Background and Purpose— Sex differences in stroke incidence over time were previously reported from the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study). We aimed to determine whether these differences continued through 2015 and whether they were driven by particular age groups. Methods— Within the GCNKSS population of 1.3 million, incident (first ever) strokes among residents ≥20 years of age were ascertained at all local hospitals during 5 periods: July 1993 to June 1994 and calendar years 1999, 2005, 2010, and 2015. Out-of-hospital cases were sampled. Sex-specific incidence rates per 100 000 were adjusted for age and race and standardized to the 2010 US Census. Trends over time by sex were compared (overall and age stratified). Sex-specific case fatality rates were also reported. Bonferroni corrections were applied for multiple comparisons. Results— Over the 5 study periods, there were 9733 incident strokes (56.3% women). For women, there were 229 (95% CI, 215–242) per 100 000 incident strokes in 1993/1994 and 174 (95% CI, 163–185) in 2015 ( P <0.05), compared with 282 (95% CI, 263–301) in 1993/1994 to 211 (95% CI, 198–225) in 2015 ( P <0.05) in men. Incidence rates decreased between the first and last study periods in both sexes for IS but not for intracerebral hemorrhage or subarachnoid hemorrhage. Significant decreases in stroke incidence occurred between the first and last study periods for both sexes in the 65- to 84-year age group and men only in the ≥85-year age group; stroke incidence increased for men only in the 20- to 44-year age group. Conclusions— Overall stroke incidence decreased from the early 1990s to 2015 for both sexes. Future studies should continue close surveillance of sex differences in the 20- to 44-year and ≥85-year age groups, and future stroke prevention strategies should target strokes in the young- and middle-age groups, as well as intracerebral hemorrhage.

Background Leukocytosis is associated with hemorrhage volume and early neurological deterioration after intracerebral hemorrhage (ICH). We examined total white blood cell (WBC) count and absolute monocyte (AMC) and neutrophil (ANC) counts as potential readily available prognostic biomarkers in human ICH. Methods In a retrospective study, adult patients aged ≥ 18 years who presented to one of two local hospitals with nontraumatic ICH from July 2008 to December 2009 within 12 hours of symptom onset were identified. Demographics, Glasgow coma scale (GCS), ICH volume, ICH location, and 30-day case-fatality rates were determined. Total WBC count, ANC, AMC, and hemoglobin concentration were determined. Linear and logistic regression were used to evaluate factors associated with baseline ICH volume (log transformed) and 30-day case-fatality, respectively. Results Of the 186 patients, mean (±SD) age was 67.3±14.8 years, 51% were male, 22% were black. Median [IQR] ICH volume was 12.8 [4.9, 29.4] ml. After adjusting for patient age and initial hemoglobin, higher initial WBC count (p=0.0009) and higher ANC (p=0.006) were associated with higher ICH volume, whereas AMC was not (p=0.4). After adjusting for patient age, GCS, intraventricular hemorrhage (+/−), stroke location, and ICH volume, baseline AMC was associated with greater odds of 30-day case-fatality (OR 2.26, 95% CI 1.10–4.65, p=0.03). Conclusion The association of AMC with higher 30-day case-fatality after ICH is hypothesis generating. Given the lack of association between presenting AMC and ICH volume, AMC may contribute to secondary injury after ICH (hematoma expansion and/or cerebral edema).

Background and Purpose Monocytes may contribute to secondary injury after intracerebral hemorrhage (ICH). We tested the association of absolute monocyte count (AMC) with 30-day ICH case-fatality in a multi-ethnic cohort. Methods Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multi-center, case-control study of ICH among white, black, and Hispanic patients. In 240 adults with non-traumatic ICH within 24 hours of symptom onset, we evaluated the influence of ICH score and complete blood count components on 30-day case-fatality using generalized linear models. Results Mean age was 62.8 years (SD 14years); 61.7% were male, 33.3% black, and 29.6% Hispanic. Median ICH volume was 9.9ml (IQR 4.4–26.7). After adjusting for patient age and initial hemoglobin, higher total white blood cell count (WBC) (p=0.0011), driven by higher absolute neutrophil count (ANC) (p= 0.002), was associated with larger ICH volume, whereas absolute monocyte count (AMC) was not (p=0.15). After adjusting for age, GCS, ICH volume, location, and presence or absence of intraventricular hemorrhage, baseline AMC was independently associated with higher 30-day case-fatality (OR 5.39, 95%CI 1.87–15.49, p=0.0018) whereas ANC (OR 1.04, 0.46-2.32, p=0.93) and WBC (OR 1.62, 0.58–4.54, p=0.36) were not. Conclusions These data support an independent association between higher admission AMC and 30-day case-fatality in ICH. Inquiry into monocyte-mediated pathways of inflammation and apoptosis may elucidate the basis for the observed association and may be targets for ICH neuroprotection.

Background and Purpose: Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. Methods: Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. Results: Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%–46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%–51%), and specifically thrombolysis by 33% (95% CI, 4%–55%), but this finding had less precision. Conclusions: Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.

Background The diagnosis of stroke in the prehospital environment is the subject of intense interest and research. There are a number of non-invasive external brain monitoring devices in development that utilize various technologies to function as sensors for stroke and other neurological conditions. Future increased use of one or more of these devices could result in substantial changes in the current processes for stroke diagnosis and treatment, including transportation of stroke patients by emergency medical services. Aims The present review will summarize information about 10 stroke sensor devices currently in development, utilizing various forms of technology, and all of which are external, non-invasive brain monitoring devices. Summary of review Ten devices are discussed including the technology utilized, the indications for use (stroke and, when relevant, other neurological conditions), the environment(s) indicated for use (with a focus on the prehospital setting), a description of the physical structure of each instrument, and, when available, findings that have been published in peer-reviewed journals or otherwise reported. The review is organized based on the technology utilized by each device, and seven distinct forms were identified: accelerometers, electroencephalography (EEG), microwaves, near-infrared, radiofrequency, transcranial doppler ultrasound, and volumetric impedance phase shift spectroscopy. Conclusions Non-invasive external brain monitoring devices are in various stages of development and have promise as stroke sensors in the prehospital setting. Some of the potential applications include to differentiate stroke from non-stroke, ischemic from hemorrhage stroke, and large vessel occlusion (LVO) from non-LVO ischemic stroke. Successful stroke diagnosis prior to hospital arrival could transform the current diagnostic and treatment paradigm for this disease.