Neurology
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To identify and compare the operating characteristics of existing prehospital stroke scales to predict true strokes in the hospital. ⋯ Prehospital stroke scales varied in their accuracy and missed up to 30% of acute strokes in the field. Inconsistencies in performance may be due to sample size disparity, variability in stroke scale training, and divergent provider educational standards. Although LAPSS performed more consistently, visual comparison of graphical analysis revealed that LAPSS and CPSS had similar diagnostic capabilities.
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Multicenter Study Observational Study
Thrombolytic therapy for stroke in patients with preexisting cognitive impairment.
We aimed to evaluate the influence of prestroke cognitive impairment (PSCI) on outcomes in stroke patients treated with IV recombinant tissue plasminogen activator (rtPA). ⋯ This study provides Class IV evidence that in patients with PSCI presenting with acute ischemic stroke, IV rtPA improves outcomes.
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While HIV-associated neurocognitive disorders (HAND) remain prevalent despite combination antiretroviral therapy (CART), the clinical relevance of asymptomatic neurocognitive impairment (ANI), the most common HAND diagnosis, remains unclear. We investigated whether HIV-infected persons with ANI were more likely than those who were neurocognitively normal (NCN) to experience a decline in everyday functioning (symptomatic decline). ⋯ This longitudinal study demonstrates that ANI conveys a 2-fold to 6-fold increase in risk for earlier development of symptomatic HAND, supporting the prognostic value of the ANI diagnosis in clinical settings. Identifying those at highest risk for symptomatic decline may offer an opportunity to modify treatment to delay progression.
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Comparative Study
Abnormal thalamic function in patients with vestibular migraine.
To investigate the functional response of neural pathways associated with vestibular stimulation in patients with vestibular migraine (VM). ⋯ We provide novel evidence for abnormal thalamic functional response to vestibular stimulation in patients with VM. These functional abnormalities in central vestibular processing may contribute to VM pathophysiology.