bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP135: Prehospital Transport Protocol For Comprehensive Stroke Center Triage Is Associated With Reduced Last Known Well To Arrival Times For Intracranial Hemorrhage
Authors: Donnelly Sarah , O'Neill Kathleen , Prabhakaran Shyam , Kass-Hout Tareq , Tataris Katie , Thomas Kathie , Sednew Renee
Published: February 2022

Background:
In September 2018, we implemented a prehospital routing protocol for patients with suspected severe stroke and large vessel occlusion using the 3 Item Stroke Scale (3I-SS). Patients who have a 3I-SS score of ≥4 and have a known last normal time of ≤6 hours were transported to the closest Comprehensive Stroke Center (CSC). While the impact on endovascular treatment for ischemic stroke is more established, the effect of this transport policy on patients with intracerebral hemorrhage (ICH) is unknown.

Objective/Methods:
The objective of the study was to determine if implementation of a regional CSC transport protocol reduced last known well (LKW) to hospital arrival time for patients with ICH.Data was retrospectively reviewed all patients with a primary diagnosis of ICH from Get With The Guidelines® (GWTG) Stroke regional registry between January 2018 to May 2019 (8 month pre and 8 months post-implementation) and consisting of 16 Primary Stroke Centers (PSCs) and 8 CSCs. We analyzed LKW-arrival times to compare median times in the pre- vs. post-implementation periods.

Results:
There were 501 ICH cases in the pre-implementation period (mean age 66, 43.3% Black, and 52.3% male) and 548 in the post-implementation period (mean age 66, 41.0% Black, and 54.3% male). In the post-implementation period, median LKW to hospital arrival time was 255 minutes vs. 270.5 minutes in the pre-implementation period (P value 0.029). LKW to hospital arrival times for those patients arriving from EMS decreased from a median 112.5 minutes to 81 minutes (P value 0.034).

Conclusions:
A prehospital direct-to-CSC transport protocol resulted in a substantial decrease in the median LKW to hospital arrival times for ICH patients, driven especially by EMS-arriving patients. Prehospital protocols could increase access to time sensitive life-saving therapies for ICH.
Abstract TP137: Ethnic/racial Variations Of Intracerebral Hemorrhage Genetics (erich-gene) Study Protocol
Authors: Falcone Guido J , Vagal Achala , Khandwala Vivek , Maloney Thomas , Flaherty Matthew , Demel Stacie , Parodi Livia , Gilkerson Lee , Fortes-Monteiro Carla , Worrall Bradford B , Nyquist Paul A , Ziai Wendy C , Langefeld Carl D. , Rosand Jonathan , Anderson Christopher D , Woo Daniel
Published: February 2022

Introduction:
Epidemiologic studies of intracerebral hemorrhage (ICH) have consistently demonstrated variation in incidence, location, comorbidity burden, age-of-onset, and outcome by race and ethnicity, and genetic studies have identified differences in risk mediated by genetic risk factors such as Apolipoprotein E (APOE). We report the design and methods of the largest multi-ethnic genome-wide association study (GWAS) of ICH risk and outcome conducted to date.

Methods:
The Ethnic/Racial Variations of ICH Genetics (ERICH-GENE) study is an international, multi-center, genetic case-control study of ICH. Cases are individuals with confirmed primary ICH with biosample availability and consent compatible with shareable genome-wide genotyping or previous genotyping. Central neuroimaging phenotype harmonization of case status, hemorrhage location, and imaging characteristics of cerebral small vessel disease including leukoaraiosis, atrophy, microbleeds, intraventricular hemorrhage severity and volume of ICH measurements will be performed. Controls are ICH-free individuals of compatible age and race/ethnicity from existing studies and biorepositories.

Results:
As of August 2021, 2,002 ICH cases have been collected and genotyped, in addition to 2,558 already-genotyped ICH cases from the multi-ethnic ERICH study. 5,600 total new ICH cases will be genotyped under ERICH-GENE, with planned meta-analyses across existing ICH GWAS datasets and international biobanks totaling >20,000 cases. We are on schedule to meet our genotyping goal within the study period. Non-European ancestry cases are being prioritized for genotyping and ~66% of the previously genotyped ERICH cases are black or Hispanic. From available cases, a total of 10,621 neuroimaging studies have been uploaded for central adjudication to date with 6,278 having undergone harmonization.

Conclusions:
ERICH-GENE is a large, multi-ethnic, international, centrally harmonized GWAS of ICH risk and outcome that will identify genetic risk factors across diverse populations for biological discovery and population-specific risk stratification.
Abstract TP15: Self-report Does Not Align With Objective Assessments Of Memory And Fine Motor Functioning In Stroke Survivors
Authors: Mendez Maria P , Drag Lauren L , Mlynash Michael , Musabbir Muhith , Kim Da Eun K , Lansberg Maarten G , Buckwalter Marion S
Published: February 2022

Introduction:
Stroke increases the risk of cognitive and motor impairment long after the subacute recovery period. Clinicians often rely on patients to self-report symptoms, though this may not always align with objective findings. The aim of this study was to determine the associations between self-report and objective methods of evaluation when examining cognitive and motor functioning in stroke survivors.

Methods:
Seventy ischemic stroke participants over age 45 completed the Hopkins Verbal Learning Test-Revised (HVLT) and the Finger Tapping Test (FTT) 5-13 months post-stroke as part of the StrokeCog study. Performance of at least one standard deviation below the normative mean was considered abnormal. Self-report ratings in memory and thinking, hand function, and depression were assessed with the Stroke Impact Scale (SIS) as well as fatigue (FACIT) and stroke severity (NIHSS). Logistic regression was used to assess associations with HVLT and FTT performance as dependent factors.

Results:
Thirty-nine percent of participants demonstrated abnormal memory performance on the HVLT. The normal and abnormal memory groups did not differ in self-reported memory (p = 0.242) or depression (p = 0.232). A trend towards less stroke severity among patients with normal (median (IQR) NIHSS 2 (1-8)) vs. impaired memory exists (NIHSS 6 (2-12.5); p = 0.08). Less fatigue (OR (95% CI) 1.05 [1.001-1.11]) and female sex (OR 3.80 [1.09-13.21]) were independently associated with normal memory. Fifty-two percent of participants demonstrated abnormal motor performance on the FTT. The normal and abnormal motor groups did not differ in self-reported hand function (p = 0.285). Male sex (OR 19.6 [3.8-100]) and lower depression (OR 1.12 [1.05 - 1.20]) were independently associated with normal motor function.

Conclusion:
Self-report did not align with objective assessments of memory and fine motor functioning in stroke survivors. Fatigue and male sex were associated with memory impairment while depression and female sex were associated with motor impairment. This highlights the role of fatigue and depression in long-term stroke outcomes and the importance of using both objective and subjective methods when evaluating cognitive and motor impairment.
Abstract TP164: Diaschisis As A Possible Predictive Factor On 90-day MRS Outcomes In Extended Window Lvos
Authors: Gillani syed , Kadipasaoglu Mehmet , Foster Zane , Misra Vivek , Vahidy Farhaan S
Published: February 2022

Objective:
To determine whether the presence of diaschisis on CT perfusion (CTP) scans is predictive of 90-day functional outcomes in stroke patients with extended window large vessel occlusion (EWLVO) treated with mechanical thrombectomy (MT).

Background:
Diaschisis is a neurophysiological phenomenon that indicates functional/metabolic depression in the cerebellar hemisphere contralateral to supratentorial cortex following focal ischemic injury. Typically seen on PET or Perfusion-MR/-CT imaging, it is thought to reflect depressed Purkinje Cell activity secondary to disruptions of excitatory cortico-ponto-cerebellar afferent projections. Despite its reported incidence of 20%, its prognostic value and clinical significance remain unclear. Given the underlying pathophysiology, we hypothesized that presence of contralateral cerebellar diaschisis would be associated with worse 90 day mRS outcomes in patients with intracranial EWLVO treated with MT.

Methods:
A retrospective review was performed evaluating all EWLVO patients who presented from 2016 to July 2021. The presence of contralateral cerebellar diaschisis was determined by visual review of CTP imaging. EWLVO patients were categorized into those with and without daichisis. The 90 day mRS outcomes were compared between the two groups while controlling for age, gender, race, medical co-morbidities, NIHSS, and reperfusion outcomes.

Results:
83 LVO patients with CTP imaging were identified by chart review. Of these, 32 (38.5%) demonstrated contralateral cerebellar diaschisis. There no statistically significant differences among all studied variables. Using logistic regression analysis, no statistical association was found between the presence of contralateral cerebellar diaschisis on EWLVO patients and their 90 day outcomes.

Conclusions:
For patients with acute EWLVO treated with thrombectomy, the presence of diaschisis on CTP is not predictive of 90 day functional outcomes.
Abstract TP17: Activation Of Erk1/2 Signaling Drives Cardiac Hypertrophy During Chronic Mild Stress-induced Depression In Mice
Authors: Singh Sarojini , Patil Mallikarjun , Dubey Praveen , Dubey Shubham , Luong Hien , Krishnamurthy Prasanna
Published: February 2022

Background:
Major depressive disorder (MDD) is one of the fastest-growing disability disorders in the US and worldwide. Extensive clinical data suggest that MDD is associated with an increased risk of hypertension, coronary heart disease, and other cardiovascular diseases. A close relation between cardiovascular and cerebrovascular diseases and clinical evidence presents a potential link between depression and stroke. MDD when combined with other comorbidities, makes the prognosis worse. Dysregulation of the sympathetic nervous system, impaired hypothalamic-pituitary-adrenal axis, and increased inflammatory response are plausible mechanisms that have been linked to depression-induced cardio- and cerebrovascular complications. In the current study, we investigated cardiac structural and functional alterations in a mouse model of chronic mild stress (CMS) exhibiting depression-like behavior.

Methods and Results:
The mice were divided into control (CT) and CMS groups. The CMS mice were subjected to various mild, unpredictable stressors for 7 weeks. Depression-like traits were confirmed in the CMS group by analyses of behavioral changes using open field and forced swim tests and a decrease in hippocampal brain-derived neurotrophic factor (BDNF) protein level. To evaluate depression-associated neuronal damage and neuronal plasticity, Fluoro-Jade C staining and expression of microtubule-associated protein 2 were examined. However, we did not observe neuronal damage in the CMS mice as compared to the CT mice. We also observed a decrease in cardiac BDNF expression and upregulation of IL-6 in the CMS mice compared to the CT group. Echocardiographic and histological analyses showed an increase in ventricular wall thickness with increased cardiomyocyte size in the CMS group. However, we did not find changes in fetal gene expression or fibrosis markers. Investigation of underlying mechanisms showed a significant upregulation in ERK1/2 signaling in the left ventricles of the CMS mice as compared to the control group, with no changes in phospho-p38, NFATc3, or JNK levels.

Conclusion:
In conclusion, these data suggest that ERK1/2 signaling might have an important role in cardiac hypertrophic response during the CMS-induced depression in mice.
Abstract TP170: Pediatric Acute Stroke Team Activation: Differentiating Stroke From Mimics
Authors: Wood William D , Hennes Halim , Dowling Michael M , Reisch Joan , Okada Pamela
Published: February 2022

Acute pediatric stroke is a medical emergency requiring prompt recognition and treatment because quicker treatment improves neurologic outcomes and reduces excess resource usage on stroke mimics (non-stroke diagnoses). There is a clear need to better differentiate between strokes and their mimics. We performed a single center retrospective cohort study using data from March 1, 2017 to December 31, 2020. We included pediatric patients (> 1m to < 18y) evaluated in the tertiary children’s hospital ED for a stroke team activation. We compared clinical features for patients with stroke and those with a stroke mimic. Of 179 children included in the study (55% female, mean age 11.2y, SD 5.7y), 38 children (21% of total patients, 50% female, mean age 10.5 SD, 6.2 years) were diagnosed with stroke. Strokes included acute ischemic stroke (AIS) (73.7%), hemorrhagic stroke (HS) (18.4%), and cerebral venous sinus thrombosis (CVST) (10.5%). The most common stroke mimics were seizure (14.5%), headache (10.5%), Bell's palsy (5.6%), and conversion disorder (2.7%). Compared to mimics, stroke patients were less likely to have a history of neurosurgery (16.3% mimic vs 2.6% stroke, p=0.028) and more likely to have altered level of alertness (7.7% vs 18.4%, p=0.001), abnormal coordination (15.7% vs 36.4%, p=0.036), abnormal muscle strength (33.1% vs 57.9%, p=0.005) and abnormal reflexes (18.9% vs 43.8%, p=0.018). Of note, there were no significant differences in stroke and mimics for: age, sex, race, ethnicity, basic metabolic panel or CBC, and time from last seen well. Differentiating between strokes and mimics remains difficult without comprehensive diagnostic testing. Our study found that stroke patients are more likely present with altered level of alertness as well as abnormal coordination, muscle strength, and reflexes.
Abstract TP171: Acute Magnetic Resonance Imaging Findings In Patients With Sturge Weber Syndrome
Authors: Maldonado-Soto Angel , Bonnet Wilmot , Dowling Michael M , Clarke Rebekah
Published: February 2022

Sturge-Weber syndrome (SWS) is a neurovascular disorder characterized by facial Port-wine stain and intracranial capillary malformations. Patients can have multiple neurological complications including seizures, headaches, and stroke-like episodes, often leading to multiple hospital presentations. Published reports have shown conflicting results on whether patients with SWS with acute neurological complaints have positive imaging findings. Small case reports have described acute ischemic or hemorrhagic changes in SWS patients, whereas larger case series have not identified such imaging findings. Our aim was to report imaging findings in a cohort of SWS patients who presented with acute neurological complaints. We performed a retrospective analysis on all MRI studies performed on SWS patients presenting to our institution with acute neurological symptoms between August 1999 and July 2018. Imaging studies were initially evaluated by the radiologists on-call, and subsequently reviewed by a separate neuroradiologist to confirm the diagnoses. Only studies that were interpreted as having acute findings by both radiologists were counted as positive. During the study period, 23 patients with SWS presented to our institution with acute neurological complaints, of which 13 (56.5%) were male, median age 3 years, with 50 MRI obtained. Seizures were the most common indication for acute imaging (58%), followed by stroke-like episodes (32%), headache (6%), lethargy (2%) and vomiting (2%). Acute changes on MRI were found in 8 studies (16%), with restricted diffusion in 5 patients (of which 4 were presumed to be due to stroke and 1 due to ongoing seizure activity), brain edema in 2 patients and a subdural fluid collection in 1 patient. Of the patients with acute imaging findings, 4 presented with seizures, 3 with stroke-like episodes, and 1 with lethargy. In conclusion, SWS patients with acute neurological complaints can have acute findings on MRI consistent with stroke or other acute injuries. Imaging appears to be an important tool in the management of acute episodes in SWS patients. Restricted diffusion in SWS patients may represent venous congestion or other hemodynamic changes leading to acute injury.
Abstract TP174: Cannabis And Stroke Outcomes: A National Registry Analysis
Authors: Siddiqui Neha , Mehta Amol , Fifi Johanna , De Leacy Reade A
Published: February 2022

Introduction:
Recreational and medical cannabis use in the United States has been increasing in recent years in light of state efforts to decriminalize and legalize its use. Its legal status has long precluded extensive research into its adverse effects, especially as it pertains to the realm of vascular and cerebrovascular outcomes. To date, minimal research has been completed on the sequelae of cannabis in cerebrovascular hospital admissions.

Methods:
A query of the 2012-2015 Nationwide Inpatient Sample searched for patients admitted with cerebrovascular related ICD-9 diagnoses. These patients were then grouped by the presence of concurrent diagnosis of cannabis use disorder, and compared with respect to various peri- and postoperative complications, all-cause mortality, discharge disposition, length of stay, and hospitalization costs. Propensity score matching was utilized to control for potential baseline confounders.

Results:
A total of 900,023 patients met inclusion/exclusion criteria, 7,231 (0.80%) of whom had cannabis use disorder. After controlling for baseline characteristics, these patients had higher rates of inpatient mortality (odds ratio [OR] 1.99; p=0.034), and non-routine discharge, as well as increased lengths of stay (6.3 vs 5.9 days, p<0.001) and no significant difference in hospitalization charges ($63805 vs. $ 63328 10, p=0.6777).

Conclusions:
Based on a national trends analysis, chronic cannabis use appears to be associated with increased perioperative morbidity and mortality among patients admitted for cerebrovascular diagnoses. Physicians should ensure that a thorough drug use history is taken, and that affected patients be adequately informed of associated risks. Further research can elucidate further the effect on specific cerebrovascular diagnoses such as stroke and aneurysms.
Abstract TP198: FIB-4 Index And Acute Ischemic Stroke Outcomes After Intravenous Thrombolysis
Authors: Toh Emma M , Joseph Ravi Priscilla Roshini , Ming Chua , Lim Amanda Y , Sia Ching-Hui , Yeo Leonard L , Huang Daniel Q , Muthiah Mark D , Tan Benjamin Y
Published: February 2022

Introduction:
It could be theorised that liver fibrosis and acute ischemic stroke (AIS) are related by inflammatory changes, but few studied this link, let alone in patients receiving intravenous thrombolysis (IVT). The Fibrosis (FIB)-4 index is an established rapid score to detect liver fibrosis. We aimed to understand the role of FIB-4 in predicting AIS subtype, severity and outcomes after IVT.

Methods:
AIS patients receiving IVT without severe liver derangement from 2006 to 2018 at a stroke centre were studied. Stroke subtype was defined using Trial of Org 10172 in Acute Stroke Treatment. Moderate and severe stroke was defined as National Institutes of Health Stroke Scale (NIHSS) ≥10. FIB-4 index was stratified into no advanced fibrosis (FIB-4 <1.45) and advanced fibrosis (FIB-4 >3.25). The primary outcome - functional outcome at 90-days using the modified Rankin Scale (mRS) - was analysed by ordinal shift analysis. Multivariable adjusted logistic regression evaluated associations of FIB-4 with stroke severity, functional independence (90-day mRS 0-2 vs 3-6), 90-day mortality, and symptomatic intracranial hemorrhage (SICH).

Results:
Among 900 patients, higher median FIB-4 was seen in cardioembolic stroke (CES) than non-CES (1.93 [IQR: 1.39-2.81] vs 1.27 [IQR: 0.92-1.90], p<0.001). On multivariate analysis, higher FIB-4 predicted moderate and severe stroke (OR: 1.33, 95% CI: 1.08-1.68, p=0.012). On ordinal shift analysis, advanced fibrosis was associated with an unfavourable shift in 90-day mRS compared to no advanced fibrosis (OR: 1.75, 95% CI: 1.06-2.89, p=0.028). Advanced fibrosis was also associated with increased mortality (OR: 3.07, 95% CI: 1.47-6.48, p=0.003) and SICH (OR: 3.65, 95% CI: 1.21-11.17, p=0.022), but not functional independence (OR: 0.80, 95% CI: 0.40-1.55, p=0.512).

Conclusion:
Liver fibrosis was associated with higher rates of CES, more severe AIS, and poorer outcomes after IVT. This is a novel marker that could prognosticate IVT use in AIS.
Abstract TP201: How Often Is Occult Atrial Fibrillation In Cryptogenic Stroke Causal Versus Incidental?
Authors: Chaisinanunkul Napasri , Khurshid Shaan , Buck Brian H , Rabinstein Alejandro A , Anderson Christopher D , Hill Michael D , Fugate Jennifer , Saver Jeffrey L
Published: February 2022

Introduction:
Long-term cardiac monitoring studies have unveiled low-burden, occult atrial fibrillation (AF) in some patients with otherwise cryptogenic stroke (CS). But occult AF is also found in some normal individuals and patients with stroke of known cause (KS). Clinical management would be aided by estimates of how often occult AF in a patient with CS is causal versus incidental.

Methods:
Through systematic search, we identified all case-control and cohort studies applying identical long-term monitoring techniques to both CS and KS patients. We performed a random-effects meta-analyses across these studies to determine the best estimate of the differential frequency of occult AF in CS and KS among all patients, and across age subgroups. We then applied Bayes’ theorem (method of Alsheikh-Ali et al, Stroke 2009) to determine the probability that occult AF is causal or incidental.

Results:
The systematic search identified 3 case-control and cohort studies enrolling 575 patients (337 CS, 238 KS). Methods of long-term monitoring were implantable loop recorder in 191 (33.2%), extended mobile external cardiac monitor in 277 (48.2%), and patch/event/Holter monitoring in 107 (18.6%). In formal meta-analysis, the summary odds ratio for occult AF in CS vs KS in all patients was 1.72 (95%CI 0.91-3.25) (Figure). With application of Bayes theorem, the corresponding probabilities indicated that, when present, occult AF in CS patients is causal in 44.4% and incidental in 55.6%. Only one study reported age-specific subgroup data: these suggested occult AF in CS patients was causal in 93% of patients <65y vs 5.6% of patients ≥65y, but estimates had limited precision.

Conclusions:
In patients with cryptogenic stroke, when occult AF is found, it is likely causal in about 44% of patients, who may benefit from anticoagulation, and likely incidental in about 56% of patients, who may not benefit from anticoagulation.

Figure
Abstract TP202: Nonstenotic Carotid Plaque As An Inverse Predictor Of PFO In Cryptogenic Stroke
Authors: Sathya Anvitha , Siegler James E , Reyes-Estevez Sahily , Kamen Scott , Hester Taryn , Vigilante Nicholas , Woo John , Zhang Linda , Cucchiara Brett L , Nguyen Thanh N
Published: February 2022

Background:
Embolic stroke of undetermined source (ESUS) accounts for up to 20% of all strokes. Potential contributors to ESUS include patent foramen ovale (PFO) and non-stenotic plaque (<50%, NSP) of the ipsilateral internal carotid artery (ICA). To better differentiate these as unique mechanisms, we explored the prevalence of each in a multicenter observational cohort.

Methods:
A retrospective multicenter cohort of consecutive patients with ESUS was queried (2015-2021). Patients with unilateral, anterior circulation ESUS who had a CTA neck scan and a transthoracic echocardiogram (TTE) and/or transesophageal echocardiogram (TEE) with adequate visualization of a PFO were included. Patients with prior carotid stent, endarterectomy or alternative etiologies were excluded from the study. Descriptive statistics were used to characterize patients with and without PFO, with multivariable logistic regression used to predict the presence of a PFO based on clinicoradiographic factors as well as degree of luminal stenosis and ipsilateral plaque thickness >3mm, based on previously published thresholds of clinical relevance.

Results:
Of the 234 included patients with unilateral anterior ESUS and adequate TTE or TEE, 17 (7.3%) had a PFO and 64 (27.4%) had ≥3mm of ipsilateral ICA plaque. Patients with PFO had significantly less NSP and less ipsilateral cervical ICA stenosis (0% [IQR 0-0%] vs. 0% [IQR 0-50%], p=0.03; Table). After adjustment for all predictors of PFO in multivariable regression (p<0.2: non-White race, Hispanic ethnicity, and ipsilateral plaque thickness), ipsilateral NSP was non-significantly associated with an 86% lower odds of finding a PFO (ORadj per 1cm of plaque 1.86, 95%CI 0.97-3.55, p=0.06). No patients with a PFO had ≥3mm of ipsilateral ICA plaque.

Conclusion:
Ipsilateral NSP is more common in ESUS patients without a PFO. While this study is limited by the small PFO event rate, it supports the notion that NSP and PFO may be independent contributors to ESUS.
Abstract TP21: The Role Of Interleukin-1α Cytokine In Poststroke Inflammation
Authors: Lemarchand Eloise , Ouvrier Blake , Rahman Abir A , Wong Raymond , Narayanappa Amruta , Gressett Timothy , Pinteaux Emmanuel , Bix Gregory J
Published: February 2022

Stroke remains the second leading cause of death globally, with a total of 5.5 million deaths in 2016 and an estimated global lifetime risk of stroke for those aged 25 years or older at 24.9%. A key feature of stroke and poststroke injury is the inflammatory response, which is driven by a variety of pro-inflammatory cytokines to include interleukin-1 (IL-1). Evidence from pre-clinical studies have demonstrated a deleterious effect of IL-1 poststroke with a beneficial effect observed after blocking IL-1 in both pre-clinical and clinical settings. The IL-1 family has both IL-1β and IL-1α forms, and although IL-1β has been most closely studied, the distinct roles of both IL-1 isoforms during poststroke inflammation is largely unknown. In this study, we examined the contribution of IL-1α in ischemic stroke. We characterized the spatio-temporal effect of IL-1 in the brain after stroke using an in vivo model of middle cerebral artery thrombosis in an inducible IL-1α knockout mouse through topical application of FeCl3. We found that IL-1α precedes IL-1β expression after ischemic stroke and is restricted to microglia whereas IL-1β is expressed by both neutrophils and microglia. Intriguingly, microglial IL-1α deletion does not influence brain damage after ischemic stroke, and furthermore does not influence cerebral blood flow or neutrophil infiltration and IL-1β expression up to 24h after ischemic stroke. Pathway analysis following RNAseq suggests that microglial IL-1α regulates neuronal activity through CREB signaling. In vitro studies in Neuro2a (N2a) murine cell line additionally show neuronal activity regulation through CREB signaling via microglial IL-1α after oxygen glucose deprivation and reperfusion (OGD/R) model of stroke. As the role of IL-1α in stroke has yet to be fully elucidated, future experiments using both murine and in vitro models will clarify the role that IL-1α has in the pathogenesis of stroke and its relevance to inflammatory features posttroke, which may lead to future therapeutic insight.
Abstract TP211: Identifying Factors Associated With Higher Risk Of Stroke In Patients With Infective Endocarditis Using The National Inpatient Sample
Authors: Abburi Nandini , Longstreth W T , Kalani Rizwan , Weathered Natalie , Davis Arielle , de Havenon Adam H , Tirschwell David L
Published: February 2022

Background:
Cerebrovascular complications (ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH)) of infective endocarditis (IE) are common and substantially increase morbidity and mortality. We aimed to identify risk factors for stroke in a nationally representative population of hospitalized IE patients from the US.

Methods:
Patient hospitalizations for IE and stroke were identified using validated International Classification of Diseases 10 diagnosis codes from the Q4 2015-2018 National Inpatient Sample. We evaluated the association between demographics, known risk factors (opioid use, cardiac valve replacement, and mitral valve disease), and Elixhauser comorbidity index-defined factors with the diagnosis of stroke using logistic regression.

Results:
Of the 53,557 patients with a diagnosis of IE, 5,754 (10.7%) had a concurrent diagnosis of stroke (75% IS, 6.9% ICH, 4.5% SAH, 14% multiple stroke types). The mean age at IE diagnosis was 59 years; 42.3% were female; 71.8% Caucasian, 14.2% Black, 7.8% Hispanic, 2.7% Asian, and 0.8% Native American; 9.2% of patients died during hospitalization (7.5% without stroke, 23% with stroke, p<0.001). Factors independently associated with stroke are shown in the Table; the C-statistic was 0.63. Opioid use and cardiac valve replacement were not associated with stroke.

Conclusion:
In this large, nationally representative sample of hospitalized IE patients, comorbidities independently associated with higher odds of stroke included mitral valve disease, metastatic cancer, coagulopathy, weight loss, and electrolyte disorders. Detailed clinical data, not available from this administrative data set, may allow better prediction of stroke, but our findings may suggest areas for additional research.
Abstract TP217: Potential Utility Of Magnetocardiogram For Patients With Embolic Stroke Of Undetermined Source
Authors: Noda Kotaro , Washida Kazuo , Tanaka Tomotaka , Hosoki Satoshi , Ikenouchi Hajime , Kandori Akihiko , Koga Masatoshi , Toyoda Kazunori , Ihara Masafumi
Published: February 2022

Background:
The magnetocardiogram (MCG) is a promising medical tool for detecting and visualizing abnormal cardiac electrical activation in cardiovascular disease patients. MCG has higher spatial resolution than the electrocardiogram (ECG) because the magnetic field is not distorted by flow through tissues. Taking advantage of these features, MCG has been applied for studying arrhythmia, such as atrial fibrillation (AF) and long-QT syndrome. Paroxysmal AF is the most common sources of thromboembolism for ESUS. Since factors that reflect left atrial overload (LAO) are independent predictors of paroxysmal AF, evaluation of these factors in ESUS patients is essential to improve their prognosis. We aimed to investigate the potential utility of MCG in ESUS patients for evaluation of the factors that reflect LAO.

Methods:
ESUS patients who underwent MCG (MC-6400 MCG system with 64 magnetic sensors) in our hospital were enrolled between September 2018 and July 2021. The peak P-wave magnitude of the right atrium segment and the left atrium segment on the MCG (MCG-RA, MCG-LA) were measured. Subsequently, the ratio of peak magnitude of the LA segment to that of the RA segment (MCG-LA/RA) was used to evaluate LAO. Other factors that reflect LAO, such as PAC frequency on Holter monitoring, LAD in transthoracic echocardiography (TTE), serum level of brain natriuretic peptide, left ventricular ejection fraction (LVEF) in TTE, and P-wave terminal force in lead V1 (PTFV1) on ECG were also evaluated.

Results:
Fifty-two ESUS patients with a mean age of 67.9±14.3 years (females, 42%) were included. The mean MCV-RA and MCG-LA were 7.70±12.82 and 4.50±7.74 pico-Tesla, respectively. The mean MCG-LA/RA was 0.66±0.31. The MCG-LA/RA was significantly correlated with the PAC frequency (r=0.293, p=0.039), although either MCG-RA or MCG-LA was not correlated. Also, the MCG-LA/RA ratio was significantly correlated with LAD (r=0.301, p=0.03) but not with brain natriuretic peptide (r= 0.25, p= 0.09), LVEF (r= -0.06, p= 0.654), or PTFV1 (r= 0.02, p=0.91).

Conclusion:
This is the first study that evaluated the relationship of the MCG-LA/RA ratio with factors that reflect LAO in ESUS patients. These results suggest that the MCG-LA/RA ratio is a novel biomarker for LAO in ESUS patients.
Abstract TP219: ACE2L: A Novel Scoring Tool With High Sensitivity And Specificity In Predicting Atrial Fibrillation In Cryptogenic Stroke
Authors: Ahmed Mohammad U , Mallick Dania , Berkompas Duane C , Merhi William , Davis Alan T , Min Jiangyong
Published: February 2022

Introduction/Background:
Stroke is a leading cause of serious, long-term disability and death worldwide. Atrial fibrillation (AF) is the most common form of sustained cardiac arrhythmia, and is associated with a high risk of ischemic stroke and thromboembolism. Many cryptogenic strokes may be due to underlying, undetected paroxysmal AF. We performed a retrospective evaluation of patients with a history of ischemic stroke who were subsequently diagnosed with AF in order to develop a novel risk score calculator to help guide management in patients with cryptogenic stroke.

Methods:
We evaluated patients with a history of ischemic stroke both with and without a subsequent diagnosis of AF. Patients with a pre-existing diagnosis of AF were excluded. 1 point was assigned for each of the following: (1) age > 60; (2) cortical ischemic stroke; (3) embolic appearance on imaging; (4) p-wave terminal force > 5000 μVms; (5) increased left atrial volume index; (6) lack of extracranial large vessel occlusion (LVO). Patients with ipsilateral extracranial LVO and patients with LVO > 70% were excluded.

Results:
A total of 74 patients with a diagnosis of ischemic stroke were evaluated. Of these, 41 patients had a subsequent diagnosis of AF, and 33 patients did not. A score of 4 or higher correlated with a sensitivity of 86.8% (95% CI: 72.7%, 94.2%), specificity of 100% (95% CI 89.8%, 100%), PPV 100% (95% CI 89.6%, 100%), NPV 87.2% (95% CI 73.3%, 94.4%), negative likelihood ratio 0.13 (95% CI 5.8%, 29.8%), and accuracy 93.1% (95% CI 84.8%, 897%).

Conclusions:
The novel ACE2L scoring tool demonstrated high sensitivity and specificity in predicting atrial fibrillation in patients with ischemic stroke. This scoring tool utilizes factors readily accessible in the evaluation of acute stroke and is a simple tool that may be used to help guide further management. Future, prospective studies are needed to further validate this scoring tool.
Abstract TP22: Coagulation Markers And Stroke Severity In Covid-19 Associated Acute Ischemic Stroke
Authors: Ludder Shaan , Meyer Dawn M , Rapp Karen , Mcquaid Theresa , Rico Jessica , Gupta Animesh , Hemmen Thomas M
Published: February 2022

Background:
COVID-19 is thought to induce a pro-thrombotic state, which might increase stroke risk. The purpose of this project is to assess stroke severity, type and coagulation markers such as D-dimer, fibrinogen, and CRP in patients with acute ischemic stroke (AIS) and COVID-19, compared to a control group of AIS without COVID-19.

Methods:
We captured discharge diagnosis of all patients at our medical center with AIS and COVID based on their discharge ICD-10 coding between June 2020 and May 2021; and identified AIS without COVID matched for age, sex, race, and ethnicity. Group 1 was AIS with COVID-19, Group 2 matched (3:1) AIS without COVID-19. We compared baseline demographics, NIHSS, D-dimer, fibrinogen, CRP, presence of large vessel occlusion (LVO) in COVID-19 AIS vs non-COVID-19 AIS. We used a T test to compare parametric and Mann Whitney U for non-parametric values.

Results:
In total 23 (of 397 total AIS) patients were in Group 1; 69 in Group 2. D-dimer levels (mean) were 3237.3 in Group 1, and 2706.8 in Group 2 (NS), Fibrinogen 464.4 and 379.8 (NS), CRP 7.9 and 9.4 (NS). Median NIHSS was 21 versus 5 (p=0.003). LVO was present in 17 patients in Group 1 (73%) and 23 (33%) in Group 2 (NS). In total, only 5.8% (23 of 397) of all AIS in our data had Covid-19 infection.

Conclusion:
COVID in stroke was an infrequent finding in our sample (5.8%). Patients with COVID and stroke had higher initial stroke severity, but did not differ in coagulation values. Weather coagulation markers can help distinguish patients with COVID related stroke will require subsequent studies. We need additional data before treatment recommendations specific to stroke in COVID can be made.
Abstract TP222: The Impact Of Il-6 Level On Visit-to-visit Blood Pressure Variability And Incidence Of Stroke: A Post-hoc Analysis Of Mesa
Authors: Wong Ka-ho , Muddasani Varsha , Peterson Cecilia , Sheibani Nazanin , Arkin Cameron , Cheong Irene , Majersik Jennifer J , Sansing Lauren H , de Havenon Adam H
Published: February 2022

Background:
Increased blood pressure variability (BPV) has been associated with stroke risk, but no serum inflammatory markers have been identified associated with increased BPV, despite preclinical data suggesting a role.

Methods:
This is a post-hoc analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study. The study exposure was tertiles of serum level of interleukin-6 (IL-6) at the baseline study visit. The primary outcome was visit-to-visit BPV measured as the residual standard deviation (rSD) of at least 4 subsequent study visits (1999-2018). Two logistic regression models were fit to the top tertile (i.e. most variability) of rSD during follow-up: in Model 1, we adjusted for covariates chosen with restricted Least Absolute Shrinkage and Selection Operator (LASSO) and in Model 2, for all covariates.

Results:
Our analysis included 5,483 patients, of mean (SD) age 61.4 (10.0) years and with 52.9% female. Mean (SD) of IL-6 was 1.7 (1.2) (pg/mL) in the top tertile BPV rSD and 1.4 (1.1) in the bottom tertiles. The incidence of ischemic stroke and all major adverse cardiovascular event was higher in top tertile of BPV (Table 1). Elevated serum IL-6, but not other serum biomarkers of inflammation and clotting (see comment below), was associated with the highest tertile of BPV, independent of potential confounders (Table 2).

Conclusion:
Higher levels of serum IL-6 were associated with increased subsequent BPV in a large multiracial cohort. Further investigation is needed to better understand the relationship between chronic inflammation and BPV.

Table 1.
Baseline demographics, serum biomarkers, and clinical outcomes during follow-up (how long was follow-up on average?) in the full cohort, and stratified by the top versus lower tertiles of BPV.

Table 2.
Association of serum biomarkers at baseline with the highest tertile of blood pressure variability.*Model 1 adjusted for patient age categories (<55, 55-64, 65-69, ≥70), sex, and hypertension.

**Model 2 (n=5,447) adjusted for patient age categories (<55, 55-64, 65-69, ≥70), sex, race/ethnicity, education, hypertension, diabetes, smoking, drinking, body mass index, lipid lowering medication, and mean systolic blood pressure
Abstract TP226: C-reactive Protein Predicts Early Neurological Deterioration After Ischemic Stroke
Authors: Bueno Pedro G , Gurel Kursat , Rahman Salwa , Spagnolo-Allende Antonio , Kozii Khrystyna , Khasiyev Farid , de Havenon Adam H , Yaghi Shadi , Gutierrez Jose
Published: February 2022

Introduction:
Early neurological deterioration (END) in patients with acute stroke is associated with poorer outcomes. We aim to investigate whether higher acute phase reactants in blood are associated with END. Identifying predictors of END could help select patient at the highest risk of END for possible interventions.

Methods:
In this cross-sectional study, we included 242 patients with acute onset of ischemic stroke admitted to Columbia University Irving Medical Center-New York-Presbyterian Hospital from 2006 to 2015. We focused on retrieving C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) when they were collected on admission. Risk factors and comorbidities were also captured from the charts. END was defined as any neurologic deterioration referable to ischemic stroke and not related to a medical or non-cerebrovascular neurological complication. We considered significant associations by a P-value <.05. We built separate logistic regression models with END as the outcome and CRP and ESR as the main exposure variables, progressively adjusting for confounders.

Results:
The study included 242 patients with a mean age of 64.2 ± 17.2, of which 108 (50%) were women, 89 (41%) were Hispanic and 40 (19%) were African American or black. The prevalence of END was 47 (19%). The most common stroke mechanism was penetrating artery infarct, 103 (43%). CRP level was associated with END, and it remained an independent predictor of END even after progressively adjusting for confounders (OR = 1.01; 95% CI 1.01 to 1.02, P <0.001). ESR was not associated with END (table 1). Among patients with acute stroke and CRP>10, there was a 28% risk of END compared with only 13% among those with CRP 10 or lower.

Conclusions:
Our results suggest that high CRP levels are associated with END. A cutoff of 10 or greater identifies patients at the highest risk of END. Replication studies are needed to understand the mechanisms behind this and further replicate these findings.
Abstract TP227: High Disability Rates In Young Patients With PFO Attributable Cryptogenic Ischemic Strokes
Authors: Rana Maheen , Moody Scott , Cutting Shawna M , Burton Tina , Sacchetti Daniel C , Reznik Michael , Mac Grory Brian , Goldstein Eric , El JAMAL SLEIMAN , Stretz Christoph , de Havenon Adam H , Gordon Paul , Furie Karen L , Yaghi Shadi
Published: February 2022

Introduction:
Approximately 30% of ischemic strokes are cryptogenic and 40-50% of these patients have a patent foramen ovale (PFO) detected during work up. While the risk of ischemic stroke attributed to PFO is 0.5-1% per year, the proportion of disabling ischemic strokes in the setting of PFO is unknown. In this study, we aim to determine differences in rates and predictors of poor outcome in patients with stroke and PFO compared to those without PFO.

Methods:
This retrospective, observational cohort study included consecutive patients aged 18-60 admitted to our comprehensive stroke center with a diagnosis of ischemic stroke over a two-year period. modified Rankin Score (mRS) was collected at 90-days according to institutional protocol. Poor functional outcome was defined as mRS of 2-6. We compared baseline characteristics of ischemic stroke patients with PFO to those without PFO, and then determined associations with poor outcome using multivariable logistic regression that adjusted for age and stroke severity. We performed similar analyses in the subgroup of patients with cryptogenic stroke.

Results:
Out of 321 patients with ischemic stroke (mean age 49; 42% women), 146 had cryptogenic stroke - embolic stroke of undetermined source subtype (CS-ESUS). Baseline characteristics, demographics, and stroke severity did not differ between those with PFO when compared to those without PFO both across the entire cohort and in the subgroup of CS-ESUS. Among patients with cs-ESUS with PFO, 48% (10/21) had poor functional outcome, and the rates did not significantly differ based on ROPE score (p = 0.362). In our binary logistic regression model adjusting for age and NIHSS score, the rate of poor functional outcome in patients with CS-ESUS did not significantly differ based on presence vs. absence of PFO (OR 1.10 95% CI 0.39-3.09, p = 0.859).

Conclusions:
Our study suggests that a significant portion (almost 1 in 2) of cryptogenic strokes in patients with a PFO were disabling at 90 days and disability rates did not significantly differ as a function of PFO attributability of their ischemic stroke. Further studies are needed to identify patients with high-risk PFOs that may especially predispose to disabling strokes and to determine optimal primary stroke prevention strategies.
Abstract TP23: Characteristics Of Patients With Acute Ischemic Stroke And Covid-19 Who Required Intensive Care Unit Admission Versus Ward-only: The Mississippi Academic Center Experience
Authors: Le Thuy Phuong , Hayek Reya , Sanchez Oriana , Austin Hannah W , San Luis Carmela , Sarkar Sanjay , Roy Debarshi , Shekhar Shashank , Nobleza Christa O
Published: February 2022

Background:
Coronavirus disease 2019 (COVID-19) is a viral disease that has primarily been known to cause respiratory symptoms; however, there has also been an association of COVID-19 with neurological symptoms, including acute ischemic stroke (AIS). There is a lack of data on the characteristics of AIS patients with COVID-19 from the stroke belt. We aim to describe the characteristics of patients with COVID-19 and AIS and compare the characteristics of those who required intensive care unit (ICU) admission versus ward-only.

Methods:
Single center, retrospective cohort study of adult patients admitted in a tertiary academic center from March 1-December 31, 2020. The institutional COVID database was utilized for data collection. Demographic, clinical and laboratory data were collected. Primary outcome measure was mortality. Secondary outcomes included hospital length of stay (LOS) and discharge disposition.

Results:
Both COVID-19 and AIS were found in 2.4% (n=75) of patients out of 3,031 patients with COVID-19, during the study period. These patients were male (45, 60%), African American (43, 57%), 65±12 years old, with hypertension (69, 92%) and Diabetes Mellitus type 2 (50, 67%). We noted a 20% (n=15) overall in-patient mortality rate among patients with both COVID-19 and AIS. Among these patients, 23% (n=17) required ICU admission. Demographic, clinical and laboratory characteristics were comparable among ICU versus ward-only patients except for higher LDH (476.12±189.70 vs 276.17±88.35 U/L, p==0.0003); and lower relative lymphocytic count (3.57±3.56 vs 8.93±7.83 10
3
cells/μL, p=0.0160) among those admitted into the ICU. Mortality (13, 68% vs 6, 32%, p<0.001) was significantly higher among the ICU cohort while majority of the ward-only cohort were discharged home (21, 95%).

Conclusion:
We present the first description of characteristics and outcomes of patients with AIS and COVID-19 from Mississippi. Novel to this cohort is the comparison of those who were admitted into the ICU versus ward-only. Prospective studies analyzing larger datasets of COVID-19 and stroke in the stroke-belt are warranted to further study disparities of care and outcomes.