IMPORTANCE Patients who survive severe intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) typically have poor functional outcome in the short term and understanding of future recovery is limited.OBJECTIVE To describe 1-year recovery trajectories among ICH and IVH survivors with initial severe disability and assess the association of hospital events with long-term recovery. DESIGN, SETTING, AND PARTICIPANTSThis post hoc analysis pooled all individual patient data from the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage phase 3 trial (CLEAR-III) and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE-III) phase 3 trial in multiple centers across the US, Canada, Europe, and Asia. Patients were enrolled from August 1, 2010, to September 30, 2018, with a follow-up duration of 1 year. Of 999 enrolled patients, 724 survived with a day 30 modified Rankin Scale score (mRS) of 4 to 5 after excluding 13 participants with missing day 30 mRS. An additional 9 patients were excluded because of missing 1-year mRS. The final pooled cohort included 715 patients (71.6%) with day 30 mRS 4 to 5. Data were analyzed from July 2019 to January 2022.EXPOSURES CLEAR-III participants randomized to intraventricular alteplase vs placebo. MISTIE-III participants randomized to stereotactic thrombolysis of hematoma vs standard medical care.MAIN OUTCOMES AND MEASURES Primary outcome was 1-year mRS. Patients were dichotomized into good outcome at 1 year (mRS 0 to 3) vs poor outcome at 1 year (mRS 4 to 6). Multivariable logistic regression models assessed associations between prospectively adjudicated hospital events and 1-year good outcome after adjusting for demographic characteristics, ICH and IVH severity, and trial cohort. RESULTSOf 715 survivors, 417 (58%) were male, and the overall mean (SD) age was 60.3 (11.7) years. Overall, 174 participants (24.3%) were Black, 491 (68.6%) were White, and 49 (6.9%) were of other races (including Asian, Native American, and Pacific Islander, consolidated owing to small numbers); 98 (13.7%) were of Hispanic ethnicity. By 1 year, 129 participants (18%) had died and 308 (43%) had achievedmRS0to3.Inadjustedmodelsforthecombinedcohort,diabetes(adjustedoddsratio[aOR], 0.50; 95% CI, 0.26-0.96), National Institutes of Health Stroke Scale (aOR, 0.93; 95% CI, 0.90-0.96), severeleukoaraiosis(aOR,0.30;95%CI,0.16-0.54),pinealglandshift(aOR,0.87;95%CI,0.76-0.99]), acute ischemic stroke (aOR, 0.44; 95% CI, 0.21-0.94), gastrostomy (aOR, 0.30; 95% CI, 0.17-0.50), and persistent hydrocephalus by day 30 (aOR, 0.37; 95% CI, 0.14-0.98) were associated with lack of recovery. Resolution of ICH (aOR, 1.82; 95% CI, 1.08-3.04) and IVH (aOR, 2.19; 95% CI, 1.02-4.68) byday30wereassociatedwithrecoverytogoodoutcome.IntheCLEAR-IIImodel,cerebralperfusion pressure less than 60 mm Hg (aOR, 0.30; 95% CI, 0.13-0.71), sepsis (aOR, 0.05; 95% CI, 0.00-0.80), and prolonged mechanical ventilation (aOR, 0.96; 95% CI, 0.92-1.00 per day), and in MISTIE-III, need f...

Background Acute encephalopathy with COVID-19 has been reported in several studies but its impact on outcomes remains unclear. We hypothesized that hospitalized COVID-19 patients with encephalopathy have worse COVID-19 related outcomes. Methods We used TriNetX, with a large COVID-19 database, collecting real-time electronic medical records data. We included hospitalized COVID-19 patients since January 20, 2020 who had encephalopathy based on ICD-10 coding. We examined clinical outcomes comprising need for critical care services, intubation and mortality among these patients and compared it with patients without encephalopathy before and after propensity-score matching. Results Of 12,601 hospitalized COVID-19 patients, 1092 (8.7%) developed acute encephalopathy. Patients in the acute encephalopathy group were older (67 vs. 61 years) and had higher prevalence of medical co-morbidities including obesity, hypertension, diabetes, heart disease, COPD, chronic kidney and liver disease among others. Before and after propensity score-matching for co-morbidities, patients with acute encephalopathy were more likely to need critical care services (35.6% vs. 16.9%, p ​< ​0.0001), intubation (19.5% vs. 6.0%, p ​< ​0.0001) and had higher 30-day mortality (24.3% vs. 17.9%, p 0.0002). Conclusion Among hospitalized COVID-19 patients, acute encephalopathy is common and more likely to occur in patients with medical co-morbidities and are more likely to need critical care, intubation and have higher 30-day mortality even after adjusting for age and underlying medical co-morbidities.

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The clinical presentation of contrast-induced encephalopathy (CIE) varies widely, including altered mental status, focal motor and sensory deficit, visual disturbance, ophthalmoplegia, global aphasia, and seizures.Radiologically, CIE can mimic subarachnoid hemorrhage (SAH) on CT head with hyperdensity in the subarachnoid space due to iodinated contrast extravasation.CIE is a diagnosis of exclusion that requires comprehensive workup and close monitoring of neurologic examination. Case reportA 72-year-old woman with history of hypertension and hyperlipidemia presented with chest pain, lightheadedness, and diaphoresis. ECG revealed acute inferior myocardial injury and she was loaded with clopidogrel 600 mg and aspirin 81 mg and underwent emergent percutaneous coronary angioplasty for 100% occlusion of the right coronary artery with placement for 3 drugeluting stents. A total of 210 mL of iodinated contrast with low osmolarity (884 mOsm/kg) was used. There was no complication during the procedure. Immediately after the procedure, the patient was found to be confused. Head CT without contrast revealed hyperdensity (70 Hounsfield units [HU]) along right hemispheric gyri with mild cerebral edema, concerning for subarachnoid hemorrhage (SAH) (figure 1A). The patient was transferred to the intensive care unit at our institution for suspected hemorrhagic stroke. There was no report of seizure activity or acute or chronic renal dysfunction.