Despite a current emphasis on equity in stroke care, one of the most common stroke assessment tools that is used both nationally and internationally, includes an anachronistic image that projects cultural, linguistic, and socioeconomic bias. This image, titled The Cookie Theft picture, is included in the National Institutes of Health Stroke Scale and was originally developed in 1972. Now, 50 years later, it does not reflect our current diverse, linguistically rich, and multicultural patient population.

Objectives: This study describes the rare disorder of vertebrobasilar strokes in children and provides an assessment strategy to alert the clinician towards the possibility of this disorder. Method: A retrospective study of vertebrobasilar strokes over 20 years was conducted in the Neurology Department at the New Children’s Hospital, Sydney, Australia. Results: There were 6 males and 3 females between the ages of 18 months and 15 years. Frequently presenting features included headache, hemiparesis, ataxia and cranial nerve palsies. Aphasia occurred in 2 and afebrile seizures in 1 patient. Five patients had depressed consciousness extending to coma in 3. Etiological factors included trauma to the head or neck in 5, rheumatic endocarditis with artificial valve embolism in 1, brain stem encephalitis in 1 and undetermined etiology in 2. Diagnostic neuroimaging studies including MRI showed infarction in the territories of the occluded arteries. MRA showed occlusion of the vertebral artery and/or its branches in 5 patients, while the other 4 patients had involvement of the basilar artery and/or its branches. No abnormalities of blood coagulation were detected. Five patients were treated with anticoagulants. Acute hydrocephalus secondary to cerebellar infarction developed in 3 patients. Recurrent vertebrobasilar strokes were reported in 2 males, each of whom was treated surgically. There was 1 late death. Residual neurological deficits were seen in 5 patients and 3 made a complete recovery. Conclusion: Although this disorder is rare in pediatric patients, it is important to consider it in those children with appropriate neurological symptoms and signs.

No abstract

Introduction: Atrial fibrillation (AF), a well-defined ischemic stroke (IS) risk factor whose prevalence increases with age, is associated with higher stroke severity. We aimed to evaluate stroke severity and hospital mortality in a nationally representative sample of AF-related IS patients. Methods: We utilized data from the National (Nationwide) Inpatient Sample databases from 2015 - 2018 using ICD-10 diagnostic codes to identify individuals with IS and comorbid AF. The NIHSS was used to characterize stroke severity in a subset of cases after 10/1/2016. Nonparametric statistics and logistic regression analyses were conducted to evaluate associations between AF and hospital death. Results: Of the 382,758 IS cases, 99,566 (26%) had comorbid AF. AF increased linearly with age, reaching at 47% of all hospitalized IS patients 85+ years of age or older (Figure). Higher age, male sex, white race, obesity, and higher median income were associated with comorbid AF, whereas diabetes, hypertension, tobacco use, and hyperlipidemia were associated with reduced odds of comorbid AF. While 5.8% of all IS patients died during hospitalization, mortality was increased nearly two-fold in those with AF (9.0% vs. 4.6%, p<.001). Among in-hospital deaths from IS, comorbid AF increased with age, present in 59% of those 85+ years of age or older (Figure). NIHSS, reported in 21% of patients, was higher in AF patients (mean NIHSS 6 vs. 9, p<.001). High NIHSS was the strongest independent predictor of hospital death. Conclusion: The burden of AF in a nationally representative sample of hospitalized IS patients is substantial, present in nearly 50% of the 85+ age group. AF-related IS is more severe and more likely to be fatal. As our population ages, the prevalence of AF will only increase. Understanding the severity and fatality of AF-related IS will have profound implications for health systems and may better facilitate anticipatory guidance and AF treatment.

No abstract