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INTRODUCTION: Mechanical thrombectomy (MT) is highly effective for acute large-vessel occlusion stroke. Evidence on how systolic blood pressure (SBP) should be managed in the periprocedural period, especially before reperfusion, is limited. The aims of the present study were to clarify the associations between BP before reperfusion and infarct growth (IG) on diffusion-weighted imaging (DWI) in consecutive acute stroke patients treated with MT. METHODS: Consecutive acute ischemic stroke patients treated with emergent MT were retrospectively enrolled. IG was defined as the difference between 24-h and baseline DWI infarct volumes. The associations between SBP parameters before reperfusion (maximum, minimum, mean, coefficient of variation [CV], SBP drop indices [from SBP on arrival], and area below the arrival SBP) and IG were assessed using multivariable regression models. RESULTS: A total of 292 MT procedures in 287 patients (175 male [60%], median age 76 [IQR 68-83] years, median onset to DWI time 131 [80-326] min) were included in this study. Follow-up MRI was performed at a median of 22 [17-26] h. On multivariable analyses, minimum SBP (standardized β -0.143, 95% confidence interval: -0.254 to -0.032, p = 0.012, i.e., low minimum SBP was associated with higher IG) and CV of SBP (0.157, 0.053-0.260, p = 0.003) were independently associated with IG. CONCLUSION: In MT-treated acute ischemic stroke, lower minimum SBP and greater SBP variability before reperfusion were associated with larger early IG, supporting the avoidance of hypotension and excessive SBP fluctuations during hyperacute management before and during MT.

DOI： 10.1159/000553650

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BACKGROUND: We compared the effectiveness of direct oral anticoagulants (DOACs) and warfarin for resolving left atrial appendage (LAA) thrombus in patients with acute stroke with non-valvular atrial fibrillation (NVAF). METHODS: Among consecutive patients with acute stroke admitted to five major comprehensive stroke centers in Japan between January 2017 and December 2022, those with NVAF and LAA thrombus detected by transesophageal echocardiography (TEE) and underwent follow-up TEE were included. All patients received DOAC or warfarin treatment. We compared the clinical characteristics, changes in LAA thrombus size, resolution, recurrent stroke, and bleeding complications within 3 months of stroke onset. RESULTS: This study included 63 patients (DOAC group, 22; warfarin group, 41). Sex, age, and National Institutes of Health Stroke Scale scores on admission did not significantly differ between the groups. The initial LAA thrombus size was 0.83 cm2 and 0.88 cm2 in the DOAC and warfarin groups, respectively. On follow-up evaluation 10 days after initial TEE, LAA thrombus was completely resolved in 59 % and 34 % of patients in the DOAC and warfarin groups, respectively (P = 0.02). Multivariable analysis revealed DOAC treatment as an independent factor for LAA thrombus resolution (odds ratio, 3.21; 95 % confidence interval: 1.07-10.23, P = 0.04). Recurrent stroke occurred in one and three patients in the DOAC and warfarin groups, respectively. No intracerebral hemorrhage cases were observed in either group within 3 months of stroke onset. CONCLUSION: In patients with acute stroke with NVAF and LAA thrombus detected by TEE, DOACs may be more effective than warfarin in resolving LAA thrombus.

DOI： 10.1016/j.jns.2025.123516

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BACKGROUND: Constipation, a symptom of autonomic nervous system dysfunction affecting gastrointestinal motility, is common after acute ischemic stroke. The insular cortex is associated with autonomic symptoms, and damage to the left insula may result in constipation. We investigated the association between constipation and left-sided insular infarction in patients with acute stroke. METHODS: We retrospectively analyzed data from consecutive patients who received a diagnosis of acute infarction in the middle cerebral artery territory between January 2015 and December 2018. Constipation was defined as bowel movements less often than three times a week or a prescription for laxatives within 2 weeks of stroke onset. Clinical characteristics and factors associated with constipation were evaluated. RESULTS: Among 892 patients (mean age, 75 [66-82] years; male, 566 [63.5%]), 301 (32.8%) had constipation. Infarction involving the insula (57.7% vs. 25.1%) and left-sided infarction (62.5% vs. 46.4%) were more frequent in patients with constipation than in those without constipation. In multivariable analysis, infarction involving the insula (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.57-3.36; P<0.001), left-sided infarction (aOR, 1.93; 95% CI, 1.40-2.64; P<0.001), and baseline National Institutes of Health Stroke Score (aOR, 1.04; 95% CI, 1.01-1.06; P<0.001) were associated with constipation. The incidence of constipation was highest in cases of left-sided infarction with insular involvement (69.2%). CONCLUSIONS: Left-sided infarction, infarction involving the insular cortex, and baseline National Institutes of Health Stroke Score were identified as independent factors associated with constipation in patients with acute stroke.

DOI： 10.1272/jnms.JNMS.2025_92-204

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BACKGROUND: Headache is frequently reported as a neurological manifestation of myeloproliferative neoplasms (MPNs), including polycythemia vera and essential thrombocythaemia. This study sought to clarify the clinical characteristics and response to treatment of headaches in patients with MPNs. METHODS: We prospectively studied 137 patients with MPNs. The following information was gathered to assess the features of headache at baseline and at follow-up (>6 months): (1) average duration of headache attacks, (2) number of headache days per month, (3) numerical rating scale (NRS), (4) Headache Impact Test-6 (HIT-6), and (5) Migraine Disability Assessment (MIDAS). We compared those parameters for headaches between the baseline and follow-up interviews according to the management. RESULTS: Thirty-seven (27.0%) patients had headache. The prevalence of headaches gradually decreased with increasing age (Age ≤ 49 years: 61.0%, 50-59 years: 38.5%, 60-69 years: 17.2%, 70-79 years: 5.1%, and ≥80 years: 0.0%, P < 0.001). Multiple logistic regression analysis showed that younger age, but not platelet counts or the JAK2 V617F mutation, was independently associated with headaches (Odds Ratios 2.004, 95% confidence intervals 1.293-3.108, P = 0.002). Scintillating scotomas were present in 22 (59.5%) of 37 patients with headaches, while four patients developed sudden headaches that lasted for only 0-10 min. Follow-up interviews were available for 31 (83.8%) of 37 patients with headaches. Twenty-one (67.7%) patients were treated with low-dose aspirin (100 mg once daily) [low-dose aspirin alone: n = 9; combined cytoreductive therapy: n = 12] for headache management. All parameters for headache [average duration of headache attacks, number of headache days per month, NRS score, HIT-6 score, and MIDAS score (all P < 0.001)] were significantly improved at follow-up in patients taking low-dose aspirin. However, there were no significant differences in these parameters of headaches in patients who did not receive low-dose aspirin. CONCLUSION: Headaches is common in patients with MPNs, particularly in younger patients. MPN-related headaches may be managed by using low-dose aspirin and controlling MPNs.

DOI： 10.3389/fneur.2022.1051093

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Myotonic dystrophy type 1 (DM1) is an autosomal dominant inherited muscular dystrophy caused by an expanded CTG repeat in the dystrophia myotonica protein kinase (DMPK) gene. Cardiac involvements in DM1 are characterized by cardiac conduction delays and atrial or ventricular tachycardia, which increase the risk of sudden cardiac death when compared with general population. Only a few reports have investigated the association between DM1 and inherited arrhythmias, including Brugada syndrome and a splicing abnormality of the SCN5A gene, encodes the α-subunit of cardiac voltage-gated Na+ channels. Here we report a 24-year-old male patient with progressive grip myotonia and dysphagia, who was genetically diagnosed with idiopathic ventricular fibrillation (IVF) caused by a novel V1764fsX1786 frameshift mutation in the SCN5A gene at the age of 18 years. Family history was negative for arrhythmia, cardiac sudden death, and neuromuscular disorders. Genetic analysis using the Southern blot technique revealed 350 CTG repeats in the DMPK gene. This is the first case of DM1 with genetically confirmed overlapping CTG repeat expansion and a V1764fsX1786 frameshift mutation in the SCN5A gene. Our case suggests that a loss-of-function in the cardiac sodium channel may contribute to the cardiac complications in DM1 patients.

DOI： 10.1016/j.jocn.2020.02.007

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