Acute unilateral posterior cerebral artery (PCA) infarction involving the hippocampus can cause clinically relevant cognitive impairment, yet the acute neuropsychological syndrome remains insufficiently defined. This retrospective observational study included 78 patients with unilateral PCA stroke involving the hippocampus who underwent assessment at a median of 5 days (IQR, 3–7 days) after symptom onset. Thirty-two patients had right-hemispheric and 46 had left-hemispheric infarctions. Cognitive symptoms at onset, structured behavioral observations, standardized clinical tasks, and formal norm-referenced neuropsychological testing were used to characterize impairment across cognitive domains. Group differences were examined, and multivariable logistic regression analyses were performed to identify predictors of cognitive dysfunction. Neuropsychological deficits involved memory, language, attention, executive functions, and visuoconstructive performance, indicating a broad range of cognitive symptoms rather than an isolated amnestic disturbance. Left-hemispheric infarctions were more often associated with amnestic symptoms at onset, and aphasic symptoms occurred exclusively in this group. Compared with right-sided lesions, left-hemispheric infarctions showed higher rates of subjective memory complaints and objective impairment in episodic memory, language production, and comprehension. Formal testing further demonstrated more frequent deficits in naming, categorical word fluency, verbal recall, verbal recognition, and visual recall. In multivariate analyses, lesion side emerged as the main predictor of neuropsychological impairment, whereas additional thalamic ischemia did not significantly improve prediction. Acute unilateral PCA infarction involving the hippocampus is associated with multidomain and possibly network-mediated early cognitive dysfunction with more extensive impairment after left-hemispheric lesions independent of thalamic involvement.

Abstract Background and aims Intravenous thrombolysis (IVT) is a highly time-sensitive and effective acute ischemic stroke (AIS) treatment. To minimize door-to-needle-times (DNT), we implemented an optimized stroke pathway based on the Helsinki Stroke model, including EMS pre-notification, AI-assisted real-time CT analysis, and bolus administration before CT angiography. This study aimed to characterize patient-related aspects associated with different DNT intervals. Ultrafast thrombolysis was defined as DNT ≤20 min. Methods We retrospectively analyzed IVT-treated AIS patients treated 2021-2024 excluding those undergoing additional thrombectomy. Patients were stratified by DNT; groups were compared regarding demographics, admission characteristics, and in-hospital outcomes. Results Among 669 patients, DNT was ≤20 min in 30.8%, 21-30 min in 44.9%, 31-60 min in 14.8%, and >60 min in 9.6%. In the ultrafast group, mean DNT was 15.7 min (SD 3.49). Baseline NIHSS differed significantly across groups, with patients in the ultrafast group presenting with slightly higher NIHSS scores (medians [IQR]: 5 [3-8], 5 [2-8], 5 [2-7], 4 [1-7]; p=0.026). Discharge mRS (1-5) varied across groups, with the fastest-treated group showing the most favorable functional status (medians [IQR]: 3 [0-4], 2 [1-4], 3 [1-4), 3 [1-4.75]; p=0.030). Early neurological improvement, measured by median NIHSS change, declined stepwise with longer DNT (median delta NIHSS [IQR]: 3 [1-5], 2 [1-4.75], 1 [0-3], 1 [0-4]; p<0.001). Conclusions Patients receiving ultrafast thrombolysis under 20 minutes presented with slightly more severe strokes but achieved greater early neurological improvement. These results highlight the clinical benefit of systematic process optimization in acute stroke care. Conflict of interest All authors: nothing to disclose. Figure 1 - belongs to Conclusions

Abstract Background and aims To determine the neuropsychological consequences of posterior cerebral artery (PCA) stroke with hippocampal involvement, focusing on hemispheric lateralization. Methods In this retrospective observational study, neuropsychological data of 78 patients with PCA stroke with hippocampal involvement, collected within the first days after the event, were analysed. Data include clinical behaviour observation, clinical tests without given norms, as well as standardized test batteries. Cognitive function data assessed in at least 20 patients were evaluated and dichotomised according to z-values as “impaired” for z ≤ -1.3, which covers the lowest 10% of normal distribution and „unimpaired“ for z > -1.3. Results When compared to right-hemispheric PCA stroke (RH, N=32), left-hemispheric PCA stroke (LH, N=46) was associated with markedly higher rates of subjective memory dysfunction (9.4% vs. 73.9%; p<0.001) and significant deficits in episodic memory (9.4% vs. 41.3%; p=.002), language production (0% vs. 45.7%; p<.001) and comprehension (0% vs. 19.6%; p=.009). Standardized testing confirmed a significantly higher frequency of impairments in verbal comprehension, naming, fluency, recall, recognition, and visual recall among left PCA stroke patients (see Figure). Logistic regression identified hemispheric lateralisation as the principal predictor of cognitive dysfunction, with no additional effect of thalamic involvement. Conclusions Left PCA stroke involving the hippocampus is strongly associated with memory and language dysfunction, underscoring hemispheric lateralisation as a key determinant of cognitive outcome. These findings highlight the need for targeted neuropsychological assessment and tailored rehabilitation strategies in this group of patients. Conflict of interest All authors: nothing to disclose Figure 1 - belongs to Conclusions

BACKGROUND AND PURPOSE:Quantitative MRI provides insights into (patho-) physiological processes of the brain macro- and microstructure. In this study, we applied a multimodal MRI approach to determine quantitative values of the brain in healthy young adults. METHODS:3 T MRI including sodium MRI (4.0 mm nominal isotropic resolution), 3D T1-weighted magnetization-prepared rapid acquisition gradient-echo (spatial resolution = 0.9 mm × 0.9 mm × 0.9 mm), T2-fluid attenuated inversion recovery (spatial resolution = 0.4 mm × 0.4 mm × 5.0 mm), diffusion-weighted imaging (spatial resolution = 1.0 mm × 1.0 mm × 4.0 mm), PD/T2 (spatial resolution = 1.0 mm × 1.0 mm × 2.0 mm), and MR fingerprinting including T1 and T2* relaxation times (spatial resolution = 1 mm × 1 mm × 2 mm) was performed on 40 healthy young adults (28 women, mean age: 24.55 years). RESULTS:Mean values for the gray matter were as follows-apparent diffusion coefficient (ADC): 0.95 ± 0.03 × 10-3 mm2/s, total sodium concentration (TSC): 41.99 ± 2.35 mM, T1: 1338.04 ± 46.29 ms, T2*: 63.39 ± 2.94 ms. For the white matter, mean values were as follows-ADC: 0.79 ± 0.02 × 10-3 mm2/s, TSC: 36.08 ± 5.62 mM, T1: 968.47 ± 48.35 ms, T2*: 53.62 ± 8.06 ms, and for the deep gray matter, mean values were as follows-ADC: 0.85 ± 0.04 × 10-3 mm2/s, TSC: 38.23 ± 2.91 mM, T1: 1087.24 ± 39.77 ms, T2*: 54.53 ± 7.15. CONCLUSION:Our multimodal, quantitative MRI atlas of the human brain in healthy young adults provides meaningful in vivo insights into the brain microstructure and can be used for reference in future studies.

BACKGROUND AND AIMS:Growing evidence suggests worse outcomes in patients with spontaneous intracerebral hemorrhage (sICH) and elevated cardiac troponin (cTn) level. While the predictive value of isolated cTn elevation in sICH on outcomes is unclear, few studies have examined patients with follow-up measurement of cTn level. The aim of this study was to investigate the association of a dynamic change in high-sensitivity cTn I (hs-cTnI) levels with in-hospital outcomes in sICH patients. METHODS:This retrospective study included acute sICH patients between 2015 and 2021 with serial hs-cTnI level measurement. Group comparisons were performed between patients with dynamic hs-cTnI change, i.e., rise or fall of hs-cTnI levels on follow-up measurement >20 %, and those with stable hs-cTnI levels. Variables with suspected impact on in-hospital mortality were analyzed for their predictive value using multivariate logistic regression analysis. RESULTS:A total of 55/105 sICH patients were found to have a dynamic change in hs-cTnI levels. A dynamic change in hs-cTnI levels was significantly associated with in-hospital mortality. Frequency of intraventricular hemorrhage (IVH) was higher in the dynamic group, while vascular risk profile, burden of coronary artery disease and functional neurological status at admission were evenly distributed. While a dynamic change in hs-cTnI levels showed a trend, solely IVH independently predicted in-hospital mortality. CONCLUSIONS:We suggest that a hs-cTnI dynamic is an expression of the acute myocardial 'hit' driven by sICH along the brain-heart axis leading to stroke-induced heart injury and not of ischemic myocardial infarction. IVH additionally contributes to the proposed pathomechanism of myocardial injury.

Background and aimsElevated cardiac troponin (cTn) levels (representing myocardial injury) are frequently found in patients with spontaneous intracerebral hemorrhage (sICH). Overall, the relationship between sICH and elevated cTn levels is not well understood. The aim of this study was to investigate patient characteristics and clinical parameters in patients with sICH and myocardial injury.MethodsThis is a retrospective observational study based on the Mannheim Stroke database. Consecutive patient cases with acute symptomatic sICH and available high-sensitivity cTn I (hs-cTnI) at hospital admission between 2015 and 2021 were included. Group comparisons of patient, clinical and imaging characteristics were performed between groups with and without hs-cTnI elevation. In addition, variables with suspected predictive clinical significance for hs-cTnI elevation were analyzed for their predictive value using multivariate logistic regression analysis.ResultsA total of 93/498 patients with sICH (18.7%; mean age 73 ± 15 years; 51.9% females) had a hs-cTnI elevation. These patients did not have a more pronounced cerebrovascular risk profile and had a comparably low prevalence of coronary artery disease (18.5%, p = NS) compared to those without elevated hs-cTnI levels. Elevated hs-cTnI levels had no impact on in-hospital mortality (21.5 vs. 20.5%, p = NS) or functional outcome at discharge. Solely clinically relevant aortic valve stenosis, graded as moderate or higher, independently predicted hs-cTnI elevation (p < 0.003). Other cardiac preconditions or neurological functional parameters did not serve as significant predictors.ConclusionsMyocardial injury is common in patients with sICH. Unlike in AIS patients, elevated hs-cTnI levels were not associated with a worse functional or mortality-related in-hospital outcome. Except for clinically relevant aortic valve stenosis, structural heart disease had no significant influence as a predictor. We therefore suggest that hs-cTnI elevation in patients with sICH is related to acute myocardial damage along the brain-heart axis.

Primary brain calcification (primary familial brain calcification in inherited cases) is an often-genetic condition characterized by symmetrical brain calcifications and neuropsychiatric symptoms. The calcifications can also occur without overt clinical symptoms. Identifying laboratory biomarkers in primary brain calcification and their association with imaging, genetic, and clinical data will be crucial for a deeper understanding of primary brain calcification causation and progression and the planning of therapeutic trials. The serum biomarkers for neuronal degeneration (phosphorylated tau, neuron-specific enolase, neurofilament light- and heavy chain) and glial activation (glial fibrillary acidic protein, S100 calcium-binding protein B) were measured in 101 probands (41 controls and 60 probands with primary brain calcification). The deep phenotyping protocol of the German Fahr-NET register included neurological and neuropsychological examination, routine laboratory workup, and whole exome sequencing. We also performed and analyzed 45 cranial CT scans using the total calcification score. While mild pallidal calcifications were observed early in young, asymptomatic primary brain calcification mutation carriers, individuals with calcifications extending beyond the pallidum were symptomatic. Individuals with primary brain calcification had elevated serum glial fibrillary acidic protein and neurofilament light chain levels. Serum biomarkers correlated with both the extent of calcifications and the clinical impairment. Elevated parathyroid hormone levels distinguished the primary brain calcification group without identified mutation from both genetic primary brain calcification and control groups. Our results define a practical imaging cut-off indicating the presence of primary brain calcification symptoms. Elevated parathyroid hormone levels in primary brain calcification without identified mutation, but not in primary brain calcification with a monogenic cause, suggest abortive calcium regulation defects as a pathogenic factor specifically for primary brain calcification without identified mutation. Elevated glial fibrillary acidic protein and neurofilament concentrations in individuals with primary brain calcification indicate early, chronic astrocytosis and neuronal impairment, respectively. The significant association of neurofilament light chain with clinical scores and brain imaging results will be relevant for future therapeutic studies.

Transient global amnesia (TGA), a transient memory disorder in clinical neurology, is a unique clinical model for the study of hippocampal dysfunction and its implications for memory processes. While data are rather unequivocal concerning the relevance of the hippocampus for episodic memory, there is considerable dispute about its role for semantic memory. This study aimed at exploring how hippocampal impairment, which underlies the clinical presentation of TGA, affects semantic memory retrieval, particularly with regard to different retrieval strategies. Data from the acute and post-acute phase of 17 TGA patients and 17 healthy controls matched on socio-demographic factors were collected. Categorical word fluency tasks were differentiated into three retrieval strategies: first, with activation of episodic-spatial memory content; second, with novel and flexible linking of semantic memory content and third, with activation of overlearned semantic memory content. We find that hippocampal impairment during TGA significantly restricts semantic word fluency performance, with the degree of impairment depending on the retrieval strategy used and most pronounced when flexible relinking of semantic content is required. Our results suggest an important hippocampal contribution to semantic retrieval, especially in connection with novel and flexible linking of semantic content. They may furthermore be practically relevant for the early differential diagnosis and therapy of memory disorders.

Headache is a frequent presenting symptom in the emergency department. While most cases are of benign aetiology, it is crucially important to identify potentially dangerous underlying disorders. We hypothesized an increase in headache-related emergency presentations after venous thrombosis of cerebral sinuses had been identified as a rare side effect of vaccination with adenovirus vector-based Coronavirus-disease 2019 (COVID-19) vaccines and that information had been publicly communicated by the Paul Ehrlich Institute. Data from patients with the diagnosis of primary headache disorders or unspecified headache presenting to the Interdisciplinary Emergency Department of the University Medicine Mannheim were retrospectively analysed. Based on vaccination dashboard data published by the Federal Ministry of Health, calendar weeks 14-30 and 47-48, on the one hand, and 1-13 and 31-46, on the othe, were categorized into a variable "vaccination epoch" (14-30, 47-48: high vaccination activity if >= 3 million weekly vaccinations in Germany; 1-13, 31-46: low vaccination activity if<3 million weekly vaccinations). The number of patients with headache was the dependent variable. A Poisson regression was performed to analyze whether the frequency of events, i. e., patient presentations, was a function of year (2019, 2021), epoch (high, low) and an interaction of year and epoch - the latter reflecting an impact of vaccination activity during the pandemic and expressed as incidence rate ratio. Compared to 2019, there was a more than 70% increase in presentations due to headache during periods of high vaccination activity in 2021 (p<0.001; 95% confidence interval 1.272-2.316), in 25% of presentations in 2021, patients considered their headache as vaccination-associated. Public communication and resulting nocebo effects may, among other factors, have contributed to our observation of increased numbers of emergency headache presentations, illustrating the impact of public distribution of medical information on practical aspects of emergency care during crises.

Abstract Background Neuroimaging plays a vital role in the diagnosis of intracerebral hemorrhage (ICH) and in identifying the underlying etiology for appropriate therapeutic approach. This study aims to determine the significance and potential advantages of using early magnetic resonance imaging (MRI) as a diagnostic tool for ICH. Methods This retrospective study included 359 patients with ICH treated at the Department of Neurology, Mannheim University Hospital between January 2017 and December 2021. Patient characteristics, stroke severity and imaging procedures were descriptively analyzed. Factors associated with the choice of imaging modalities were evaluated. The etiology of hemorrhage was retrospectively analyzed using the existing data. We recorded the reassignment of ICH etiology by comparing the assessment after first sole review of CT scan and then subsequent MRI review. The overall rate of reassignments and the reassignments per CT-based initial etiology were analyzed. Results In the sample of 359 patients with ICH (mean age 73.1 years, 55.4% male), patients receiving an additional MRI were significantly younger (p < .001) and were less severely affected by stroke (median NIHSS score 5 vs. 15, p < .001). MRI was performed significantly less frequently in patients who died during hospitalization (11.7% vs. 63.9%, p < .001). MRI led to a reassignment of ICH etiology in 48.2% of cases (80/166), uncovering unknown underlying causes in 69% of cases (49/71). Reassignment occurred most frequently in patients with a CT-based diagnosis of hypertensive ICH (18/50). The most frequent reassigned etiologies after MR imaging were cerebral amyloid angiopathy (CAA; 36 patients) and secondary hemorrhage of an ischemic stroke (30 patients). Conclusions Early MR imaging in patients with ICH improves the determination of underlying etiology and the conception of an appropriate treatment approach, potentially contributing to better patient outcomes.

Genetic alterations in the ERCC4 gene typically cause Xeroderma pigmentosum and other nucleotide excision repair disorders. Neurologic symptoms are present in some of these patients. In rare cases, ERCC4-mutations can manifest with prominent neurologic symptoms. We report a 62-year-old woman who presented with a movement disorder caused by a homozygous pathogenic variant in the ERCC4 gene. She presented with a hyperkinetic movement disorder (chorea) that affected the distal limbs as well as facial muscles and jaw. There was no ataxia. Extensive clinical evaluation revealed predominantly fronto-parietal and cerebellar atrophy on brain MRI with sparing of the basal ganglia and mesial temporal lobe. Iron and sparse Ca2+ deposits were found in the basal ganglia. The detailed neuropsychological evaluation revealed deficits indicating subcortical-prefrontal, subcortical-parietal and frontotemporal dysfunction, without significant impairments in activities of daily living. The audiogram revealed mild age-related hearing impairment, electroneurography was unremarkable without signs of polyneuropathy. The dermatologic examination showed no signs of skin cancer. Knowledge about ERCC4-related neurodegeneration is limited and the disease is likely underdiagnosed. Nucleotide Excision Repair Disorder-related neurodegeneration should be considered as a differential diagnosis in patients with adult-onset neurodegenerative disorders, even if dermatologic complications are absent and the family history is negative. The preserved caudate volume in our ERCC4 patient could be a hint towards this rare condition. Treatment is symptomatic. Once the diagnosis is established, patients need to be advised to have regular medical consultations to prevent disease complications such as skin cancer.

Background and aimsLeft atrial (LA) enlargement has been repeatedly shown to be associated with the diagnosis of atrial fibrillation (AF). In clinical practice, several parameters are available to determine LA enlargement: LA diameter index (LADI), LA area index (LAAI), or LA volume index (LAVI). We investigated the predictive power of these individual LA parameters for AF in patients with acute ischemic stroke or transient ischemic attack (TIA).MethodsLAETITIA is a retrospective observational study that reflects the clinical reality of acute stroke care in Germany. Consecutive patient cases with acute ischemic cerebrovascular event (CVE) in 2019 and 2020 were identified from the Mannheim stroke database. Predictive power of each LA parameter was determined by the area under the curve (AUC) of receiver operating characteristic curves. A cutoff value was determined. A multiple logistic regression analysis was performed to confirm the strongest LA parameter as an independent predictor of AF in patients with acute ischemic CVE.ResultsA total of 1,910 patient cases were included. In all, 82.0% of patients had suffered a stroke and 18.0% had a TIA. Patients presented with a distinct cardiovascular risk profile (reflected by a CHA2DS2-VASc score ≥2 prior to hospital admission in 85.3% of patients) and were moderately affected on admission [median NIHSS score 3 (1; 8)]. In total, 19.5% of patients had pre-existing AF, and 8.0% were newly diagnosed with AF. LAAI had the greatest AUC of 0.748, LADI of 0.706, and LAVI of 0.719 (each p < 0.001 vs. diagonal line; AUC-LAAI vs. AUC-LADI p = 0.030, AUC-LAAI vs. AUC-LAVI p = 0.004). LAAI, increasing NIHSS score on admission, and systolic heart failure were identified as independent predictors of AF in patients with acute ischemic CVE. To achieve a clinically relevant specificity of 70%, a cutoff value of ≥10.3 cm2/m2 was determined for LAAI (sensitivity of 69.8%).ConclusionLAAI revealed the best prediction of AF in patients with acute ischemic CVE and was confirmed as an independent risk factor. An LAAI cutoff value of 10.3 cm2/m2 could serve as an inclusion criterion for intensified AF screening in patients with embolic stroke of undetermined source in subsequent studies.

Background: Many survivors of cardiovascular arrest remain in a postanoxic coma. The neurologist’s task is to provide the most accurate assessment of the patient’s neurologic prognosis through a multimodal approach of clinical and technical tests. The aim of this study is to analyze differences and developments in the concept of neurological prognosis assessment and in-hospital outcome of patients over a five year-period. Methods: This retrospective observational study included 227 patients with postanoxic coma treated in the medical intensive care unit of the University Hospital, Mannheim from January 2016 to May 2021. We retrospectively analyzed patient characteristics, post-cardiac arrest care, and the use of clinical and technical tests for neurological prognosis assessment and patient outcome. Results: Over the observation period, 215 patients received a completed neurological prognosis assessment. Regarding the multimodal prognostic assessment, patients with poor prognosis (54%) received significantly fewer diagnostic modalities than patients with very likely poor (20.5%), indeterminate (24.2%), or good prognosis (1.4%; p = 0.001). The update of the DGN guidelines in 2017 had no effect on the number of performed prognostic parameters per patient. The finding of bilaterally absent pupillary light reflexes or severe anoxic injury on CT contributed most to a poor prognosis category (OR 8.38, 95%CI 4.01–7.51 and 12.93, 95%CI 5.55–30.13, respectively), whereas a malignant EEG pattern and NSE > 90 µg/L at 72 h resulted in the lowest OR (5.11, 95%CI 2.32–11.25, and 5.89, 95%CI 3.14–11.06, respectively) for a poor prognosis category. Assessment of baseline NSE significantly increased over the years (OR 1.76, 95%CI 1.4–2.22, p < 0.001), and assessment of follow-up NSE at 72 h trended to increase (OR 1.19, 95%CI 0.99–1.43, p = 0.06). In-hospital mortality was high (82.8%), remained unchanged over the observation period, and corresponded to the number of patients in whom life-sustaining measures were discontinued. Conclusions: Among comatose survivors of cardiac arrest, the prognosis remains poor. Prognostication of a poor outcome led nearly exclusively to withdrawal of care. Prognostic modalities varied considerably with regard to their contribution to a poor prognosis category. Increasing enforcement of a standardized prognosis assessment and standardized evaluation of diagnostic modalities are needed to avoid false–positive prognostication of poor outcomes.

Primary familial brain calcification (PFBC; formerly Fahr's disease) and early-onset Alzheimer's disease (EOAD) may share partially overlapping pathogenic principles. Although the heterozygous loss-of-function mutation c.1523 + 1G > T in the PFBC-linked gene SLC20A2 was detected in a patient with asymmetric tremor, early-onset dementia, and brain calcifications, CSF β-amyloid parameters and FBB-PET suggested cortical β-amyloid pathology. Genetic re-analysis of exome sequences revealed the probably pathogenic missense mutation c.235G > A/p.A79T in PSEN1. The SLC20A2 mutation segregated with mild calcifications in two children younger than 30 years. We thus describe the stochastically extremely unlikely co-morbidity of genetic PFBC and genetic EOAD. The clinical syndromes pointed to additive rather than synergistic effects of the two mutations. MRI data revealed the formation of PFBC calcifications decades before the probable onset of the disease. Our report furthermore exemplifies the value of neuropsychology and amyloid PET for differential diagnosis.

ZusammenfassungKopfschmerzerkrankungen sind häufige Vorstellungsgründe in der Notaufnahme. Wichtig ist hierbei das Erkennen von potenziell gefährlichen Grunderkrankungen, die mit Kopfschmerzen einhergehen. Wir hypothetisierten, dass es zu einer verstärkten Inanspruchnahme der Notaufnahme aufgrund von Kopfschmerzen kam, nachdem die venöse Thrombose zerebraler Sinus, die oft starke Kopfschmerzen bedingt, als seltene Nebenwirkung der Impfung mit Adenovirus-Vektor-basierten Coronavirus-disease 2019 (COVID-19)-Impfstoffen identifiziert und durch das Paul-Ehrlich-Institut öffentlich kommuniziert worden war. Es erfolgte eine retrospektive Analyse der Daten von Patient*innen mit der Abschlussdiagnose einer primären Kopfschmerzerkrankung oder eines nicht näher spezifizierten Kopfschmerzes der Jahre 2019 und 2021, die sich in der Zentralen Notaufnahme der Universitätsmedizin Mannheim vorgestellt hatten. Auf Grundlage der Daten des vom Bundesministerium für Gesundheit herausgegebenen Impfdashboards wurden die Kalenderwochen 14–30 und 47–48 einerseits sowie 1–13 und 31–46 andererseits in eine Variable „Impfepoche“ kategorisiert (14–30, 47–48: hohe Impfaktivität bei bundesweit≥3 Mio. Impfungen/Woche; 1–13, 31–46: niedrige Impfaktivität bei bundesweit<3 Mio. Impfungen/Woche). Abhängige Variable waren die Anzahl der Vorstellungen. Mittels Poisson-Regression wurde geprüft, ob die Häufigkeit der Ereignisse sich als Funktion des Jahres (2019, 2021), der Impfepoche (niedrig, hoch) und einer Interaktion von Jahr und Epoche – letzteres den Effekt der Impfaktivität vor dem Hintergrund der Pandemie reflektierend und als Inzidenzratenverhältnis angegeben – darstellt. Im Vergleich zu 2019 ergab sich eine über 70%ige Zunahme von Vorstellungen aufgrund von Kopfschmerzen in Phasen hoher Impfaktivität im Jahr 2021 (p<0.001; 95%-Konfidenzintervall 1.272–2.316), 25% der Vorstellungen im Jahr 2021 erfolgten aufgrund einer patient*innenseitig vermuteten Assoziation mit stattgehabter Impfung. Neben anderen Faktoren, welche im Rahmen der Pandemiesituation zu einer veränderten Vorstellungssituation führen, mögen die öffentliche Informationsverbreitung und dadurch induzierte Noceboeffekte Ursachen der in unserer Analyse zutage gekommenen Unterschiede in den Vorstellungszahlen zwischen den Epochen mit unterschiedlich starker Impfaktivität sein. Dies illustriert die Auswirkungen der Kommunikation medizinischer Fakten und Informationen in Krisensituationen auf praktische Aspekte notfallmedizinischer Versorgung.

Post-stroke dysphagia (PSD) is a severe and common complication after ischemic stroke. The role of silent aspiration as an important contributing factor in the development of a dysphagia-associated complications, in particular aspiration-associated pneumonia has been insufficiently understood. The aim of this study was to investigate the characteristics and risk factors of silent aspiration in patients with acute infratentorial stroke by FEES and to identify culprit lesions in stroke patient with a high risk of silent aspiration via voxel-based-symptom-lesion mapping (VBS/ML). This study is a retrospective observational study based on a prospectively collected FEES and stroke database. Consecutive patient cases with acute ischemic infratentorial stroke and FEES examination between 2017 and 2022 were identified. Group allocation was performed based on PAS scores. Imaging analysis was performed by manual assignment and by VBS/ML. Group comparisons were performed to assess silent aspiration characteristics. Binary logistic regression analysis was performed to determine if baseline clinical, demographic, and imaging parameters were helpful in predicting silent aspiration in patients. In this study 84 patient cases with acute infratentorial stroke who underwent FEES examination were included. Patients were moderately affected at admission (mean NIH-SS score at admission 5.7 SD ± 4.7). Most lesions were found pontine. Overall 40.5% of patients suffered from silent aspiration, most frequently in case of bilateral lesions. Patients with silent aspiration had higher NIH-SS scores at admission ( p < 0.05), had a more severe swallowing disorder ( p < 0.05) and were 4.7 times more likely to develop post-stroke pneumonia. Patients who underwent FEES examination later than 72 h after symptom onset were significantly more likely to suffer from silent aspiration and to develop pneumonia compared to patients who underwent FEES examination within the first 72 h ( p < 0.05). A binary logistic regression model identified NIH-SS at admission as a weak predictor of silent aspiration. Neither in manual assignment of the lesions to brain regions nor in voxel-wise statistic regression any specific region was useful in prediction of silent aspiration. Silent aspiration is common in patients with infratentorial stroke and contributes to the risk for pneumonia. Patients with silent aspiration are more severely affected by stroke, but cannot reliably be identified by NIH-SS at admission or lesion location. Patients suffering from acute infratentorial stroke should been screened and examined for PSD and silent aspiration.

Current clinical diagnostic criteria of transient global amnesia (TGA) require the episode to completely resolve within 24 h. Small case series investigating the neuropsychological profiles obtained during the first days after TGA are inconclusive, with some suggesting the persistence of memory deficits. In this retrospective observational study, neuropsychological data of 185 TGA patients obtained during the first days following an attack were analysed. Data of cognitive functions assessed in at least 50 patients were evaluated and dichotomised according to z-values as “impaired” or “unimpaired”. Moreover, the results of magnetic resonance imaging (MRI) were collected. Neuropsychological assessment was performed within the first 3 days after TGA in 158 (85.4%) of all patients. The majority of patients showed no significant neuropsychological sequelae in the postacute phase of TGA. However, Mini-Mental Status Examination showed impairment in 22.6% of 159 patients, and we found subtle reductions of patients’ performance in tests of verbal long-term memory and executive function in 16.3–24.6% of patients. Patients with hippocampal diffusion-weighted imaging (DWI) lesions performed significantly worse in a verbal recognition task than those without DWI lesions. Our findings reflect subtle performance reductions in different cognitive domains in a small subgroup of TGA patients. This implies that the gradual resolution of subclinical symptoms may take longer than the 24 h required as maximum episode duration by current diagnostic criteria.

Background: Patients with diabetes mellitus (DM) are known to show poor recovery after stroke. This specific burden might be due to acute and chronic hyperglycemic effects. Meanwhile, the underlying mechanisms are a cause of discussion, and the best measure to predict the outcome is unclear. Skin autofluorescence (SAF) reflects the in-patient load of so-called advanced glycation end products (AGEs) beyond HbA1c and represents a valid and quickly accessible marker of chronic hyperglycemia. We investigated the predictive potential of SAF in comparison to HbA1c and acute hyperglycemia on the functional outcome at 90 days after ischemic stroke in a cohort of patients with DM. Methods: We prospectively included 113 patients with DM type 2 hospitalized for acute ischemic stroke. SAF was measured on each patient’s forearm by a mobile AGE-Reader mu© in arbitrary units. HbA1c and the area under the curve (AUC) of the blood sugar profile after admission were assessed. Functional outcome was assessed via phone interview after 90 days. A poor outcome was defined as a deterioration to a modified Rankin Scale score ≥ 3. A good outcome was defined as a modified Rankin Scale score < 3 or as no deterioration from premorbid level. Results: Patients with a poor outcome presented with higher values of SAF (mean 3.38 (SD 0.55)) than patients with a good outcome (mean 3.13 (SD 0.61), p = 0.023), but did not differ in HbA1c and acute glycemia. In logistic regression analysis, age (p = 0.021, OR 1.24 [1.12–1.37]) and SAF (p = 0.021, OR 2.74 [1.16–6.46]) significantly predicted a poor outcome, whereas HbA1c and acute glycemia did not. Patients with a poor 90-day outcome and higher SAF experienced more infections (4.2% vs. 33.3% (p < 0.01)) and other various in-hospital complications (21.0% vs. 66.7% (p < 0.01)) than patients with a good outcome and lower SAF levels. Conclusions: SAF offers an insight into glycemic memory and appears to be a significant predictor of poor stroke outcomes in patients with DM exceeding HbA1c and acute glycemia. Measuring SAF could be useful to identify specifically vulnerable patients at high risk of complications and poor outcomes.

While the sexually dimorphic character of ischemic stroke has been acknowledged along several dimensions, age-specific sex disparities regarding pre-stroke characteristics in particular have received comparatively little attention. This study aimed to identify age-dependent associations between sex and risk factors, premorbidity, and living situation in patients with ischemic stroke to foster the continuing development of dedicated preventative strategies. In a retrospective single-center study, data of patients with acute ischemic stroke (AIS) admitted to the Department of Neurology, University Hospital Mannheim, Germany, between June 2004–June 2020 were included; AIS frequency, vascular risk factors, premorbidity, living situation, and stroke etiology were analyzed across sexes and different age spectra. From a total of 11,003 patients included in the study, 44.1% were female. Women aged >70–≤90 years showed a pronounced increase in stroke frequency, lived alone significantly more frequently, and had a significantly higher degree of pre-stroke disability than men; however, only hypertension and atrial fibrillation were more prevalent in women in this age segment. The seventh and eighth decades are a critical time in which the pre-stroke risk profile changes resulting in an increase in stroke morbidity in women. This emphasizes the relevance of and need for an approach to stroke prevention that is both targeted and integrative.

Background: Primary progressive aphasia (PPA) may present with three distinct clinical sybtypes: semantic variant PPA (svPPA), nonfluent/agrammatic variant PPA (nfvPPA), and logopenic variant PPA (lvPPA). Objective: The aim was to examine the utility of the German version of the Repeat and Point (R&P) Test for subtyping patients with PPA. Method: During the R&P Test, the examiner reads out aloud a noun and the participants are asked to repeat the word and subsequently point to the corresponding picture. Data from 204 patients (68 svPPA, 85 nfvPPA, and 51 lvPPA) and 33 healthy controls were analyzed. Results: Controls completed both tasks with >90% accuracy. Patients with svPPA had high scores in repetition (mean=9.2±1.32) but low scores in pointing (mean=6±2.52). In contrast, patients with nfvPPA and lvPPA performed comparably in both tasks with lower scores in repetition (mean=7.4±2.7 for nfvPPA and 8.2±2.34 for lvPPA) but higher scores in pointing (mean=8.9±1.41 for nfvPPA and 8.6±1.62 for lvPPA). The R&P Test had high accuracy discriminating svPPA from nfvPPA (83% accuracy) and lvPPA (79% accuracy). However, there was low accuracy discriminating nfvPPA from lvPPA (<60%). Conclusion: The R&P Test helps to differentiate svPPA from 2 nonsemantic variants (nfvPPA and lvPPA). However, additional tests are required for the differentiation of nfvPPA and lvPPA.