CurePSP

INTRODUCTIONCognitive impairment is common but often overlooked due to motor symptoms in progressive supranuclear palsy‐Richardson syndrome (PSP‐RS). This study investigates whether cognitive deficits predict disease progression in PSP‐RS.METHODSA total of 146 PSP‐RS from the Tilavonemab trial were evaluated at baseline and over 52 weeks using the PSP‐Rating Scale (PSPRS), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Unified Parkinson's Disease Rating Scale Part‐II (UPDRS‐II). Multiple linear regression analyses were performed between the RBANS, UPDRS‐II, and the PSPRS change. Clinical scores, gray matter volumes, and neurofilament‐light chain (NfL) were compared using analyses of covariance (ANCOVAs) and linear mixed models between language score‐groups.RESULTSLower RBANS‐language at baseline predicted greater PSPRS worsening over time. The low language‐score group showed poorer cognitive performance, elevated NfL, and reduced gray matter volume in language‐related areas.DISCUSSIONSpeech/language deficits predict worse prognosis in PSP‐RS, emphasizing the value of including language scores in clinical trials.HighlightsSpeech and language deficits predict a worse prognosis in progressive supranuclear palsy‐Richardson syndrome (PSP‐RS).Lower language scores are associated with worse cognitive performance over time.Lower language scores related to higher neurofilament‐light chain (NfL) at baseline.The low language‐score group presented greater atrophy in language‐related brain areas.Stratifying PSP‐RS cases using language scores may improve clinical trials.

To investigate how the lived experiences of people with progressive supranuclear palsy (PSP) can inform strategies for early and accurate diagnosis, effective interventions, and person-centered clinical trial designs.

Introduction: Early neurologic deterioration (END) and poor functional outcomes are more frequent with night than daytime onset of ischemic stroke. This variation may be related to: 1) circadian variation endogenous bodily rhythms and/or 2) extrinsic environmental time cues. Methods: To assess the contribution of extrinsic environmental time to ischemic stroke course, we evaluated patients with acute cerebral ischemia (ACI) onset within last 2h, enrolled in the NIH FAST-MAG trial of prehospital neuroprotection, consisting of patients with witnessed/wake onset. Results: Among 1235 ACI patients (ischemic stroke 1033, TIA 202), age was 70.8 [±13.2], 45.3% female, initial NIHSS 7 (IQR 2-15), LKW to randomization 59 mins (IQR 46-80), and 473 (38%) treated with IV lytics. Onset occurred during clock daytime (07:00-22:59) in 1147 (92.9%) and night-time (23:00-06:59) in 88 (7.1%). Patients were similar in 18 baseline characteristics, but night-onset had higher initial SBP (162 vs 155, p=0.01) and longer onset to paramedic times (33m vs 23m, p = 0.0002). Among non-lytic patients, both unadjusted and adjusted clinical outcomes were similar in night vs daytime patients, including END (13.6% vs 16.4%), 90d mRS 0-2 (63.6% vs 58.5%), and 90d mortality (10.2% vs 12.8%). Among lytic patients, clinical outcomes were also similar in night vs daytime onset patients, including unadjusted END (36% vs 21.7%), 90d mRS 0-2 (52% vs 46.9%), and 90d mortality (12% vs 17.4%). Night vs daytime onset did not modify the effect of magnesium vs placebo on outcome among either non-thrombolytic or thrombolytic-treated patients (Figure). Conclusion: Among acute cerebral ischemia patients, efficacy, safety, and neuroprotective agent response outcomes were not modified by witnessed onset during active versus inactive phase clock times. These findings suggest biological wake-sleep state rather than chronologic clock time is the driver of known circadian rhythmicity in stroke course.

Background: Patients with stroke frequently suffer from post-stroke mood disturbances (PSMD) which decrease their quality of life. It remains unclear whether the prevalence of PSMD differs according to stroke subtype. The aim of our study was to investigate PSMD incidence among stroke subtypes in the large, prospective Field Administration of Stroke Therapy - Magnesium (FAST-MAG) Trial. Methods: In the publicly-available FAST-MAG database, we identified all patients with imaging-confirmed diagnoses of ischemic stroke (IS), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH). Data on age, sex, NIHSS at presentation, stroke subtypes, and Stroke Impact Scale (SIS) 64 v3.0 at 90 days were collected. Differences in SIS Emotion Domain scores between IS, TIA, and ICH were assessed using the Mann-Witney U Test. Results: SIS Emotion Domain scores were available in 1239/1370 (90.4%) of patients. Mean age was 68.7 years (SD 13.4), and 41% were female. Median NIHSS was 7.0 (IQR 3-14). 65.3% had IS, 14.3% TIA, and 20.3% ICH. The preponderance of SIS-64 scores were patient-reported (86%) with the remainder completed by a patient proxy (14%). Emotion domain scores at 3 months were: lowest (most abnormal) in ICH patients (median 77.8, IQR 58.3-88.9); intermediate in IS patients (median 83.3, IQR 66.7-94.4); and highest in TIA patients (median 88.9, IQR 72.2-97.2), p<.01) (Figure). Neither age nor sex were strongly associated, but more abnormal mood scores were associated with greater presenting deficit severity (NIHSS 0-4: median SIS-64 mood score 88.9; NIHSS 5-14: 81.3; NIHSS ≥15: 75.0; Spearman’s rho: -0.30, p<.01). Conclusions: In this prospective study of a large population with broad enrollment criteria, mood disturbances at 90 days were most common among ICH patients and least common among TIA patients. Further work should investigate the driving factors of greater PSMD in patients with ICH compared to other patients with acute cerebrovascular disease.

Supplemental Table 1 (Cohort 1, N=120): Demographics and progression rates. V1: visit when downgaze palsy was first detected. V2: last visit within 1 year of death. IQR: interquartile range; NS: statistically non-significant; Acceleration in green; Deceleration in yellow; SD: standard deviation. *: Statistically significant with more than 25% change, excluding ocular motor items, which correlate closely with downgaze palsy, our input measurement benchmark. Supplemental Table 2 (Cohort 2, N=42): Demographics and progression rates. V1: visit when downgaze palsy was first detected. Vm: visit when the maximal PSPRS item score of 4 was first detected. V2: last visit within 1 year of death. IQR: interquartile range; NS: statistically non-significant; Acceleration in green; Deceleration in yellow; SD: standard deviation. *: Statistically significant with more than 25% change, excluding ocular motor items, which correlate closely with downgaze palsy, our input measurement benchmark. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Background: Ischemic and hemorrhagic stroke onset exhibit is known to exhibit diurnal variation throughout the 24-hour cycle. But whether this variation differs on weekdays compared with weekends/holidays has not been well delineated. Methods: We evaluated consecutive patients with acute cerebral ischemia [(ACI), including ischemic stroke (IS) and transient ischemic attack (TIA)] and intraparenchymal hemorrhage (IPH) enrolled during ambulance transport to 60 receiving stroke centers in the NIH FAST-MAG trial. Enrollment required onset within the prior 2 hours, excluding confounding by wake-up and unwitnessed onset strokes. The patterns of time of onset were analyzed: 1) hourly, 2) in 4-hour increments, and 3) daytime (08:00-19:59) vs. night-time (20:00-07:59). Diurnal variation in presenting demographic/clinical features were assessed using ANOVA, Kruskal-Wallis, t-tests, and Wilcoxon Rank-Sum. Results: Among 1615 patients (1202 enrolled on weekdays and 442 on weekends/holidays), 64% had IS, 12.5% TIA, and 23.5% IPH. ACI patients had different patterns of onset time (Figure). During weekdays, a broad plateau of highest rates of onset occurred 09:00-22:00. Conversely, during weekends/holidays, a unimodal peak was observed between 14:00-16:00. In contrast, patterns of onset time in IPH patients were broadly similar, with bimodal peaks on both weekdays and weekends/holidays. However, the first peak occurred earlier on weekdays (09:00-12:00 vs. 11:00-13:00), with the second peak occurring within 17:00-20:00 in both groups. Conclusion: Acute cerebral ischemia shows marked, and intraparenchymal hemorrhage minor, pattern differences in onset times on weekdays vs. weekends/holidays, likely related to variations in times of greater physical activity and stress. These findings can inform EMS resource allocation to stroke, aligned with weekday vs. weekend/holiday onset patterns.

The literature has witnessed an evolution in brachioplasty technique since the procedure was introduced by Thorek in 1930. Aesthetic refinements in brachioplasty have been increasingly described in the literature, and this has paralleled the rise in the massive weight loss population. The aim of this review is to share the plastic surgery experience with this challenging body region and present different approaches to achieve the best results for a broad spectrum of patients. A literature review studying brachioplasty was performed through PubMed. Throughout the literature there has been debate about scar placement, scar length, application of liposuction, drain placement, and optimization of outcomes, and differences of opinion have been compared. There is no definitive best method of brachioplasty, as evidenced by multiple classification systems which present algorithms for management depending on presentation. Not only does approach differ depending on degree of presentation, but there are also different approaches depending on author for similar manifestations. Approaches vary through incision length, incision placement, and use of liposuction. Outcomes studies similarly reveal lack of consensus. This literature review has elucidated multiple approaches to brachioplasty, and the pearls and pitfalls described may all be incorporated to produce excellent outcomes and patient satisfaction in an individualized approach.

Three-dimensional and multiplanar reconstruction of CT images has become routine in diagnostic imaging. The technology also facilitates surface reconstruction, in which facial features and, as a result, patient identity may be recognized, leading to risk of violations of patient privacy rights. The purpose of this study was to assess whether volunteer viewers can recognize faces on 3D reconstructed images as specific patients. A total of 328 participants were included: 29 patients underwent clinically indicated CT of the maxillofacial sinuses or cerebral vasculature and were also photographed (group A); 150 patients volunteered to have their faces photographed (group B); and 149 observers reviewed the images. Surface-reconstructed 3D images of group A were generated from CT data, and digital photographs of both groups A and B were acquired for a total of 179 facial photographs. Image reviewers were recruited with a web-based questionnaire that required observers to match surface-reconstructed images generated from CT data with randomized digital photographs from among the 179 photographs. Data analyses were performed to determine the ability of observers to successfully match surface-reconstructed images with facial photographs. The overall accuracy among the image observers was approximately 61%. No significant differences were found with regard to sex, age, or ethnicity and accuracy of image observers. Image reviewers were relatively poor at even side-by-side matching of patient photographs with 3D surface-reconstructed images. This finding suggests that successful identification of patients using surface-rendered faces may be a relatively difficult task for observers.