bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 294: Impact Of COVID‐19 Pandemic On Incidence And Outcome Of Cerebral Venous Sinus Thrombosis: A Nationwide Analysis
Authors: Reddi P. , Mehta A. , Hardigan T. , Kellner C. , Fifi J. , Mocco J. , Majidi S. 
Published: January 2025

Introduction
Coagulation pathway activation linked to COVID‐19 predisposes patients to thromboembolic events. The association between cerebral venous sinus thrombosis (CVST) and COVID‐19 has been reported in small retrospective studies and case reports and series.ObjectivesTo examine the incidence of CVST before and during COVID‐19 pandemic and to analyze patients’ demographics and clinical outcome using a nationally representative database.

Methods
The Nationwide Inpatient Sample (NIS) 2018‐2021 databases were queried for CVST patients. Patients were stratified into cohorts based on COVID‐19 as a primary diagnosis. Demographics, comorbidities, rate of stroke and National Institutes of Health Stroke Scale (NIHSS) score were compared between the two groups. Primary outcomes were in‐hospital mortality, and the rate of favorable hospital outcome defined as discharge to home or acute rehab center. Propensity score matching was used for multivariable analyses. Poisson regression analysis was used to analyze CVST trends between pre‐pandemic (2018‐2019) and pandemic (2020‐2021) time periods.

Results
Of 37,635 patients with CVST, 385 had COVID‐19 as a primary diagnosis. A higher proportion of patients with COVID‐19 were Black (24.3% vs 16.0%) and Hispanic (20.3% vs 12.3%). The COVID‐19 cohort had a higher mean Elixhauser Comorbidity Score (11.03 vs 8.63, p=0.03) and higher baseline NIHSS score (15.91 vs 6.38, p=0.001). The COVID‐19 group experienced higher rates of in‐hospital mortality (13.0% vs 5.7%, p=0.007) and longer mean length of stay (12.58 vs 8.11 days, p=0.008). A lower proportion of patients had favorable hospital outcome in the COVID‐19 cohort (45.5% vs 57.7%, p=0.031). However, primary outcomes were comparable in adjusted, propensity matched multivariable analyses. Trend analysis showed a significant increase in CVST rates each year from 2018‐2021, with the greatest increase (33%, p<0.001) occurring during the pandemic between 2020 and 2021.

Conclusions
CVST rates increased during the COVID‐19 pandemic. COVID‐19 related CVST disproportionately affected Black and Hispanic patients and trended towards worse hospital outcomes.
Abstract 317: Isolated Sixth Cranial Nerve Palsy as a Rare Manifestation of Iatrogenic Intracranial Hypotension: A Case Report
Authors: Idris A. , Iqbal Z. , Albanna A. , Eltahir M. 
Published: January 2025

Introduction/Purpose
Iatrogenic intracranial hypotension (IH) is an uncommon complication that arises due to cerebrospinal fluid (CSF) leakage, often following spinal procedures or surgeries. The most common presentation is orthostatic headache. In this case, we describe a rare presentation of IH with sixth cranial nerve palsy.

Materials and Methods:
A 32‐year‐old female with a past medical history of heterozygous MTHFR gene mutation and seven first‐term spontaneous abortions presented with one‐day history of double vision. One week before the presentation, she had undergone a caesarean section with epidural anesthesia. On the second day after the procedure, she started to experience holocranial headache with a positional component, improving with lying down and worsening upon standing. Five days later, she started to experience double vision. The diplopia was worst on left gaze. It was horizontal, constant, and worse with distance. Physical examination revealed left sixth cranial nerve palsy with esotropia, while the rest of the examination was unremarkable. Ophthalmologic evaluation showed sharp optic discs without vessel obscuration. Laboratory workup was insignificant. Imaging studies included a CT head showing slight prominence of the pituitary gland, a normal CT venogram, and an MRI brain that revealed diffuse dural thickening and enhancement, narrowing of the mamillopontine distance, and distention of the dural venous sinuses—findings consistent with intracranial hypotension. The patient was treated with an epidural blood patch on the day of presentation. Following the blood patch, the patient experienced significant improvement in her headache the next day, though she continued to experience double vision. She was discharged with follow‐up with neurology clinic.

Results
N/A

Conclusion
This case highlights the possibility of isolated sixth cranial nerve palsy as a manifestation of intracranial hypotension, likely due to nerve traction secondary to low CSF pressure. It highlights the importance of considering intracranial hypotension as a differential diagnosis in patients presenting with headache and sixth cranial nerve palsy, as it challenges the common association with intracranial hypertension and changes the management.
Abstract 327: Mentorship Program for Young Neurologists, Medical Students and Researcher: Lessons from COVID‐19 Lockdown
Authors: Elsayed M. M. , Saleh N. , Elsayed M. , Elsayed A. , Ali M. 
Published: January 2025

Introduction
COVID‐19 pandemic has caused unprecedented public health and economicchallenges. Current public health, scientific and research communities are faced by thenecessity to provide a fundamental contribution to tackle the crisis. During the past couple ofyears, we have witnessed an impressive number of initiatives to encourage networkingopportunities, to foster virtual interactions between the different stakeholders involved (healthcare, industry, governments, academics, and patients), and to develop innovative strategies andcollaborative infrastructures in support of clinical care, scientific research, and medicaleducation. In this study, we propose and adopt a novel open and collaborative approach to joinforces from around the world social media websites as an essential tool in the fight against theCOVID‐19 crisis. We also investigated the involvement of crowds as innovation partners can beof great support in medical education.To propose novel virtual mentorship program as a teaching tool to improve career skills amongyoung Neurosurgeon and Ophthalmologists.

Methods
Virtual training program was designed and crowdsourcing was used using socialmedia. Highly qualified senior physicians were paired with junior trainees/students throughonline workshops. Juniors were guided through online platforms and interactive sessions onclinical, research, interviewing, and CV writing skills

Results
Program received an initial wave of 965 applicants from 18 countries. Total of 719participants were provided a generic teaching program, while 246 were enrolled to a morepersonalized program where they received at least 20 sessions from their assigned mentors. Allparticipants had significantly improved their set of skills as evidenced by their community work,clinical skills, and research output.

Conclusion
Online virtual training programs can help great skills transfer between skilledacademic young neurosurgeon, ophthalmologists and young trainees worldwide.
Abstract 332: Multi‐Center Comparison of Safety and Efficacy of Intravenous Thrombolytics in Patients Undergoing Endovascular Therapy: Regression Discontinuity Analysis
Authors: Ali A. , Bauknight M. , Iyyangar A. , Azeem H. , Ballekere A. , Le M. , Bajaj R. , Lee E. , Sheth S. A. 
Published: January 2025

Introduction
Many clinical practices have switched from alteplase (tPA) to tenecteplase (TNK) given recent clinical trial results. The safety and efficacy of TNK in endovascular treated cohorts, compared to tPA and no thrombolytic remain incompletely characterized.

Methods
From our prospectively collected multi‐center institutional registry, we identified patients treated with endovascular therapy with and without thrombolysis. All 4 hospitals in the cohort switched from tPA to TNK on a single day (March 7 2023), and patients were included if they were treated within 300 days before or after this date. The primary outcome was likelihood of functional independence (mRS 0‐2) at 90 days. Secondary endpoints included rates of intracranial hemorrhage and substantial reperfusion (TICI 2c‐3). Analysis was performed using sharp regression discontinuity, taking advantage of the fact that switch from tPA to TNK occurred at a specific time, such that other measured and unmeasured confounders should be matched.

Results
Among 161 patients that met inclusion criteria, median age was 69 [IQR 57 ‐ 78], median NIHSS 17 [IQR 11 ‐ 22] and 50% were female. 100 (62%) of patients did not receive thrombolysis, 37 (23%) tPA and 24 (15%) TNK. In univariable analysis, rates of substantial reperfusion were comparable (71% vs. 73% vs. 71%, no thrombolysis vs. tPA vs. TNK, p=0.9), as were rates of hemorrhagic transformation (38% vs. 30% vs. 29%, no thrombolysis vs. tPA vs. TNK, p=0.85). Rates of functional independence were similar (27% vs. 43% vs. 33%, no treatment vs. tPA vs. TNK, p=0.19). In regression discontinuity analysis, restricted to only the patients who were treated with tPA or TNK, there were no differences in likelihood of functional independence (coef = ‐0.96, p=0.83).

Conclusion
In this multi‐center cohort of patients treated with EVT, we did not identify any differences in rates of reperfusion, hemorrhage or functional independence after switching from tPA to TNK.
Abstract 376: Prestroke Cognitive Impairment: Investigating the Role of Premorbid Neuropsychiatric Symptoms and Functional Limitations in Stroke Outcomes
Authors: Elsayed M. M. , Elsayed A. M. , Ramadan D. , Elsayed M. M. , Hussein M. , Alnahdi M. 
Published: January 2025

Introduction
Prestroke cognitive impairment plays a critical role in influencing treatment outcomes and recovery in stroke patients. This study explores the relationship between prestroke cognitive status, neuropsychiatric symptoms, and functional limitations, aiming to inform more tailored interventions.

Methods
We conducted a cross‐sectional analysis of 520 stroke patients hospitalized in a neurology unit. The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) was used to assess cognitive status prior to stroke onset. Neuropsychiatric symptoms were measured using the Neuropsychiatric Inventory Questionnaire (NPI‐Q), and functional abilities were evaluated through Activities of Daily Living (ADL) and the Clinical Dementia Rating (CDR) scale.

Results
Our findings revealed that 32.5% of patients exhibited cognitive impairment before experiencing a stroke. This cognitive decline was significantly associated with an increase in neuropsychiatric symptoms (NPI‐Q score: 5.5 ± 4.9 vs. 1.7 ± 2.3, p < 0.001) and greater functional limitations (ADL score: 1.8 ± 1.9 vs. 0.3 ± 0.8, p < 0.001). Further analysis through logistic regression identified older age, the presence of white matter lesions (OR: 1.26, 95% CI: 1.003‐1.58), and medial temporal lobe atrophy (OR: 3.97, 95% CI: 1.62‐9.73) as significant predictors of cognitive impairment.

Conclusion
The study underscores the prevalence of cognitive impairment before a stroke and its substantial impact on neuropsychiatric and functional outcomes post‐stroke. These findings highlight the necessity of early cognitive evaluations in stroke care, suggesting that addressing cognitive decline prior to a stroke could improve patient outcomes through more personalized and timely interventions.
Abstract 411: Starting anticoagulation within 24 hours of primary Middle Meningeal artery embolization for chronic subdural hematoma (SDH) is safe and allows for chronic SDH resorption.
Authors: Zacharatos H. , Snyder T. , Jankowitz B. 
Published: January 2025

Introduction
Middle Meningeal artery (MMA) embolization has emerged as an effective treatment for the resorption of chronic subdural hematoma (cSDH), by occluding the blood supply to the subdural hematoma membrane; thereby preventing leakage of blood into the subdural space. Limited data is available for initiating anticoagulation within 24 hours post primary MMA embolization and maintaining the anticoagulation treatment, with regards to its effect on the cSDH.

Methods
A prospective collection of patients requiring MMA embolization for cSDH was maintained from a single center between 2019 and 2023. Patients that received full strength anticoagulation within 24 hours of primary MMA embolization were included in this study. All patients were treated with 100‐300 micron embospheres for distal penetration. Some patients received ONYX embolization at the proximal portion of the Middle Meningeal artery. Alternatively, some patients had the proximal portion of the MMA occluded using coils. A successful outcome is defined as complete resolution of the subdural hematoma and/or trace residual (less than or equal to 4 mm) between 1 and 6 months post treatment, while maintaining medication compliance to the anticoagulation treatment. Subdural hematoma expansion, need for surgical treatment (burr hole and/or craniotomy) and mortality were documented.

Results
39 out of 148 patients (26%) were treated with primary MMA embolization (25 male). Anticoagulation was required for atrial fibrillation (36 patients) and DVT/PE (3 patients). All patients that followed up in clinic confirmed anticoagulation medication compliance. Complete subdural hematoma resolution was seen in 17 (43.5%) patients (mean age 74). 7 patients (18%) demonstrated trace residual (less than or equal to 4 mm) subdural hematoma on the three month follow up CT scan, but they all did not have a six month follow up CT scan. Burr hole evacuation was required in 1 patient (2.5%) due to hematoma expansion. There were no patient deaths or neurologic deficits related to subdural hematoma expansion on anticoagulation following embolization. Following the initial embolization, 8 patients (22%) demonstrated reduced/stable subdural hematoma on their approximate one month follow up imaging, but they had incomplete follow up imaging. Following the initial embolization, 6 patients (15%) have no follow up imaging. The COVID pandemic created an environment that limited access to the hospital for many patients.

Conclusion
Initiation of anticoagulation within 24 hours of primary MMA embolization is safe and can lead to complete resorption of the chronic subdural hematoma. Further studies are required to identify patient characteristics that may lead to hematoma expansion following embolization and the initiation of anticoagulation.
Abstract 419: The Contribution of Neutrophil Extracellular Traps to Coagulopathy in Patients with COVID‐19 Related Vascular Thrombosis
Authors: Couture L. , Baskin L. , Cahuiche A. E. , Enochs C. , Colpo G. Delevati , Nimjee S. , McCullough L. D. 
Published: January 2025

Introduction
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and has been associated with hypercoagulability and an increased incidence of thrombotic events as compared to other viral respiratory infections. In this study, we investigated the levels of neutrophil extracellular trap (NET) biomarkers and von Willebrand factor (VWF) to assess if these could be used to predict the occurrence of a thrombotic event in COVID‐19 patients.

Methods
We enrolled 202 patients hospitalized with symptomatic COVID‐19 infections. Of those, 104 patients did not experience any type of thrombotic events at any time preceding or during their hospitalization. These patients were compared to the other cohort of 98, who experienced thrombotic events before or during their hospitalization. 61 of the thrombotic event patients had the event after initial blood collection, so the predictive capacity of biomarkers in these patients was evaluated.

Results
We found that citrullinated histone H3 (ciH3) was the best predictive biomarker for thrombotic events in COVID‐19 regardless of age, sex, and race. We also found that disease severity was a significant predictor of occurrence of thrombotic event in most groups, including sex, race, and age. Thrombotic events are associated with a higher risk of mortality, specifically in COVID‐19 infection compared to other illnesses. Interestingly, in the age group less than 60, citH3 and neutrophil count were found to be significant predictors of thrombotic event occurrence but was not a significant predictor in the age group above 60.

Conclusion
Our findings of predictive capacity of citH3 and neutrophil count in patients younger than 60 could indicate newfound screening biomarkers for patients in this population. NETs may be involved in the thrombotic complications of COVID‐19, and these thrombotic events contribute to multi‐system organ failure and mortality in COVID‐19. These results may better inform treatment and prophylaxis of thrombotic events, with an emphasis in COVID‐19 and similar viral illnesses in the future to improve outcomes and reduce mortality. Understanding the biological etiologies of this disease and its thrombotic complications can improve therapeutic interventions to reduce the burden of thrombosis in patients with COVID‐19. These results may also be relevant to other infections and may inform potential mechanisms for treatment development for other respiratory diseases with thrombotic complications as well as thrombotic diseases such as Myocardial Infarctions and Ischemic stroke.
Abstract 424: The Impact of RapidAI on Thrombectomy Notification Times in a Large, Multi‐Site, Telestroke System
Authors: Sambursky J. , Avila A. , Boyd C. , Gao L. , McCoy M. , Mayer L. , Devlin T. , Sevilis T. 
Published: January 2025

Background
Mechanical thrombectomy is considered the gold standard for treatment of large vessel occlusion (LVO) stroke. Early identification leads to faster puncture times as communication with the team is key. The integration of artificial intelligence (AI) platforms into acute stroke evaluation protocols may lead to more rapid and accurate detection of LVOs resulting in earlier notification of the neurointerventional (NIR) team, as was demonstrated in the VALIDATE study. In this study, we will evaluate if these findings can be generalized to other platforms such as RapidAI®.

Methods
Acute stroke consultations seen in the emergency department in 103 facilities (35 RapidAI® and 68 non‐AI) in 24 states from July 1, 2021 to December 31, 2021 were extracted from the TeleCare by TeleSpecialistsTM database. The encounters were reviewed for LVO, arrival‐to‐NIR notification time (ATN), and whether RapidAI® software was utilized. Patients were classified into two groups based on use of RapidAI® or no AI software. Then subcategorized further based on if they were seen at a thrombectomy capable center vs non‐thrombectomy capable center. The median arrival to NIR notification times were compared.

Results

A total of 14,159 patients (6,726 AI and 7,433 non‐AI) were included. The median ATN for AI was 57.5 min [40.3, 85.0] and non‐AI was 88.5 min [63.0, 116.3; Δ
min
= 31.0 min, p < 0.0001]. The median ATN for those at a thrombectomy center (TC) with AI was 49.0 min [36.0, 75.0] and non‐AI was 81.0 min [52.5, 97.8], p = 0.0077. The median ATN for non‐thrombectomy centers (non‐TC) with AI was 73.0 min [56.0, 115.5] and non‐AI was 90.0 min [66.5, 120.5], p = 0.0563. [TS1] . There was no difference in the AI vs non‐AI groups for door to needle times with thrombolytics at thrombectomy or non‐thrombectomy centers.

Conclusions
This large, multicenter study demonstrated a 31‐minute faster arrival to neurointerventionalist notification time with the aid of RapidAI®. A significant reduction in NIR notification times at both TC and non‐TC sites highlights the impact of AI software on expediting acute stroke care.
Abstract 425: The Impact of White Matter Lesions and Medial Temporal Lobe Atrophy on Prestroke Cognitive Function: A Multicenter Study
Authors: Elsayed M. M. , Esmail A. , Abouzaid M. , Abouelseoud M. , Hegazy N. Y. 
Published: January 2025

Introduction
The predictive value of neuroimaging findings, specifically white matter lesions and medial temporal lobe atrophy, in assessing cognitive impairment before a stroke has been insufficiently explored. This study aims to clarify the relationship between these imaging markers and prestroke cognitive function across multiple clinical environments.

Methods
We conducted a retrospective analysis of 271 stroke patients who had undergone magnetic resonance imaging (MRI). Cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). MRI scans were systematically assessed for the presence and severity of white matter lesions and medial temporal lobe atrophy. Multivariate logistic regression was employed to determine the associations between these neuroimaging findings and prestroke cognitive impairment.

Results
Our analysis demonstrated a significant association between cognitive impairment and the presence of both white matter lesions (OR: 1.34, 95% CI: 1.04‐1.72) and medial temporal lobe atrophy (OR: 3.56, 95% CI: 1.38‐9.19). Notably, the impact of white matter lesions on cognitive decline was more pronounced in patients aged under 75, whereas a higher prevalence of medial temporal lobe atrophy was observed in younger cohorts. These findings suggest distinct age‐related patterns in the influence of neuroimaging markers on cognitive impairment.

Conclusion
This study highlights the critical role of white matter lesions and medial temporal lobe atrophy as early indicators of cognitive impairment prior to stroke. By integrating these neuroimaging assessments into routine clinical practice, healthcare providers can better identify patients at risk of cognitive decline, thereby enhancing preventative strategies to mitigate the risk of future strokes. Early identification and targeted interventions could significantly improve patient outcomes, underscoring the importance of incorporating neuroimaging markers into comprehensive stroke care protocols.
Abstract 458: Utilizing Transcranial Doppler in the Diagnosis of Cervical Artery Dissection: Insights from a Multicenter Survey within the STOP‐CAD Study
Authors: Guo X. , Shahripour R. Bavarsad 
Published: January 2025

Background
Cervical artery dissection (CAD) is a common cause of ischemic stroke in young adults. Local blood clot formation and distal emboli are the key mechanisms for the development of stroke in patients with CAD. Microemboli distal to the dissection point can be detected as high‐intensity transient signals (HITS) using Transcranial Doppler (TCD). Despite this unique capability, TCD is used inconsistently in the management of CAD. In this international survey, we aim to explore the frequency and potential barriers to TCD use in CAD.

Method
This study was an international electronic survey, based on the Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP‐CAD) study, aiming at evaluating the use of TCD in diagnosing and managing CAD patients. A comprehensive questionnaire was developed to gather insights into the current practices, perceptions, and potential barriers to the effective use of TCD in participating centers. The collected data was then analyzed.

Results
Fifty‐eight medical centers with advanced stroke care capabilities from Europe and United States participated in this study. Half (29 out of 58) of the sites routinely perform TCD on CAD patients, particularly in the presence of carotid or vertebral artery stenosis, complete carotid occlusion, and early neurologic deterioration. The primary reason for participating institutions not performing TCD was because its results would not change their practice. The protocol for TCD monitoring and managing HITS‐positive CAD patients varied among centers but transitioning from antiplatelet to anticoagulant was the most common practice in this patient population.

Conclusion
Half of the stroke centers in our survey routinely perform TCD monitoring for CAD patients. The detection of HITS in CAD patients is a warning sign for providers, which may prompt a change in secondary stroke prevention management. However, a standard protocol for performing TCD in CAD and treatment recommendations for HITS‐positive CAD are not currently available, which warrants further research.