Clinical features distinguish cerebral amyloid angiopathy-associated convexity subarachnoid haemorrhage from suspected TIA

OBJECTIVE: To identity clinical features that distinguish between cerebral amyloid angiopathy (CAA)-associated convexity subarachnoid haemorrhage (cSAH) and suspected TIA. METHODS: We undertook a single-centre, retrospective case-control study. We identified cases [patients with cSAH presenting with transient focal neurological episodes (TFNE)] from radiological and clinical databases of patients assessed at the National Hospital for Neurology and Neurosurgery and UCLH Comprehensive Stroke Service. We identified age- and gender-matched controls at a 1:4 ratio from a database of consecutive suspected TIA clinic attendances at UCLH. We compared presenting symptoms and vascular risk factors between cases and controls. RESULTS: We included 19 patients with cSAH-associated TFNE and 76 matched controls with suspected TIA. Migratory (spreading) symptoms (32% vs. 3%, OR 17.3; p = 0.001), sensory disturbance (47% vs. 14%, OR 5.3; p = 0.003,) and recurrent stereotyped events (47% vs. 19%, OR 3.7; p = 0.02,) occurred more frequently in patients with cSAH compared to controls. Hypercholesterolaemia was less common in patients with cSAH (16% vs 53%, OR 0.17; p = 0.008). CONCLUSION: Simple clinical features could help distinguish cSAH-associated TFNE from suspected TIA, with relevance for investigation and management, including the use of antithrombotic drugs

Modelling Automation–Human Driver Handovers Using Operator Event Sequence Diagrams

This research aims to show the effectiveness of Operator Event Sequence Diagrams (OESDs) in the normative modelling of vehicle automation to human drivers’ handovers and validate the models with observations from a study in a driving simulator. The handover of control from automation to human operators has proved problematic, and in the most extreme circumstances catastrophic. This is currently a topic of much concern in the design of automated vehicles. OESDs were used to inform the design of the interaction, which was then tested in a driving simulator. This test provided, for the first time, the opportunity to validate OESDs with data gathered from videoing the handover processes. The findings show that the normative predictions of driver activity determined during the handover from vehicle automation in a driving simulator performed well, and similar to other Human Factors methods. It is concluded that OESDs provided a useful method for the human-centred automation design and, as the predictive validity shows, can continue to be used with some confidence. The research in this paper has shown that OESDs can be used to anticipate normative behaviour of drivers engaged in handover activities with vehicle automation in a driving simulator. Therefore, OESDs offer a useful modelling tool for the Human Factors profession and could be applied to a wide range of applications and domains.</jats:p

Abstract WP77: Final Infarct Volume May Predict Functional Outcome After Mild, Nondisabling Ischemic Stroke: Results From the PRISMS Trial

Introduction: In patients with acute cerebral ischemia (ACI) within 3h of onset with mild deficit judged as nondisabling at presentation, up to 20% experience poor functional outcome at 90 days. We tested the hypothesis that the presence of infarction at 24h would independently predict worse outcome at 3 months, and also explored the role of final infarct volume (FIV) on outcomes. Methods: The phase 3b, randomized PRISMS trial compared intravenous alteplase to aspirin for mild (NIHSS 0-5), nondisabling stroke at <3 h from onset. In a prespecified analysis, we included patients with 24h MRI performed and excluded acute cerebral ischemia mimics. Central readers assessed Day 24h MRIs for acute infarct, chronic infarcts, and white matter hyperintensity (WMH) burden; FIV and WMH volumes were measured quantitatively using semi-automated software. The primary outcome was 3-month EQ5D scores, a measure of QOL, and the secondary outcome was modified Rankin Scale (mRS) scores, a measure of disability. Multivariable linear regression and proportional odds cumulative logit models were used to evaluate the association between (1) acute infarction presence and (2) FIV on the primary and secondary outcomes, respectively, adjusting for relevant covariates (Table 1). Results: Of 313 patients enrolled, 273 had a final diagnosis of ACI and 212/273 (77%) had 24h MRI scans. Acute infarcts were present In 109 (51%), and median FIV was 1.20 mL (IQR 0.57-2.50). No association between presence of acute infarcts and 3-month EQ5D (p=0.84) or mRS (p=0.17) scores was observed (Table 1A). No association between FIV and EQ5D scores (p=0.31) was observed as well, but FIV was strongly associated with mRS scores (OR 1.11, 95% CI 1.04-1.18, p<0.001), in adjusted models (Table 1B). Conclusions: Among patients presenting with mild, nondisabling ACI, FIV appears to be associated with worse functional outcome. Since this was a post-hoc analysis, this hypothesis requires further prospective study