Introduction Arterial input function (AIF) dispersal on brain computed tomography (CT) perfusion reflects delayed cerebral contrast transit and is associated with reduced left ventricular ejection fraction (LVEF). We hypothesized that delayed contrast transit through the LA due to LA enlargement may prolong AIF, independent of LVEF. Patients and methods We analyzed patients with ischemic stroke or transient ischemic attack from the prospective INSPIRE registry (December 2020–June 2024) who underwent multimodal CT including brain perfusion CT (CTP), as well as transthoracic echocardiography (TTE) within 90 days of stroke. On TTE, left atrial (LA) enlargement was defined as area ≥ 24 cm² and left ventricular ejection fraction (LVEF) as < 50%. Prolonged AIF dispersal from CTP was defined as ≥ 29 s from scan onset to the end of AIF (return to baseline). Multivariable logistic regression was performed, adjusted for clinical and cardiac covariates. Results Among 172 patients, prolonged AIF was observed in 50 (29.1%), LA enlargement in 52 (30.2%), and reduced LVEF in 28 (16.3%). In multivariate analysis including both variables, LA enlargement (≥24 cm²: OR 3.76, 95% CI 1.66–8.52, p = 0.002) and reduced LVEF (OR 3.35, 95% CI 1.21–9.27, p = 0.020) were independently associated with prolonged AIF dispersal. Discussion and conclusion Both LA enlargement and reduced LVEF were associated with prolonged AIF dispersal, suggesting that AIF delay on CTP is a useful screening tool to identify stroke patients with cardiac dysfunction.
Background and objectives Though largely regarded as benign, the frightening experience of transient global amnesia (TGA) raises concerns over recurrence and long-term impact for patients. We aim to provide a comprehensive systematic review and meta-analysis of the long-term sequelae of TGA regarding recurrence, cognitive, neurological and neuropsychiatric complications. Methods PubMed, Embase, Scopus, Cochrane, WHO ICTRP, and ClinicalTrials.gov were searched from January 1, 2000 to January 31, 2026. Eligible studies assessed recurrence, stroke, seizure/epilepsy, cognitive and neuropsychiatric outcomes post-TGA. Random-effects meta-analysis of proportions was done for recurrence, stroke and seizure/epilepsy. Lack of standardised control arms prevented relative risk analysis. Results In 14 cohort studies (n = 3365), the pooled proportion of recurrence post-TGA was 8% (95% CI, 5–12%; I2 84.6%). GRADE certainty was ‘very low’. For stroke occurrence post-TGA, 4 studies (n = 852) showed a pooled proportion of 3% (95% Cl, 2–6%; I2=42.1%). GRADE certainty was ‘low’. For seizure/epilepsy post-TGA, 4 studies (n2=964) provided a pooled proportion of 1% (95% Cl, 0–4%; I2 = 36.7%). GRADE certainty was ‘very low’. Qualitative synthesis finds, in a small and heterogeneous dataset, a favourable prognostic profile regarding cognitive and neuropsychiatric sequelae with transient effects resolving on long-term follow-up. Conclusion This meta-analysis finds that TGA has a reassuring pattern of complications. However, the low certainty of evidence indicates the current evidence base is insufficient to draw strong conclusions. Patients should be informed of low pooled proportions, but clinician advice should be tailored to individual significance of complications. Protocol registration information PROSPERO ID CRD420261304248
Neurological conditions account for a small but poorly quantified proportion of cardiac arrests in adults. Recognising them means separating the disease that triggered the arrest from the hypoxic-ischaemic injury that follows it, a distinction that the initial presentation often obscures. Electrocardiographic abnormalities suggestive of a coronary origin, non-epileptic convulsive movements, and injury sustained during the fall are all confounders. Reported proportions, approximately 3–8% across series, depend on recruitment, on access to investigations, and on the attribution rules applied. This Review examines the conditions involved, the pathways by which they compromise ventilation and cardiovascular control, and the features that point to a neurological cause after return of spontaneous circulation. It sets out what this attribution implies for aetiological treatment, for prevention, and for the interpretation of prognosis, since the performance and calibration of standard multimodal algorithms are insufficiently established when a primary brain injury preceded the arrest.
