bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 105: Gaze, weakness, neglect and speech (GWNS), an LVO stroke sale is also predictive of distal medium vessel occlusion (DMVO) in the emergency department.
Authors: Lodi Y. M. , Khan I. , Saini H. 
Published: January 2025

Background and objective
In acute ischemic stroke, DMVOs and LVOs are associated with disability and death. There are no stroke scales that predict DMVOs. The objective is to evaluate if the GWNS stroke scale predicts DMVO as it does for LVOs in hyper‐acute state.

Methods
Consecutive AIS with suspected PLVOs and DMVOs were prospectively enrolled from January 2020 to December 2022. NIHSS and GWNS scale were obtained prior to CTA and DSA. GWNS scale scores range from 0 to 4. We defined DMVO as distal terminal branches of middle cerebral artery (MCA); M2, M3, M4. Internal carotid artery (ICA), terminus and MCA, M1 were defines as PLVOs.

Results
We have enrolled 148 patients; mean age 68.74+/‐15.37, 52.70% female, GWNS 2 in 32 3 in 35 and 4 in 57. Time to obtain GWNS from arrival was 1.5 minutes (range 1 ‐3) and CTA was 30.3 plus‐minus 9 minutes. PLVOs were present in 61% and DMVOs in 39%. All GWNS scale 3 and 4 had vessel occlusion except in 2; one with seizure and other with formed stroke. None with GWNS scale 2 or less had occlusion. GWNS scale score 4 with gaze deviation were more frequent in PLVOs as opposed to GWNS 3 with gaze preferences, which were more frequent in DMVO. Patients with DVMOs demonstrated a lower NIHSS compared to PLVOs. GWNS 3 or 4 is associated with both PLVOs and DMVOs including M3 and M4. GWNS score predicts DMVO better (0.88) than NIHSS (0.66) irrespective of right or left hemispheric vessels. GWNS score 3/4 with Gage predicts the most for DMVOs (0.9).

Conclusions
GWNS stroke scale predicts DMVOs in our study. This is the only reported scale for DMVOs in our knowledge. The GWNS scale could be used for early detections of both DMVOs and PLVOs for faster perfusion therapy. Further studies are needed.
Abstract 122: Maternal Stroke and Malnutrition: a Cross‐Sectional Analysis of the National Inpatient Sample
Authors: Christopher K. M. , Lyons A. , Kaur G. 
Published: January 2025

Introduction
Malnutrition is present on admission in approximately 20% of stroke patients, contributing to stroke morbidity and mortality. While stroke during the peripartum period is rare, it accounts for 18% of strokes in women aged 18‐35. Additionally, health inequities in stroke incidence persist, with previous studies reporting that Black mothers had 50% higher odds of having a stroke than white mothers. The objective of the current study was to (a) determine the prevalence of malnutrition in women during the peripartum hospital stay and (b) calculate the odds of ischemic and hemorrhagic stroke in women with malnutrition.

Methods
We utilized the National Inpatient Sample (NIS) years 2016‐2020, selecting women aged 18‐44 with a pregnancy related ICD‐10 code. The presence of ICD‐10 codes for malnutrition were used to determine malnutrition status. Weighted logistic regression models were fitted with ischemic stroke and hemorrhagic stroke as the outcomes; covariates included age, socioeconomic status, stroke history, hypertensive disorders of pregnancy, and having obesity. All analyses were completed in SAS v9.4.

Results
Malnutrition was associated with stroke occurrence, with 35 times increased odds of ischemic stroke in women with malnutrition as compared to women without malnutrition (aOR=35.10; 95% CI: 18.89, 65.22). History of stroke (aOR: 39.92; 95% CI: 23.83, 57.18), low and middle socioeconomic status (low SES aOR: 1.41; 95% CI: 1.10‐1.81; middle SES aOR: 1.34; 95% CI: 1.04‐1.72), hypertensive disorders of pregnancy (OR: 2.75; 95% CI: 2.20, 3.44), age (aOR: 1.05; 95% CI: 1.03, 1.07), and race (aOR: 1.33; 95% CI: 1.04, 1.70) were also significant covariates in this model. Obesity (aOR: 1.12; 95% CI: 0.85‐1.48) was not associated with ischemic stroke. Malnutrition was also two times more prevalent in black women as it was in white women in this sample (cOR=2.09, 95% CI: 1.88, 2.33).

Conclusions
Malnutrition has a significant impact on stroke occurrence during peripartum period, increasing the odds of stroke by 35 times. This relationship could contribute to the overall disparity in maternal morbidity and mortality between black and white mothers, since black women have 50 percent higher odds of stroke and two times higher odds of malnutrition. The overall higher prevalence of malnutrition among Black women could contribute to greater stroke risk in that population.
Abstract 147: System Improvements in Acute Stroke Management: Impact on Picture‐to‐Puncture Times
Authors: Elsayed M. 
Published: January 2025

Introduction/Purpose
This study aims to investigate the impact of system improvements on picture‐to‐puncture (P2P) times in acute stroke management. Time efficiency is crucial in acute stroke care, andunderstanding how system enhancements affect P2P times can lead to improved patient outcomes.

Materials/Methods
A single‐center retrospective analysis was conducted using a prospective acutestroke database from October 2007 to October 2013. Patient demographics, stroke severity, andtreatment time points were collected to assess the annual trends in P2P times.

Results
The study identified a total of 189 patients, with 181 meeting the study criteria. Annual medianP2P times decreased over the 6‐year period, showing a significant trend towards improved efficiency. Factors such as stroke onset times and CT acquisition times were found to influence P2P times.

Conclusion
System improvements in acute stroke management have led to a significant reduction in P2Ptimes over the study period. Understanding the impact of these enhancements on time metrics isessential for optimizing acute stroke care and improving patient outcomes.
Abstract 168: A Case of Large Vessel Occlusion Presenting as a New‐Onset Focal Seizure
Authors: Furr T. , Blanden A. R. , Masoud H. E. 
Published: January 2025

Introduction
Hemiparesis after a new onset seizure was originally considered a contraindication to lytic administration to avoid the hemorrhagic risk associated with thrombolysis in patients experiencing post‐ictal Todd's paralysis [1]. However, the observation window required to establish an improved diagnosis of a post‐ictal Todd's paralysis runs counter to the rapid treatment requirements for acute ischemic stroke. Seizure at stroke onset is a recognized but poorly studied phenomenon, and presents a critical diagnostic dilemma to patients in the hyper‐acute window, requiring rapid triage to a seizure vs a stroke treatment pathway.

Methods
Here we present a case of a 73‐year‐old woman with pancreatic cancer who developed focal status epilepticus due to an emergent large vessel occlusion (LVO).

Results
Patient is a 73‐year‐old woman with metastatic pancreatic cancer and a recent stroke taking aspirin and Plavix who initially presented to the emergency department with the concern for an NSTEMI. She was admitted to the medicine service and treated with a heparin drip. On day 7 a stroke code was called as the patient was unresponsive and had tonic activity on the right side of her body. Her NIHSS was 26 for decreased level of consciousness and intermittent right hemiparesis. She was given Ativan, Versed, loaded with Vimpat to control the seizures without success, and ultimately intubated and taken for a stat CT head and CT angiography. This showed a left distal ICA occlusion. She was taken for emergent thrombectomy with TICI IIb revascularization.
The patient was placed on video EEG showing severe slowing of background with no epileptiform abnormalities. Her transthoracic echocardiogram had moderate left atrium dilatation but was otherwise unremarkable. MRI brain without contrast presented a large left MCA acute ischemic stroke. The patient continued to have a poor hospital course and had persistent deficits from her left MCA territory stroke. Due to her poor prognosis from her pancreatic cancer and her deficits from her large left MCA stroke, comfort measures were pursued. The patient was pronounced deceased 11 days after being in the hospital. The reason for the stroke was determined to be a malignancy‐associated embolism.

Conclusions
Seizure stroke onset is a known presentation of a stroke but is poorly studied and under‐recognized [2]. The purpose of our report is to raise awareness of this presentation, particularly in patients with no history of epilepsy and with significant vascular risk factors presenting with new‐onset seizures with persistent localizable deficits. We would recommend CT angiography as the first imaging study in these patients rather than plain CT, with a low threshold to treat with thrombolytic if an alternative cause is not found and the patient is otherwise a candidate, or endovascular therapy in the instance of LVO, as in our case.
Abstract 205: Barriers in Acute Stroke Care for Patients with Limited English Proficiency
Authors: Trang I. , Ali A. , Ganne C. , Malagon C. Perez , Nguyen T. P. , Sharrief A. Z. 
Published: January 2025

Introduction
Research shows that ischemic stroke patients with limited English proficiency (LEP) experience disparities in stroke care, including increased time to treatment with intravenous thrombolysis. During code strokes, translation devices are necessary to evaluate stroke patients with LEP, but the devices may not be readily available or may have poor reliability (e.g., poor connection, poor audio quality). This study aims to systematically evaluate the challenges that clinicians, nurses, and other healthcare professionals encounter when assessing stroke patients with LEP.

Methods
A survey was distributed to clinicians, nurses, and other healthcare personnel who provided care to stroke patients over a six‐month period. We collected information regarding role (e.g., physician, nurse), availability of translation devices, and reliability of translation devices in this survey. Descriptive statistics were used to analyze the data.

Results
Of the clinician respondents, 71% (12/17) reported inaccessibility to translation devices during code strokes. Additionally, 65% (11/17) experienced technical difficulties with translation devices during code strokes. Furthermore, 76% (13/17) of clinicians believed that inadequate or unreliable translation services have compromised their ability to manage code strokes for LEP patients. A significant majority of overall respondents, 88% (28/32) expressed interest in a mobile application to aid in evaluating stroke patients with LEP and 81% (26/32) showed interest in learning how to perform the NIH Stroke Scale in another language.

Conclusion
Despite the availability of translation services, issues with reliability and accessibility hinder the quality of care for stroke patients with LEP, highlighting the need for systemic improvements. Many clinicians call for improved services and technology, which our group will focus on developing.
Abstract 208: BIUXX
Authors: Betgeri S. Shankerappa 
Published: January 2025

Introduction
Efficacy of transvenous endovascular complete embolisation of the superior ophthalmic vein (SOV) through external jugular venous approach in cranial and extra cranial arterio venous malformations.

Methods
Tranvenous endovascular embolisation of the superior ophthalmic vein was done in the following 3 patients. First patient, 40yr male had sudden onset right sided rapidly progressing proptosis and eye redness following a bout of cough during bronchoscopy for evaluation of a lung mass. Immediate CECT imaging brain and orbit showed phleboliths in a slow flow vascular malformation with rupture in the intra conal space with venous drainage into the SOV. No definite arterial feeders were identified. Second patient, 50 yr old lady, had gradually progressive right sided proptosis with peri orbital pain and eye redness over a period of 5 months. CECT brain and orbit showed indirect carotico cavernous fistula (CCF Barrow type B) with dilated right SOV. Third patient, 38yr old male, had a slowly progressive left sided peri orbital tortous swelling and mild proptosis over a period of 3 months following forehead trauma. CECT brain and face showed left frontal scalp and peri orbital arterio venous fistula with feeders from the superficial temporal artery and ophthalmic artery with venous drainage into the dilated SOV, facial vein and superficial temporal vein opening into the external jugular vein. Feeder from the superficial temporal artery was initially embolised from the arterial side in this patient followed by embolisation of the SOV through the trans venous approach. In all the 3 patients, SOV was the main or one of the major draining vein of the vascular malformations causing the orbital symptoms. In all the 3 patients, under general anaesthesia, USG guided access was taken from the ipsilateral external jugular vein with a 5F radial slender sheath. SOV was reached with a 2.4F microcatheter and 0.014 wire combinations manoeuvring the catheter via the facial vein and angular vein. Complete SOV embolisation was done using coils or glue mixed with lipiodol in1:1 ratio. Arterial access (Common femoral artery) was taken only in two patients. One with indirect CCF and another with left frontal arterio venous fistula to indentify the filling of the SOV in the former and to embolise the arterial feeders from the superficial temporal artery in the latter.

Results
Each of the 3 patients successfully underwent SOV embolisation via the trans venous approach. All the 3 patients had progressive decrease in proptosis and eye congestion in immediate post procedure period and follow up till now.

Conclusions
Endovascular trans venous SOV embolisation is simple and effective technique in treating indirect CCF, slow flow orbital venous malformations and extra cranial arterio venous fistula. This backdoor approach is also effective in cases where in there is no definite identifiable arterial feeder to the vascular malformation or when the feeder is a very tiny artery (ophthalmic artery) with difficult cannulation.
Abstract 212: Cardiac CT Imaging in Embolic Stroke of Undetermined Source (ESUS)
Authors: Seblani N. El , Madden S. , Srivastava R. , Lichtenberger J. , Gulati A. 
Published: January 2025

Background
Up to 40% of ischemic strokes meet the definition of embolic stroke of undetermined source (ESUS). Although transthoracic echocardiography (TTE) is the conventional method for detecting cardiac structural abnormalities, Cardiac CT Angiography (CCTA) is emerging as a valuable non‐invasive alternative for evaluating intra‐cardiac thrombi, particularly in high‐risk patients.

Methods
A 42‐year‐old right‐handed male with a history of ischemic strokes, including a left ventricular (LV) thrombus previously managed with warfarin, coronary artery disease, and systolic congestive heart failure (EF 24‐30%), presented to the emergency department with acute aphasia, right facial paralysis, and right hemiparesis. His NIHSS score was 6, with a baseline mRS of 1. Non‐contrast CT of the head (NCCTH) showed multiple chronic strokes in the left frontal and parietal lobes, right frontal and parietal‐occipital regions, left pontine and midbrain areas, and bilateral thalami/internal capsules, as well as probable chronic lacunar infarcts. CTA revealed occlusion of the superior branch of the left M2 MCA and right V1‐V2 segments. CT perfusion (CTP) demonstrated a 39 cc penumbra and 5 cc core in the left MCA territory. Due to concerns about acute‐on‐chronic ischemic strokes with left M2 occlusion and a high risk of hemorrhagic transformation, thrombectomy was not performed. Brain MRI showed acute embolic strokes in the left frontal lobe, insular cortex, and right thalamus. TTE indicated severe left ventricular hypokinesia with an EF of 24% and a markedly dilated left atrium, but no shunt or intra‐cardiac thrombus was detected. Telemetry showed no arrhythmias. Given the suspicion of a cardioembolic source in this young patient with low ejection fraction heart failure, a CCTA was performed, revealing three LV thrombi (measuring 1.3 times 1.1 cm, 0.9 times 0.9 cm, and 0.7 times 0.7 cm) against the distal and apical lateral walls. The patient was subsequently started on Apixaban for LV thrombus treatment and secondary stroke prevention.

Conclusion
Although earlier retrospective studies have emphasized the value of CCTA in evaluating embolic strokes, the latest AHA guidelines still fall short in providing comprehensive diagnostic recommendations for ESUS. This case highlights the critical role of CCTA in identifying intra‐cardiac thrombi among high‐risk patients with cardioembolic strokes and concurrent heart failure.
Abstract 221: Challenging the Norm: Large Stent Retrievers Show No Disadvantage in Medium Vessel Occlusions
Authors: Miller S. , Sy S. , Saei H. , Georgiadis A. , Tekle W. , Hassan A. 
Published: January 2025

Background
Mechanical thrombectomy has become widely used in order to treat patients with ischemic stroke. While studies have examined the effect of stent retriever size in various cerebral vessels, the efficacy of differently sized stent retrievers for mechanical thrombectomy in M2 segment middle cerebral artery (MCA) occlusions is as of yet unknown. Understanding the efficacy of differently sized stent retrievers could lead to better outcomes for affected patients, therefore this retrospective study examines 3mm, 4mm, and 6mm stent retrievers in order to determine how size affects patient outcomes.

Methods
Data collected from M2 MCA strokes in a comprehensive stroke center was retrospectively analyzed and multivariable analysis performed. Patient outcomes were quantified using NIHSS 24 hours post procedure and modified Rankin score (mRS) at discharge and after 90 days. Successful outcomes were defined as an NIHSS score of less than 10 and an mRS score less than 3. First pass success rate and final TICI scores of 3 were used to quantify successful recanalization while noting the incidence of complications such as symptomatic intracranial hemorrhage. Time from puncture to recanalization was also collected to give an idea of the difficulty of the procedure. Variables were compared using Chi Square, ANOVA and Kruskal Wallis tests, with subgroup analysis performed to further investigate between group differences as needed.

Results
A total of 139 patients were included who underwent thrombectomy with stent retrievers sized 3mm (n=23), 4mm, (n=56), and 6mm (n=60). No significant between group difference was noted in baseline demographics, clinical characteristics, 24h NIHSS (p=0.83), 24h NIHSS <10 (0.2), mRS at discharge (p=0.14), mRS at 90 days (p=0.07), time from puncture to recanalization (p=0.12), first pass success rate (p=0.98) and rate of final TICI 3 (p=0.21). All three sizes had similar rates of complication, with no significant difference in rates of death (p=0.46) or symptomatic intracranial hemorrhage (p=0.32). These findings were further supported by a multivariable regression model adjusting for baseline NIHSS and other relevant factors.

Discussion
This retrospective study failed to show a significant difference between differently sized stent retrievers in treating isolated M2 occlusion. This study was limited by its sample size andpotential unmeasured confounders such as variation in M2 occlusion severity. Further clinical trials are needed to determine whether the location or extent of the occlusion are important factors that might affect the efficacy of differently sized stent retrievers.
Abstract 293: Identifying risk factors for post‐operative seizure after chronic subdural hematoma treatment with craniotomy, burr hole evacuation or middle meningeal artery embolization.
Authors: Ranawaka K. 
Published: January 2025

Objective
Post‐operative seizures can occur in 2.6% to 23% of patients with chronic subdural hematomas (cSDH). Hematoma size, midline shift, worse clinical status at admission, and craniotomy with membranectomy have been described as risk factors for its development; however, the impact of middle meningeal artery embolization (MMAe) remains unexplored. This retrospective study aims to determine post‐operative seizure rates in cSDH patients treated with MMAe and compare them with those undergoing craniotomy and burr hole evacuation.

Methods
A bi‐institutional retrospective review of 592 cSDH treated surgically and endovascularly from 2017 to 2021 was conducted. Patient, hematoma, and procedural characteristics were compared among interventions using Fisher exact tests, t‐tests, and ANOVA. Multivariate logistic regression was employed to compare the relationship of post‐operative seizures with the type of treatment, adjusting for sex, age, subdural SDH thickness, midline shift, pre‐operative GCS score, and prophylactic AED use. Secondary outcomes evaluated included complications, additional drainage, and length of hospitalization.

Results
Post‐operative seizure rates were 3.1% for burr hole evacuation, 2.6% for burr hole evacuation with MMAe, 15.3% for craniotomy, 11.1% for craniotomy with MMAe, and 6.7% for MMAe alone. Multivariate logistic regression revealed lower seizure rates in patients undergoing burr hole evacuation with or without MMAe compared to those with MMAe alone (p=0.007, OR 0.18, 95% CI 0.05‐0.62). Craniotomy with or without subsequent MMAe had a higher risk of post‐operative seizure compared to burr hole drainage with or without MMAe (p=0.0002, OR 5.66, 95% CI 2.28‐14.04). Overall post‐operative complications were lower in MMAe alone compared to burr hole drainage alone (P=0.01, OR 0.35, 95% CI 0.15‐0.79).

Conclusion
Burr hole evacuation demonstrated the lowest post‐operative seizure rates in cSDH patients, followed by MMAe alone and then craniotomy, and this association was significant after controlling for confounders.