bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract T MP77: Intraventricular Hemorrhage and Long-term Incontinencea and Dysmobility After Intracerebral Hemorrhage
Authors: Woo Daniel , Kruger Andrew , Sekar Padmini , Worrall Bradford B , Osborne Jennifer , Moomaw Charles J , Hosseini Shahla , Elkind Mitch S , Sung Gene , James Michael L , Flaherty Matthew L , Testai Fernando , Langefeld Carl D , Koch Sebastian
Published: March 2022

Background:
After intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH) is associated with worse short- and long-term disability.

Similar to other ventricular diseases, we hypothesized that IVH may be associated with urinary incontinence and gait disturbance.

Methods:
The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multi-center, prospective, study of ICH among whites, blacks, and Hispanics. Baseline CT images were analyzed for ICH location and volume, and IVH volume and presence. Incontinence and dysmobility were obtained by Barthel Index at 3 months post stroke. Multivariable logistic regression analysis was used to assess risk factors for incontinence and dysmobility. ICH and IVH volumes were log transformed to minimize extreme volumes influence on models.

Results:
Between 8/1/10 and 12/31/13, 2276 cases of ICH were enrolled. Of these, 250 died and 372 were lost to follow-up by 3 months. After removing cases with premorbid modified Rankin (mRankin) >3, lacking Barthel index or imaging, IVH was present in 487 (37.7%) of 1290 cases. Hypertension (88% vs. 84%; p=0.03), larger ICH volume (median 11.1 ml vs. 7.9 ml; p<.0001), and deep ICH (67% vs. 49%; p<.0001) were associated with IVH. Age, sex, anticoagulant use, and pre-stroke mRankin were not. At 3 months, cases with IVH were more likely to have incontinence (41% vs. 20%; p<.0001) and impaired mobility (58% vs. 33% <.0001). After controlling for ICH volume, age, pre-stoke mRS, baseline Glasgow Coma Scale, and sex, IVH volume was independently associated with incontinence and dysmobility (Table).

Conclusion:
We found that IVH after ICH is associated with developing long-term incontinence and dysmobility similar to other non-stroke ventricular disease patients. This finding may explain, in part, how IVH continues to affect outcomes after the resolution of IVH.
Abstract T MP79: Baseline disparities and Outcomes in Public vs Private US Health Care Institutions: The SPS3 Trial
Authors: Wilson Laura K , Field Thalia S , McClure Leslie A , White Carole L , Benavente Oscar R
Published: March 2022

BACKGROUND:
For optimal secondary stroke prevention timely access to medical care is paramount. Disparities in stroke care related to race-ethnicity, socioeconomic status and health care access are present. It is unclear if these variables are modified within a clinical trial setting. Our aims were to compare baseline demographic, clinical and neuroradiological features and clinical outcomes (recurrent stroke, death and myocardial infarction (MI)) in US participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial from public vs private institutions.

METHODS:
There were 1677 participants from US sites. We characterized sites as “public” or “private” based upon for-profit status and source of operational funding. Baseline demographic, clinical and neuroradiological features between groups were compared using Chi-square and unpaired t-tests, as appropriate. Cox proportional hazard models were used to compare risk of outcomes between groups in crude and adjusted models including age, sex, hypertension, diabetes, smoking, dyslipidemia, ischemic heart disease, body mass index and race-ethnicity as co-variates.

RESULTS:
Of the 1677 US patients, 1009 (60%) were enrolled at public and 668 (40%) at private institutions. There were significant differences in public vs. private groups with respect to age (60 vs 64 y, p=0.001), race-ethnicity (59% non-white vs. 24%, p <0.0001), and educational status (15% with <9 y of education vs 4%, p<0.0001). Antiplatelet use at the time of the index event was higher in the private group (43% vs 35%, p=0.0005). Over a mean of 3.7y (SD 2.0) of follow-up, no significant differences between groups were found with regards to stroke recurrence (Adjusted HR 1.2, 95% CI 0.9-1.5), death 0.9 (0.6-1.3) or MI 1.1(0.62-1.8).

CONCLUSION:
Despite baseline demographic disparities between groups from public and private sites, there were no significant differences in this trial setting with regards to outcomes. It is possible that strict control of risk factors, adherence to protocol and active interventions during the trial overcame disparities associated with differences in institutions, including differences related to medical care prior to study enrolment.
Abstract T MP8: Faster Angiographic Reperfusion is Associated with Improved Outcomes Across the Full Rankin Distribution: An Ordinal Analysis of the IMS III Trial
Authors: Khatri Pooja , Yeatts Sharon D , Fan Liqiong , Broderick Joseph P , Saver Jeffrey L ,   for the IMS III Trialists
Published: March 2022

INTRODUCTION:
In the NIH-funded IMS III trial, faster angiographic reperfusion led to a greater likelihood of good clinical outcome based on the dichotomized modified Rankin Score (mRS) score of 0-2 (minimal or no disability) vs. 3-6. From 240 to 390 minutes, among 1000 patients, every 15 minute acceleration in reperfusion was associated with 32 more patients with mRS 0-2. We hypothesized that faster reperfusion would lead to better clinical outcomes across the full mRS distribution (0, 1, 2, 3, 4, 5-6).

METHODS:
IMS III randomized subjects to IV/endovascular vs IV tPA alone. We analyzed the endovascular cohort with M1, M2 and ICAT occlusions reperfused (TICI 2-3) during the procedure (up to 7 hours). Time to reperfusion was defined as time from stroke onset to procedure termination. The ordinal 90-day mRS as a function of time to reperfusion was assessed using a proportional odds model with adjustment for pre-morbid mRS>0, ASPECTS 0-4, and NIHSS strata (10-19 vs ≥20). “Typical patient” covariate values were used to obtain mRS distributions at prespecified time points. An algorithmic joint table analysis was applied to generate number-needed-to-treat values.

RESULTS:
Among 177 M1, M2, and ICAT occlusion cases with angiographic reperfusion (after excluding 2 cases with missing 90-day mRS and 3 with missing baseline ASPECTS), the common OR for improvement across all levels of the mRS was 0.78 (95% 0.66-0.91) adjusted and 0.77 (95% 0.66-0.89) unadjusted for each 30 minute increase in time. See Figure for adjusted probabilities based on the fitted model. From 240 to 390 minutes, among 1000 patients, every 15 minute acceleration in reperfusion was associated with 57 more patients with improvement of ≥ 1 mRS disability level.

CONCLUSION:
Faster time to reperfusion improves clinical outcomes for substantially more patients when considering the potential effects across all mRS levels, as opposed to considering a single transition between binary endpoints 0-2 vs 3-6.
Abstract T MP89: A Comparison of Stroke Core Measure Performance Between Comprehensive Stroke Centers and Primary Stroke Centers
Authors: Alberts Mark J , Range Jean , Kolbusz Karen , Watt Ann , Morton David , Zibrat Frank
Published: March 2022

Objectives:
Performance on the eight Stroke Core Measures (SCM) is a major benchmark used to determine how organizations deliver stroke care. We now compare performance on these SCMs between certified Primary Stroke Centers (PSCs) and Comprehensive Stroke Centers (CSCs). Our hypothesis was that CSCs would achieve higher levels of meeting the SCMs compared to PSCs.

Methods:
We analyzed performance data on the eight SCMs between the 1046 Joint Commission (JC) certified PSCs and 74 JC certified CSCs using data available in 2013. Data were reported by the hospital via a third-party vendor to the JC. Comparisons were performed using Chi-square analyses.

Results:
Significant differences between CSC and PSC performance, with CSCs performing better, were seen in the following four SCMs: STK-4, thrombolytic therapy administered to eligible patients (CSC compared to PSC, 94.4% vs 84.2%, p = 0.0002); STK-6, discharge on statin (98.1% vs 97%, p = 0.009); STK-8, stroke education (95.2% vs 93.3%, p = 0.003); and STK-10, assessed for rehabilitation (99.7% vs 98.6%, p = 0.0001). For STK-5, antithrombotic Rx by day 2, PSCs performed better than CSCs (98.5% vs 97.9%, p = 0.02). For STK-1, venous thrombosis prophylaxis, STK-2, discharge on antithrombotic therapy, and STK-3, anticoagulation for atrial fibrillation/flutter, the performance rates between PSCs and CSCs was not significantly different (p > 0.25).

Conclusions:
CSCs performed better than PSCs for 4 SCMs, as well as PSCs for 3 measures, and not as well as PSCs for one SCM. Overall both types of stroke centers met the SCMs in >93% of cases with one exception (thrombolytic therapy at PSCs). Although CSCs see more complex patients than PSCs, they are still able to provide basic care with a high degree of compliance with SCMs.
Abstract T MP91: A Simple Systemic Inflammatory Response Syndrome Prediction Score for Patients with Intracerebral Hemorrhage
Authors: Boehme Amelia K , Kicielinski Kimberly , Shiue Harn , Kapoor Niren , Alvi Muhammed , Miller David , Elkind Mitchell , Harrigan Mark
Published: March 2022

Background and Purpose:
Systemic Inflammatory Response Syndrome (SIRS) is a predictor of poor functional outcome at discharge in stroke patients. We developed a prediction score to identify patients at greatest risk for developing SIRS after admission for an intracerebral hemorrhage (ICH).

Methods:
Retrospective review of consecutive patients presenting to our tertiary care center from 2008-2013 with primary ICH. Patients with a documented source of infection at any point during their hospitalization were excluded. SIRS was defined as having 2 or more of the following: 1) body temperature less than 36°C or greater than 38°C, 2) heart rate greater than 90, 3) respiratory rate greater than 20, or 4) white blood cell count less than 4000/mm or greater than 12,000/mm or more than 10% polymorphonuclear leukocytes for more than 24 hours. A prediction score was developed and adjusted for internal validation using Harrell’s Optimism method.

Results:
A total of 295 ICH patients met inclusion criteria. Sixty-eight (23.1%) patients developed SIRS during their hospital stay. On univariable analysis, patients with SIRS during hospitalization had a higher frequency of intubation (55.9% vs. 24.7%; p<0.0001) and SIRS in the ED (42.7% vs. 9.7%; p<0.0001), with higher median NIHSS at baseline (17 vs. 6; p<0.0001), lower median GCS at baseline (10 vs. 15; p<0.0001), higher median ICH score (2 vs. 1; p=0.0042), and greater ICH volume (18 vs. 9; p=0.0012). A score was developed ranging from 0-3 with 1 point for SIRS in the ED, 1 point for an ICH score of 2 or 3, and 2 points if the ICH score was 4 or more. The SIRS prediction score was predictive of developing SIRS during hospitalization (OR 2.86 per point from the score, 95%CI 1.94-4.21, p<0.0001; adjusted AUC 0.701). A SIRS Score of 2 or more places a patient at a 3 fold increased odds of developing SIRS during hospitalization (OR 3.05, 95%CI 1.28-6.71, p=0.0056).

Discussion:
Approximately 20% of patients develop SIRS during their hospitalization for ICH, and a simple scoring system identifies those patients at highest odds of developing SIRS. Further research will determine whether the score can be used direct intervention to prevent the development of SIRS and improve outcomes after ICH.
Abstract T P100: Optimal Duration of Dual Antiplatelet Therapy for Symptomatic Intracranial Stenosis
Authors: Winningham Melanie , Kasshout Tareq , Bamford Laura , Tong Frank , Dion Jacques , Cawley Michael , Ayala Lauren , Blanke Debra , Belagaje Samir , Frankel Michael , Anderson Aaron , Nahab Fadi
Published: March 2022

BACKGROUND:
There is limited data on the optimal duration of dual antiplatelet therapy in combination with aggressive optimization of risk factors for secondary stroke prevention in patients with symptomatic intracranial stenosis.

METHODS:
Consecutive patients presenting to Emory University Hospital with high-grade (70-99%) symptomatic intracranial stenosis from January 1, 2011 to December 31, 2013 and evaluated within 30 days of the index event (stroke or TIA) were eligible for this analysis. All patients underwent treatment with aspirin plus clopidogrel for a target duration of 12 months along with aggressive medical management based on the SAMMPRIS protocol; all patients were given an H2 blocker as gastrointestinal prophylaxis for the duration of their aspirin and clopidogrel treatment. Clinical and safety outcomes of our cohort were compared with the medical arm of the SAMMPRIS trial cohort (n=227).

RESULTS:
Of 25 patients who met inclusion criteria, mean age was 65 +/- 14 years, 77% male, 58% white, 92% with hypertension, 100% with dyslipidemia, 15% with coronary artery disease, and 73% had stroke as their symptomatic event; baseline characteristics were similar between the Emory cohort and the SAMMPRIS cohort except for active smoking at the time of symptomatic event (Cohort 8%, SAMMPRIS 30%) and basilar site of symptomatic stenosis (Cohort 44%, SAMMPRIS 22%). Achievement of blood pressure and LDL cholesterol targets were similar between our cohort and SAMMPRIS cohort. At 1 year, rates of stroke, myocardial infarction or vascular death were 0% in our cohort vs 16% in the SAMMPRIS cohort (p = 0.03). At 1 year, major bleeding occurred in only 1 (4%) patient who had gastrointestinal bleeding requiring transfusion while taking concomitant non-steroidal anti-inflammatory medication.

CONCLUSIONS:
A prolonged course of dual antiplatelet therapy with aspirin and clopidogrel for at least 12 months in combination with aggressive medical management based on the SAMMPRIS protocol may be associated with reduced rates of stroke, myocardial infarction, and vascular death compared to dual antiplatelet therapy for 3 months.
Abstract T P110: Impact Of Systolic Blood Pressure On Cerebral Hemoynamics Measure By Computational Fluid Dynamics In Patients With Intracranial Atherosclerosis
Authors: Nam Hyo Suk , Scalzo Fabien , Leng Xinyi , Johnson Mark , Ip Hing Lung , Fan Florence , Chen Xiangyan , Soo Yannie , Miao Zhongrong , Liu Liping , Feldmann Edward , Leung Thomas , Wong Ka Sing , Liebeskind David S
Published: March 2022

Background:
Success in clinical trials of intracranial atherosclerosis (ICAS) hinges upon the definition of high-risk patients. Noninvasive computational fluid dynamics (CFD) of stenotic lesions may enhance therapeutic decision-making, yet the wide hemodynamic variation may limit the snapshot data of CFD. We determined whether different physiologic parameters may change downstream cerebral hemodynamics in patients with ICAS.

Methods:
Based on degree of stenosis, patients were divided into a moderate (50-69%) and severe group (70-99%). CFD models were made using CTA source images of patients with symptomatic middle cerebral artery stenosis. Inlet boundary conditions were defined using three ranges (2.5, 50, and 97.5 percentiles) of systolic BP (109.2, 158, and 225 mmHg) and hematocrit (27.3, 40.2, and 48.8). According to systolic BP and hematocrit, 9 distinct scenarios were simulated. Ratio of pressure was calculated using the simulated pressure at pre- and post-stenotic segments. Ratio of shear strain rate (SSR) and velocity were assessed between throat and proximal normal segment. A linear mixed model was used for the statistical analysis of repeated simulations.

Results:
Among the 56 patients, 32 (57.1%) patients had moderate stenosis and 24 (42.9%) had severe stenosis. Patients with severe stenosis showed unfavorable hemodynamics in terms of ratio of pressure, velocity, and SSR comparing with moderate stenosis group. A linear mixed model revealed that ratio of pressure was predicted by systolic BP X stenosis group interaction (p = 0.036). These pressure drops were associated with systolic BP (p<0.001), and stenosis group (p<0.001), not with hematocrit (p = 0.337). Ratios of SSR and velocity were only associated with stenosis group.

Conclusions:
Downstream blood flow may be significantly altered by systolic BP along with severity of stenosis. As individual patient’s specific anatomy influences hemodynamics, physiologic conditions may superimpose further changes in post-stenotic blood flow in patients with ICAS.
Abstract T P113: Structural Changes In The Corticospinal Tract After 10 Days Of Combined Physical Therapy And Transcranial Direct Current Stimulation
Authors: Schlaug Gottfried , Zheng Xin
Published: March 2022

A few studies have shown that long-term skill acquisition can lead to changes in white matter tracts. Studies examining structural changes in the corticospinal tract in patients recovering from a stroke have yielded mixed results. The current study examines whether 10 days of combined physical therapy (PT) and non-invasive brain-stimulation (using dual transcranial direct current stimulation) can lead to changes in the corticospinal tract (CST) on the affected hemisphere.

Seven stroke patients participated in an intense 10-day long treatment of physical therapy (1 hour/day) and tDCS (30 minutes per session) with anodal stimulation applied over the affected motor cortex and cathodal stimulation over the unaffected motor cortex. Each patient also underwent Fugl-Meyer assessments (UE-FM) and diffusion tensor imaging (DTI) before and after the treatment phase. A control group of seven patients were also scanned at two time points and assessed without any intervening therapy. The DTI images were processed using the standard algorithms provided by FSL and normalized to FSL's FA template. We used a section of the CST derived from the JHU atlas, between the internal capsule (below each patient’s lesion) and upper brain stem as our region of interest to extract FA and other diffusivity values before and after therapy.

All patients showed an increase in proportional UE-FM scores (+21%; SD 10%) and an increase in average FA (+0.013; SD 0.01) of the descending CST below the lesion after the intervention and no significant change was seen in the patient that were assessed two times but had no treatment. In addition, we found a strong correlation between the change in FA and a proportional improvement in the UE-FM score (r=0.689). These findings support the notion that focal white matter changes can be detected with DTI and that an intense course of an experimental treatment (2x5 days of combined PT+tDCS) induced structural changes in the descending CST that were not seen in patients scanned twice without treatment.
Abstract T P116: Impact of Serum Nutritional Status on Physical Function in African American and Caucasian Stroke Survivors
Authors: Serra Monica C , Hafer-Macko Charlene E , Ivey Frederick M , Macko Rickard F , Ryan Alice S
Published: March 2022

Difficulties with speech and cognition may interfere with obtaining accurate dietary records to assess dietary quality in those chronically disabled by stroke. Several serum biomarkers commonly found on general comprehensive chemistry panels (e.g. albumin, hemoglobin, uric acid, and lipids) may provide a surrogate clinical indication of nutritional risk when dietary recall is not valid. Thus, the purpose of this study was to determine whether serum nutritional markers differ by race and relate to physical function in stroke. Further, we sought to compare serum profiles in chronic stroke survivors with a representative sample of U.S. Adults (NHANESIII). Fasting serum samples were collected for analysis of lipids, hemoglobin, uric acid, and albumin in 145 African American (AA) and 111 Caucasian (C) stroke survivors (age: 60±1 years [mean±SEM]; BMI: 28 kg/m2). VO2max (N=159), six-minute walk (N=134), 30 foot timed walk (N=161), and isokinetic hamstring strength (N=91) tests were performed in subsets of stroke survivors. VO2max was “very poor” in 96% of stroke survivors and mean walking speed was 40% below recommendations for maintenance of functional independence. Lipids were less favorable in C than AA women stroke survivors (40% higher triglycerides (TG) and 11% lower HDL cholesterol; Ps<0.05). In contrast, serum albumin was 6% lower in AA than C women (P<0.05). Uric acid was ~10% lower in C than AA stroke survivors (P<0.05). These racial differences were similar to that observed in the reference sample, but HDL cholesterol, albumin, and hemoglobin generally were lower (Ps<0.05) in stroke. Lipids were more favorable (~20% lower total cholesterol and ~25% lower TG; Ps<0.01) in stroke, likely due to a high prevalence of lipid lowering medication usage (64%). Uric acid was related to six-minute walk time (r=0.16) and hamstring strength (r=0.20) in stroke survivors (Ps<0.05), suggesting that low uric acid qualifies as a marker worth monitoring in the context of predicting stroke-related functional decline. Although nutritional risk varies according to race in stroke, the racial differences appear similar to a representative U.S. non-stroke sample. Regardless of race, serum nutritional risk does appear elevated in stroke compared to the general population.
Abstract T P117: Progress Update From a Very Early Rehabilition Trial
Authors: Donnan Geoff , Lindley Richard , Thrift Amanda , Dewey Helen , Langhorne Peter , Bernhardt Julie
Published: March 2022

Introduction:
Very early rehabilitation may be an important component of effective stroke unit care, but this requires testing. AVERT is an international clinical trial which can enroll eligible patients treated with rtPA if the physician allows. Patients randomized to intervention, commence training within 24hrs of stroke onset.

Hypothesis:
AVERT tests whether very early and frequent out of bed activity post stroke reduces 90 day death and disability. Due to the 24 hour time window, we hypothesized that around 20% of patients in the trial would be treated with rtPA.

Methods:
Inclusion criteria: adults over 18 yrs admitted within 24 hrs of stroke, whose physiological parameters fall within set limits. Exclusions: patients with severe premorbid disability, severe comorbidities or requiring palliative care. The intervention is delivered by a nurse/physiotherapy team and starts within 24 hours, for a maximum of 14 days. Control group patients receive standard care. A blinded assessor evaluates 3 and 12 month outcomes. Primary outcome: 3 month modified Rankin Scale. Secondary outcomes include complication rates, quality of life, time to walking (days) and cost effectiveness. Sample size is 2104 patients (n=1052 per group) with recruitment from 5 countries (Australia, New Zealand, Malaysia, Singapore, UK). Patients are followed for 12 months with primary endpoint (mRS) at 90 days.

Results:
Current recruitment sits at 2017 patients and is expected to close in early October 2014. Recruited patients: mean(SD) age: 70.6(12.9) years; male: 61.0%; first stroke: 81.5%; infarct 87.8%; mean(SD) NIHSS: 8.7(6.3); rtPA: 24.0%. Data completion rates are excellent: primary and secondary outcome over 90%, cognitive function and mood over 80%. rtPA patients have been recruited from Australia (250 patients), UK (189), New Zealand (30), Singapore and Malaysia (6 each).

Conclusions:
The trial data quality is high. The Data Monitoring Committee has met 14 times and no safety issues have been identified. By the conclusion of the trial we expect to have recruited 500 patients treated with rtPA.
Abstract T P120: Perception of Self-Motion using a Virtual Reality Environment Enhances Gait Adaptation in Chronic Stroke Survivors
Authors: Mukherjee Mukul , Rand Troy , Fayad Pierre
Published: March 2022

Background & Purpose:
Perception of self-motion through VR provides a unique avenue to improve gait adaptation in chronic stroke survivors. Stroke subjects show deterioration in bilateral coordination during gait. Such asymmetrical gait patterns may benefit from training the lower limbs to walk under different task constraints for each leg. In this ongoing study, bilateral incoordination in gait was targeted with a split-belt paradigm and perception of self-motion was provided with a Virtual Reality (VR) environment. The VR environment was hypothesized to enhance the split-belt adaptation by removing conflict between the static visual input (as in normal treadmill walking) and the dynamic proprioceptive input.

Subjects & Methods:
Healthy young, healthy older adults and chronic stroke survivors walked on a split-belt treadmill in either a VR or a non-VR environment while being exposed to different belt speeds (fast: 1.5m/s and slow: 0.5m/s) for each leg. The VR stimuli consisted of walking in an infinitely long virtual corridor. Spatiotemporal measures as correlates of adaptation were compared between groups (young, old, stroke) and conditions (VR and non-VR).

Results:
The participants in the VR condition demonstrated an increase in stride length compared to the non-VR condition for both healthy young (P = .019) and healthy elderly (P = .014). Preliminary results from the stroke group showed a trend towards a more stable coordination pattern that was reached quicker in the VR group than the non-VR group.

Conclusion:
Results show that the perception of self-motion provided through VR may lead to faster and more enhanced adaptive capabilities. Such enhancement of adaptive capabilities during gait has important implications for pathological populations such as stroke survivors.
Abstract T P122: Dose-Response Relationships in Brain and Behavioral Measures with Stroke Rehabilitation Using a Brain-Computer Interface
Authors: Young Brittany M , Nigogosyan Zack , Walton Léo M , Remsik Alexander , Song Jie , Nair Veena A , Tyler Mitchell E , Edwards Dorothy F , Caldera Kristin , Sattin Justin , Williams Justin C , Prabhakaran Vivek
Published: March 2022

Introduction:
Brain-computer interface (BCI) is an emerging technology for stroke rehabilitation, but little is known about how the administration of these therapies affects brain and behavior. We examine relationships between BCI therapy dose, intensity, and frequency with changes in laterality index (LI), Action Research Arm Test (ARAT), and Stroke Impact Scale (SIS).

Methods:
We collected ARAT and SIS scores as well as anatomical and functional MRI of 16 stroke patients with upper extremity motor impairment before, during, and after therapy using a BCI system with tongue and functional electrical stimulation. We acquired fMRI during finger tapping of each hand and computed LI with 3 mask sets at 2 thresholds. Changes from baseline LI and behavioral scores were assessed for correlation with cumulative therapy sessions, cumulative BCI runs, and overall runs/session using Spearman analysis and generalized estimating equations (GEE). Changes from baseline were also compared between subjects with different therapy frequencies.

Results:
Increased sessions correlated with changes in impaired finger tapping LI in 2 of 6 mask-threshold combinations (p<0.05) and trended to significance (0.05≤p<0.1) in 2 additional mask-threshold combinations. The relationship between cumulative runs and changes in impaired finger tapping LI also trended to significance (0.05≤p<0.1) in 2 mask-threshold combinations. Changes in SIS Strength correlated (p<0.05) with cumulative runs and with runs/session. All 8 of these relationships identified with Spearman analysis were significant with analysis using GEE (p < 0.05). No relationships were observed between therapy dose or intensity and ARAT scores or unimpaired hand measures. No differences were observed between subjects with higher and lower therapy frequency.

Conclusions:
Patterns of brain activation shift toward contralesional hemisphere with additional therapy sessions and additional BCI runs. Increased BCI therapy intensity also correlates with increased self-reported strength. When using BCI in stroke rehabilitation, therapy frequency may be less important than dose and intensity, and neuroimaging and self-report measures may be more sensitive to differences in therapy administration.
Abstract T P125: Does the Stroke Impact Scale-16 (SIS-16) PositivelyCorrelate with the Functional Independence Measure ( FIM) During AcuteInpatient Rehabilitation Following Stroke?
Authors: Kunsman Steven
Published: March 2022

Background and Purpose:
For patients who require acute inpatient rehabilitation after stroke, affect and level of motivation are important for successful outcomes. Conversely, patients who have decreased insight into their deficits are more likely to have negative rehabilitation outcomes, including poorer function and longer hospital stay. Previous research has shown a significant correlation between Stroke Impact Scale(SIS) and Functional independence Measure(FIM) scores in patients undergoing rehabilitation 3 to 6 months after stroke. There is no data on whether these scores correlate immediately after stroke. The purpose of this study is to determine if SIS-16 scores positively correlate with FIM scores after stroke, during acute rehabilitation.

Methods:
Using a self-reported survey methodology, 70 adult patients with a primary medical diagnosis of stroke who were admitted to an inpatient rehabilitation hospital were surveyed using the Stroke Impairment Scale-16 at the time of admission and again at discharge. During the same time intervals, patients were assessed using the Functional Independence Measure. Data of the two assessment tools were analyzed using a Pearson Correlation Coefficient.

Results:
Based on the data analysis, the data demonstrated good correlation between SIS-16 average and FIM total motor scores on admission(r = .66) and discharge(r = .67). Additionally, The SIS-16 score change, showed good correlation with the total FIM score change(r = .31) and motor FIM change(r = .34). Interestingly, the degree of functional cognitive ability did not correlate to the same level of perceived impairment.(r = .17/.06)

Conclusions:
As found in previous research involving patients 3-6 months status post stroke, this study found that the SIS-16 and FIM demonstrate a direct correlation in patients within the inpatient rehabilitation hospital setting. Future research into interventions to improve the correlation between SIS-16 and the cognitive FIM scores are warranted.
Abstract T P135: Outcome Following Stroke in a Tertiary Care Centre in South India
Authors: Mishra Ajay K , Aaron Sanjith , Lazarus Emmanuel , Alexander Vijay , George Anu A , Peravali Visali , Sudarsanam Thambu D
Published: March 2022

OBJECTIVES:
To study the demographic characteristics, risk factors, long term mortality and morbidity among patients admitted with cerebrovascular accident in a tertiary care hospital in South India.

METHODS:
All patients diagnosed with cerebrovascular accident, who met the inclusion criteria were enrolled into the study which was conducted between December 2011 and June 2013. Baseline demographic data, risk factors and details of the stroke were recorded. The severity of stroke in all patients was scored with the Modified Rankin score (MRS) and National Institute of Health Stroke Scale (NIHSS) at admission. MRS, details of incontinence and dysphagia were obtained at 1 month, 6 months and 1 year through telephonic communication.

RESULTS:
Of the 439 patients enrolled into the study, 63% were males. 90% of the patients had accessed a medical care centre within 6 hours of onset of stroke, however only 45% had accessed a medical care centre offering neuroimaging and thrombolysis facilities.93% of patients had positive findings on imaging, 74% being ischemic in etiology. Hypertension was the most common risk factor (71%). 15% of these patients were newly detected to have hypertension and 25 % of the above were normotensive at discharge from hospital. Mortality in the hospital was 11%, the most common cause being severity of the stroke itself (in the first one week) followed by aspiration pneumonia (between 1st to 4th week). At follow up, 80% of the patients could be contacted and a majority of them (95%) responded positively to the telephonic mode of communication. Mortality at the end of 1 month, 6 months and 12 months was 25%, 31.7% and 33.7% respectively. Though nearly 50% of the patients had dysphagia and incontinence at admission, during the follow up there was a trend towards improvement of both. High MRS and NIH were good predictors of mortality. NIH correlated better with mortality than MRS.

CONCLUSIONS:
In a developing country like India, timely access to a competent health care facility still remains a challenge. Measures to prevent aspiration pneumonia will help in reducing mortality while in the hospital. NIHS was better than MRS in predicting mortality. Telephonic communication is a good method for follow up in resource limited settings.
Abstract T P14: In-Hospital Cost Analysis of the Addition of Hyperacute MRI for Selection of Patients for Endovascular Stroke Therapy
Authors: Hussain Muhammad S , Thompson Nicolas R , Lesko Terry , Papesh Nancy , Obuchowski Nancy , Tomic Dan , Wisco Dolora , Khawaja Zeshaun , Uchino Ken , Man Shumei , Cheng-Ching Esteban , Hui Ferdinand , Bain Mark , Toth Gabor , Rasmussen Peter , Masaryk Thomas , Ruggieri Paul
Published: March 2022

Background:
Patient selection is important for acute endovascular stroke therapy. We previously reported that a hyperacute MRI protocol for patient selection was associated with decreased utilization of endovascular stroke therapy and improved outcomes. A cost analysis comparing the pre and post-MRI protocol periods was performed to determine if the previous findings translated into cost savings.

Methods:
We retrospectively identified patients considered for endovascular stroke therapy from January 2008 to August 2012 who were ≤8 hours from stroke symptoms onset. Prior to April 30, 2010 selection was based on results of the CT/CTA alone (pre-hyperacute), whereas afterwards selection was based on results of MRI (hyperacute MRI). Demographic, outcomes and financial information was collected. Log-transformed average daily direct costs were regressed on time period. The regression model included demographic and clinical covariates as potential confounders. Multiple imputation was used to account for missing data.

Results:
We identified 267 patients, 88 in pre-hyperacute MRI and 179 in hyperacute MRI protocol. Length of stay was not significantly different in both groups (10.6 vs. 9.9 days; p< 0.42). The median of average daily direct costs was reduced by 24.5% (95% CI = 14.1% to 33.7%; p<0.001). Decreases in the proportion of cost from imaging (including endovascular intervention) and anesthesia services was seen, whereas increases were seen in the neurological and pharmacy charges (Figure).

Conclusions:
Use of the hyperacute MRI protocol translated into reduced costs, in addition to reduced utilization of the invasive therapy and better outcomes. MRI selection of patients is an effective strategy, both for patient and hospital systems.
Abstract T P145: Incidence and Determinants of Clinical Dementia after Ischemic Stroke: a Population-based Study in Rochester, MN
Authors: Kramer Neha M , Sedova Petra , Klaas James P , Mandrekar Jay , Brown Robert D
Published: March 2022

Introduction:
Studies have suggested a high incidence of dementia after stroke; however data regarding risk factors are conflicting and few studies are population-based. The aims of this population-based study are to determine the frequency of diagnosis and predictors of clinical dementia after ischemic stroke.

Methods:
The Rochester Epidemiology Project medical records linkage system was used to ascertain all first ischemic strokes (IS) occurring among Rochester, MN residents between 1990 -1994. Comprehensive medical records were reviewed. Patient and stroke characteristics, medical comorbidities, and the development of clinical dementia any time after IS were recorded. Dementia was defined as any reflection in the chart by a clinician of memory loss resulting in functional impairment. Patients with a pre-stroke diagnosis of dementia were excluded. Associations between new dementia after the index IS and other variables of interest were analyzed using univariate logistic regression.

Results:
First IS was detected in 490 people, 82 of whom had a prior history of dementia, and 119 (29%) of whom developed dementia during a mean follow-up of 6.5 years (range 0-23.8). The mean age at index stroke was 76.6 years (SD 12.9). Those who developed dementia were a mean 4 years older at the time of IS (p = 0.003). The odds of developing dementia were 1.7 higher in those who had at least one recurrent stroke. There was no effect of sex, stroke location (cortical, subcortical, brainstem), stroke mechanism, or premorbid stroke risk factors (coronary artery disease, atrial fibrillation/flutter, hypertension, diabetes mellitus, left-sided valvular disease) on the occurrence of dementia.

Conclusions:
Dementia is commonly diagnosed following ischemic stroke. While stroke risk factors did not impact the risk of diagnosis of dementia, recurrent stroke increased this risk. Stroke risk factors may indirectly increase the risk of dementia by increasing the risk of recurrent IS. This suggests that aggressive secondary stroke prevention measures may significantly decrease the risk of being diagnosed with dementia following IS.
Abstract T P162: Predicting Recurrent Stroke: Comparison of CHADS2 to CHA2DS2-VASC Scale Among Patients With and Without Atrial Fibrillation at a Designated Primary Community Hospital Stroke Center
Authors: Jain Ash , Sheikh Lamiya , Van Houten Douglas
Published: March 2022

Background:
CHADS2 and CHA2DS2-VASC are predictors of thromboembolic events for atrial fibrillation (AF). There is limited data on using CHA2DS2-VASC to evaluate stroke recurrence in community hospitals. This study compared the utility of CHADS2 and CHA2DS2-VASC to predict recurrent stroke risk in a community hospital setting.

Methods:
• The study population included all ischemic stroke cases from July 2006 to July 2014.

• Demographics including age, gender, ethnicity; co-morbidities including hypertension, dyslipidemia and diabetes and neurological-impairment-on-arrival were considered as confounders. The outcome was number of recurrent strokes over the eight year period.

• CHADS2 and CHA2DS2-VASC were analyzed as continuous variables.

Results:
• Of 1,986 ischemic stroke patients, 468 had AF either prior to hospitalization, at admission or at discharge.

• In our patient population, CHADS2 was a more sensitive predictor recurrent stroke predictor compared to CHA2DS2-VASC (c-statistic: 0.85 and 0.78 respectively).

• Average CHADS2 score of patients with recurrent stroke was 2.9 vs. 1.4 in patients with no recurrent stroke.

• Average CHA2DS2-VASC score of patients with recurrent stroke was 4.2 vs. 2.7 in patients with no recurrent stroke.

• With every one point increase in CHADS2 patients were six times as likely to have a recurrent stroke, while with every one point increase in CHA2DS2-VASC, patients were 2.5 times as likely to have a recurrent stroke. o Vascular disease (p=0.62) and gender (p=0.87) did not affect recurrent stroke. Hypertension (p<0.0001) and congestive heart failure (p<0.0001) were most significant predictors of recurrent stroke.

Conclusion:
• At our community hospital, CHADS2 was the better predictor of recurrent strokes.

• While composite scores are clinically useful, vascular disease and gender were not strong predictors of recurrent stroke in our population.
Abstract T P164: New ABC (Age, Blood Pressure, and Clinical Features) Score Can Predict Early Ischemic Stroke After Transient Ischemic Attack
Authors: Mori Kota , Uehara Toshiyuki , Ohara Tomoyuki , Hayakawa Mikito , Sato Shoichiro , Suzuki Rieko , Toyoda Kazunori , Minematsu Kazuo
Published: March 2022

Background and Purpose:
Several clinical scales, such as the ABCD2 score, were developed for predicting early stroke after transient ischemic attack (TIA). We aimed to derive a new score from our TIA registry.

Methods:
The PROMISE-TIA registry was a multicenter prospective study in Japan. From June 2011 to December 2013, 1353 patients within 7 days of TIA onset were enrolled. Among them, we analyzed 1277 patients (822 men, 69.5 ± 12.4 years) who completed followed-up at 90 days after TIA onset. The components of the score were determined by the multivariate Cox proportional hazards model. We included them into the analysis if the p-value was under 0.1. The accuracy of our score was compared to that of the ABCD2, ABCD3, and ABCD3-I scores by using the C-statistics.

Results:
Cox hazard model showed that age≧80 years (HR: 1.91; 95%CI: 0.95-3.61, p=0.069), systolic blood pressure (SBP)≧160 or diastolic blood pressure (DBP)≧90 at presentation (HR: 4.05; 95%CI: 2.01-9.05, p<0.001), hemiparesis (HR: 4.05; 95%CI: 1.23-8.27, p=0.0124), and speech disturbance (HR: 2.68; 95%CI: 1.39-5.57, p=0.0026) were related to ischemic stroke within 7 days. One point was given for each of the following factors : age≧80, SBP≧160 or DBP≧90, hemiparesis, and speech disturbance. The sum of these scores was defined as “ABC score”. The 7-day ischemic stroke risk was 0% for ABC score of 0, 1.37% (0.52-3.62) for 1, 2.06% (1.14-3.67) for 2, 6.36% (4.19-9.56) for 3, 16.7% (8.15-31.0) for 4. The 90-days ischemic stroke risk was 2.50% (0.63-9.45), 3.44% (1.86-6.29), 3.74% (2.43-5.73), 9.70% (6.94-13.4), and 16.7% (8.15-31.0), respectively. The incidence of ischemic stroke was significantly higher in patients with a score of 3-4 than those with a score of 0-2; HR being 3.27 (1.19-11.5) for 7 days and 2.76 (1.35-6.20) for 90 days. The C-statistics of the ABC score was significantly higher than that of the ABCD2, ABCD3, or ABCD3-I score (vs. ABCD2: 0.721 vs. 0.596, p=0.0011, vs. ABCD3: 0.721 vs. 0.597, p=0.0087, vs. ABCD3-I: 0.720 vs. 0.566, p=0.0050).

Conclusions:
Our ABC score can be useful for predicting risk of ischemic stroke within 7 days and 90days after TIA onset.
Abstract T P169: Acute Cardioembolic vs. Large Artery Atherosclerotic Infarction-related Lesion Topography and Right-Left Propensity: A Multi-center Quantitative Magnetic Resonance Imaging Study
Authors: Kim Dong-Eog , Ryu Wi-Sun , Woo Sung-Ho , Jang Min Uk , Jeong Sang-Wuk , Hong Keun-Sik , Cho Yong-Jin , Kim Joon-Tae , Lee Jun , Cha Jae-Kwan , Lee Soo Joo , Yu Kyung-Ho , Park Jong-Moo , Lee Kyung Bok , Park Tai-Hwan , Lee Byung-Chul , Bae Hee-Joon
Published: March 2022

Background and Purpose:
A recent study showed that cardiogenic emboli might flow more frequently into the right hemisphere, whereas atheromatous aortic arch emboli might flow more frequently into the left hemisphere. We tried to 1) see if cardioembolic (CE) infarct volume would be larger in the right hemisphere than in the left hemisphere, and 2) depict anatomical regions showing CE vs. large artery atherosclerotic (LAA) infarction-related right-left propensity.

Methods:
In this study on carotid artery territory CE (n = 694) vs. LAA (n = 1162) acute ischemic stroke patients who were enrolled consecutively from 11 nationwide stroke centers, we quantitatively registered diffusion magnetic resonance imaging lesions onto the Montreal Neurologic Institute brain template.

Results:
In patients with bilateral CE stroke (n = 163), right hemispheric infarct size was about two times bigger than the contralateral left hemispheric infarct size (p = 0.002). However, in patients with either unilateral (n = 925) or bilateral (n = 184) LAA stroke, there was no significant difference in the right vs. left hemispheric infarct size between the right vs. left unilateral infarct groups or within the bilateral infarct group (all p > 0.05). In patients with unilateral CE stroke (n = 510), there was no significant difference in the infarct size between the groups with right vs. left hemispheric lesions. Age and infarct volume-adjusted p-value maps of the CE vs. LAA stroke patients, which were corrected for multiple comparisons, revealed the brain regions with a significantly higher infarct frequency in CE stroke than in LAA stroke. The significant clusters were observed only in the right hemisphere, encompassing both the superior and inferior division middle cerebral artery territories, particularly in the pial and corticosubcortical regions including the claustrum and insula.

Conclusion:
The present multi-center quantitative magnetic resonance imaging study confirms the ‘right > left’ propensity of CE (vs. LAA) stroke.
Abstract T P17: Intra-arterial Therapy In Patients With In-hospital Ischemic Strokes Have More Frequent Early Improvement Than Out Of Hospital Strokes
Authors: Itrat Ahmed , Taqui Ather , Cerejo Russell , Wisco Dolora , Man Shumei , George Pravin , Uchino Ken , Toth Gabor , Hussain Muhammad S
Published: March 2022

Background:
Stroke is a major complication of many hospital related procedures and prolongs hospital stay. In-hospital stroke alerts provide a unique opportunity to reduce time to treatment, and may be associated with greater chance of neurologic improvement.

Objective:
To assess outcomes of patients undergoing intra-arterial stroke treatment (IAT) who were originally admitted for a non-stroke diagnosis to the hospital.

Methods:
A retrospective analysis of stroke patients who qualified for IAT between 7/10/06-6/6/14 was performed. Variables measured included demographics, time to tissue Plasminogen Activator (tPA), time to cerebral angiogram and recanalization, and admission and discharge National Institute of Health Stroke Scale (NIHSS), and pre-treatment core infarct volume by MRI diffusion weighted imaging. Outcome measure was early major improvement of NIHSS≥8 points between pretreatment baseline and discharge. Unadjusted associations were calculated for demographics, time to intervention, stroke severity, stroke volume, hemorrhagic transformation (HT), and outcome measures between in-hospital strokes (IHS) alerts versus out of hospital strokes. An adjusted model was created using variables reaching significance in univariable analysis and those likely to affect outcome.

Results:
A total of 271 patients underwent IAT during the specified period. These included 47 (17.3%) IHS patients. Mean age was similar in both groups. Median NIHSS at onset of stroke was the same (16, p=0.6), while median discharge NIHSS showed trend towards lower scores in the IHS group(6 vs 12, p0.09). Intravenous thrombolysis was administered less frequently to IHS group (15.2% vs 38.9%; p<0.05). Time to treatment showed a trend towards shorter times for IHS (IV tPA, median 1h:47m vs 2h:15m, p0.13; time to recanalization, median 4h:10m vs 7h:23m, p0.25). In our adjusted model, in-hospital stroke (OR 4.75, CI1.2-19.1), IV thrombolysis (OR 2.4, CI 1.1-6.0), pretreamet core infarct volume (unit OR 0.98, p=0.03), and HT (OR 0.29, p=0.01) were independently associated with an NIHSS improvement of ≥8.

Conclusion:
Patient developing acute stroke during their hospital stay who undergo IAT have higher chance of early neurologic improvement.