Clinical associations and prognostic value of MRI-visible perivascular spaces in patients with ischemic stroke or TIA: a pooled analysis

BACKGROUND AND OBJECTIVES: Visible perivascular spaces are an MRI marker of cerebral small vessel disease and might predict future stroke. However, results from existing studies vary. We aimed to clarify this through a large collaborative multicenter analysis. METHODS: We pooled individual patient data from a consortium of prospective cohort studies. Participants had recent ischemic stroke or transient ischemic attack (TIA), underwent baseline MRI, and were followed up for ischemic stroke and symptomatic intracranial hemorrhage (ICH). Perivascular spaces in the basal ganglia (BGPVS) and perivascular spaces in the centrum semiovale (CSOPVS) were rated locally using a validated visual scale. We investigated clinical and radiologic associations cross-sectionally using multinomial logistic regression and prospective associations with ischemic stroke and ICH using Cox regression. RESULTS: We included 7,778 participants (mean age 70.6 years; 42.7% female) from 16 studies, followed up for a median of 1.44 years. Eighty ICH and 424 ischemic strokes occurred. BGPVS were associated with increasing age, hypertension, previous ischemic stroke, previous ICH, lacunes, cerebral microbleeds, and white matter hyperintensities. CSOPVS showed consistently weaker associations. Prospectively, after adjusting for potential confounders including cerebral microbleeds, increasing BGPVS burden was independently associated with future ischemic stroke (versus 0-10 BGPVS, 11-20 BGPVS: HR 1.19, 95% CI 0.93-1.53; 21+ BGPVS: HR 1.50, 95% CI 1.10-2.06; = 0.040). Higher BGPVS burden was associated with increased ICH risk in univariable analysis, but not in adjusted analyses. CSOPVS were not significantly associated with either outcome. DISCUSSION: In patients with ischemic stroke or TIA, increasing BGPVS burden is associated with more severe cerebral small vessel disease and higher ischemic stroke risk. Neither BGPVS nor CSOPVS were independently associated with future ICH

Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

OBJECTIVES: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with Vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet) METHODS: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use. RESULTS: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (aHR 2.74, 95% confidence interval 1.76 - 4.26) and ischemic stroke (aHR 1.29, 95% confidence interval 1.04 - 1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleeds burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2-4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥11 microbleeds (94 vs 48 per 1,000 patient-years). INTERPRETATION: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. This article is protected by copyright. All rights reserved

Disrupting Disconnections: A Case Study of One First-Gen Student’s Quest to Belong

Increasing consensus about the value of a college degree in providing socioeconomic mobility and better health outcomes for communities experiencing poverty has contributed to rising college matriculation rates for first-gen students. One in three students in college are first-gen, yet college completion rates for first-gen students are significantly lower than the national average in the United States (10% versus 60%) (Forrest Cataldi et al., 2018). While there are various factors that contribute to the disparity in graduation outcomes, this dissertation focuses on the role a sense of belonging plays. Research on a sense of belonging has shown that higher rates of belonging are correlated with high academic achievement for all students, and low rates of belonging are particularly detrimental for first-gen students’ academic achievement, which is correlated with graduation outcomes (Gopalan & Brady, 2019). The complex psychological dynamics students experience as they navigate and develop their individual sense of belonging on their campuses warrants further study to better understand the phenomenon (Strayhorn, 2012). The first paper of this two-paper dissertation provides a comprehensive literature review on college outcomes and theories on college student belonging. The second paper presents a qualitative exploratory case study of one first-gen student’s quest to belong on their campus. The case study utilizes a Relational Cultural Theory lens from which to understand and explore the nuanced experiences of belonging that develop as this student navigates their college experience. An analysis of the interview data illustrates several significant themes: an inherent yearning for connection and relationship with others; the critical nature of growth-fostering moments and people; and the active disconnecting from the campus and from others as a strategy for survival, particularly if the yearning for connection and belonging is unmet. These findings have several implications for practice for those working with first-gen students including those in higher education. First, the findings suggest that the sense of disconnection that first-gen students experience can be invisible and hard to gauge from quantitative data alone (class attendance, test scores). Second, belonging often is experienced in phases and cycles and disrupting the cycle of disconnection can be possible through growth-fostering moments. Third, relationships matter, including relationships with peers, faculty, advisors and other staff at colleges that all have the potential to leave an imprint on how a first-gen student negotiates the various emotions of belonging at any given moment

Organization of stroke care in Turkey

Stroke is one of the major health problems in Turkey. Since cerebrovascular disease is the second leading cause of death, institutional organizations are important to decrease the burden of stroke in our country. Although the number of comprehensive stroke centers has been increasing constantly and many significant improvements have been realized in last years, there are still some regions without a comprehensive stroke center in Turkey

Non-prescripted usage of psychostimulant drugs by medical students

6th Congress of the European-Academy-of-Neurology (EAN) -- MAY 23-26, 2020 -- ELECTR NETWORKWOS: 000534616800419[No abstract available]Europ Acad Neuro

Auditory Delta Event-Related Oscillatory Responses are Decreased in Alzheimer’s Disease

Background: Visual delta event-related (ERO) and evoked oscillations (EO) of Alzheimer patients (AD) are different than healthy. In the present study, the analysis is extented to include auditory ERO and EO in AD. The rationale is to reveal whether the auditory ERO delta responses are also reduced, and whether this is a general phenomenon in Alzheimer patients upon applying stimuli with cognitive load. Methods: Thirty-four mild AD subjects (17 de-novo and 17 medicated (cholinergic)) and seventeen healthy controls were included. Auditory oddball paradigm and sensory auditory stimuli were applied to the subjects. Oscillatory responses were analyzed by measuring maximum amplitudes in delta frequency range (0.5–3.5 Hz). Results: Auditory delta ERO (0.5–3.5 Hz) responses of healthy controls were higher than either de-novo AD or medicated AD group, without a difference between two AD subgroups. Furthermore, the auditory EO after presentation of tone bursts yielded no group difference. Conclusion: Our findings imply that delta ERO is highly unstable in AD patients in comparison to age-matched healthy controls only during the cognitive paradigm. Our results favor the hypothesis that neural delta networks are activated during cognitive tasks and that the reduced delta response is a general phenomenon in AD, due to cognitive impairment

Lack of association between cerebral microbleeds and low serum cholesterol in patients with acute intracerebral hemorrhage

Background: The association of cerebral microbleeds (CMBs) with intracerebral hemorrhage (ICH) is well known and its relationship with low serum cholesterol in ICH patients might be of interest