bluuebunny/crossref_metadata_2025_split huggingface dataset:
198 Should we thrombolyse cognitively impaired patients with acute ischaemic stroke?
Authors: Ramnarine Isabela , Rasheed Omar , Harkness Kirsty , Majid Arshad , Bell Simon 
Published: August 2022

IntroductionUnderlying pathological mechanisms of cerebral vessel damage in dementia patients have been suggested to increase the risk of intracranial haemorrhage following thrombolysis for acute ischaemic stroke. This has not been demonstrated in earlier literature. Our study compared the throm- bolysis outcomes of stroke patients with and without cognitive impairment.MethodsA retrospective cohort analysis of stroke patients receiving thrombolysis was conducted. Cognitive impairment was defined as: a diagnosis of dementia, mild cognitive impairment, or clinical evidence of mild cognitive impairment. Outcome measures included haemorrhagic complications, NIHSS and mRS scores, and mortality.ResultsStatistical analysis included data from 428 ischaemic stroke patients, 62 of whom had cognitive impairment. Following thrombolysis, cognitively impaired stroke patients had greater increments in dis- ability level, an increased risk of haemorrhagic complications, and a lower likelihood of 90-day survival. Logistic regression modelling revealed the main predictors of these poorer outcomes to be age, time to thrombolysis, and NIHSS on admission. Two thirds of the variance in stroke outcomes remained unex- plained by our models.ConclusionConfounding variables were the main predictors of poorer thrombolysis outcomes in cogni- tively impaired stroke patients. A large portion of these poorer outcomes remains unexplained, leaving potential for further investigation.
200 Covid-19 and acute ischaemic strokes in CADASIL: a systematic review of the literature
Authors: Noui Yassine , Williams Owain , Chan Nathan , Chandra Julie , Sztriha Laszlo 
Published: August 2022

IntroductionAcute ischaemic stroke (AIS) has been reported as a relatively infrequent complication of Covid-19. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the commonest inherited stroke disorder. Our aim was to determine the clinical and radio- logical features of Covid-19 associated AIS in patients with CADASIL.MethodsWe performed a systematic review of publications of patients with Covid-19 and CADASIL and included one unpublished case from two such presentations to our center.ResultsWe identified a total of 6 cases; average age 46 years, all female. Mean time from Covid-19 to AIS was 9.8 days, with no severe infection. Imaging demonstrated multiple infarcts in 66%, mean number of DWI lesions 9.6, 83% sustained infarcts located in the internal borderzones. An initial diagnosis of neuro- inflammation was revised in 50% following genetics, with 83% unaware of the CADASIL diagnosis.ConclusionsThis systematic review describes the pattern of COVID-19 associated AIS in CADASIL. Such multiple infarcts, primarily affecting the internal borderzones, have been described in patients with Covid-19 without CADASIL. We discuss possible pathophysiological mechanisms, which may be extrapolated to patients with cerebral small vessel disease, including endothelial injury causing microvascular thrombosis and hypoperfusion due to cerebral blood flow dysautoregulation.
202 Frequency of inter-specialty consensus decisions and adherence to advice following a weekly neurovascular multidisciplinary meeting
Authors: Offiah C , Tierney S , Egan B , Collins DR , Ryan DJ , McCarthy AJ , Smith DR , Boyle E , Delaney H , McCabe DJH ,   on behalf of the TUH/AMNCH NV MDT Team
Published: August 2022

Background/AimsData are limited on the frequency of ‘consensus’ between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses, and post-MDM ‘adherence’ to advice. This prospective audit/quality improve- ment project collated data at a Neurovascular/Stroke Centre.MethodsData from a weekly MDM were prospectively-recorded to document the proportion of extrac- ranial carotid/vertebral stenosis patients in whom ‘consensus management decisions’ were reached by Neurologists/Vascular Surgeons/Stroke Physicians-Geriatricians. Adherence to MDM advice was analysed in patients with asymptomatic, symptomatic and ‘indeterminate symptomatic status [ISS]’ stenoses, including intervals between symptom onset-MDM discussion +/- intervention.Results115 patients were discussed (September/2017-February/2020). Consensus regarding manage- ment was 96.5% (111/115) overall; 100% (29/29) with asymptomatic carotid stenosis [ACS], 96.5% (55/57) with symptomatic carotid stenosis [SCS], and 93.1% (27/29) with ISS. Overall adherence to MDM advice was 93% (107/115); 100% (29/29) with ACS, 89.5% (51/57) with SCS, 93.1% (27/29) with ISS. Median interval from index TIA/stroke to intervention was 12.5 days (IQR:9-18d), and MDM discussion-to-intervention was 5.5d (IQR:1-7d) in patients with 50-99% SCS.ConclusionsHigh-frequency inter-specialty consensus regarding management/adherence to proposed treatment supports a collaborative, multidisciplinary model-of-care in patients with extracranial arterial stenosis. Service development should shorten intervals between symptoms-MDT discussion-intervention to optimise secondary prevention.
206 Stroke and sociodemographic factors: a review
Authors: Vidot Micha , Wu Kit , Mitchell James , Nitkunan Arani , Carr Georgina 
Published: August 2022

BackgroundTo improve equity of service, in line with the aspirations of public policy across the UK, it is imperative that we understand how sociodemographic factors affect the management and care of stroke.AimsTo describe the relationship between sociodemographic factors and the epidemiology, clinical factors, diagnosis, treatment, patient experience and outcomes for people with stroke.MethodsWe conducted a focused review of published literature from 2000 to 2021 looking at stroke and each of the patient protected characteristics, as outlined in the Equality Act 2010, and the relationship to epidemiology, treatment and patient outcomes. Additional patient factors such as socioeconomic status, education and employment were also explored.ResultsThere is plenty of evidence published exploring the relationship of stroke with age, pregnancy, race, sex and gender. There is a lack of evidence exploring that relationship with disability, gender reas- signment, marriage and civil partnership, religion and beliefs, sexual orientation, geographical variation, socioeconomic status, settlement status, education and employment.DiscussionCertain areas within stroke medicine are well researched, with cause and effect relationships established. However, there are certain protected patient characteristics with minimal/no evidence which require further research to ensure equal access for all patients to stroke care.
Longitudinal clinical study of patients with white matter iron rims lesions in multiple sclerosis
Authors: Altokhis Amjad , Hibbert Aimee , Allen Christopher , Mougin Olivier , Alotaibi Abdulmajeed , Lim Su-Yin , Constantinescu Cris , Abdel-Fahim Rasha , Evangelou Nikos 
Published: August 2022

IntroductionIdentifying accurate prognostic imaging biomarkers in multiple sclerosis (MS) is crucial. Iron rims (IR) surrounding white matter lesions (WML) are suggested to predict a more severe disease course. Only small longitudinal cohorts of patients with and without IRL have been reported so far.ObjectiveTo assess if the presence and number of IRL in patients with CIS and MS are associated with worse long-term clinical disability.MethodsNinety-one CIS/MS patients were recruited between 2008 and 2013 and scanned with 7T MRI. Age-Related Multiple Sclerosis Score (ARMSS), a validated measure of disease severity, was calculated for patients at the time of scan and at the latest clinical follow-up after 9 years. WMLs were assessed for the presence of IRL using SWI-filtered phase images.Results132 IRLs were detected in 42 patients (46%). 9% of WMLs had IR. 54% of the cohort had no rims, 30% had 1-3 rims and 16% had ≥4. Patients with IRL at baseline had a higher EDSS and ARMSS. Presence of IRL was also a predictor of long-term disability especially in those patients with ≥4 IRL. The effect of IRL on disability was greater than the baseline WML numbers, another known prognostic biomarker.ConclusionThe presence and number of perilesional IR at a baseline scan hold prognostic value for long term clinical disability in MS.
Long term outcomes of deep brain stimulation for treatment refractory chronic cluster headache and SUNHA
Authors: Cheema Sanjay , Parras Olga , Ferreira Francisca , Lagrata Susie , Hyam Jonathan , Zrinzo Ludvic , Akram Harith , Matharu Manjit 
Published: August 2022

ObjectiveTo present long term outcomes of ventral tegmental area (VTA) deep brain stimulation (DBS) for medically refractory chronic cluster headache (CCH) and short-lasting unilateral neuralgiform headache attacks (SUNHA)MethodsOpen label study using prospectively collected clinical data in consecutive patients treated by VTA DBS between 2009 and 2019 in a single tertiary neuroscience centre, treated by a multidisciplinary team.ResultsBetween 2009 and 2019, 71 patients (43 CCH and 28 SUNHA) were treated with VTA DBS. Mean duration of follow up was 5.6 years (range 1.0-11.7 years).Overall, there was a significant improvement in attack frequency, attack severity, and attack duration in both groups (all p<0.001). Twenty nine (67.4%) CCH patients and 20 (71.4%) SUNHA patients were classed as responders (a greater than 50% improvement in attack frequency).Adverse events were rareFour non-responders had the DBS system explanted, two of them secondary to infection and one due to post-surgical neuropathic pain around the head wound site. Four patients died from unrelated conditions during the study period.ConclusionsThis study provides open label evidence than VTA DBS is a safe and effective treatment for refractory CCH and SUNHA, an effect which is maintained at long term follow up.
004 Dermato myo myelitis: a case of concurrent anti-synthetase syndrome and NMOSD
Authors: Heller Simon , Sanna Giovanni , Williams Victoria 
Published: August 2022

A 50 year old Afro-Caribbean gentleman with a background of Ro52 and MDA5 antibody positive anti- synthetase syndrome on prednisolone and mycophenolate mofetil presented with a tight band like pain around his thorax and abdominal pain. Examination identified severe dysaesthesia with a T6 spinal level, as well as lower limb and truncal weakness. MRI showed an expansile T2 hyperintense lesion from C7 to T8 with patchy enhancement in keeping with a NMOSD. He had no optic nerve involvement, confirmed by OCT. The weakness and dysaesthesia responded rapidly to high dose methylprednisolone however he developed constipation, recurrent neuropathic pain and tonic spasms. Serum AQP4 antibodies were present. At presentation serum CK was also raised.Up to 25% of patients with NMOSD have co-existing autoimmunity. However, there are very few reports of anti-synthetase syndrome and NMOSD. Ro-antibodies are well documented in studies on Sjögren’s disease and transverse myelitis. Patients with autoimmune connective tissue diseases who develop neurological symptoms should be investigated for neurological autoantibodies too as they are at risk of multiple autoimmune disorders. Furthermore, neurologists should be observant to other systems when presented with a patient with NMOSD as they may have other diseases which are currently asymptomatic or minimally symptomatic.
013 The community neuroscience project: transforming the delivery of neuroscience care across North Central London
Authors: Balaratnam Michelle , Okin Rachel , Powell Freya , Prior Stephen , Tasnim Sabiha , Baulk Ryan , Capp Adrian , Turner Patricia , Gunn Fergus Rugg , Turner Chris 
Published: August 2022

The Community Neuroscience Project has brought together clinicians from community services, secondary care and tertiary neuroscience to understand the existing neuroscience services in each region of North Central London (NCL), assess where there may be inequalities in accessing neuroscience services across boroughs, and harmonise neuroscience care across the sector.The team are working closely with NCL CCG, exploring ways to support the existing primary care and community services. All GP practices across NCL have been given the opportunity to feedback on their experience of NCL neurological services. Neurology pathways for primary care are being developed. A neurological seminar series will be delivered for community-based clinicians.Two virtual MDT clinics commenced in January 2022. A Community Neuroscience MDT clinic and a Community Neuroscience MDT Clinic for FND enable clinicians discuss their patients with a specialist multi-disciplinary team. These clinics aim to support community services provide care to their patients. We anticipate this will help build a cohesive neurological network across NCL, raising the profile of commu- nity-based services, and ensuring that patients receive the right care in the right place at the right time.The Community Neuroscience Project is an innovative step in transforming the delivery of neuroscience care across NCL.
014 Medical student and consultant surveys assessing educational value of telephone and video neurology clinics
Authors: Balfour Katharine , Lavin Tim 
Published: August 2022

IntroductionThe COVID-19 pandemic affected medical students experience of clinical neurology. Outpatient clinics reverted to telephone or video consultations. We sought to assess the impact of this change via a survey of both students and consultant neurologists.MethodsAn online 14-part questionnaire using Likert scales and free text options was distributed to all Year 4 medical students and consultant neurologists via email.Results366 students received the survey and 39 responded (an 11% response rate). 41 consultants received the survey and 9 responded (a 22% response rate). 83% of consultants felt the student’s inter- action with the patient was affected by the telephone/video software. 29% of students strongly agreed and 36% agreed that technological barriers impacted their learning experience.The free text student feedback highlighted good practice. We developed best practice guidance which included use of video consultation software, student engagement and clinic debrief. This was distributed as digestible checklists for students and clinicians. The limitations of this survey are the small response rates of both consultant and student groups.ConclusionRemote consultations are likely to remain part of neurological practice. Ongoing evaluation of its effect on medical student education and specific guidance for educators is required.
Tofersen in adults with SOD1-ALS: phase 3 VALOR trial and open-label extension results
Authors: Shaw Pamela , Miller Timothy , Cudkowicz Merit , Genge Angela , Sobue Gen , Nestorov Ivan , Graham Dan- ielle , Fanning Laura , Fradette Stephanie , McNeill Manjit 
Published: August 2022

VALOR was a Phase 3, placebo-controlled trial to evaluate the clinical efficacy and safety of tofersen in adults with ALS and a confirmed SOD1 mutation (SOD1-ALS). Participants were randomised 2:1 to tofersen 100 mg (3 doses ~2 weeks apart, then 5 doses every 4 weeks) or placebo administered intrathecally. The primary endpoint was change from baseline to Week 28 in the ALS Functional Rating Scale-Revised (ALSFRS-R) total score. Key secondary endpoints included CSF total SOD1 concentration and other clinical outcome measures. Participants could continue in an open-label extension (OLE) upon completion of VALOR. 108 total participants were enrolled (tofersen [n=72], placebo [n=36]). VALOR did not achieve statistical significance on the ALSFRS-R at Week 28, the primary endpoint. Tofersen administration led to robust reductions in CSF total SOD1 protein and plasma neurofilament light chain (NfL) at Week 28 compared to baseline. Trends favoring tofersen were seen across clinical outcome measures of respira- tory function, muscle strength, and quality of life. These effects became more apparent with longer-term follow-up in the OLE, particularly with earlier tofersen initiation. Most adverse events were mild to moderate in severity. Serious neurologic events, including myelitis (2%), were seen in tofersen-treated participants.Study sponsored by Biogen.
024 Croydon neurology: assessing the impact of the introduction of patient initiated follow-up
Authors: Sutton Fiona , Balakrishnan Kamal , Nitkunan Arani 
Published: August 2022

NHS England identified Patient Initiated Follow Up (PIFU) as part of NHS COVID-19 recovery, in line with the personalised-care agenda. We aimed to assess how the introduction of PIFU for neurology patients at Croydon University Hospital (CUH) has impacted patient outcomes, capacity and non-elective admissions.Data were extracted from electronic records on all patients booked into a CUH neurology PIFU appoint- ment from 1st June to 29th October 2021. Data were collected on the number of admissions or outpatient attendances for 5 years pre-PIFU appointment and compared with 0-6 months post-PIFU.355 patients had a PIFU appointment at CUH neurology between 1st June and 29th October 2021. The most common neurological conditions prompting a PIFU appointment were epilepsy (40%), multiple sclerosis (22%) and Parkinson’s disease (12%). The average number of outpatient appointments reduced from 11.0 pre-PIFU to 1.5 post-PIFU. The average number of ED attendances reduced from 3.1 pre-PIFU to 0.4 post-PIFU.Although there are significant limitations in this study (inadequate time since appointment, the pandemic), we remain keen on PIFU and had been running an advice line service before it was labelled as PIFU. Further follow-up data and patient satisfaction data is needed.
025 Croydon neurology: 5 years of novel service developments
Authors: Nitkunan Arani , Bagtas Creselda , Boodhoo Ajay , Grant Charmaine , Lastrilla Glenda , MacDonald Bridget , Mastrolilli Francesca , Rashid Waqar , Southam Medina , Schon Fred 
Published: August 2022

5 years ago we embarked on a series of novel developments to improve our DGH neurology services. The key was ever closer integrated working between consultant neurologists and specialist nurses with support from our Trust and commissioners.We highlight 6 very diverse ongoing projects:1. Acute neurology ward referrals have increased by 49% between 2016-2021 with nurses triaging referrals prior to consultant review.2. Post discharge nurse telephone review for selected patients since 2020 to try and reduce readmission rates.3. Consultant delivered helpline for all local GPs Monday to Friday since 2020 to discuss urgent cases of concern.4. Nurse delivered lumbar puncture service, since 2019 138 procedures carried out.5. Diagnostic coding for all neurology outpatients started in 2021. Within 8 months all 5 consultants were coding over 70% of attendances.6. Patient initiated follow up (PIFU) – 2020 NHS England initiative. Specialist nurse Helpline for patients with epilepsy, multiple sclerosis and Parkinson’s running successfully since 2018.Service improvements need not be expensive or onerous but require imagination and team cohesion. We strongly recommend others to try what seems most appropriate to their service.
030 Post COVID-19 syndrome dysautonomia: a tertiary referral centre experience
Authors: Mangion Sean Apap , Oommen Grace , VIchayanrat Ekawat , Heightman Melissa , Hillman Toby , Bell Robert , Hagen Ellen Merete , Ingle Gordon , McNamara Patricia , Iodice Valeria 
Published: August 2022

Post-coronavirus disease 19 (COVID-19) syndrome has substantial health and economic implications. It is multi-systemic, with prevalent autonomic symptoms. Understanding presentations and potential autonomic causes may help guide treatment strategies and recovery.All patients with a suspected or confirmed history of COVID-19 infection who underwent autonomic testing between May 2020 and October 2021 were reviewed retrospectively.We evaluated 62 patients (20 male, 42 female, mean age of 41.38 ±11.52). COVID-19 was PCR confirmed in 15 patients (26%), and five (8%) required acute hospital intervention. Most common symptoms included palpitations (81%), light-headedness/dizziness (62%), dyspnoea (48%), fatigue (46%), or cognitive symptoms(33%)Autonomic testing showed normal blood pressure responses to pressor stimuli, a mean respiratory sinus arrhythmia of 18.89b/m, and Valsalva ratio of 2.09. Postural tachycardia syndrome (PoTS) was diagnosed in 12 patients, autonomically mediated syncope (AMS) in 11, neurogenic orthostatic hypotension (NOH) in two, and initial orthostatic hypotension (IOH) in seven.Normal supine and upright plasma noradrenaline levels were measured in 34 patients (mean 283.38 pg/ml supine; 472.43pg/ml tilted).Autonomic testing was reassuring (PoTS and syncope) in the majority with abnormal testing (n=32, or 52%). Further phenotyping of PoTS to exclude neuropathic pathology may be needed. IOH and OH are important considerations.
032 Supine hypertension and cardiovascular autonomic failure in patients with alpha-synucleinopathies
Authors: Vichayanrat Ekawat , Koay Shiwen , Ingle Gordon , Hagen Ellen Merete , McNamara Patricia , Watson Laura , Iodice Valeria 
Published: August 2022

IntroductionOrthostatic hypotension (OH) and supine hypertension (SH) are prevalent in alpha-synucle- inopathies, posing a therapeutic dilemma as OH treatment may worsen SH. We aimed to characterise SH in pure autonomic failure (PAF), multiple system atrophy (MSA), and Lewy body disorders (LBD: Parkinson’s disease and Dementia with Lewy bodies).Methods166 patients (72 PAF, 59 MSA, 35 LBD) underwent cardiovascular autonomic testing and 24hr- ambulatory blood pressure monitoring (24hr-ABPM). Demographic, clinical features, medications and cardiovascular autonomic biomarkers were compared.ResultsSH was present in more than half of patients with PAF, MSA and LBD (56%, 51% and 50%, respec- tively) without anti-hypotensive medications. Supine pre-stand BP during 24hr-ABPM detected SH with 60% sensitivity and 86% specificity [area under the curve 0.73 (95%CI 0.66-0.81)]. Supine noradrenaline levels were significantly higher in MSA vs PAF and LBD (268 vs 183 and 210 pg/ml, p<0.01). There was a strong correlation between OH, SH and nocturnal hypertension after adjusting for age, anti-hypotensive medications and supine noradrenaline levels (R2=0.48, p<0.01).ConclusionsSH and nocturnal hypertension commonly co-exist and are independently associated with OH in alpha-synucleinopathies. 24hr-ABPM is useful in detecting SH in these patients. The pathophysiology of SH is likely to be heterogeneous and not entirely explained by residual sympathetic tone.