eversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches, radiographic evidence of vasoconstriction with subsequent resolution, and a normal or near-normal cerebrospinal fluid profile. More than one-half of cases of RCVS occur postpartum or in association with exposure to serotonergic or adrenergic medications. 1 The syndrome is considered relatively rare, but its exact incidence is unknown. Because cerebral angiography-a requisite for diagnosis-is not always performed in symptomatic patients with recurrent thunderclap headache and/or transient neurological symptoms, the disorder is probably underrecognized. A high index of suspicion is necessary to diagnose RCVS, especially on initial presentation. The initial presentation of RCVS is not limited to recurrent thunderclap headache but can also include encephalopathy and seizures. Brain imaging can show cortical subarachnoid hemorrhage, intraparenchymal hemorrhage, or vasogenic edema. 1-6 Reversible cerebral vasoconstriction syndrome is traditionally considered to have a monophasic and benign clinical course. However, the clinical course after the establishment of the diagnosis has not been thoroughly studied. Previous reports detail transient ischemic attacks and cerebral infarction occurring as late as 2 weeks after the diagnosis of RCVS, some-IMPORTANCE Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches and evidence of vasoconstriction with subsequent resolution. The clinical course of RCVS is traditionally considered monophasic and benign. However, recurrent episodes of focal neurological symptoms have been described after initial presentation. OBJECTIVE To define the frequency, timing, and consequences of clinical worsening in patients with diagnosis of RCVS. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study of consecutive patients with RCVS at 2 referral institutions for neurological disease. MAIN OUTCOME AND MEASURE Clinical worsening after diagnosis of RCVS. We defined clinical worsening as new permanent or transient neurological deficits (compared with presenting signs and symptoms) or new onset of seizures. We performed a logistic regression analysis to assess associations between patient characteristics and clinical worsening. Functional outcome was assessed at 1 to 3 months using the modified Rankin score. RESULTS We identified 59 patients (median age, 47 years; interquartile range, 32-54 years) with RCVS. Twenty patients (34%) experienced clinical worsening after a median of 2.5 days (range, several hours to 14 days). Eight of the 20 patients who worsened had permanent deficits, including 4 who died. We did not find an association between age, sex, smoking, migraine, acute or chronic hypertension, peripartum state, or use of serotonergic drugs with clinical worsening. Clinical worsening was associated with radiological infarction (P = .001) and worse functional outcome (P < .004). Functional outcome was favorable (modified Rankin score...

Objective:The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods.Methods:We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases.Results:There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI, -11.7 to - 11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI, -13.8 to -12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI, -13.7 to -10.3, p=0.001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions.Conclusions:The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

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Bradykinin (BK) B 1 receptors are thought to exert a pivotal role in maintaining and modulating inflammatory processes. They are not normally present under physiological situations but are induced under physiopathological conditions. In isolated human umbilical vein (HUV), a spontaneous BK B 1 receptor upregulation and sensitization process has been demonstrated. Based on pyrrolidine-dithiocarbamate inhibition, it has been proposed that this phenomenon is dependent on nuclear factor-B (NF-B) activation. The aim of this study was to further evaluate the NF-B pathway involvement on BK B 1 receptor sensitization in isolated HUV, using several pharmacological tools. In 5-h incubated rings, either the I-B kinase inhibitor 3-(4-methylphenylsulfonyl)-2-propenenitrile or the proteasome activity inhibitor Z-Leu-Leu-Leu-CHO (MG-132) inhibited the development of the BK B 1 receptorsensitized contractile responses. Furthermore, pro-inflammatory cytokine interleukin-6 (IL-6) produced a leftward shift of the concentration-response curve to the BK B 1 receptor agonist, whereas anti-inflammatory cytokines interleukin-4 (IL-4) and tumor growth factor-␤1 (TGF-␤1) produced a rightward shift of the responses to des-Arg 9 -BK in our preparations. Taken together, these results point to NF-B as a key intermediary in the activation of the expression of BK B 1 receptor-sensitized responses in HUV and support the role of inflammatory mediators in the modulation of this process.

<b><i>Background and Objectives:</i></b> Information about stroke awareness in Latin America is scant. We conducted a large population survey in Argentina to assess stroke knowledge. <b><i>Methods:</i></b> We distributed 110,000 multiple-choice anonymous questionnaires using the house distribution system of a bottled water dispensing company. The survey assessed demographic characteristics and stroke knowledge. <b><i>Results:</i></b> A total of 12,710 surveys were returned (12%). Even though 95% of the respondents reported some prior information about stroke, only 37% had adequate knowledge based on prespecified criteria. The Spanish acronym for accidente cerebrovascular, was the most frequently identified name for stroke. Sixty nine percent of respondents were able to identify stroke main risk factors and only 29% knew about transient ischemic attacks. If a hypothetical scenario of stroke was presented, 63% knew the existence of a time-dependent treatment, 25% would call an ambulance, and 50% would go to an emergency room by own means. A lower degree of knowledge was present in young, single, and nonuniversity men. <b><i>Conclusions:</i></b> This study represents the largest stroke awareness survey in a Spanish-speaking population. There was good recognition of some basic facts of stroke. However, the population had poor knowledge of prevalence and severity of the disease, transient ischemic attacks, and treatment availability.