Background Early outcome prediction after acute ischemic stroke (AIS) might be improved with blood‐based biomarkers. We investigated whether the longitudinal profile of a multi‐marker panel could predict the outcome of successfully recanalized AIS patients. Methods We used ultrasensitive single‐molecule array (Simoa) to measure glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), total‐tau (t‐tau) and ELISA for brevican in a prospective study of AIS patients with anterior circulation large vessel occlusion successfully submitted to thrombectomy. Plasma was obtained at admission, upon treatment, 24 h and 72 h after treatment. Clinical and neuroimaging outcomes were assessed independently. Results Thirty‐five patients (64.8%) had good early clinical or neuroimaging outcome. Baseline biomarker levels did not distinguish between outcomes. However, longitudinal intra‐individual biomarker changes followed different dynamic profiles with time and according to outcome. GFAP levels exhibited an early and prominent increase between admission and just after treatment. NfL increase was less pronounced between admission and up to 24 h. T‐tau increased between treatment and 24 h. Interestingly, GFAP rate‐of‐change (pg/ml/h) between admission and immediately after recanalization had a good discriminative capacity between clinical outcomes (AUC = 0.88, p < 0.001), which was higher than admission CT‐ASPECTS (AUC = 0.75, p < 0.01). T‐tau rate‐of‐change provided moderate discriminative capacity (AUC = 0.71, p < 0.05). Moreover, in AIS patients with admission CT‐ASPECTS <9 both GFAP and NfL rate‐of‐change were good outcome predictors (AUC = 0.82 and 0.77, p < 0.05). Conclusion Early GFAP, t‐tau and NfL rate‐of‐change in plasma can predict AIS clinical and neuroimaging outcome after successful recanalization. Such dynamic measures match and anticipate neuroimaging predictive capacity, potentially improving AIS patient stratification for treatment, and targeting individualized stroke care.

INTRODUCTION : The SARS-CoV-2 pandemic greatly influenced the overall quality of healthcare. The purpose of this study was to compare the time variables for acute stroke treatment and evaluate differences in the pre-hospital and in-hospital care before and during the SARS-CoV-2 pandemic, as well as between the first and second waves. PATIENTS AND METHODS : Observational and retrospective study from an Italian hospital, including patients who underwent thrombectomy between January 1st 2019 and December 31st 2020. RESULTS : Out of a total of 594 patients, 301 were treated in 2019 and 293 in 2020. The majority observed in 2019 came from spoke centers (67,1%), while in 2020 more than half (52%, p<0.01) were evaluated at the hospital's emergency room directly (ER-NCGH). When compared to 2019, time metrics were globally increased in 2020, particularly in the ER-NCGH groups during the period of the first wave (N= 24 and N= 56, respectively): “Onset-to-door”:50,5 vs 88,5, p<0,01; “Arrival in Neuroradiology – groin”:13 vs 25, p<0,01; “Door-to-groin”:118 vs 143,5, p=0,02; “Onset-to-groin”:180 vs 244,5, p<0,01; “Groin-to-recanalization”: 41 vs 49,5, p=0,03. When comparing ER-NCGH groups between the first (N=56) and second (N=49) waves, there was an overall improvement in times, namely in the “Door-to-CT” (47,5 vs 37, p<0,01), “Arrival in Neuroradiology – groin” (25 vs 20, p=0,03) and “Onset-to-groin” (244,5 vs 227,5, p=0,02). CONCLUSIONS : During the SARS-CoV-2 pandemic, treatment for stroke patients was delayed, particularly during the first wave. Reallocation of resources and the shutting down of spoke centers may have played a determinant role.

Introduction: Spontaneous intracranial hypotension is a secondary cause of headache caused by suspected cerebrospinal fluid leaks. It is associated with vascular changes that may predispose to superficial siderosis. When treated with an epidural blood patch, rebound intracranial hypertension may ensue. Case Report: A 55-year-old man presented with orthostatic headaches responsive to rest and hydration. Brain magnetic resonance revealed subdural collections, consistent with intracranial hypotension. Three weeks later, the patient experienced sudden severe holocranial headache and spontaneous subarachnoid hemorrhage was found. This resulted in rebound intracranial hypertension with bilateral papilledema and sixth-nerve palsy, which completely resolved with acetazolamide. Discussion: Spontaneous intracranial hypotension may predispose to subarachnoid hemorrhage through vascular compensatory changes. Blood in subarachnoid space may seal the hidden cerebrospinal fluid leak or trigger an inflammatory reaction, leading to rebound intracranial hypertension, a well-known epidural blood patch complication.