The effects of hormonal contraceptives on structural features of the hypothalamus and pituitary are incompletely understood. One prior study reported microstructural changes in the hypothalamus with oral contraceptive pill (OCP) use. However, effects on hypothalamic volume have not been reported. One prior study reported volumetric changes in the pituitary. However, this study was limited by including participants evaluated for neurological symptoms. We sought to determine if OCP use is associated with alteration of hypothalamic or pituitary volume. High-resolution 3T MRI was performed for a prospective cohort of 50 healthy women from 2016 to 2018, which comprised 21 OCP users (age, 19–29) and 29 naturally cycling women (age, 18–36). Participants were excluded if they were pregnant or had significant medical conditions including neurological, psychiatric, and endocrine disorders. After confirming reliability of the image analysis techniques, 5 raters independently performed manual segmentation of the hypothalamus and semi-automated intensity threshold-based segmentation of the pituitary using ITK-SNAP. Total intracranial volume was estimated using FreeSurfer. A general linear model tested the association of OCP use with hypothalamic and pituitary volumes. Hypothalamic (B = -81.2 ± 24.9, p = 0.002) and pituitary (B = -81.2 ± 38.7, p = 0.04) volumes in OCP users were smaller than in naturally cycling women. These findings may be related to interference with known trophic effects of sex hormones and suggest a structural correlate of central OCP effects.

Introduction: Delay to stroke diagnosis can postpone appropriate treatment leading to worse outcomes. We hypothesize that interpreter use can contribute to a delay to treatment. Methods: We identified consecutive patients between January 2019 and June 2021 with acute stroke (hemorrhagic or ischemic) using the Get with the Guidelines Database (GWTG). We determined the requirement for interpreter via chart review. We assessed time from last known well (LKW) to CT. We also looked at time to treatment, defined as the time from LKW to tPA administration or groin puncture. Finally, we assessed the difference in outcomes in patients using discharge modified Rankin Score (mRS). We compared these values for patients that did and did not require the use of an interpreter. Results: We identified 2,576 patients from GWTG and found 1,306 patients (mean age 69±16, 48% female) with acute stroke notifications. The majority (78%) of these patients were diagnosed with ischemic stroke. For patients presenting with an acute stroke, 27% required interpreter use. For patients who required an interpreter, Spanish (28%), Russian (21%) and Cantonese (18%) were the most common primary language. Compared to patients who spoke English, patients with interpreter requirements were older (73±13 years vs 68±16 years) and had a higher median NIHSS admission score (8[3-18] vs 4[2-13]), p<.05 for both. There was no difference in arrival time to stroke code activation. However median time to CT [IQR] from LKW was longer for patients who required an interpreter (334 minutes [121-955] vs. 274 minutes [106-765], p=.03). Patients who required an interpreter were less likely to get tPA (15% vs 24%, p=.05), and had a longer time between LKW and treatment (60 minutes [36-85] vs 48 [31-75], p=.02). Patients who required an interpreter had a higher discharge mRS (3 [1-4] vs 2 [1-4], p=.02). Discussion: Interpreter requirement was associated with longer time to stroke diagnosis, reflecting a pre-hospital delay in the identification of stroke symptoms, despite the higher NIHSS. These patients were less likely to receive tPA and had a higher discharge mRS. Interpreter requirement merits consideration for systemic changes that might prevent this health care administration disparity.