bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 247: Multimodal imaging approach for the diagnosis of (ICAD): basic principles, current and future perspectives
Authors: Charles Jude H , Desai Sohum , Hassan Ameere 
Published: April 2023

Introduction
Symptomatic intracranial atherosclerotic disease is among the most common causes of acute ischemic stroke. The imaging tools utilized for the diagnostic of ICAD have significantly evolved over the past few decades. This paper is a review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD.

Methods
A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included “imaging modalities in ICAD” “ICAD diagnostic” “Neuroimaging of ICAD” “Evaluation of ICAD”. A summary and comparison of each modality’s basic principles, advantages and disadvantages were included.

Results
A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD.

Conclusions
ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
Abstract Number ‐ 250: Case Series of Moyamoya Patients Diagnosed on Hyperacute Imaging
Authors: Xia Christina , Draytsel Dan , Gould Grahame 
Published: April 2023

Introduction
Moyamoya disease is the idiopathic bilateral progressive stenosis of the anterior circulation arteries at the skull base, followed by the compensatory formation and proliferation of collateral small vessel arteries typically in the lenticulostriate region. The clinical diagnosis is made by neurovascular imaging with digital subtraction angiography being the gold standard of diagnosis. The term moyamoya syndrome is used when the formation of collateral arteries occur after unilateral vasculopathy or if the progressive stenosis occurs in the setting of known associated conditions such as sickle cell disease or prior cranial radiation treatment. For patients who have undiagnosed moyamoya syndrome, stroke symptoms may be the first presentation of the underlying disease.

Methods
We present a case series of 15 patients who arrived to our tertiary care hospital from December 2014 to July 2022.

Results
The majority of the patients were women with the average age of 43 years old. Patients were admitted with NIHSS ranging from 0 to 14, and two patients presented with signs suggestive of MCA syndrome. Including major ischemic stroke risk factors, five patients also had differentials of antiphospholipid antibody syndrome, connective tissue disorder, vasculitis, and congenital rubella as possible underlying conditions promoting the vasculopathy. Morbidity was high for moyamoya patients, with an average modified Rankin scale of 2 at discharge. Eleven patients had unknown moyamoya history at time of arrival and were identified based on hyperacute diagnostic CT angiography during stroke evaluation. Five patients were initially diagnosed as large vessel occlusion on CT angiography. Given the speed at which IV thrombolysis and mechanical thrombectomy decisions are made, patients with moyamoya vasculopathy require rapid and accurate interpretation of CT findings that distinguish them from standard large vessel occlusion patients and prevent the potentially catastrophic consequences of inappropriate treatment.

Conclusions
The pathophysiology leading to moyamoya disease is not well understood, but the stenosis process of major arteries is thought to be secondary to irregular hyperplasia of the tunica media, followed by compensatory growth of small collateral vessels. This collateralization leads to micro‐aneurysm formation in the small perforator branches. Moyamoya patients are at an increased risk of hemorrhage, representing a contraindication to IV thrombolysis, and, if mechanical thrombectomy is attempted, risk of possible large vessel rupture. In our case series, the 15 patients did not receive IV thrombolysis or mechanical thrombectomy based on appropriate diagnosis of moyamoya vasculopathy at time of emergency CT angiography, subsequently confirmed by elective, catheter cerebral angiography.
Abstract Number ‐ 261: Gender Specific Risk Factors for Recurrent Ischemic Stroke With Previous History of TIA
Authors: Djerdjour Leila , Nathaniel Thomas 
Published: April 2023

Introduction
Gender differences in stroke outcomes have been investigated extensively, but whether this extends to recurrent strokes with a history of trans ischemic attack (TIA) is not fully understood. We examined gender differences in recurrent strokes patients with a history of TIA using a retrospective data analytical approach.

Methods
We assessed the risk factors of recurrent stroke patients with TIA in women compared to men using data collected between January 2010 through January 2016 from a Stroke Registry. We used logistic regression to determine risk factors associated with recurrent strokes with and without history of TIA. Our model was tested using the Hosmer‐Lemeshow test for the overall correct classification percentage, while interactions and multicollinearity between independent variables were examined using variance inflation factor.

Results
In the adjusted analysis, smoking history (OR = 2.763, 95% CI, 1.063‐7.185, P = 0.037), dyslipidemia (OR = 1.073, 95% CI, 1.039‐1.108, P< 0.001), and higher heart rate (OR = 1.049, 95% CI, 1.017‐1.082, P = 0.002) were associated with female patients with history of recurrent stroke and TIA. On the other hand, men were shown to have a higher incidence of coronary artery disease (CAD), elevateddiastolic blood pressuresand creatinine levels.

Conclusions
Our findings indicate risk factors in ischemic stroke patients with history of TIA that can be managed to improve the care of men and women with a recurrent stroke and a history of TIA.
Abstract Number ‐ 271: Comorbidities: Severe Stroke in Thrombolysis for Ischemic Stroke with Elevated Diastolic Blood Pressure
Authors: Knisely Krista M , Sanders Carolyn B , Edrissi Camron K , Poupore Nicholas S , Rathfoot Chase A , Nathaniel Thomas I 
Published: April 2023

Introduction
Patients are at risk for different outcomes following stroke based on their diastolic blood pressure on admission. In this study, we determine differences in risk factors between patients with DBP < 80 and > = 80 mmHg and then determine which of these risk factors are associated with worsening neurologic outcomes after rtPA administration.

Methods
A retrospective analysis was performed by looking at demographics, history, and clinical factors that are known risk factors for acute ischemic stroke. Data were obtained from a stroke registry that includes patient data from between 2010 and 2016. Univariate analysis was performed based on presenting diastolic blood pressure group. Patients who did not receive rtPA were excluded from further study and then patients were further divided by NIHSS > = 7 or > 7. Logistic regression was used to further evaluate variables. Odds Ratios with 95% Confidence Intervals (C.I.) were calculated and used to predict worsening neurologic outcomes for stroke patients based on their blood‐pressure group.

Results
In the population of stroke patients with diastolic blood pressure < 80 mmHg, increasing age (OR = 1.025, 95% C.I. = 1.011 – 1.039 . P‐value = < 0.001), and elevated blood glucose levels (OR = 1.003, 95% C.I. = 1 – 1.006, P‐value = 0.03) were associated with worsening neurologic outcomes. In the diastolic blood pressure group > = 80 mmHg, increasing age (OR = 1.026, 95% C.I. = 1.012 – 1.04. P‐value = < 0.001), history of drug or alcohol abuse (OR = 2.11, 95% C.I. = 1.116 – 3.988, P‐value = 0.022), hypertension (OR = 1.572, 95% C.I. = 1.01 – 2.449, P‐value = 0.035), and increasing heart rate (OR = 1.012, 95% C.I. = 1.012 – 1.022, P‐value = 0.024) were associated with worsening neurologic outcomes.

Conclusions
This study found that there are significant differences in the clinical factors between patients with a DBP < or > = 80 mmHg with acute ischemic stroke and these groups also had different risk factors for severe stroke after rtPA administration. In both groups, increasing age was associated with worsening neurologic outcomes, while direct admission was associated with improving outcomes. In the DBP < 80 mmHg group, elevated blood glucose levels were associated with worsening neurologic outcomes. In the DBP > = 80 mmHg group, a history of alcohol or drug use and increased heart rate were associated with worsening neurologic outcomes.
Abstract Number ‐ 275: Novel 3D Virtual Reality Simulator Use in Stroke Code Simulation
Authors: Reddy Aravind , Michael Mina , Zidan Awss , Masoud Hesham 
Published: April 2023

Introduction
Stroke code simulations have gained popularity as an educational model for neurology resident and fellow training in the diagnosis and management of hyperacute stroke. Previous simulations have used live patients or standardized patients as surrogates for learners to interact with in the simulated codes. While these provide high fidelity, there can be significant costs associated with the training and deployment of standardized patients, as well as potential for inconsistencies from encounter to encounter. A novel 3D virtual reality based simulator (Dancing Eyes LLC, Skaneateles, NY) aims to reduce the costs of running stroke code simulations while maintaining high fidelity and encounter consistency. It can also have the additional benefit of being utilized at the convenience of the trainee’s schedule, reducing logistical hurdles for scheduling and organizing simulations.

Methods
Neurology residents (who have previously experienced live simulation stroke codes with standardized patients) will undergo simulation encounters using the 3D virtual reality‐based simulator. We will enroll 20–25 residents at post graduate year levels (PGY) 2–4. Following the simulated encounter, a debriefing session is conducted for learners to review the case, share their experience, and provide additional feedback. A post‐simulation survey will be comnducted that solicits trainee experience with the VR simulator in defined domains such as comfort, ease of use, fidelity, and overall educational experience and value.

Results
The VR simulator has been designed to be worn over the face and can be adjusted for trainee comfort. The simulator integrates imaging, labs, the ability to use a virtual NIH‐stroke‐scale booklet, and other neurologic examination tools by virtually grabbing them or selecting them from a panel user interface. The simulated VR patient registers the trainee’s voice and shows the speech that was detected. It then attempts to answer the question or perform the issued command based on variables that have been pre‐programmed for the specific encounter/simulation. Trainees are able to perform a full NIH stroke scale assessment on the simulated patient. We aim to report the results of our study in time for the SVIN Annual Meeting/update deadline prior to the meeting.

Conclusions
Figure 1 shows a trainee using the VR simulator in a simulated stroke code encounter, as well as a rendering of the simulated patient. The VR simulator aims to serve as a high‐fidelity, low‐cost, convenient and consistent training modality for stroke code simulation and enhance trainees ability and comfort with diagnosis and management of hyperacute stroke.
Abstract Number: LBA15 Transient Ischemic Attack Uncovering An Absent ICA
Authors: Dalal Siddharth , Kapoor Gaurav , Salamon Elliot 
Published: April 2023

Introduction
Absence of the Internal Carotid Artery (ICA) is a rare cerebrovascular anomaly signified by agenesis, aplasia, or hypoplasia of the ICA and its’ bony canal. Agenesis refers to complete absence whereas aplasia refers to some partial remanent of the ICA or the carotid canal however, these terms are often used interchangeably. There are 6 types of ICA agenesis/aplasia of which type A consists of collateral flow supplied to the MCA via the P‐comm and ACA via the A‐comm. The prevalence of such a condition is reported at around .01% of the population. Patients are usually asymptomatic due to robust collaterals but, in some cases, can present with focal neurologic deficits. Here, we present a case of a patient who endured a transient ischemic attack and was subsequently found to have type A Right ICA aplasia on cerebrovascular imaging.

Methods
Case Report

Results
A 24‐year‐old Right‐handed Female with no past medical history except for tobacco use presented with transient left arm monoparesis. The patient had received chiropractic treatment involving hyperextension of her neck to the left just prior to symptom onset which transiently caused her left arm to become plegic and she resolved back to her neurologic baseline within 10 minutes. Neurologic exam was normal and non‐contrast head CT was negative however, demonstrated significant hypoplasia of the right carotid canal (Figure 1‐A). Contrast enhanced CT Angiogram of the head and neck demonstrated lack of contrast opacification of the Right Internal Carotid artery with absent Right carotid bulb and opacification of only the Right ECA (Figure 1‐B). MRI of the brain did not demonstrate any acute infarction. Gadolinium enhanced MRA of the Head and Neck confirmed absence of the Right internal carotid (Figure 2‐A) with prominent Right P‐comm and absent Right A1 segment (Figure 2‐B). Due to this variant anatomy, the postulated mechanism of patient’s TIA was thought to be related to transiently decreased cerebral perfusion caused by partial mechanical compression of her vertebral arteries asymmetrically affecting the Right MCA distribution due to sole supply from the Right posterior communicating artery.

Conclusions
This case illustrates a fascinating variation from normal embryologic angiogenesis and highlights the importance of collateral blood flow through the circle of Willis in patient’s with congenitally absent internal carotid arteries. Particularly, this patient’s presentation demonstrates the risk that vascular compromise of posterior circulation vessels may play in patients with Type A ICA agenesis/aplasia and their subsequent risk of incurring transient ischemic events.
Abstract Number: LBA16 Does Intracranial Hemorrhage Associated with Tenecteplase Occur Exclusively Within the Stroke Burden?
Authors: Fourcand Farah , Sahito Sindhu , Gadallah Nancy , Fourcand Farah , Aziz Kashif , Dubinsky Ilya , Peter Yong‐Bum , Tabibzadeh Navid , Mehta Siddhart , Panezai Spozhmy , Kirmani Jawad 
Published: April 2023

Introduction
As IV tenecteplase (TNK) is becoming an alternative to IV alteplase in acute ischemic stroke (AIS), establishing the incidence of intracranial hemorrhage (ICH) complications is important. Given the higher fibrin specificity of TNK as compared to alteplase, our aim was to distinguish hemorrhage within the stroke burden versus spontaneous ICH in patients with AIS with TNK‐associated ICH.

Methods
Retrospective chart review of patients presenting from February 2020 to January 2022 with anterior circulation AIS to our comprehensive stroke center who received TNK was performed to evaluate for associated ICH. ECASS‐3 criteria was used to define hemorrhagic transformation and ICH score was used for primary, spontaneous ICH. Fisher exact test statistic was used to evaluate for significant differences in ASPECTS score, medium versus versus large vessel occlusion, angiographic recanalization, IV eptifibatide use, pre‐morbid antiplatelet use, and association with symptomatic versus asymptomatic hemorrhage. A benchmark less than 5% symptomatic ICH incidence was set based on historical alteplase rates within our network. Social science statistics software was used for data analysis.

Results
Out of 77 subjects who received TNK, 20.7% (n = 16) developed ICH, 9.1% (n = 7) of which were symptomatic ICH with a temporally‐related increase in NIHSS of at least 4 or greater. Seven subjects (43.75%) were male. Mean age was 73.38 (95% CI 65.92, 80.83). Median initial NIHSS was 16, 95% CI [11.74, 21.51]. Median ASPECTS was 9, 95% CI [8.74, 9.89]. Two subjects developed spontaneous, primary ICH (n = 1 symptomatic ICH, n = 1 non‐symptomatic ICH) in the absence of hemorrhagic transformation of ischemic stroke. No significant difference between subjects with asymptomatic hemorrhage versus symptomatic hemorrhage was found when comparing ASPECTS > = 7 versus < 7 (Fisher value = 1), angiographic recanalization (Fisher value = 1), use of IV eptifibatide (Fisher value = 1), pre‐morbid antiplatelet use (Fisher value = 0.13), or medium vessel occlusion (Fisher value = ‐0.63).

Conclusions
Expected rates of hemorrhagic transformation were higher in tenecteplase than our historical benchmark rate for alteplase. Spontaneous hemorrhage unrelated to ischemic stroke area were seen in 2 subjects without known hematological disorders. Larger, prospective studies are needed to validate safety of tenecteplase in real world settings.
Why Electoral Violence Persists in Africa? A Critical Review of Literature
Authors: Henry Rodrick 
Published: April 2023

Abstract
Electoral violence is a persistent phenomenon in Africa. Studies reveal that no single election has been held in Africa without incidents of violence. There is a surge of interest in electoral violence as an academic field, although still in its infancy. The existing literature on electoral violence primarily focuses on the concept, causes, impact and prevention mechanisms. Nevertheless, the question as to why electoral violence persists is inadequately addressed. This paper engages varied literature on electoral violence to uncover why electoral violence persists in Africa. I argue that although the literature provides diverse explanations on electoral violence in Africa, institutional account, particularly the consolidation of democratic institutions, is the most plausible explanation for why electoral violence persists.
The View through a Different Lens
Authors: Lush Emma 
Published: April 2023

Abstract
In years past, much of the discussion around International Humanitarian Law and International Human Rights Law has been dedicated to considering the convergence of the two regimes; to discover a way to increase respect for the protection of the individual in armed conflict. Meanwhile, egregious violations of individual’s human rights continue to occur in armed conflicts – those in Ukraine, Yemen, Ethiopia, Afghanistan, and many others. This paper surveys the relationship between the two international disciplines, and considers that though ihl and ihrl are two regimes that have different aims, both contain norms that strive for the protection of the individual in armed conflict. Ultimately, this paper argues that protection of individuals in armed conflict can be strengthened by importing ihl norms into the ihrl framework. This cross-pollination allows treaty bodies to interpret, and make comments about, State Parties’ adherence to ihl that can increase respect for those norms, given ihrl’s associated enforcement mechanisms and communications machinery.
“A Global Web of Elegies”
Authors: Ramazani Jahan 
Published: April 2023

Abstract
Is the elegy global? To wrestle with this impossibly large question, can we approach it intrinsically by searching within elegy for traces of the genre’s worldwide reach? A contemporary elegy that can serve as a portal to the genre’s globality is Edward Hirsch’s book-length Gabriel (2014), a lament for the poet’s son that weaves a global web of elegies, citing more than a dozen mourning poets from classical and Edo Japan, medieval, Renaissance, and Romantic Britain, Renaissance Poland, nineteenth-century Germany and France, and twentieth-century Italy, Russia, and India. Though not comprehensive, Hirsch’s gathering makes visible the elegy’s global resonances, divergences, and scope.
The Elegiac Transnational
Authors: Admussen Nick 
Published: April 2023

Abstract
This essay is an elegy for the study of a Chinese elegy. Its putative archive is a book of poems printed in Shenzhen by the late Hei Guang, a collection I do not own by a poet who I never got to meet. My pursuit of the collection is hampered by my recent inability to travel to China, by changes in my ability to transculturate, and by the limits on global circulation in the age of climate change. Experimenting with tactics drawn from China’s tradition of lei elegy, I identify the loss of the collection as a disruption of the process of thick translation, of the ethical direction that animates world literature. By mourning the type of interactions that would have allowed me to translate Hei Guang well, I hope to reproduce the desire for heterogeneity and circulation into the post-pandemic, warming world.
Governing through big data: An ethnographic exploration of invisible lives in China's digital surveillance of the coronavirus disease 2019 pandemic
Authors: Zhang Liyuan , Rafiq Mohamed Y 
Published: April 2023

Introduction/Background Since 2020, China has implemented unprecedented digital health surveillance over citizens and residents in response to the coronavirus disease 2019 pandemic. We explore the implementation of Health Code ( jiankang ma), a contract-tracing and risk assessment app for coronavirus disease 2019, in China. By engaging with the concept of ‘ocular ethics’, we ask why and how some populations become invisible in China's Health Code surveillance system. Methods This study used an ethnographic approach to critically examine the role of digital technology in the coronavirus disease 2019 pandemic governance. Three months of participant observation and 20 interviews were conducted to understand the design of Health Code and the situation of homeless population. Results We find that China's digital health surveillance during the coronavirus disease 2019 pandemic has failed to cover the homeless population, who either fail to access Health Code or find ways to avoid its mandatory health surveillance. We further summarize four problems resulting in their exclusion, including the loss of ID cards, access to smartphones and phone numbers, problematic design and elastic surveillance, and the neglect of homeless community's precarious living situation. Conclusion Situating our work in the literature on theories of surveillance and anthropology of pandemics, we argue that without recognizing the structural problems embedded in homelessness, a large number of poor and homeless migrants are rendered invisible in this data-driven health surveillance, which further pushes them into social exclusion.