody Disorder Churg-Strauss Syndrome Restless legs syndrome (RLS) ENT Paediatric Physician Pregnancy Reproductive Endocrinology & Infertility Vulval Cancer Giant cell myocarditis Alzheimers Autoimmune oophoritis Sympathetic ophthalmia (SO) Benign Hypertension Aerospace Medicine Speech Pathologist Medical Administration Palindromic rheumatism (PR) Atrial Fibrillation Transplant Nuclear Medicine Women's Health Breast Fibromyalgia Meningitis CREST syndrome Takayasu’s arteritis Osteopathy Relapsing polychondritis Kawasaki disease Ligneous conjunctivitis Huntingtons Disease Goodpasture’s syndrome COPD Bowel Cancer Skin Cancer Mooren’s ulcer Pars planitis (peripheral uveitis) Inflammatory Arthritis Primary sclerosing cholangitis Haematology Rural & Remote Agammaglobulinemia Organ Donation Raynaud’s phenomenon Addiction Psychiatry Histopathology Vogt-Koyanagi-Harada Disease Hashimoto’s thyroiditis Radiation Oncology Paediatric Respiratory Baló disease Craniofacial Surgery Anal Cancer Medical Organisation Chiropractice Infectious Disease Clinical Researcher Laboratory Immunology Sexual Health Medicine Addison’s disease Achalasia Vitiligo Scleroderma Eosinophilic esophagitis (EoE) Parsonage-Turner syndrome Rare Disease Craniofacial Microsomia Immune thrombocytopenic purpura (ITP) Lambert-Eaton syndrome Rare Diseases Coeliac disease Neurodevelopmental Disabilities Sleep Medicine Lichen planus Mircobiology Diabetes & Metabolism Burns Cystic Fibrosis Optometry Spinal Surgery Clinical Cardiac Electrophysiology Complementary Medicine Delirium Physiotherapy Emergency Medicine Brain Injury Medicine Hospital Geriatric Medicine Polymyositis Insulin Resistance Fibrosing alveolitis Anesthesiology Neuro Ophthalmology Axonal & neuronal neuropathy (AMAN) MedicalDirector software Testicular Cancer Schizophrenia Mucha-Habermann disease Rheumatology Womb Cancer Clinical Genetics Adult Reconstructive Orthopaedics Gynecologic Oncology Neonatal Lupus Chronic Myeloid Leukaemia Gynaecology Pediatric Allergy & Immunology Paediatric Emergency Medicine Uveitis & Ocular Immunology Hemolytic anemia Internal Medicine Oesophaegal Cancer Forensic Psychiatry Physiotherapist Paediatric Orthopaedics Oncology Cerebral Atherosclerosis Myeloma cleft palate Provider Postpericardiotomy syndrome Penile Cancer Neurology Queer Health Occupational Therapy Cardiothoracic Intensive Care Chinese Medical Practitioner Cerebrovascular & Skull Base Surgery Disaster Medicine Chagas disease Intensive Care Medicine International Health Sleep Apnoea Glomerulonephritis Psychologist Nutrition Graves’ disease TIA Interventional Radiology Acute Lymphoblastic Leukaemia Thyroid Cancer Dietician Crohn’s disease Sports & Exercise Medicine Scleritis Advanced Heart Failure & Transplant Cardiology Orthodontics Adult Still's disease Dentistry Myelodysplasia Cicatricial pemphigoid Paramedicine Cosmetic Medicine Lichen sclerosus Radiology Multiple Sclerosis Neuro Oncology Child And Adolescent Psychiatry Geriatric Wellness Polyarteritis nodosa Phonetics Hypercholesterolaemia Neurodegenerative Disorders Myocardial infarction Kidney Cancer Stiff person syndrome (SPS) Cataracts Neuro Intensive Care Susac’s syndrome Neuromuscular Medicine Leukocytoclastic vasculitis POEMS syndrome Eosinophilic fasciitis Cogan’s syndrome Thrombocytopenic purpura (TTP) Meniere’s disease Ophthalmic Pathology Endovascular Surgical Neuroradiology Optometrist Audiology Sperm & testicular autoimmunity Carotid Artery occlusion Adult Cardiothoracic Anesthesiology Gastroenterology Giant cell arteritis (temporal arteritis) Simulation Medicine Sjögren’s syndrome Stroke Multifocal Motor Neuropathy (MMN) Autoimmune urticaria HIV / AIDS Female Pelvic Medicine & Reconstructive Surgery Respiratory Medicine IgG4-related sclerosing disease Tolosa-Hunt syndrome (THS) Nurse Juvenile arthritis Celiac disease Diabetes Mellitus Mouth, Head and Neck Cancer Pharmacist Sarcoidosis Autoimmune pancreatitis Oral Health Dermatopathology Laryngeal Cancer Lyme disease chronic Autoimmune hepatitis Paraneoplastic cerebellar degeneration (PCD) Interventional Cardiology Technology Podiatry Endoscopy Stomach Cancer Patient Paroxysmal nocturnal hemoglobinuria (PNH) Psychology Benign mucosal pemphigoid Psoriatic arthritis Endometriosis Obstetric Anesthesiology Healthcare Otolaryngology Bariatric Surgery Coxsackie myocarditis Breast Cancer Nuclear Radiology Applied Dermatology Metabolic Syndrome Cervical Cancer Uterine Cancer Eye Cancer Diagnostic Laboratory Immunology Transplant Pulmonology IgA Nephropathy Public Health Rehabilitation Medicine Erythema nodosum Mesothelioma Robotic Surgery Inflammatory Bowel Disease Clinical Immunology General Practice (Family Medicine) Toxicology ATSI Health Practitioner Non Hodgkin Lymphoma Transplant Nephrology Wheel Travel Medicine Neutropenia Public Health Medicine Musculoskeletal Radiology Retrieval Medicine Blood Cancer Ovarian Cancer Addiction Medicine Plastic Surgery Conference Organiser Osteopath Oral & Maxillofacial Surgery Motor Neuron Disease Occupational Therapist Trauma Cerebral Palsy Autoimmune angioedema

The latest medical research on Stroke

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about stroke gathered by our medical AI research bot.

The selection below is filtered by medical specialty. Registered users get access to the Plexa Intelligent Filtering System that personalises your dashboard to display only content that is relevant to you.

Want more personalised results?

Request Access

Natural Evolution of Incomplete Reperfusion in Patients following Endovascular Therapy after Ischemic Stroke.

Stroke

A third of endovascularly treated stroke patients experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, eTICI<3) and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy.

A systematic review of MEDLINE, Embase and PubMed up until March 1, 2024 using a predefined strategy. Only full-text English written articles reporting rates of either favorable (i.e., delayed reperfusion or no new infarct) or unfavorable progression (i.e., persistent perfusion deficit or new infarct) of incompletely reperfused tissue were included. Primary outcome was the rate of delayed reperfusion and its association with functional independence (modified Rankin Scale, mRS 0-2) at 90 days post-intervention. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model.

Six studies involving 950 patients (50.7% female; median age 71, IQR 60-79) were included. Four studies assessed the evolution of incomplete reperfusion on MRI perfusion imaging, while two studies used DWI and NCCT imaging, where new infarct was used to denote unfavorable progression. Five studies defined incomplete reperfusion as eTICI2b50 or 2c. Delayed reperfusion occurred in 41% (IQR 33%-51%) of cases 24h post-intervention. Achieving delayed reperfusion was associated with higher likelihood of functional independence at 90 days (OR 2.5, 95%CI 1.9-3.4).

Nearly half of eTICI<3 patients achieve delayed reperfusion, leading to favorable clinical outcome. This subgroup may derive limited or potentially harmful effects from pursuing additional reperfusion strategies (e.g., intra-arterial lytics or secondary thrombectomy). Accurately predicting the evolution of incomplete reperfusion could optimize patient selection for adjunctive reperfusion strategies at the end of an intervention.

NSAID Allergy Labels Associated With Mortality and Cardiovascular Outcomes in Stroke.

Stroke

Mislabeled drug allergy can restrict future prescriptions and medication use, but its prevalence and impact among patients with stroke remain unknown. This study investigated the prevalence of the most commonly labeled drug allergies, their accuracy, and their impact among patients with stroke.

In this combined longitudinal and cross-sectional study, we compared the prevalence of allergy labels among the general population and patients with ischemic stroke between 2008 and 2014 from electronic health care records in Hong Kong. Outcomes between patients with stroke with or without the most prevalent labels (ie, NSAID) were compared. Rate of mislabeled NSAID allergy was confirmed by provocation testing.

Compared with the general population (n=702 966), patients with stroke had more labels (n=235) to cardiovascular and hematopoietic system (prevalence, 19.5% versus 9.2%; odds ratio [OR], 2.4 [95% CI, 1.74-3.32]; P<0.001) and radiographic and diagnostic agents (prevalence, 4.2% versus 0.9%; OR, 4.82 [95% CI, 2.56-9.08]; P<0.001). The most common labels were to NSAID (prevalence, 1.8%). Patients with NSAID allergy labels were significantly less likely to be prescribed aspirin after acute stroke (OR, 0.24 [95% CI, 0.09-0.60]; P=0.003) and on follow-up (OR, 0.22 [95% CI, 0.08-0.56]; P=0.002). The median duration of follow-up was 6.7 years (6499±2.49 patient-years). Patients with stroke with NSAID allergy labels also experienced significantly higher mortality (OR, 7.44 [95% CI, 2.44-23.18]; P<0.001), peripheral vascular disease (OR, 9.35 [95% CI, 1.95-44.86]; P=0.005), and major adverse cardiovascular events (OR, 6.09 [95% CI, 2.00-18.58]; P=0.001) in the poststroke period. Patients with NSAID allergy labels (who remained alive and could consent) were referred for allergist assessment and offered drug provocation testing. The majority (80%; 4/5) had negative provocation tests and were delabeled.

NSAID allergy labels were significantly more prevalent among patients with stroke, associated with excessive mortality, peripheral vascular disease, and major adverse cardiovascular events. Given the high rate of mislabeled allergies, multidisciplinary neuro-allergy interventions could have the potential to improve patient outcomes.

EXCELLENT Registry: A Prospective, Multicenter, Global Registry of Endovascular Stroke Treatment With the EMBOTRAP Device.

Stroke

The EXCELLENT registry aimed to evaluate the effectiveness of the EMBOTRAP Revascularization Device in an all-comer population in a real-world setting, with a focus on the composition of retrieved clots.

EXCELLENT is a prospective, global registry of patients with acute ischemic stroke treated with EMBOTRAP as the first-line mechanical thrombectomy device conducted at 34 sites (25 sites contributing clot) from September 2018 to March 2021, utilizing core imaging and central histology laboratories blinded to clinical data, independent 90-day modified Rankin Scale assessment and Clinical Events Committee.

After screening 3799 patients, a total of 997 subjects (mean age, 70.0±14.2 years; 51.8% women; 19.7% non-White) were included. The first-pass modified Treatment in Cerebral Infarction (mTICI) ≥2b rate was 64.5% (623/966), first-pass mTICI ≥2c was 39.1% (378/966), and final mTICI ≥2b was 94.5% (931/985). A total of 427/912 (46.8%) patients achieved a 90-day modified Rankin Scale of 0 to 2 or ≤baseline. Embolization to a new territory occurred in 0.2% (2/984), and symptomatic intracranial hemorrhage at 24 hours in 1.6% (16/997). The 90-day mortality was 19.1% (175/918). Device- and/or procedure-related serious adverse events occurred in 5.9% (54/912) through 90 days. The mean RBC percentage of retrieved clots was 45.62±21.372. Among patients who achieved mTICI ≥2b with the first pass, 15.7% (52/331) and 9.7% (32/331), respectively, had RBC-poor (<25%) and RBC-rich (>75%) clots. Patients with no clot retrieved in any procedural pass had a lower percentage of hyperdense or susceptibility vessel sign on baseline imaging (58.9% versus 74.7%; P<0.001), pointing to a potential preprocedure indicator of challenging clot.

The EXCELLENT registry informs real-world practices in mechanical thrombectomy and sheds light on the range of clots effectively retrieved by current technology. This is the first report of detailed patient characteristics where mechanical thrombectomy maneuvers failed to remove any clot material. Although the composition of nonretrievable clots cannot be assessed histologically, the results support the notion that no retrieval may be correlated with imaging findings suggesting clots lower in RBC.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03685578.

WMH Contributions to Cognitive Impairment: Rationale and Design of the Diverse VCID Study.

Stroke

As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequ...

Cerebral Infarct Growth: Pathophysiology, Pragmatic Assessment, and Clinical Implications.

Stroke

Cerebral ischemic injury occurs when blood flow drops below a critical level, resulting in an energy failure. The progressive transformation of hyp...

Neuroprotective Effects of Rapid Local Ischemic Postconditioning in Successful Endovascular Thrombectomy Patients.

Stroke

We aim to assess the efficacy of rapid local ischemic postconditioning (RL-IPostC) following successful reperfusion in patients with acute ischemic stroke with anterior circulation large vessel occlusion who underwent endovascular thrombectomy.

We conducted an ambidirectional cohort study with 78 prospectively enrolled patients with RL-IPostC and endovascular thrombectomy and 129 retrospectively enrolled patients with endovascular thrombectomy. The RL-IPostC procedure involved 5 cycles of 15-s balloon inflation and deflation in the ipsilateral internal carotid artery. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0 to 2. Secondary outcomes included excellent outcomes (modified Rankin Scale score, 0-1) and early therapeutic response. Imaging outcomes involved infarct volume changes and cerebral edema measurements. Outcomes were compared with postpropensity score matching (1:1) and assessed using univariable and multivariable regression models.

In the matched cohort of 136 patients (mean age, 71±14 years; 70 men [51%]), RL-IPostC was associated with a higher rate of functional independence (adjusted odds ratio, 2.47 [95% CI, 1.10-5.68]; P=0.030). The RL-IPostC group exhibited significantly reduced infarct volumes at 24 hours (difference, -12.2 [95% CI, -23.9 to -0.53]; P=0.041) and less infarct growth (difference, -12.2 [95% CI, -23.9 to -0.45]; P=0.042). Furthermore, RL-IPostC correlated with lower increases in net water uptake (difference, -0.04 [95% CI, -0.07 to -0.01]; P=0.018), lower decrease cerebrospinal fluid volume (difference, -7.75 [95% CI, -11.7 to -3.84]; P<0.001), and reduced midline shift at 24 hours (difference, -1.39 [95% CI, -2.48 to -0.30]; P=0.013).

RL-IPostC tends to promote functional independence and reduces infarct growth and cerebral edema in patients with acute ischemic stroke post-reperfusion.

Diastolic Dysfunction and the Risk of Stroke and Major Bleeding.

Stroke

Left ventricular diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes including atrial fibrillation. Whether DD is independently associated with incident stroke and transient ischemic attack (TIA) and with bleeding events is not known. We performed this observational cohort analysis to examine the impact of DD on the risk of stroke/TIA and major bleeding.

Patients who underwent at least 1 cardiac echocardiogram and were followed for at least 3 months were included in this study. Patients with a prior history of stroke, TIA, or major bleeding, as determined by International Classifications of Diseases codes, were excluded. Smart key-phrase search was applied to echocardiographic reports to classify patients into 4 groups based on the most severe DD assessment. Patients in whom the presence of DD could not be determined were excluded. The final study cohort was followed to the end point of hospital admission for stroke/TIA and major bleeding, and independent predictors of these events were evaluated using the multivariable Cox proportional hazards method.

The final study cohort (age, 56±18 years; 56% women) had 96 702 patients with no DD and 18 164, 5881, and 1340 patients with DD grades I, II, and III, respectively. Over a median follow-up of 3.4 years, 2938 (2.4%) patients were hospitalized for stroke/TIA and 5567 (4.6%) for major bleeding. After adjusting for age, the CHA2DS2-VASc score, chronic kidney disease, use of antiplatelet agents, use of anticoagulation agents, the year of echocardiographic testing, household income, and history of atrial fibrillation, DD remained a strong predictor of incident stroke/TIA (hazard ratio, 1.22 per grade increase in DD [95% CI, 1.16-1.29]; P<0.001) and major bleeding (hazard ratio, 1.20 per grade increase in DD [95% CI, 1.16-1.25]; P<0.001).

DD is independently associated with a higher risk of cerebrovascular accidents and major bleeding. DD should be considered when counseling patients regarding their risk profile and management options.

Anti-Inflammatory Thrombolytic JX10 (TMS-007) in Late Presentation of Acute Ischemic Stroke.

Stroke

Contemporary thrombolytics in acute ischemic stroke are limited to administration within 4.5 hours of last known normal. JX10 (formerly TMS-007), a Stachybotrys microspora triprenyl phenol family member, may extend this therapeutic window.

In this multicenter, randomized, double-blind, placebo-controlled, dose-escalation phase 2a study, JX10 or placebo was administered as a single intravenous infusion to Japanese patients with acute ischemic stroke who were unable to receive tissue-plasminogen activator or thrombectomy within 12 hours of last known normal. Primary end point was incidence of symptomatic intracranial hemorrhage with a worsening National Institutes of Health Stroke Scale score of ≥4 points within 24 hours of drug administration (symptomatic intracranial hemorrhage incidence).

Ninety patients received either placebo (n=38; female 26.3%) or JX10 at 1, 3, or 6 mg/kg (n=6, 18, 28; female 0%, 33.3%, and 42.9%, respectively). Median age (range) and baseline median (range) National Institutes of Health Stroke Scale scores were respectively 76.5 (42-87) and 8 (6-21) for the combined JX10 cohort (JX10 Cohorts) and 75.0 (34-85) and 8 (6-22) for placebo. Median (range) dosing time since last known normal was 9.5 (5.0-12.1) and 10.0 (3.7-12.0) hours for JX10 Cohorts and placebo, respectively. Symptomatic intracranial hemorrhage incidence was 0% (0/52 [95% CI, 0.0-5.6]) for JX10 Cohorts versus 2.6% (1/38 [95% CI, 0.1-13.8]) for placebo (P=0.42). Vessel patency at 24 hours (secondary end point) in patients with baseline arterial occlusive lesion score <3 (39/90) improved in 58.3% (14/24) of patients in JX10 Cohorts versus 26.7% (4/15) for placebo (odds ratio, 4.23 [95% CI, 0.99-18.07]). In JX10 Cohorts, a significantly higher proportion of patients had modified Rankin Scale scores of 0 to 1 on day 90 (secondary end point) versus placebo (JX10: 21/52, 40.4% versus placebo: 7/38, 18.4%; P=0.03).

JX10 was well tolerated and may expand the acute ischemic stroke therapeutic window as a novel thrombolytic agent.

URL: https://rctportal.niph.go.jp/en; Unique identifier: jRCT2080223786.

Menstruation: An Important Indicator for Assessing Stroke Risk and Its Outcomes.

Stroke

In recent years, stroke incidence in older adults has declined strikingly, but stroke in younger women has become more common. Abnormalities of men...

Interfacility Transfer for Thrombectomy: A Promising Therapeutic Window.

Stroke

Currently, most acute ischemic stroke patients presenting with a large vessel occlusion are first evaluated at a nonthrombectomy-capable center bef...

Polygenic Risk of Epilepsy and Poststroke Epilepsy.

Stroke

Epilepsy is highly heritable, with numerous known genetic risk loci. However, the genetic predisposition's role in poststroke epilepsy (PSE) remains understudied. This study assesses whether a higher genetic predisposition to epilepsy raises poststroke survivor's risk of PSE.

We conducted a case-control genetic association study nested within the UK Biobank, a large UK-based prospective cohort. Our exposures of interest were 2 distinct polygenic risk scores-generalized and focal epilepsy-modeled as deciles and constructed using genetic variants identified in the latest International League Against Epilepsy genome-wide association study meta-analysis. We aimed to evaluate the association between these polygenic risk scores and their corresponding subtype of PSE-generalized and focal. In sensitivity analyses, we evaluated participants of European ancestry separately and considered focal and generalized epilepsy outcomes in participants without a history of stroke. In secondary analyses, we evaluated the polygenic risk of PSE by stroke subtype (ischemic, hemorrhagic, or any stroke). Multivariable logistic regression models were fitted, adjusting for age, sex, genetic ancestry, and the first 5 principal genetic components.

Among 17 549 UK Biobank stroke survivors with available genetic information (mean age, 61; 43% female), 185 (1%) developed generalized PSE, while 124 (0.7%) developed focal PSE. Multivariable logistic regression results showed that, when compared against the lowest decile, participants within the highest PRS decile for generalized PSE had 5-fold higher odds of developing generalized PSE (OR, 5.05 [95% CI, 2.37-12.5]; P trend<0.001). Similarly, when compared against the lowest decile, participants within the highest polygenic risk score decile for focal PSE had 3-fold higher odds of developing focal PSE (OR, 3.20; [5% CI, 1.25-9.82]; P trend=0.024). Sensitivity analyses among participants of European ancestry yielded similar results.

Our findings suggest that, like other forms of epilepsy, genetic predisposition plays an essential role in PSE. These results underscore the need for future studies to elucidate the mechanisms underlying PSE development and to identify novel therapeutic avenues.

Care Quality and Outcomes of Ischemic Stroke in Patients With Premorbid Dementia: Get With The Guidelines-Stroke Registry.

Stroke

Patients with premorbid dementia have been generally excluded from trials of stroke therapies, and their dementia diagnosis may affect the care received. There are few data on the quality of stroke care and outcomes in these patients.

We compared the quality of care and outcomes for acute ischemic stroke patients with versus without premorbid dementia using national data from the Get With The Guidelines-Stroke registry between July 1, 2020, and December 31, 2021. Process outcomes included receiving intravenous thrombolysis, endovascular thrombectomy, and additional national quality measures. Clinical outcomes included ambulatory status at discharge, discharge destination, and mortality. The analyses were adjusted for patient and hospital characteristics.

Among 609 350 patients with acute ischemic stroke, 29 751 of 546 407 (5.4%) had documented prestroke dementia (median age, 84 [interquartile range, 78-89]; 62.8% female). Patients with versus without premorbid dementia were more likely to arrive via emergency medical services (70.5% versus 46.8%) and had more severe strokes (median National Institutes of Health Stroke Scale score, 7 [interquartile range, 3-15] versus 3 [interquartile range, 1-8]). They were less likely to be admitted to a comprehensive stroke center (17.9% versus 22.7%; P<0.0001), to receive intravenous thrombolysis (9.6% versus 11.1%; adjusted odds ratio [aOR], 0.91 [95% CI, 0.87-0.95]) or endovascular thrombectomy (4.5% versus 7.4%; aOR, 0.62 [95% CI, 0.56-0.68]), attain each of the Get With The Guidelines-Stroke Achievement Measures and Quality Measures, or attain defect-free stroke care (92.0% versus 95.0%; aOR, 0.75 [95% CI, 0.71-0.78]). Patients with premorbid dementia had longer door-to-needle times (adjusted difference, 3.17 minutes [95% CI, 1.34-5.01]), lower odds of being discharged home (43.8% versus 60.1%; aOR, 0.96 [95% CI, 0.93-1.00]), and higher odds of being nonambulatory at discharge (25.8% versus 9.3%; aOR, 1.62 [95% CI, 1.54-1.69]), and of in-hospital mortality or hospice admission (23.3% versus 8.6%; aOR, 1.38 [95% CI, 1.32-1.43]). Symptomatic intracranial hemorrhage after intravenous thrombolysis/endovascular thrombectomy did not differ (5.3% versus 3.7%; aOR, 1.13 [95% CI, 0.97-1.31]).

Patients with premorbid dementia experienced slightly poorer quality of stroke care across multiple measures, were less likely to receive acute stroke interventions, and had worse poststroke outcomes than patients without dementia in a large nationwide registry. Our findings underscore the need for concerted efforts to further improve care quality and outcomes in this population.