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To determine the proportion of subtypes of ischemic strokes, vascular risk factors and treatment prior to stroke between 1997 and 2018 in a single institution in Argentina.

Demographics, risk factors, medications and TOAST subtypes were assessed and compared in ischemic stroke patients admitted during two periods of time, 1997-2007 (P1) and 2008-2018 (P2).

There were 2747 patients (64% men, aged 67 ±15 years), 920 subjects in P1 and 1827 in P2. Age and gender distribution did not change over time. Proportion of large artery atherothrombotic strokes decreased from 29% in P1 to 14% in P2 (p <0.0001) and small vessel strokes from 15% to 11% (p <0.05). Cardioembolic and undetermined strokes increased from 17 to 25% (p <0.0001) and from 30% to 41% (p <0.0001), respectively. There were no changes in stroke of other etiologies (9% in both periods). Detection of atrial fibrillation increased from 14% to 19% (p<0.001). Use of medications prior to stroke increased for aspirin from 27% to 45% (p <0.0001), for antihypertensive drugs from 26% to 62% (p <0.0001), for statins from 14% to 42% (p<0.0001) and for anticoagulants from 4% to 9% (p<0.0001).

The proportion of strokes associated to large and small vessel atherosclerosis is declining in our population with an increase in the proportion of cardioembolic and undetermined strokes. Better management of risk factors and higher prevalence and/or better screening for atrial fibrillation could explain, at least in part, these findings.

The proportion of strokes associated to large and small vessel atherosclerosis is declining in our population with an increase in the proportion of cardioembolic and undetermined strokes. Better management of risk factors and higher prevalence and/or better screening for atrial fibrillation could explain, at least in part, these findings.

Although many emergency departments (EDs) have telestroke capacity, it is unclear why some EDs consistently use telestroke and others do not. We compared the characteristics and practices of EDs with robust and low assimilation of telestroke.

We conducted semi-structured interviews with representatives of EDs that received telestroke services from 10 different networks and had used telestroke for a minimum of two years. We used maximum diversity sampling to select EDs for inclusion and applied a positive deviance approach, comparing programs with robust and low assimilation. Data collection was informed by the Consolidated Framework for Implementation Research. For the qualitative analysis, we created site summaries and conducted a supplemental matrix analysis to identify themes.

Representatives from 21 EDs with telestroke, including 11 with robust assimilation and 10 with low assimilation, participated. In EDs with robust assimilation, telestroke workflow was highly protocolized, programs had the support of leadership, telestroke use and outcomes were measured, and individual providers received feedback about their telestroke use. In EDs with low assimilation, telestroke was perceived to increase complexity, and ED physicians felt telestroke did not add value or had little value beyond a telephone consult. EDs with robust assimilation identified four sets of strategies to improve assimilation strengthening relationships between stroke experts and ED providers, improving and standardizing processes, addressing resistant providers, and expanding the goals and role of the program.

Greater assimilation of telestroke is observed in EDs with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant providers.

Greater assimilation of telestroke is observed in EDs with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant providers.Pulmonary arteriovenous malformations (PAVMs) are pathologic low-resistance conduits between a pulmonary artery and vein. Over 80% PAVMs occur in patients with hereditary hemorrhagic telangiectasia (HHT) and result from mutations in the transforming growth factor-beta signaling pathway. Mutations in the Growth Differentiation Factor 2 (GDF2) gene have recently been described to result in a vascular-anomaly syndrome with phenotypic overlap with HHT. We report a 43-year-old woman with a PAVM related ischemic stroke who was subsequently found to have a novel GDF2 gene mutation. The patient underwent coil-embolization of the PAVM with stable clinical and radiographic follow-up. It is important to diagnose PAVMs as they are an important cause of stroke-in-young; and can be treated definitively, reducing risk of recurrent stroke and migraine.

To build radiomic model in differentiating dissecting aneurysm (DA) from complicated saccular aneurysm (SA) based on high-resolution magnetic resonance imaging (HR-MRI) through machine-learning algorithm.

Overall, 851 radiomic features from 77 cases were retrospectively analyzed, and the ElasticNet algorithm was used to build the radiomic model. A clinico-radiological model using clinical features and conventional MRI findings was also built. selleck chemical An integrated model was then built by incorporating the radiomic model and clinico-radiological model. The diagnostic abilities of these models were evaluated using leave one out cross validation and quantified using the receiver operating characteristic (ROC) analysis. The diagnostic performance of radiologists was also evaluated for comparison.

Five features were used to form the radiomic model, which yielded an area under the ROC curve (AUC) of 0.912 (95 % CI 0.846-0.976), sensitivity of 0.852, and specificity of 0.861. The radiomic model achieved a better diagnostic performance than the clinico-radiological model (AUC=0.743, 95 % CI 0.623-0.862), integrated model (AUC=0.888, 95 % CI 0.811-0.965), and even many radiologists.

Radiomic features derived from HR-MRI can reliably be used to build a radiomic model for effectively differentiating between DA and complicated SA, and it can provide an objective basis for the selection of clinical treatment plan.

Radiomic features derived from HR-MRI can reliably be used to build a radiomic model for effectively differentiating between DA and complicated SA, and it can provide an objective basis for the selection of clinical treatment plan.