bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract Number ‐ 268: Sarcoid Induced Posterior Circulation Abnormality With Recurrent Ischemic Strokes
Authors: Karim Nurose , Nour Hassan Aboul 
Published: April 2023

Introduction
The estimated incidence of Neurosarcoidosis is ∼5‐15%. Most of these cases involve anterior circulation. Here we are presenting a case of recurrent posterior circulation ischemic stroke in a patient with neurosarcoidosis.

Methods
A 41‐year‐old Male had biopsy proven sarcoidosis diagnosed in 2012 with pulmonary involvement. He was on chronic low dose Corticosteroid. In 2014, he presented with right pontine ischemic infarction causing left‐sided hemiplegia. He underwent extensive workup including conventional angiogram that showed irregular intracranial left vertebral artery with mild narrowing distal to posterior inferior cerebellar artery (PICA) and mild dilatation proximal to basilar artery (Image on the top). He was started on Aspirin 81 mg. In 2021, he had a right inferior cerebellar peduncle infarction with repeat angiogram showing abnormal dysplastic dilatation of the left vertebral artery at V4 segment and the top of basilar artery that has progressed since 2014 (image on the bottom). Workup showed that he was Aspirin non‐responder and has been switched to Clopidogrel.

Results
The most common presentation of neurosarcoidosis is cranial neuropathy, mostly facial nerve. Ischemic stroke is one of the uncommon presentation of neurosarcoidosis. The likely mechanism could begranulomatous invasion of the blood vessel wall with vasculitic disruption of the media and internal elastic lamina.

Conclusions
To our knowledge, this is a rare case of neurosarcoidosis progressively affecting posterior circulation causing recurrent stroke.
Abstract Number ‐ 270: Assessing Biceps Brachii Functional Recovery after Stroke: Comprehensive Analysis of Two Decades of Patient Data
Authors: Brown Nolan , Aguirre Alexander , Hsu Timothy , Harris Mark , Yang Chenyi , Kortz Michael , Shahrestani Shane , Singh Rohin , Sahyouni Ronald 
Published: April 2023

Introduction
Severe loss of muscle strength is common following stroke, and rehabilitation in the form of targeted physical therapy is often needed to recover partial muscular function. Although lower limb weakness is typical in stroke patients, upper body complications presenting as decreased grip strength and hand motor coordination can also occur. The biceps brachii, one of the most frequently used upper body muscles, often shows weakness post‐stroke. Although recent literature has touched on various techniques to help regain biceps brachii function, studies looking at quantifiable recovery of muscular strength are limited.In this review, we summarize strength recordings of the biceps brachii from stroke patients collected over the past 20 years to better characterize upper extremity functional recovery after stroke.

Methods
Using PRISMA guidelines, we queried 3 databases to identify all studies reporting findings of stroke recovery including isolated strength measurement of the bicep brachii muscle in newtons (N).

Results
15 studies describing 384 patients (mean age range: 55.7‐73.6 years) were included for formal analysis. Baseline biceps strength range following stroke was 12.1‐91.23 N. At 4 weeks, strength ranged from 16.3‐85.8N, and this range improved to 85.31‐97.38N and 29–125.04N at 5 and 8 weeks, respectively. Additionally,Folkerts et al. found a significant improvement in biceps function from the 5 week value (97.38N) to the 10 week final follow‐up (108.46N). Over 12 weeks post‐stroke, Donaldson and colleagues observed a significant improvement in bicep strength range (27.1‐61.0N vs. 59.5‐76.1N).

Conclusions
Our study is the first systematic review assessing the recovery of biceps function with time following stroke in the current literature. Singular timepoint studies showed a significant loss of bicep function post‐stroke. Multiple timepoint studies showed semi‐linear relationships between biceps strength recovery and time within studies but no patterns when comparing between studies. Further research is required to quantify biceps strength recovery in a sex‐specific manner.
Abstract Number ‐ 272: Effect of the Time between Thrombolysis and Mechanical Thrombectomy on Outcomes of Stroke
Authors: Miremadi Brian B , Chen Willian , Gasimova Ulviyya , Khasiyev Farid , Rodriguez Wilson , Hakoun Abdullah , Scott Jordan , Gordon Weston , Christopher Kara , Linares Guillermo , Edgell Randall , Miremadi Brian B 
Published: April 2023

Introduction
Administration of intravenous thrombolytics (IVT) within 4.5 hoursof symptoms onset, prior to performing mechanical thrombectomy(MT) in patients with acute ischemic stroke (AIS) secondary tolarge vessel occlusion (LVO) is thoroughly studied and hassuggested to improve reperfusion rates and clinical outcomes. [1,2] The outcomes of combined IVT and MT in STEMI patientshavebeen studied comprehensively and revealed worsening clinicaloutcomes when a shorter Lapse of Time (LoT) isintroduced.[3,4]Those studies stemmed the question of whetherLoTbetween IVT and MT in AIS patients has any significance. We investigated the effects of theLoTbetween IVT and MT onoutcomes of MT revascularization, as well as on the functionaloutcomes in patient with AIS with LVO.

Methods
We performed a retrospective analysis ofgathereddataduring a 6‐year period (2016‐2021) for all ourpatients with AIS and LVO who received both IVT and MT. We analyzed the MT revascularization outcomes using thethrombolysis in cerebral infarction(TICI)scale, as well as thestroke functional outcomes using the modified Rankin Scale(mRS)at discharge and 90 days to detectany significant differencesin positive or negative direction.LoT was measured as minutes from tPA administration and reperfusion on a continuous scale. Nonparametric tests (Kruskal‐Wallis analysis of variance on ranks, K‐W H) were used to determine if there were differences between mRS at discharge and at 90 days (as an ordinal variable, possible score 0–6) based on LoT.

Results
A total of 48 patients who received both IVT and MT were includedin the study.Those included were primarilyBlack (57.1%) and male(59.2%). Mean age was62.5 years (sd = 15.5, range 21–89 years).Median minutes between tPA and reperfusion was 74 minutes (min‐max = 44‐143 minutes). There were no significant differences betweenmRSatdischarge (K‐W H = 5.13, p = 0.40), nor at 90 days (K‐W H = 8.71, p = 0.19) as a function of theLoTbetween IVT and MT. There were no significant differences between TICI scores, as afunction of theLoTbetween IVT and MT, (K‐W H = 5.49,p = 0.14).

Conclusions
In this study we compared the impact of the time differencebetween IVT and MT on revascularization and functionaloutcome in patients with AIS and LVO.Unlike the findings in STEMI, we did not detect any significant outcomedifferences in MT results (TICI scale) and functional outcomes(mRSat discharge and 90 days), when IVT was given at differentLoTbeforeMT.
Abstract Number ‐ 280: A Unique Case of Pial AVF Presenting as Hemispheric Cerebral Edema
Authors: Welsh Connor , Youn Jina , Venkatesh Anita 
Published: April 2023

Introduction
To describe a unique case of pial arteriovenous fistula presenting as left hemispheric cerebral edema with hemianopsia, sensory change and ataxia.

Methods
Case report

Results
Our patient is a 38 year old male with a history of diabetes, hyperlipidemia and congenital deafness with a left cochlear implant who presented to an outside hospital for visual complaints. Non‐contrast CT of the head was negative at that time; he could not obtain an MRI due to his cochlear implant. He developed worsening right hemianopia and aphasia, prompting his transfer to our facility. Upon arrival, repeat imaging was done, including a CTA of the head and neck. This revealed a large region of hypodensity involving the left PCA and distal MCA territories. An MRI was attempted but artifact from his implant obscured visualization of the left hemisphere. Post‐contrast CT was negative for evidence of tumor. CT venogram was negative for veno‐occlusive disease. He complained of worsening headache and demonstrated worsening word‐finding ability. He received100g total of mannitol divided across 3 boluses which improved his symptoms mildly. Over the following days he began to become ataxic and clumsy in the right upper extremity and his headache worsened further and he began to develop focal seizures electrographically localized to the left parietal lobe. Repeat CTA demonstrated expanding hypodensity with marked vascular engorgement in the left hemisphere. He underwent 6‐vessel digital subtraction angiography (DSA) of the head which revealed gross left hemispheric venous congestion with early filling of the left hemispheric venous system by a parasagittal pial ateriovenous fistula believed to be responsible for his hemispheric edema. He was discharged on acetazolamide and acetaminophen for headache management and plans for outpatient follow‐up and potential intervention. Follow‐up DSA revealed improvement in his venous congestion and reduction in the degree of his early venous filling with some symptomatic improvement by medical management.

Conclusions
Pial arteriovenous fistulae (pAVF) are a rare entity and can present in a variety of ways, with symptomatic intracranial hemorrhage and ischemia being two of the most common. This case illustrates an unusual instance of hemispheric edema initially mistaken for venous infarct caused by a pAVF, and prompts the physician to consider angiography and further exploration when initial workup for cerebral edema and/or venous infarct is initially unrevealing.
Abstract Number ‐ 282: Surgical Treatment for Moyamoya Disease with Coexisting Autoimmune Conditions: A Systematic Review
Authors: Brown Nolan , Singh Rohin , Bauman Megan , Harrison Daniel , Seas Andreas , Shahrestani Shane , Quinones‐Hinojosa Alfredo , Gottfried Oren , Grant Gerald 
Published: April 2023

Introduction
There have been several studies of Moyamoya disease (MMD) with concurrent autoimmune (AI) disease. It has been proposed that there may be a causal or synergistic effect of autoimmune and inflammatory conditions in patients with MMD. As such, in the present study we seek to characterizethe surgical outcomes of adults and children with MMD and coexisting AI conditions.

Methods
A systematic review was performed of published studies reporting patient level data of Moyamoya disease and concomitant autoimmune disease. Relevant studies were identified using Preferred reporting Items for Systematic Reviews and Meta‐Analysis criteria.

Results
A total of 149 studies were included, encompassing 257 patients. Of the 257 patients with concurrent AI and MMD, 107 (88 females, 19 males) underwent surgery. The average age was 31.3 years (Range 5–65; SD 12.5). Five cases presented with hemorrhagic symptoms, 87 ischemic, and 15 were unspecified. The most commonly associated AI conditions were Graves’ disease (71 cases, 66.4%), Lupus (17 cases, 15.9%), and T1DM (6 cases, 5.6%).Follow‐up was reported in 25 cases and was an average of 17.8 months. Surgical outcomes were reported in 82 cases; 63 (76.8%) improved, 7 (8.5%) were stable, 9 (10.9%) developed a new deficit, and 3 (3.7%) died at most recent follow up. Eight patients (7.5%) had disease progression. 63 (58.8%) patients were treated with additional autoimmune therapy although this therapy did not lead to any difference in outcomes. Twenty patients (18.7%) required additional supportive medical therapy (eg: aspirin, statins).

Conclusions
Moyamoya disease may be multifactorial. Patients with concomitant AI and Moyamoya disease may be at increased risk and warrant additional surveillance or intervention. The ideal therapy for these patients remains to be understood. These findings warrant further study into optimal diagnostic and therapeutic techniques for concomitant MMD and AI conditions.
Abstract Number: LBA11 CADASIL revealed by COVID‐19: A case report and systematic review
Authors: Najdawi Zaid R , Kurra Nithin , Elfil Mohamed , Aladawi Mohammad , Fayad Pierre 
Published: April 2023

Introduction
Cerebral Autosomal Dominant Arteriopathy with subcortical Infarcts and leuko‐encephalopathy (CADASIL) is a genetic condition characterized by migraine, ischemic strokes, mood disturbances, and cognitive impairment. Since COVID‐19 pandemic started in late 2019, six patients (including our case) were reported to present with neurological symptoms associated with CADASIL mutation and four of them were diagnosed while hospitalized for COVID‐19 illness.

Methods
A case report anda systematic literature review done via PubMed search that was performed up to Oct 15, 2022. Studies reporting on CADASIL and COVID‐19 infection were included.

Results
In addition to our case report, 5 case‐reports were identified, and full articles were reviewed and summarized. Including our case, the mean age of patients was 45.44 years, and all of them were females. The diagnosis of CADASIL was established after COVID‐19 infection in four of the cases including ours, while the diagnosis of CADASIL was established in the other two patients after neurological symptoms and prior strokes warranting investigations and stroke workup. CADASIL diagnosis was confirmed with genetic testing in all of them. Two cases had history of migraines with aura, three cases had hypertension, and two patients had unremarkable past medical history. Four cases reported dysarthria as one of the initial symptoms at presentation. The initial MRI brain reported involvement of corona radiata in two cases, centrum semiovale in two cases, cerebellum in one case. All cases reported bilateral changes on imaging. Aspirin, clopidogrel, statins, intravenous immunoglobulins, and steroids were the medical treatment modalities used amongst those patients. Four cases had mild‐complete recovery of symptoms, one case was reported to have partial resolution of deficits, and one patient had complete resolution of motor deficit and persistent mild neurocognitive dysfunction.

Conclusions
COVID‐19 infection might be a triggering factor forCADASIL flare. Although it is unclear whether CADASIL mutations would be the only etiology behind the neurological deficits in these patients, as COVID‐19 infection has been reported to be associated with many neurological manifestations, the reported imaging findings along with the genetic confirmation weighs more towards COVID‐19 infection acting as a trigger for CADASIL flare.
Abstract Number: LBA12 Cortical Venous Thrombosis As Cause Of Atypical Cortical Intracerebral Hemorrhage
Authors: Amireh Abdallah , Scarpiello Sean , Fourcand Farah , Haimi Joshua , Bozkurt Sokutay , Sindhu Sindhu , Tabibzadeh Navid , Gadallah Nancy , Mehta Siddhart , Kirmani Jawad F 
Published: April 2023

Introduction
Cortical venous thrombosis is a rare and underrepresented etiology for atypical cortical intracerebral hemorrhages (ICH). Cortical venous thrombosis poses a diagnostic challenge compared to dural venous sinus thrombosis. Venogram studies may show a dural sinus filling defect in cases but may not demonstrate thrombosed cortical veins, especially given their variable anatomy. Our aim was to identify cases of atypical cortical ICH in the absence of other secondary ICH risk factors that may have been associated with cortical venous thrombosis.

Methods
Retrospective chart review of cases of nonaneurysmal ICH over a 3‐year period at our comprehensive stroke center were reviewed. Imaging study and clinical data were reviewed to include only atypical cortical hemorrhages. All subjects were required to have computed tomography (CT) with thin 0.625 mm slices, CT angiogram (CTA) that included venous phases, diagnostic cerebral angiograms without identifiable vascular etiologies, and MR imaging. Atypical ICH was defined as cortical hemorrhage in the absence of vascular malformation, hematological disorders, suspected amyloid angiopathy, hypertension, trauma, dural venous sinus thrombosis, and other secondary etiologies. Social science statistics software was used for data analysis.

Results
From April 2019 to July 2022, out of 344 total ICH cases, 10 cases were deemed idiopathic despite rigorous investigation, including evaluation for venous sinus thrombosis. Six subjects were male. Mean age was 46.5 (95% CI 35.99, 57.02), and median NIHSS was 7 (95% CI 1.86, 12.54). Two of the ten patients were identified to have ICH‐adjacent hyperdense cortical vein on CT indicating thrombosis. On MRI brain, both patients had susceptibility weighted imaging (SWI) blooming within an adjacent cortical vein as well as hyperintense filling defect of veins on T2 sequence.

Conclusions
In our study population of atypical intracerebral hemorrhages, cortical venous thrombosis was identified in 20% of subjects. Cortical venous thrombosis may not represent a rare etiology in this unique patient population. Multimodal neuroimaging may be required to identify this underdiagnosed pathology.
Abstract Number: LBA14 Incidence of Intracranial Hemorrhage & Clinical Outcomes in Fast Versus Slow Progressors as per ASPECTS
Authors: Fourcand Farah , Sahito Sindhu , Fourcand Farah , Ghori Arifa , Abbasi Hamidreza , Singh Zamir , Joshi Rudra , Amireh Abdallah , Gadallah Nancy , Tabibzadeh Navid , Mehta Siddhart , Kirmani Jawad 
Published: April 2023

Introduction
Heterogeneity of collateralization in patients with acute ischemic stroke (AIS) is a marker of fast versus slow progression of penumbral consumption and infarct expansion. Our aim was to evaluate the relationship between time‐dependent stroke progression and incidence of intracranial hemorrhage (ICH) and acute neurological deficits.

Methods
Retrospective chart review of patients presenting with anterior circulation large vessel occlusion (LVO)‐associated AIS at our comprehensive stroke center with 24 hours last known normal (LKN) who underwent endovascular thrombectomy (EVT) without intra‐arterial thrombolytics or non‐thrombolytics were included. We used Alberta Stroke Program Early CT Score (ASPECTS) on initial non‐contrast CT to identify slow versus fast progressors. ASPECTS < = 7 was defined as fast progressor. Subgroup analysis was performed based on LKN < 3 hours, 3–9 hours, and 9–24 hours. We evaluated rate of hemorrhagic transformation using ECASS‐3 criteria and determined change in NIHSS from baseline to discharge. Mann‐Whitney U test and Fisher exact test statistic with Social science statistics software used for data analysis.

Results
From September 2019 to December 2021, out of 268 subjects who underwent EVT, 48 met inclusion criteria. Mean age was 65.29 (95% CI 61.32, 69.27), and median presenting NIHSS was 16 (95% CI 14.39, 18.40). Mean ASPECTS was 7.71 (95% CI 7.21, 8.20). There was significant difference is hemorrhagic transformation rate between ASPECTS >7 and < = 7 (Fisher value = 0.018). Sample size was not large enough to perform subgroup analysis based on last known normal. However, there was a trend towards increase in hemorrhagic transformation rate with greater time from last known well at same ASPECTS score. Slow progressors also had a significant improvement in presenting and discharge NIHSS as compared to fast progressors (z‐score is ‐3.10, p‐value is 0.002).

Conclusions
Our study suggests that ASPECTS score as assessed in different time windows to differentiate fast versus slow progressors is not only a predictor of clinical outcome, but also independently associated with risk of hemorrhagic transformation. Larger, prospective studies are needed to validate our results.
Abstract Number: LBA17 SARS‐CoV‐2 Infection Might be a Predictor of Mortality in Intracerebral Hemorrhage
Authors: Mowla Ashkan , Shakibajahromi Banafsheh , Shahjouei Shima , Zand Ramin 
Published: April 2023

Introduction
SARS‐CoV‐2 infection may be associated with uncommon complications such as intracerebral hemorrhage (ICH), with a high mortality rate. We compared a series of hospitalized ICH cases infected with SARS‐CoV‐2 with a non‐SARS‐CoV‐2 infected control group and evaluated if the SARS‐CoV‐2 infection is a predictor of mortality in ICH patients.

Methods
In a multinational retrospective study, 63 cases of ICH in SARS‐CoV‐2 infected patients admitted to 13 tertiary centers from the beginning of the pandemic were collected. We compared the clinical and radiological characteristics and in‐hospital mortality of these patients with a control group of non‐SARS‐CoV‐2 infected ICH patients of a previous cohort from the country where the majority of cases were recruited.

Results
Among 63 ICH patients with SARS‐CoV‐2 infection, 23 (36.5%) were women. Compared to the non‐SARS‐CoV‐2 infected control group, in SARS‐CoV‐2 infected patients, ICH occurred at a younger age (61.4± 18.1 years versus 66.8± 16.2 years, P = 0.044). These patients had higher median ICH scores ([3 (IQR 2–4)] versus [2 (IQR 1–3)], P = 0.025), a more frequent history of diabetes (34% versus 16%, P = 0.007), and lower platelet counts (177.8± 77.8 × 109/L versus 240.5± 79.3 × 109/L, P< 0.001). The in‐hospital mortality was not significantly different between cases and controls (65% versus 62%, P = 0.658) in univariate analysis; however, SARS‐CoV‐2 infection was significantly associated with in‐hospital mortality (aOR = 4.3, 95% CI: 1.28‐14.52) in multivariable analysis adjusting for potential confounders.

Conclusions
Infection with SARS‐CoV‐2 may be associated with increased odds of in‐hospital mortality in ICH patients.
Abstract Number: LBA19 Network‐Wide Incidence of Intracranial Hemorrhage in Patients with Acute Ischemic Stroke Receiving Tenecteplase
Authors: Fourcand Farah Y , Sahito Sindhu , Ali Ch Hassan , Marandi Elahe , Haimi Joshua , Dubinsky Ilya , Song Yong‐Bum , Mehta Siddhart , Tabibzadeh Navid , Gadallah Nancy , Panezai Spozhmy , Kirmani Jawad F 
Published: April 2023

Introduction
Intravenous tenecteplase (TNK) is currently being used as a thrombolytic agent in acute ischemic stroke (AIS) and has has been shown to be non‐inferior to intravenous alteplase according to recent studies. Intracranial hemorrhage (ICH) as a complication of alteplase is approximately at 6%. The aim of our study was to determine the rate of significant ICH in patients receiving TNK indicated for AIS in a real world setting.

Methods
A network‐wide (3 CSCs, 6 PSCs), multicenter retrospective chart review of patients receiving TNK from February 2020 to January 2022 was performed using the Get With The Guidelines database. TNK bolus dose of 0.25mg/kg was used according to a network‐wide policy. ICH was categorized using ECASS‐3 criteria. Fisher exact test statistic was used to determine if a significant association existed between the presence of ICH and baseline ASPECTS score, endovascular treatment (EVT), and IV eptifibatide use. A benchmark less than 2% PH‐2 incidence was set based on historical alteplase related PH‐2 rates within our network. Social science statistics software was used for data analysis.

Results
Out of 180 patients who received TNK, 25 subjects (13.89%) developed hemorrhagic transformation. Mean age was 71.88 (95% CI 65.54, 78.22). Forty‐eight percent of subjects were female. Median ASPECTS score was 8 (95% CI 7.54, 8.78). Median 90 day mRS was 3 (95% CI 2.1, 3.9). Hemorrhagic transformation was classified as HI‐1 in 5% (n = 9), HI‐2 in 1.7% (n = 3), PH‐1 in 3.8% (n = 7), and PH‐2 in 3.3% (n = 6) subjects. No significant difference between subjects with other subtypes versus PH‐2 was identified when adjusting for ASPECTS score > = 7 versus < 7 (Fisher value = 1), EVT versus no EVT (Fisher value = 0.65), or use of IV eptifibatide (Fisher value = 0.06).

Conclusions
Tenecteplase is associated with higher rates of PH‐2 intracranial hemorrhage when compared with our benchmark rates of alteplase‐related PH‐2. This study is significantly limited by small sample size, retrospective nature, and uncontrolled variables. Larger, prospective studies are needed to validate our results.