Background: Childhood stroke is defined as stroke occurrence after 28 days to 18 years of age. The aim of this study is to investigate the epidemiology of childhood stroke in children in Hong Kong from 2006 to 2020, as well as to examine the risk factors that are related to poorer functional outcomes.

Methods: We conducted a population-based retrospective cohort study on childhood stroke by analyzing clinical data from the 2006 to 2020 birth cohorts in Hong Kong. We identified cases of childhood stroke using the following ICD-9 codes: 430 (Subarachnoid hemorrhage), 431 (Intracerebral hemorrhage), 433 (Occlusion and stenosis of precerebral arteries), 434 (Occlusion of cerebral arteries), 435 (Transient cerebral ischemia), and 437 (Other and ill-defined cerebrovascular disease). Using ICD-9 codes to indicate related disorders and impairments, we identified stroke outcomes in motor, cognitive, neuropsychiatric, and speech/language aspects among the selected stroke cases. We also utilized allied health service utility data, including physiotherapy, occupational therapy, speech therapy, and clinical psychology, to assess and identify the outcomes. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) between age of stroke onset and post-stroke adverse outcomes.

Results: From 2006 to 2020, there were 49 (33.1%) cases of arterial ischemic stroke, and 98 (66.2%) cases of hemorrhagic stroke. Among the children with stroke, 105 children presented with motor deficits, 18 children presented with cognitive deficits, 57 children presented with neuropsychiatric deficits, and 67 children presented with speech/language deficits. Cox regression analyses revealed that age of stroke was significantly associated with an increased risk for adverse motor (adjusted HR, 1.69 [95% CI 1.04,2.75]) and neuropsychiatric (2.96 [1.39,6.32]).

Conclusions: Over half of the children with stroke suffer from motor deficits. In addition, a high proportion of children with stroke also suffer from speech/ language, neuropsychiatric, and cognitive deficits. Our findings demonstrate a significant correlation between the age of stroke diagnosis and the probability of experiencing unfavorable functional outcomes. Additional research is required to gain a more comprehensive understanding of the functional abilities of children with stroke. This knowledge is necessary to create effective interventions and rehabilitation approaches that can improve their quality of life and long-term outcomes.

Historically, a specific set of symptoms has been related to the rupture and repair of anterior communicating artery (ACoA) aneurysms. These consequences were defined as the 'ACoA syndrome' and included observations of severe memory loss, confabulation and personality or behavioral changes. These observations correspond to neuropsychological impairments in memory, executive functions and social cognition. However, in more recent studies, the existence of such a distinct syndrome has been called into question. First, we aimed to investigate the existence of the ACoA syndrome in a group of patients who suffered an aneurysmal subarachnoid hemorrhage (aSAH), by investigating differences in neurocognitive funtions between patients with and without ACoA aneurysms. Secondly, we systematically reviewed the literature from the first mentioning of the ACoA syndrome until 2022.

Methods: Data of a consecutive cohort of 88 patients with a confirmed diagnosis of aSAH, who were admitted to the University Medical Center in Groningen (UMCG) between 2010 and 2012 were re-examined to answer the present research question. Around 6 months post-SAH, three neurocognitive domains were investigated using neuropsychological tests: memory, executive functions and social cognition. Scores of SAH patients with ACoA aneurysms (N = 28) were compared to patients with aneurysms in other locations (N = 66). Subsequently, a systematic review of the existing literature on the ACoA syndrome was performed using Embase and PubMed until October 2022. Studies that investigated cognitive functions after rupture and repair of ACoA aneurysms were included.

Results: No significant difference in the proportion of patients with impaired performance on all tests for neurocognitive functions between the ACoA and non-ACoA group was found (all ps > .05). Second, the systematic search yielded 847, 199 full-text articles were assessed for eligibility and 55 articles were included. Evidence was found for the ACoA syndrome in studies between 1960 and 2000, with impairments in memory and executive problems in the majority of studies. However, the majority of studies from 2000 did not demonstrate a distinct ACoA syndrome, although neuropsychological measurements (for instance for social cognition) improved.

Conclusion: The ACoA syndrome seems to 'vanish' over time. This vanishing coincides with changes in the management of ACoA aneurysms over the past decades, such as the emergence of endovascular treatment and improvement of neurointensive care. Therefore, we hypothesize that the management techniques of ACoA aneurysms until around 2000, i.e. mainly conventional clipping, could be related to the presence of symptoms of the ACoA syndrome several decaded ago. Given this possible association and the negative effects of neurocognitive impairments on daily functioning, cognitive outcome deserves to be weighted as an outcome measure, next to more traditional factors such as neurological outcome and survival.

This research aims to investigate various forms of brain injury following subarachnoid hemorrhage (SAH) by conducting three distinct studies using different advanced MRI techniques, focusing on cerebral parenchymal and ventricular volume changes, white matter abnormalities, and cortical superficial siderosis (cSS), and their associations with cognitive impairment.

Methods: The studies are part of the ICONS (Imaging, Cognition and Outcome of Neuropsychological Functioning After Subarachnoid Hemorrhage) study. Analyses were performed five months post-ictus. The first study involved volumetric assessments of 17 patients with aneurysmal SAH (aSAH) and 21 patients with angiographically negative SAH (anSAH), along with 15 healthy controls, using an automated segmentation tool to evaluate cerebral parenchymal and ventricular volumes. In the second study, 34 patients with aSAH, 24 patients with anSAH, and 17 healthy controls underwent diffusion kurtosis imaging (DKI) to assess white matter abnormalities and cognitive functioning. In the third study, 49 patients with aSAH and 24 with anSAH underwent susceptibility-weighted imaging (SWI) to assess the prevalence of cSS. Neuropsychological tests were administered across all analyses to evaluate cognitive domains, including memory, attentional control, and executive functioning.

Results: Lower frontal lobe volumes were associated with cognitive deficits in aSAH and anSAH groups, with significant correlations for psychomotor speed (U = 81, p = 0.02) and attentional control (t = 2.86, p = 0.004) observed. Additionally, larger lateral ventricular volumes were associated with poorer memory performance (t = 3.06, p = 0.002). DKI revealed significant white matter diffusion abnormalities in the aSAH group, while no significant differences were found in the anSAH group. Overall, white matter abnormalities were not significantly correlated with cognitive impairments in either SAH group. Lastly, cSS was identified in 96% of aSAH and 63% of anSAH patients, however, no significant associations were found with cognitive deficits.

Conclusions: In summary, the findings emphasizes that both neuropsychological assessments and neuroimaging markers are essential in identifying brain damage following SAH, yet they provide different insights into the severity of cognitive impairments. The lack of correlation between these measures indicates that neuroimaging alone cannot capture the complexity of cognitive outcomes, necessitating a comprehensive evaluation that integrates neuropsychological assessments. These evaluations are crucial for understanding the multifaceted nature of cognitive deficits, which can significantly affect daily functioning and quality of life. Therefore, incorporating thorough neuropsychological assessments into standard care protocols is vital for tailoring intervention strategies, addressing cognitive and emotional challenges, and enhancing overall patient management following aSAH and anSAH.

Stroke research in Ghana often focuses on risk factors relating to lifestyle-related diseases, including diabetes and high blood pressure. Among the few studies conducted on the rehabilitation of Ghanaian stroke survivors, the focus has been on physiotherapy. Like this Ghanaian empirical stroke literature, clinical services for stroke patients often excludes rehabilitation for communication disorders (speech, language and hearing), despite these being prominent among stroke survivors. This study aimed to explore communication disorders as outcomes of stroke, so as to use available evidence to contribute to the development of better protocols for stroke care. More specifically, stroke patients are (a) screened once for hearing disorders using pure tone audiometry and (b) screened trice (with three-months interval) for language disorders (aphasia, which affects 30% of stroke survivors) using an ecologically adapted (culturally and linguistically) tool. This fundamental study aimed at generating descriptive data on post-stroke communication disorders, addresses the lack of data and tests for aphasia despite the country’s growing stroke population, and yields information regarding characteristics of Ghanaian stroke survivors via a tailored screening protocol, which would be validated in subsequent studies. Also pertinent is the advocacy for routine audiological assessments as part of regular care for stroke patients.

Background: Mild stroke affects a growing number of young adults under the age of 65, accounting for almost one in five cases in Canadian hospitals. Although often perceived as less severe than other types of strokes, mild stroke can have subtle but significant consequences that may restrict participation in more complex occupations such as driving, work and leisure. However, few services tailored to the specific needs of young adults with mild stroke are available, due to the underestimation of the consequences of this condition and the limited data on their long-term participation.

Objectives: The aim of this study is to document changes in the participation of adults aged 18 to 64 with mild stroke, by comparing two measurement periods, taking place on average 6 months post-stroke (T1) and 12 months post-stroke (T2).

Methods: A longitudinal prospective single cohort study design was used. Participants were 57 adults with mild stroke (54% women; mean age = 52 years, range = 22-64). Two standardized questionnaires were administered to participants at T1 (n=57; mean time after stroke = 6 months, range = 3-12) and T2 (n=44; mean time after stroke = 17 months, range = 13-23): the participation scale of the Mayo-Portland Adaptability Inventory-4 (M2PI) and the recently developed Participation after a Mild Stroke Questionnaire (PMS-Q). The interval between T1 and T2 ranged from 8 to 14 months (mean = 10 months). Data were analyzed using mixed model ANOVAs.

Results: Overall, mean participation scores tended to remain stable between the two measurement times, for both the M2PI and the PMS-Q (p > 0.1). However, a statistically significant improvement was observed from T1 to T2 for work and leisure items on the M2PI (p < 0.05), although the scores suggest that some restrictions persisted at T2 (e.g., partial resumption of previous responsibilities, activities of reduced intensity and complexity). On the PMS-Q, no significant changes were found over time for individual items. At both T1 and T2, sleep had one of the lowest participation scores on the PMS-Q, along with two work-related items, physical exercise, physically demanding activities, and intimate relationships.

Discussion: In general, participation remained stable over time, although there were notable variations between participants. These results suggest that a portion of young adults could benefit from targeted interventions to improve participation in the activities most affected, such as sleep, return to work and leisure. Further efforts are needed to develop and implement a broader range of evidence-based rehabilitation interventions to meet the long-term participation needs of young adults with mild stroke.

Background: Little is known about the role of resilience in contributing to quality of life and other outcomes after stroke. This study aimed to (i) examine the resilience profile of people living with stroke in the community; (ii) to identify the association between resilience and both functional and patient reported outcomes; and (iii) to examine whether resilience made an independent contribution to quality of life (physical, mental) after stroke.

Methods: Participants were recruited from the Kumla stroke study (n=330), a prevalence study conducted in the Kumla municipality (population approximately 23,000) of Sweden. Study participants completed the Connor-Davidson Resilience Scale, alongside demographic, Riksstroke questionnaire items (examining accommodation, local service needs, patient reported outcomes, comorbidities) and standardised questionnaires/objective performance measures (Montreal Cognitive Assessment; SF-36, Fatigue Assessment Scale, Activities-specific Balance Confidence Scale [ABC]; Timed Chair Stand Test).

Results: Participants of the Kumla study (n=330) comprised 58% males, an overall mean age 74.5 years (SD 13.7), 8.3 (SD 6.3) years post first stroke (85% ischemic stroke, 11% intracerebral haemorrhage, 4% subarachnoid haemorrhage), with no difference between the total sample and the sub-group who completed the CD-RISC (n=122) by sex and age. The total CD-RISC score was 64.8±16.4 with a range of 93 (minimum=7, maximum value=100). Scores were normally distributed (Kolmogorov-Smirnov .057, p=.200) and internal consistency was strong (Cronbach’s alpha .927). Higher resilience scores were associated with the degree respondents were able to return to pre-stroke life and activities and having an independent mindset. Similarly, higher resilience scores were observed among respondents who did not need municipal services such as aids/adaptions or transport, but who also knew where to access support/help if needed. Turning to patient reported outcomes, higher resilience scores were associated with lower levels of fatigue and depression. Two regression analyses then tested whether resilience made an independent contribution alongside other significant variables in predicting quality of life after stroke. The model tested for the SF-36 Physical Component Score (PCS) comprised nine predictors. The full model (comprising 9 variables including resilience) was statistically significant (F9,78 =22.727, p<.001), accounting for 69.2% of the variance in PCS scores, with three significant individual predictors (higher general state of health and Activity-specific Balance Confidence scores; lower experience of pain). The full model (comprising 6 variables) for the Mental Component Score (MCS) was statistically significant (F 6,95 =25.908, p<.001), accounting for 59.7% of the variance, with three significant individual predictors (levels of resilience; decreasing ‘ability to return to pre-stroke life’ and higher levels of ‘feeling depressed’

Conclusions: Resilience levels among the Kumla stroke population were similar to reports of stroke samples from other countries. Resilience was an important predictor of quality of life and future studies could examine interventions to build resilience among stroke survivors.

Introduction: Brain injury may occur from traumatic – external damage to the brain, or non-traumatic causes – internal damage to the brain, such as cerebrovascular accident (CVA) or stroke. Both CVA and traumatic brain injury (TBI) are leading causes of death and disability around the world and are further associated with comorbid chronic health conditions such as heart disease, hypertension, diabetes, and other significant cardiometabolic risk factors. Lifestyle behavior interventions, such as the diabetes prevention – group lifestyle balance (GLB) program, are the cornerstone of effective treatment for cardiometabolic conditions and although CVA and TBI share many similarities in pathology, the different mechanisms of brain injury and resulting cognitive and behavioral changes associated with brain damage are not always well understood. There was a need to examine the characteristics (e.g., biopsychosocial factors) that contribute to CVA and TBI responses to the GLB program to inform future adaptations and equitable health outcomes. The purpose of this secondary analysis was to combine data from two 12-month randomized control trials (GLB-CVA and GLB-TBI) to examine how the association and temporal relationship between weight change and biopsychosocial factors (demographic, injury-related, physiological, and self-report outcomes) differed for participants with CVA and TBI.

Methods: All participants from the GLB-CVA/TBI studies with 12-month follow-up study data were included. Demographic characteristics were summarized with standard descriptive statistics and compared between groups using t-tests or ANOVA tests for categorical variables and Pearson’s correlation for numerical variables. Outcome variables were evaluated using general linear models to assess the correlation between weight change and variables. Regression analysis was conducted using variables that had a p-value of ≤ 0.1 from the demographics and biomarkers or self-report outcomes. Analyses were performed using SAS 9.4 with a significance level of 0.05.

Results: There were 69 (45 CVA, 24 TBI) participants who completed 12-month follow-up assessments and were included in this secondary analysis. Overall, participants with TBI (-15.5 lbs. ± 16.4) responded more favorably to the GLB intervention than people with CVA (-10.1 lbs. ± 16.8) at 12-month follow-up. When groups were combined, statistically significant associations with weight-change were identified for race and insurance. Evaluation of the variables between baseline measures and corresponding change in weight identified a significant association for the Six Minute Walk Test at 12-months. Combined regression analyses demonstrated that variables with a p < 0.05 showed a positive relationship with weight change, including 8 Year Diabetes Risk and Six Minute Walk Test.


Discussion: Implications about differences in weight-change based on diagnosis will be discussed, in addition to how factors related to racial background and health insurance can potentially influence individual responses to the diabetes prevention program.