bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract DP8: Multifaceted Approach to Improving Hemorrhagic Stroke Scoring Performance
Authors: Kennelly Megan , Cabusao Marilou
Published: January 2025

Background:
Hemorrhagic stroke is associated with severe morbidity and high mortality with the progression of hemorrhagic stroke leading to worse outcomes.Early diagnosis and treatment are crucial due to the rapid expansion of hemorrhage, which can cause sudden deterioration and neurologic dysfunction.This underscores the importance of an interprofessional team in evaluating and treating hemorrhagic stroke patients.Documenting hemorrhagic stroke scoring is vital to capture the patient's clinical state, predict outcomes, and plan future care with patients, families, and providers.

Purpose:
The project aims to enhance hemorrhagic stroke scoring documentation at a large comprehensive stroke center.This improvement is expected to positively affect patient outcomes.The Joint Commission mandates that comprehensive stroke centers meet all benchmark criteria to maintain certification.In the 2023 calendar year, our comprehensive stroke metric for hemorrhagic stroke scoring was at 64%, below the 'Get with the Guidelines' benchmark of 87%.To address this, we initiated a performance improvement project to emphasize the importance of hemorrhagic stroke severity scoring and to streamline the assessment and documentation process.

Methods:
The rapid response stroke nurse, who attends every code stroke, was designated to document the hemorrhagic stroke score for intracerebral or subarachnoid hemorrhages.This initiative was supported by robust nursing education and a commitment from our radiologists to document the specifications of hemorrhage.We also developed a flow diagram to manage code strokes that bypass the ED, or do not present as a code stroke.

Results:
This performance improvement project began in March 2024.Current year data available from January to May 2024 shows an increased overall compliance rate of 70% from previous year of 64% with significant improvements in the intracerebral hemorrhage scoring. We continue to assess compliance and project feasibility.We are addressing challenges such as the workflow for ED patients presenting as non-code strokes and exploring solutions like targeted paging or AI software.

Conclusions:
Involvement of a dedicated stroke nurse in all code strokes has been instrumental in improving hemorrhagic stroke score documentation.This has positively impacted the Joint Commission Comprehensive Stroke measure and patient care.Further review and process enhancements are necessary for non-code stroke patients diagnosed with intracerebral hemorrhage.
Abstract NS3: The Mystique of PCA Stroke: Targeted Education for Prehospital Providers
Authors: Steiner Nili , Figueroa Sonia , Jack Caroline , Stokes Sean , Paletz Laurie
Published: January 2025

Background and Purpose:
Prehospital recognition of stroke directly contributes to the reduction of mortality for stroke patients. Posterior circulation artery stroke (PCAS) continues to be a commonly missed vascular neurologic diagnosis in prehospital and emergency department settings nationally and worldwide. Furthermore, inaccurate last known well times (LKWT) can delay emergent stroke care. Goals for this project were to demystify PCAS symptoms for a select group of local prehospital providers, Beverly Hills Fire Department (BHFD), to improve their comfort level with PCAS symptom recognition, increase suspicion of stroke in patients with nebulous symptoms, and provide tools to improve accuracy of LKWT in the field.

Methods:
We created a multimodal educational module consisting of an interactive lecture and two patient care simulation cases with class participation, focusing on PCAS. The class participants performed a pre- and post-class survey which included questions regarding information required for accurate last known well times (LKWT), PCAS symptoms and confidence scores for recognizing PCAS. A Likert scale of 0-5 was utilized for the confidence questions, zero being not at all confident and five being extremely confident. A QR code was used to access the survey and surveys were performed anonymously. We performed the same education for all three shifts at their home fire station.

Results:
The question “which symptom is most likely related to a PCA stroke” had the most common pre-class answer of “dizziness” by a slim margin, followed by “aphasia” and “facial droop.” The most common post-class answer was “dizziness” by a large margin, followed by “aphasia.” There were no post-class answers of “facial droop.” The question of, “How confident are you with recognizing a patient with a posterior/cerebellar acute stroke?”: pre-class score was 2.79, post-class score was 3.96. The question of, “How confident are you with obtaining an accurate LKWT?”: pre-class score was 3.7, post-class score was 4.35.

Conclusions:
Our targeted education improved PCAS symptom recognition and prehospital provider confidence for a differential of prehospital provider impression of stroke, with the most common PCAS symptom of “dizziness.” Confidence levels for accurate LKWT increased as well. Our hope is that increased confidence for our prehospital providers equates to increased disposition to certified stroke centers and improved stroke treatment times.
Abstract TMP113: Sex differences in the effects of social isolation on behavioral and metabolic parameters in a model of cerebral amyloid angiopathy
Authors: Liu Lillianne , Garg Shivi , Khan Romeesa , Jiang Danye , McCullough Louise
Published: January 2025

Introduction:
The prevalence of social isolation (SI) increases with aging and contributes to poor health outcomes and increased risk of cognitive impairment, especially in Aβ-related diseases. Cerebral amyloid angiopathy (CAA) is characterized by amyloid β (Aβ) deposition in the cortical and leptomeningeal vessels, and is a leading cause of hemorrhagic stroke and age-related cognitive impairment. How social isolation affects vascular amyloid deposition, cognitive decline and social behavior in CAA is unknown.

Methods:
TgSwDI mice carrying Swedish, Dutch, and Iowa mutations of human amyloid precursor protein were used as a CAA model. Male and female C57BL/6 wildtype (WT) and CAA mice were randomly assigned to pair housing (PH) or SI at 3 months of age. Affective and social behaviors were assessed at baseline and every 3 months thereafter using the tail suspension test (TST) and three-chamber social interaction test. At 9 months post-SI, cognitive behaviors and general well-being were measured using fear conditioning (FC) and the nesting test, respectively. Body weights were recorded, and white adipocyte size was measured using immunostaining.

Results:
SI led to increased immobility in the TST at 3- and 6-months post-SI in both male and female WT and CAA mice, suggesting depressive-like behavior (n=5-8/grp, p<0.05). Isolated CAA mice displayed greater cognitive deficits in FC, while only male WT SI mice showed impaired cognition (n=5-12/grp, p<0.005). Sex differences in social behavior were observed in isolated CAA mice. Specifically, at 6 months post-SI, female CAA mice displayed deficits in sociability and social novelty (n=4-9/grp, p<0.05), which was not seen in male CAA mice. SI negatively impacts the general well-being in both male WT and CAA SI animals (n=5-12/grp, p<0.005). Preliminary findings showed increased white adipocyte size in male WT SI mice with a similar trend in male CAA SI animals, pointing to potential metabolic effects of isolation.

Conclusion:
SI induced cognitive decline in both male and female CAA mice. Behavioral differences between sexes were noted in CAA mice including nesting ability, sociability, and depressive-like behaviors. Further research is needed to determine the cellular and molecular mechanism underlying SI-induced metabolic changes in CAA.
Abstract TMP114: Characterizing Anemia’s Impact on Cerebral Immune Response after Intracerebral Hemorrhage
Authors: Kumar Aditya , Cottarelli Azzurra , Mao Eric , Dei Zotti Flavia , Falk Irene , Hudson Krystalyn , Hod Eldad , Roh David
Published: January 2025

Background:
Anemia is a risk factor for worse intracerebral hemorrhage (ICH) outcomes, yet the underlying drivers remain unclear. Though anemia and inflammation are interrelated, it is unknown whether anemia influences inflammatory responses to ICH. We investigated the impact of anemia on inflammatory cell phenotypes seen in murine brains with and without ICH.

Methods:
Two different models of anemia were generated from 8-week-old, female C57/BL6 mice. The separate cohorts included: 1) chronic anemia model via iron-deficient chow compared to iron replete control diet, and 2) acute anemia model via red blood cell hemolysis using anti-TER119 injection compared to IgG control injection. After confirmation of anemia vs control via modified Drabkin assays, ICH was induced via collagenase injection into the right striatum, and brains and peripheral blood harvested 24 hours after ICH. Separate single cell suspensions were prepared from ICH and non-ICH hemispheres as well as peripheral blood and cells were stained for immunophenotyping using flow cytometry. Similar procedures were performed in mice without ICH. Two-tailed Student's t-tests were performed to compare immune cell populations between anemic vs non-anemic mice.

Results:
We identified a robust cerebral immune response to ICH in all groups. In the chronic anemia model, infiltrating macrophages and lymphocytes, particularly T cells, were elevated, while helper and gamma-delta T cells were lower in the ICH hemisphere in iron deficient anemic mice compared to iron replete controls (p<0.05). However, in the acute anemia model, only non-parenchymal intracranial macrophages were significantly elevated in the ICH hemisphere in anemic anti-TER119 injected mice compared to IgG injected controls (p<0.05). Notably, we observed a significant increase in infiltrating lymphocytes in the contralateral hemispheres in both acute and chronic models of anemia, compared to non-anemic controls. These findings in the brain were distinct from peripheral blood, where no major differences in immune cell populations were noted. Finally, in anemic mice without ICH, we did not identify a differential cerebral immune response compared to non-anemic controls.

Conclusions:
Anemia can differentially impact the inflammatory response to ICH in the central nervous system, based on its etiology and chronicity. Further work is required to assess whether anemia modification can abrogate pathologic immune pathways and improve ICH outcomes.
Abstract TMP15: Stroke Nurse Navigator Structured Phone Call Protocol to Improve Transitions of Care After Stroke
Authors: Skeels Katelyn , Caffrey Lorna , Kendall Sarah , Leung Lester
Published: January 2025

Background:
After discharge can be a vulnerable time for stroke patients and their caregivers. Nurse navigators have been utilized in other specialties resulting in positive impacts on patient care. Nurse navigators are becoming an important part of Stroke Center teams. Responsibilities vary, including patient education and post-discharge phone calls. A Primary Stroke Center found nurse navigator post-discharge calls improved follow-up and decreased 30-day stroke and all cause readmissions.

Purpose:
To implement a Stroke Nurse Navigator (SNN) at a Comprehensive Stroke Center (CSC), providing in-person stroke education during the hospitalization and a structured post-discharge phone call protocol with the patient and/or caregiver. The goal is to connect care settings, improve transitions of care, improve secondary stroke prevention medication adherence, and increase Stroke Clinic follow-up.

Methods:
All patients discharged with stroke, including TIA, AIS, ICH, and SAH receive post-discharge phone calls by the SNN. Additional high risk patients can be added at discretion. Patients discharged home receive a call within 7 post-discharge in which the SNN reviews and verifies the patient’s Stroke Clinic follow-up, outpatient testing, and medications. Stroke symptom recognition and patient concerns are also discussed. All patients regardless of discharge disposition receive calls at various time points post-discharge. The call time points were determined based on predictive recovery curves for stroke subtypes and to anticipate potential vulnerable points after discharge; e.g. AIS patients receive calls at 30, 60, and 90 days post-discharge. For the 30 day call, the SNN reviews the patient’s stroke risk factors and educates on interventions. A Late Complications After Stroke (LCAS) screening tool to identify complications, like depression and headaches is completed at the 60/90 day call. Concerns are communicated to the outpatient stroke clinician to address at follow-up. During the 90/180 day call, a mRS is completed. Calls are completed with the patient or caregiver if the patient is unable to participate for any reason.

Discussion:
The impact of a structured post-discharge call protocol on secondary stroke prevention medication adherence and Stroke Clinic retention will be evaluated. This initiative aims to prove that it is feasible and beneficial to have a SNN and post-discharge calls as standard of care for stroke patients to improve transitions of care.
Abstract TMP24: Stroke Response Team
Authors: Carey Conrad , Watkins Joshua , Horn Christian , Johnson Anita , Hatch Janie , Leclerc Lucy
Published: January 2025

Background and Purpose:
The Stroke Response Team (SRT) is comprised of a critical care RN with neuro experience and a Neuro ICU APP. The SRT RN acts as a critical link in the care continuum for stroke patients by providing consistent ICU-level care from initial entry into the ED through transitions to procedural areas and the ICU. The SRT resulted from the need to increase patient safety, enhance continuity of care, and improve clinical outcomes. Additional aims are to improve compliance with core measures and standardization of patient care. Data collection is ongoing. Before implementation, charting metrics were at <80%, transfer time to ICU was high and RNs in the ED and ICU were overburdened with the care and stabilization of critically ill patients. The project was approved by the organization's IRB committee and as an EBP project.

Methods:
The SRT was implemented at a Comprehensive Stroke and level I trauma center including all interventional areas and the ICU. The SRT RN is based in the Neuro ICU and is available to respond to stroke alerts/code FAST in the ER when certain criteria are met (See Figure 1). The pilot was resourced with 2-day shift RNs. If a stroke alert was called in the ED, the SRT RN met the patient in the ED to establish a baseline exam. The SRT RN provided surveillance, care, and assessment throughout the patient's hospitalization. When the SRT RN is not assisting with stroke patient care in other units, they are a resource in the ICU.

Results:
The median Door to VI time is 31.5 (n=26). The door to ICU time has trended down with a 24% reduction from March to July, the avg time being 186 mins (n=72). Once a clean and ready bed is assigned, the median time to ICU is 47 mins, which includes imaging that occurs during transport (n=53). The ICU LOS for stroke patients is 4.38 days (n=59). The Modified Rankin (mRS) < 2 after 90 days was 66.67% for March (n=12) and 62.50% in April, an approximate 10% improvement from calendar year 2023 (mRS=56.2%). When SRT is present, post-intervention vitals, neuro checks, post-intervention 2hr NIHSS and 24hr NIHSS have a 100% accuracy rate. The missed documentation is due to the SRT role not being staffed.

Conclusion:
Implementation of the SRT has produced several patient benefits. By decreasing both the time to intervention and ICU, ICU LOS has been reduced by 0.5 days on avg. The SRT RN supports the ICU staff, provides consistent care throughout the patient’s journey, and improves 90-day mRS.
Abstract TMP27: Impact of the COVID-19 Pandemic on In-Hospital Stroke Mortality in California: A Retrospective Analysis from 2016 to 2022
Authors: Shanaa Jean , Augustynski Robert , Chang Sean , DILIBERO RALPH , Ratnasiri Anura
Published: January 2025

Background:
In 2022, stroke shifted from the fourth to the fifth leading cause of death in the U.S. as COVID-19 temporarily took its place. Despite this change, stroke remains a significant cause of mortality and long-term disability in the U.S. This study analyzes trends in in-hospital mortality among stroke-related hospitalizations in California from 2016 to 2022, with a particular focus on the pandemic years.

Methods:
This retrospective analysis utilized patient discharge data from the California Department of Health Care Access and Information, screening nearly 25 million inpatient events for stroke-related ICD-10-CM diagnosis codes (I60-I63) among individuals 20 and older. Multivariate logistic regression (MLR) analysis assessed the impact of the pre- and post-COVID-19 periods on in-hospital mortality, adjusting for confounders such as age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).

Results:
The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). Initially, the age-and-sex-adjusted in-hospital mortality rate decreased from 28.88 per 100,000 in 2016 to 27.38 in 2019. However, with the onset of COVID-19 in 2020, the rate increased to 27.94, peaking in 2021 at 30.78 during the pandemic's height. In 2022, the rate slightly declined to 28.30 but remained above pre-pandemic levels.

Similar trends from 2016 to 2022 were observed in age-adjusted rates for males, which increased from 27.77 to 29.73, and for females, which decreased from 29.91 to 26.98. The gap between male and female mortality rates widened significantly during the pandemic, with male mortality peaking in 2021 with a difference of 3.75.

MLR analysis revealed a 22.6% increase in in-hospital mortality during the post-COVID period compared to the pre-COVID period (AOR=1.23, p<0.001). Additionally, male mortality was 25.3% higher than female mortality (AOR=1.25, p<0.001). Racial disparities were also noted, with Asians having a 53.9% higher prevalence of stroke compared to Whites (AOR=1.54, p<0.001), followed by Blacks at 38.8%.

Conclusion:
The COVID-19 pandemic significantly impacted in-hospital stroke mortality rates in California, particularly during the peak in 2021. The study highlights the differential impact on males, who experienced higher mortality increases, and the pronounced racial disparities, with Asians and Blacks showing higher prevalence rates compared to Whites.
Abstract TMP31: Distinguishing Intracerebral Hemorrhage from Acute Cerebral Ischemia in the Prehospital Setting: Development and Validation of the California Acute stroke Subtype PRehospital (CASPR) Scale
Authors: Hsu Jamie , Eckstein Marc , Stratton Samuel , Liebeskind David , Sharma Latisha , Restrepo Lucas , Kim-Tenser May , valdes-sueiras miguel , Gornbein Jeffrey , Hamilton Scott , Conwit Robin , Taleb Shayandokht , Sung Gene , Saver Jeffrey , Sanossian Nerses
Published: January 2025

Background:
A prehospital, paramedic-administered scale to distinguish intracerebral hemorrhage (ICH) from acute cerebral ischemia (ACI) could improve routing to appropriate centers, enrich field randomized trials with targeted subtype patients, and potentially guide prehospital clinical treatment such as hyperacute blood pressure (BP) lowering. We aimed to create a quickly administered prehospital scale from prospectively performed field assessments.

Methods:
Two scales were created from NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) trial data, using logistic regression model with backward stepwise variable selection and retention criterion of p<0.1. Scale one—CASPR-DB (Data-Based)—assessed 26 candidate variables available in routine prehospital care in 1675 patients (77.3% ACI, 22.7% ICH), who were randomly assigned to training (n=1114) or validation (n=561) sets. Scale two—CASPR-CS (Clinical Symptoms)—came from a subset of patients (n=467) in whom three additional clinical symptoms elicited in the field were also candidate items—headache, nausea, and progressing deficit.

Results:
For the CASPR-DB scale, the logistic regression model selected 10 of the 26 candidate variables in the training population. Factors associated with ICH were higher Los Angeles Motor Scale (LAMS) score, higher Glasgow Coma Score (GCS), higher systolic BP, Hispanic and Caucasian race-ethnicity, male sex, use of anti-platelet agents, decreased age, and absence of diabetes, atrial fibrillation, or valvular heart disease. Each was given a point value between 1-3, yielding a 19-point scale (Table 1).

For the CASPR-CS scale, the logistic regression model selected 10 of the 29 candidate variables. All three symptom items—headache, nausea, and progressing deficit—were associated with ICH, along with 7 data-based variables. Each was given a point value between 1-3, yielding a 20-point scale (Table 2).

CASPR-DB performance in training was sensitivity 64.4%, specificity 78.6%, accuracy 71.5%, c=0.774 and in validation was sensitivity 69.3%, specificity 61.7%, accuracy 71.5%, c=0.710. CASPR-CS performance was sensitivity 71.8%, specificity 77.8%, accuracy 74.8%, c=0.830. Figure 1 shows the proportions of ICH patients at each CASPR-CS score level.

Conclusions:
The CASPR-DB scale shows good and CASPR-CS scale very good performance in distinguishing ICH vs ACI in prehospital setting. These readily performable scales could improve prehospital routing and treatment of ICH patients.
Abstract TMP36: The Ultimate Stroke Scale (USS): An Innovative Tool for Automated LVO Screening and Stroke Scale Accuracy
Authors: Kothari Sachin , Morsi Rami , Desai Harsh , Carrion Penagos Julian , Baskaran Archit , Kozel Olivia , Sehgal Neha , Metman Okker , Chahine Ahmad , Patel Shyam , Karar Lina , Iourinets Julia , Rana Rohini , Thind Sonam , Coleman Elisheva , Brorson James , Siegler James , Prabhakaran Shyam , Kass-Hout Tareq
Published: January 2025

This study compares the accuracy of manual stroke scale calculations against electronically calculated scores using the Ultimate Stroke Scale (USS), a new software designed to automate large vessel occlusion (LVO) screening scales from a modified National Institute of Health Stroke Scale (NIHSS). The USS has the potential to streamline LVO screening with enhanced accuracy using multiple validated stroke scales simultaneously.

We prospectively applied eight stroke screening scales (NIHSS, BE-FAST, VAN, LAMS, FAST-ED, EMS RACE, 3-ISS, and PASS) to 199 stroke activations between January 2021 to December 2023. These values were recalculated with the USS calculator which incorporates inputs from a modified NIHSS score, including up to two additional points for hand grip strength. A Bland-Altman analysis was conducted to assess agreement between manual and USS-calculated scores.

The NIHSS showed a percentage error of -8.24% and a mean difference of -0.97 (LoA: -3.88 to 1.93). The BE-FAST scale exhibited a percentage error of -14.72% and a mean difference of -0.12 (LoA: -0.85 to 0.60). The VAN scale had a percentage error of -21.76% and a mean difference of -0.11 (LoA: -0.83 to 0.62). The LAMS scale had a percentage error of 6.59% and a mean difference of 0.15 (LoA: -1.20 to 1.50). The FAST-ED scale had a percentage error of -4.82% and a mean difference of -0.15 (LoA: -2.10 to 1.80). The EMS-RACE scale had a percentage error of -9.99% and a mean difference of -0.39 (LoA: -3.20 to 2.42). The 3-ISS scale exhibited the highest percentage error of -29.36% and a mean difference of -0.54 (LoA: -2.47 to 1.39). The PASS scale had the lowest percentage error at -2.86% and a mean difference of -0.04 (LoA: -0.66 to 0.58). The combined percentage error for all scales was -8.44%, increasing slightly to -8.61% when excluding the NIHSS score. Excluding both NIHSS and 3-ISS reduced the combined error to -5.44%.

Our findings demonstrate a general agreement between the manual and USS-calculated scores, with the strongest concordance observed in PASS, FAST-ED, and LAMS. Although some scales exhibited larger discrepancies, the moderate overall combined percentage error suggests that USS-calculated scores are generally consistent with manual calculations. These findings support the potential of the USS software to streamline LVO stroke screening, although further validation is necessary.
Abstract TMP38: Real World Experience of an MRI-Based Wake-Up Stroke Protocol For Acute Ischemic Stroke
Authors: Westover Deborah , Obideen Mahmoud , Groover Olivia , Shi Hang Helen , Memon Aurangzeb , Elson Andrew , Winkel Daniel , Benameur Karima , Greene James , Segovis Colin , Hu Ranliang , Patel Sumir , Victor Patricia , Senter Catherine , Campbell Carol , Ashraf Shanza , Nahab Fadi
Published: January 2025

Background:
Randomized clinical trials have demonstrated that IV thrombolysis (IVT) can be administered safely in wake-up stroke (WUS) after MRI- or CT-based imaging selection to improve clinical outcomes. The objective of this study was to evaluate the utilization of IVT to treat WUS using a standardized WUS protocol across a healthcare system.

Methods:
A WUS protocol using MRI-based imaging selection was implemented across an academic healthcare system with 6 acute care hospitals in the state of Georgia. We prospectively identified all WUS patients who underwent the WUS protocol over a 12 month period through August 15, 2024. Patients were eligible for the WUS protocol if they presented with disabling symptoms identified on awakening, had a CT head without contrast showing no hypodensity to explain clinical symptoms and had CT angiography of the head and neck demonstrating no large vessel occlusion as a cause of symptoms. All patients underwent expedited brain MRI sequences (DWI, T2w FLAIR, GRE) without contrast and IVT was administered at the discretion of the treating neurologist.

Results:
During the study period, the WUS protocol was activated for 27 patients of which 6 (22%) received IVT (median NIHSS 10, IQR 5-15). Reasons for not receiving IVT included lack of DWI-FLAIR mismatch on MRI (n=11), DWI negative MRI (n=8), IVT declined by patient (n=1) and IVT contraindication (n=1). A modified Rankin scale of 0-1 at 90 days was achieved in 67% of WUS patients treated with IVT and no symptomatic intracerebral hemorrhages. Door-to-needle time within 60 minutes was significantly less likely in WUS compared with non-WUS cases (0% vs 69%, p=0.001). IVT administration in WUS patients made up 2% of all acute ischemic stroke patients receiving IVT.

Conclusions:
An MRI-based WUS protocol was able to identify a small subset of acute ischemic stroke patients who met eligibility criteria for IVT outside of the 4.5 hour time window. IVT was associated with good clinical outcomes and not associated with any complications.
Abstract TMP41: Ethnic Disparities in Stroke Outcomes Within a Tele-Stroke Network: A Retrospective Cohort Study
Authors: Musmar Basel , Roy Joanna , Abdalrazeq Hammam , Sizdahkhani Saman , Koduri Sravanthi , Atallah Elias , Karadimas Spyridon , Gooch M. Reid , Rosenwasser Robert , Jabbour Pascal , Tjoumakaris Stavropoula
Published: January 2025

Background:
Stroke remains a leading cause of mortality and morbidity, with treatment and outcomes differing across ethnic groups. Tele-stroke networks have expanded access to stroke care, particularly in underserved areas, but the impact of ethnicity on these outcomes is still being explored. This study aims to compare stroke treatment outcomes among White/Caucasian, African-American, and Other ethnic groups within a tele-stroke network.

Methods:
We conducted a retrospective analysis of 4,256 stroke patients treated within a tele-stroke network spanning 38 hospitals. Patients were categorized into three ethnic groups: White/Caucasian (n = 2,925), African-American (n = 1,122), and other (n = 209). Data on baseline characteristics, treatment interventions, and discharge outcomes were analyzed using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables.

Results:
The median age was highest in White/Caucasian patients (70 years, IQR 57-81) and lowest in the other group (61 years, IQR 49-72) (p < 0.001). True strokes occurred in 82.3% of White/Caucasian patients, 79.3% of African-American patients, and 89.9% of the other group (p = 0.001). tPA was administered to 19.4% of White/Caucasian patients, 16.7% of African-American patients, and 15.2% of the other group (p = 0.12). Mechanical thrombectomy rates were similar across all groups (p = 0.07). Discharge to home was most common in the other group (58.4%), followed by African-American (50.3%) and White/Caucasian patients (44.9%) (p = 0.01).

Conclusion:
This study identified important ethnic differences in stroke treatment and outcomes within a tele-stroke network. While there were no significant disparities in the administration of key treatments such as tPA and mechanical thrombectomy, differences in age, gender distribution, stroke severity, and true stroke rates highlight the need for tailored approaches in stroke management to address the unique needs of different racial/ethnic groups.
Abstract TMP52: Corticospinal Tractography and Motor Function in Patients Undergoing Intracerebral Hemorrhage Evacuation
Authors: Cummins Daniel , Rifi Ziad , Kalagara Roshini , Kellner Christopher
Published: January 2025

Introduction:
A recent randomized-controlled trial confirmed the value of minimally-invasive intracerebral hemorrhage (ICH) evacuation to improve outcomes in properly-selected patients. Yet, there remains a need to optimize patient selection and prognosis following ICH evacuation. Magnetic resonance diffusion tensor imaging (DTI) allows visualization and quantification of critical white matter tracts. Corticospinal tract DTI (CST-DTI) in particular can be associated with motor function, which may improve prognosis and patient selection for ICH evacuation.

Methods:
Patients who underwent minimally-invasive ICH evacuation and had perioperative DTI performed were retrospectively reviewed. CST metrics including fractional anisotropy, radial diffusivity, axial diffusivity, geodesic anisotropy, fiber count, and tract volume were associated with motor function pre- and postoperatively. Motor function was scored on each hemibody via the weakest muscle group in each extremity according to the Medical Research Council grading scale (maximum score of 10 on each hemibody).

Results:
Eighteen patients with available peri-operative DTI data were included, 12 each with preoperative and postoperative DTI, seven with matched pre- and postoperative DTI. Preoperative geodesic anisotropy was significantly associated with both preoperative motor function on the contralateral hemibody (R=0.616, p=0.032, Pearson correlation) and at postoperative day one (R=0.606, p=0.038). Restoration of a deformed CST could be seen in several patients from preoperative to the immediate postoperative period (
Figure 1)
. However, no preoperative or postoperative CST-DTI metrics were associated with motor scores at a median follow-up of 6.3 months post-ICH (p>0.05 for all comparisons). There was a significant increase in motor scores on the affected hemibody from postoperative day one to last follow-up (3.8±3.5 vs 6.3±6.8; p = 0.038, Wilcox signed-rank test).

Conclusions:
Preoperative CST-DTI metrics are associated with both preoperative and immediate postoperative motor function after minimally invasive ICH evacuation. A restored CST after ICH evacuation could be seen in a subset of patients. However, neither preoperative nor immediate postoperative CST-DTI metrics were associated with longer-term motor function. Tractography from the perioperative period should be used with caution in providing motor prognosis.
Abstract TMP66: Implementing Intracerebral Hemorrhage-Specific Time Interval Metrics in the Emergency Department Reduces Door-to-Goal Blood Pressure Time.
Authors: Javadzadeh Ashkan , Santosa Rhendy , Gaffney Denise , Zhang Jing , Jacobson Prashanta , Strait Yvette , Salinas Jackalyn , Mkrtumyan Alvina , Taleb Shayandokht , Sangha Navi
Published: January 2025

Introduction:
The 2022 AHA/ASA Guidelines for Nontraumatic ICH recommend initiating blood pressure (BP) reduction within 2 hours of onset and achieving a target systolic BP of 130-150 mmHg within one hour of initiating a BP medication. This study evaluates the effectiveness of implementing ICH-specific time intervals, modeled after TARGET: STROKE, coupled with provider education to improve the timeliness of BP reduction in ICH patients.

Methods:
Data were retrospectively collected at a CSC from 01/1/2021 to 12/31/2022 (pre-intervention) and from 1/1/2023 to 5/31/2024 (post-intervention). Emergency Department (ED) code stroke patients with an ICH were included. ED providers were given education on which BP intervals would be measured, and how to improve the timeliness of BP reduction. Baseline demographics, NIHSS, ICH volume, ICH score, 90-day mRS and door-to-BP reduction-related time metrics were collected. The data were analyzed using Kruskal-Wallis and Chi-square tests.

Results:
91 code stroke patients presented to the ED with ICH. 32 pre- and 59 post-intervention. There were no differences between mean age, gender, race/ethnicity, NIHSS, ICH score or time from last known well to ED arrival between groups. Both groups had similar median ICH volumes; post- 18.4ml (IQR 5.2-44.7) vs. pre-intervention: 19.7ml (IQR 5.3-44.3) vs. (p=1.0). Door to first BP medication ordered was reduced to 13 (IQR 10.0-21.0) minutes post vs. 19 (IQR 14.5-25.5) minutes pre-intervention (p=0.007). Door to first BP medication administered was reduced to 21.0 (IQR 14.0-34.0) minutes post vs 29.5 (IQR 18.5-47.5) minutes pre-intervention (p=0.03). Time from first BP medication administration to goal SBP in rage of 130-150 improved to 43 minutes (IQR 33-52.3) post vs. 75 minutes (IQR 46.7-80) minutes pre-intervention. Door to first SBP in range of 130-150 mmHg improved to 60 minutes (IQR 46.0-80.0) post vs 98 minutes (IQR 69.5-141.0) pre-intervention p<0.0001. There were no differences in hematoma expansion or 90-day mRS between both groups, possibly due to the small sample size.

Conclusion:
This is the first study to show that implementing ICH-specific time intervals in the ED, combined with provider education, effectively improve the timeliness of BP management in ICH patients. It highlights the value of ED education on guideline recommended time-targeted treatment of ICH care.
Abstract TMP67: Validation and Modification of the Simplified Edinburgh CT Criteria in Asian Lobar Intracerebral Hemorrhage: The Proposal of Asian CT Criteria for Cerebral Amyloid Angiopathy
Authors: Shih Yu-Chen , Lee Bo-ching , Tsai Li-Kai , Tsai Hsin-Hsi
Published: January 2025

Background and Objective:
The simplified Edinburgh CT criteria allowed a diagnosis of cerebral amyloid angiopathy (CAA) in spontaneous lobar intracerebral hemorrhage (ICH) for patients with limited accessibilities to MRI. However, its applicability to Asian populations remains uncertain. This study evaluated the diagnostic accuracy of the simplified Edinburgh CT criteria in Asian lobar ICH and to propose modifications if the performance is suboptimal.

Methods:
We analyzed patients with spontaneous lobar ICH (≥ 50 years) from 2015 to 2022 who underwent an acute CT and an MRI. The CT images were assessed according to the LINCHPIN CT RATING FORM. Demographic and imaging parameters were compared between probable CAA and non-CAA groups with modified Boston criteria as reference standards, and were selected to establish a logistic regression model. The modified version of CT criteria was evaluated by diagnostic accuracy, inter-rater reliability and decision curve analysis.

Results:
A total of 87 lobar ICHs were included (ICH volume 20.1 [10.0-39.9] ml, 46.0% probable CAA). The presence of subarachnoid hemorrhage (SAH, 47.5% vs 21.3%, p=0.010), but not finger-like projection (FLP, 42.5% vs 23.4%, p=0.057), showed significant difference between probable CAA and non-CAA groups. The simplified Edinburgh CT criteria yielded only moderate diagnostic accuracy for CAA (AUC 0.66). To enhance the diagnostic performance, we identified additional CT markers that are related to CAA including cortical atrophy and deep atrophy; absent old striatocapsular insult, old lacune or vascular lesions (all p<0.05). The hematoma in CAA tended to be less oval, had more irregular borders and variable density, and almost always reached the cortex (all p<0.05). Accordingly, we developed the new criteria that incorporated hematoma cortical involvement, absence of old lacune, and presence of cortical atrophy in predicting probable CAA. All three markers showed excellent inter-rater reliability. The updated criteria yielded good AUC of 0.843 (0.759-0.927) without evidence of poor calibration, and provided the rule-in specificity of 85.1% and the rule-out sensitivity of 85.0%. Decision curve analysis supported the clinical net benefit.

Conclusions:
The diagnostic accuracy of simplified Edinburgh CT criteria was suboptimal in Asians. We proposed the Asian version using CT markers of cortical involvement, absence of old lacune, and presence of cortical atrophy. External validation is warranted.
Abstract TMP85: Radiographic severity is associated with moderate to severe neurodevelopmental impairment in survivors of neonatal deep medullary vein thrombosis.
Authors: Pal Ria , Barsh Gabrielle , Luo Ingrid , Dahmoush Hisham , Lee Sarah , Mayne Elizabeth
Published: January 2025

Introduction:
Neonatal deep medullary vein (DMVT) is an increasingly recognized etiology of brain injury in term and preterm infants. However, long-term outcomes remain poorly described, and the prognostic significance of the radiographic findings is uncertain.

Methods:
We extracted demographics and clinical variables for all infants with DMVT at our institution from 2007 to 2023. MRIs were scored as mild if there was isolated DMVT with no or only punctate parenchymal injury; moderate if there was DMVT with focal, unilateral ischemic or hemorrhagic injury, and severe if there was bilateral, confluent ischemic or hemorrhagic injury. The primary outcome was the presence of moderate-to-severe neurodevelopmental impairment (NDI), defined as a composite of any of the following at 2 years of age a) score < 70 on Bayley II/III/IV cognitive/language; cerebral palsy with GMFCS > 1; or profound vision or hearing impairment. We preformed univariate and multivariate logistic regression to evaluate whether moderate-to-severe initial imaging was associated with the likelihood of developing NDI.

Results:
64 infants had DMVT, of whom 30/64 (47%) were preterm. The median age of presentation was 2.5 days (1-8), and presenting symptoms included seizures (29/64, 45%), encephalopathy (24/64, 38%), respiratory distress (21/64, 33%), and abnormal tone (15/64, 23%). Neonatal comorbidities included congenital cardiac disease (14/64, 22%) and infection (12/64, 19%), but concurrent cerebral venous sinus (3/64, 5%) or systemic (5/64, 8%) thromboses were rare. Most infants had moderate (21/64, 33%) or severe (20/64, 31%) injury on initial MRI. Of 27 infants with follow up imaging at a median of 5.5 (4-19) days after the initial scan, only 3 had radiographic worsening. Most (54/64, 85%) survived to discharge. In the univariate analysis, the odds of NDI were 7-fold higher for moderate/severe MRI patients (OR: 8.182, 95% CI: 2.018 - 55.647, p=0.0092). Patients with moderate or severe initial MRI had 5-fold higher odds of developing NDI compared to those with mild MRI, after adjusting for confounding factors (OR: 6.356, 95% CI: 1.423 - 45.358, p=0.0283).

Conclusions:
While mortality after symptomatic DMVT is low, nearly half of survivors will develop moderate to severe neurodevelopmental impairment by 2 years of age. Moderate-to-severe injury on initial MRI is associated with a 5-fold higher odds of developing moderate to severe neurodevelopmental impairment at 2 years of age.
Abstract TMP86: Stratifying risk of hemorrhage of pedatriac brain arteriovenous malformation using quantitative color-coded digital subtraction angiography and iflow analysis
Authors: Perez Edgar , Nelson Jeffrey , Kim Helen , Orscelik Atakan , Cooke Daniel
Published: January 2025

Background:
Pediatric brain arteriovenous malformation (bAVM) patients often present with intracranial hemorrhage. While certain angioarchitectural features, such as aneurysms, deep venous drainage, a single draining vein, venous outflow stenosis, or small nidus size, increase hemorrhage risk, they do not fully predict it. Hemodynamic factors, particularly those assessed by quantitative color-coded digital subtraction angiography (cDSA), have also been linked to hemorrhage risk. This study evaluated the relationship between nidal mean transit time (MTT) and hemorrhage history in pediatric bAVM patients.

Methods:
We retrospectively analyzed 40 pediatric bAVM patients using flow analysis software (syngo iFlow®; Siemens) to generate cDSA images. A neurointerventional radiologist identified regions of interest (ROIs) in each bAVM’s major arterial afferent and venous efferent. ROI peak time and MTT were obtained. ROI peak time was defined as the time that contrast intensity of the selected ROI reached the peak value and MTT was defined as the difference between venous and arterial peak times. Multivariable logistic regression analysis assessed the association between MTT and prior hemorrhage, adjusting for bAVM size.

Results:
Among the 40 patients (median age 13 years ; 42.5% female), 47.5% (n=19) had a history of hemorrhage. The median bAVM size was 2.7 cm (IQR: 1.8-4.2), and the median nidal MTT was 0.97 seconds (IQR: 0.79-1.27). In logistic regression analysis, each 0.25-second increase in nidal MTT time was associated with a 24% reduction in the risk of prior hemorrhage (OR=0.76, 95% CI: 0.53-1.08, p=0.122), although not statistically significant. Larger bAVM size was significantly associated with a lower risk of prior hemorrhage (OR=0.48 per cm increase, 95% CI: 0.27-0.87, p=0.014).

Conclusion:
Our findings suggest that prolonged nidal MTT may be associated with a reduced risk of prior bleeding in pediatric bAVM patients after accounting for bAVM size. Larger bAVM size was significantly associated with a lower likelihood of prior hemorrhage.
Abstract TMP88: Clinical Utility of Genetic Testing in Pediatric and Young Adult Hemorrhagic Stroke and Cerebrovascular Malformations
Authors: Vassar Rachel , Shieh Joseph , Winkler Ethan , Weinsheimer Shantel , Cooke Daniel , Hetts Steven , Ko Nerissa , Fox Christine , Fullerton Heather , Kim Helen
Published: January 2025

Introduction:
Pediatric and young adult cerebrovascular disease is more commonly associated with genetic conditions compared to in adults. This pilot study aims to characterize utility of genetic testing in a pediatric and young adult neurovascular clinic.

Methods:
This was a single center cohort study of pediatric and young adult patients (age <25 years) with cerebrovascular conditions who underwent clinical genetic testing between 7/2023-7/2024. Cerebrovascular conditions included brain or spine AVM, cavernous malformation, cerebral aneurysm, Moya-Moya vasculopathy, and/or unexplained hemorrhagic stroke. Individuals with perinatal or isolated arterial ischemic stroke were not included. Genetic testing ranged from a custom gene panel (including 4-175 genes) to whole exome/genome sequencing. Chart review was performed by a pediatric vascular neurologist to determine clinical details and genetic results. Identified genetic variants were further classified as 1) pathogenic or highly suspicious, 2) actionable but unrelated to phenotype, and 3) possibly relevant.

Results:
Twenty patients underwent genetic testing, including 7 with brain or spine AVM, 3 with ruptured cerebral aneurysm, 5 with spontaneous intracranial hemorrhage without underlying vascular malformation, and 5 with other cerebrovascular malformations. Median age at testing was 14 years (range 2mo – 24 years), and 11 (55%) were male. Panel testing was performed on 16/20; exome/genome trio sequencing was performed in 4/20. Definite pathogenic or highly suspicious variants relevant to underlying phenotype were noted in 4/20 (20%), an unrelated but actionable pathogenic variant was noted in 1/20 (5%), and possibly relevant variants were noted in an additional 3/20 (15%) patients. Genes with identified variants included RNF213 (n=2), ENG, EPHB4, F2, F5, COL4A1, and DIAPH1. Positive or negative results informed or changed clinical management in 17/20 (85%) patients, prompting additional testing, altered imaging surveillance, and/or expectant guidance for the patient and family members.

Conclusions:
Genetic testing has become increasingly available and has relatively high yield in pediatric and young adult hemorrhagic stroke and cerebrovascular malformations. Panel or exome/genome-based testing can inform care in these individuals and their families. Larger cohort studies are needed to determine more precise yield of genetic testing across a variety of cerebrovascular conditions.
Abstract TMP94: Mental Health Outcomes In Parents with Children with Pediatric Arterial Ischemic Stroke
Authors: Lehman Laura , Beslow Lauren , Dlamini Nomazulu , Kirton Adam , Guilliams Kristin , Taylor John , Fain Daniel , Glass Hannah , Peglar Lindsay , Rafay Mubeen , Dowling Michael , Pergami Paola , Fox Christine
Published: January 2025

Introduction:
Previous single-center studies have found a higher prevalence of mental health disorders in parents of children with pediatric stroke compared to general population prevalences of 5% with depression and 6% with anxiety. Social determinants of health may influence mental health outcomes. We aimed to measure associations between social determinants of health and parental report of mental health symptoms following their child’s diagnosis of ischemic stroke.

Methods:
We performed a multicenter, international prospective study through the International Pediatric Stroke Study (IPSS). From 2016 to 2021, parents of children within 3.5 years after arterial ischemic stroke enrolled and completed validated and standardized surveys on anxiety (Beck’s Anxiety Inventory II), depression (Beck’s Depression Inventory), post-traumatic stress disorder (PTSD) (Post-Traumatic Stress Disorder Checklist for DSM-5), severity of their child’s stroke deficits (Recovery and Recurrence Questionnaire), and social determinants of health. For our statistical analysis we employed a linear mixed-effects model, both unadjusted and adjusted.

Results:
Fifty-two parents (13 fathers, 39 mothers) of 39 children enrolled. Of the 39 children 21 (54%) had perinatal stroke and 18 (46%) had childhood stroke. Median time from stroke diagnosis to parental survey completion was 1.3 years (interquartile range [IQR] 1.0-2.0). On parental surveys, parents scored in the clinical range for: depression in 35% of mothers and 23% of fathers; anxiety in 2% of mothers and 0% of fathers; PTSD in 26% of mothers and 8% of fathers. Lower parental education was significantly associated with higher levels of depression both in our unadjusted (0.02) and adjusted (0.03) models. Interestingly, the child’s functional outcome and parental income were not significantly associated with any parental mental health outcomes.

Conclusion:
Among social determinants of health, parental education level may be associated with depression in parents of children with pediatric arterial ischemic stroke and needs further exploration. Parents of children with pediatric arterial ischemic stroke had higher rates of depression and PTSD compared to general population estimates. Further research in this area will help facilitate understanding and development of interventions to prevent these mental health outcomes.