Abstract Background Posterior Fossa Syndrome/Cerebellar Mutism Syndrome (PFS/CMS) is a serious surgical complication that causes severely debilitating long-term deficits in communication, motor function and cognition in affected children. Despite emerging evidence that injury to efferent cerebellar pathways may account for the wide variety of symptoms observed in PFS/CMS, the underlying pathophysiology remains poorly understood. Here, we aim to identify critical structures that are frequently affected in PFS/CMS using multivariate lesion symptom mapping. Methods Early postoperative cerebellar lesions were analyzed in 154 children with midline intraventricular medulloblastoma from a German medulloblastoma series. 52 children developed postoperative PFS/CMS (34%) defined as complete mutism (PFS1, 41/52) or the inability to string 3-word sentences (PFS2, 11/52). Lesions were manually segmented and defined as new T2-FLAIR hyperintensities surrounding the surgical cavity, reflecting surgery-related tissue damage. Lesion maps were transformed into MNI-152 space using a customized pipeline. Sparse canonical correlation analysis for neuroimaging (SCCAN) was conducted to identify patterns of surgical damage associated with PFS/CMS. 47/154 patients underwent follow-up neuropsychological testing. The surgical approach to tumor resection was evaluated from surgical reports. Results SCCAN identified a pattern of surgical damage significantly associated with PFS/CMS (r=.35, p<.001) with peak voxel weights in the right superior cerebellar peduncle, vermal lobule VI and left lobule IX. PFS/CMS was associated with reduced processing speed (β = −.42, p=.006) and fine motor skills (Purdue Pegboard dominant hand: β = −.42, p=.011; non-dominant hand: β = −.48, p=.004). Vermian incision was not associated with an increased risk for PFS/CMS (OR = 1.78, p=.204). Conclusion Our findings suggest that surgical damage to the cerebellar outflow pathways and superior vermis is associated with PFS/CMS, potentially implicating disrupted cerebello-cortical communication. Surgical techniques that minimize damage to these structures may reduce the incidence and severity of PFS/CMS in the future.

BACKGROUND:We aimed to examine the impact of sedative prescription patterns in hospitalized older adults on post-discharge adverse drug events (ADEs), falls, and sleep. METHODS:We conducted a secondary analysis of the MedSafer randomized controlled trial (RCT; NCT03272607) which included hospitalized adults ≥ 65 years of age who were taking ≥ 5 medications. We identified patients who completed follow-up at 30 days post-discharge and provided patient-reported outcomes for sleep disturbance (PROMIS SD 4a). We grouped patients based on sedative use as follows: nonusers, continued home use (pre- and post-hospitalization), deprescribed home use, and new use at discharge. Using multivariable logistic regression, we compared the odds of patients having experienced ≥ 1 ADE (not necessarily ascribed to sedatives), a fall, or any adverse event within 30 days post-discharge. We also used ordinal logistic regression and a minimal important difference approach to compare the change in sleep disturbance at 30 days post-discharge. RESULTS:The cohort comprised 3630 patients with a median age of 78. A total of 2810 (77.4%) were categorized as nonusers; 475 (13.1%) continued home use; 293 (8.1%) deprescribed home use; and 52 (1.4%) new users at discharge. Compared to the continued home use group, the deprescribed group was substantially less likely to experience an ADE post-discharge (adjusted odds ratio [aOR], 0.39 [95% CI, 0.16-0.97]). Correspondingly, new users at discharge had substantially higher odds of falls (aOR, 2.51 [95% CI, 1.13-5.61]). Favorable changes in sleep disturbance were more likely among nonusers (aOR, 1.29 [95% CI, 1.05-1.58]) and deprescribed users (aOR, 1.11 [95% CI, 0.82-1.50]) when compared to continued users. CONCLUSIONS:In this cohort, patients who had their sedatives deprescribed were 61% less likely than continued users to have a post-discharge ADE, and new sedative use at discharge was associated with appreciable risk of falls. Hospitalization likely represents a window of opportunity to improve care by promoting sedative deprescription and avoiding new starts.

Background Measurement of left ventricular end‐diastolic pressure (LVEDP) is an established diagnostic method to evaluate heart failure but requires an invasive procedure. A noninvasive technique for detecting elevated LVEDP would improve the diagnosis of heart failure. Herein, we present the results of a multicenter study to validate a noninvasive system to detect elevated LVEDP. Methods The Vivio System includes a modified blood pressure cuff and single‐lead ECG to capture brachial artery waveforms. A model was created to identify patients with elevated LVEDP (>18 mm Hg). For the invasive cohort, all patients were referred for coronary angiography and left heart catheterization for clinical indications. A group of 321 patients with no significant health problems were enrolled as a control cohort. Invasive LVEDP measurements were performed using Millar catheters. The training data set (n=262) contained 101 patients with LVEDP measurements (n=44 with LVEDP >18 mm Hg) and 161 controls. The validation data set (n=155) contained 75 patients with LVEDP measurements (n=40 with LVEDP >18 mm Hg) and 80 controls. Results Leave‐one‐out cross‐validation on the training data set yielded a sensitivity of 0.84 (95% CI, 0.70–0.93]) and a specificity of 0.84 (95% CI, 0.79–0.89). The validation data set showed a sensitivity of 0.80 (95% CI, 0.64–0.91) and a specificity of 0.83 (95% CI, 0.75–0.90). Conclusions The Vivio System can accurately detect elevated LVEDP and has the potential to significantly improve early detection of heart failure in the outpatient setting.

Hematoma volume is a major pathophysiological hallmark of acute intracerebral hemorrhage (ICH). We investigated how the variance in functional outcome induced by the ICH volume is explained by neurological deficits at admission using a mediation model. Patients with acute ICH treated in three tertiary stroke centers between January 2010 and April 2019 were retrospectively analyzed. Mediation analysis was performed to investigate the effect of ICH volume (0.8 ml (5

Non-contrast computed tomography (NCCT) markers are robust predictors of parenchymal hematoma expansion in intracerebral hemorrhage (ICH). We investigated whether NCCT features can also identify ICH patients at risk of intraventricular hemorrhage (IVH) growth. Patients with acute spontaneous ICH admitted at four tertiary centers in Germany and Italy were retrospectively included from January 2017 to June 2020. NCCT markers were rated by two investigators for heterogeneous density, hypodensity, black hole sign, swirl sign, blend sign, fluid level, island sign, satellite sign, and irregular shape. ICH and IVH volumes were semi-manually segmented. IVH growth was defined as IVH expansion > 1 mL (eIVH) or any delayed IVH (dIVH) on follow-up imaging. Predictors of eIVH and dIVH were explored with multivariable logistic regression. Hypothesized moderators and mediators were independently assessed in PROCESS macro models. A total of 731 patients were included, of whom 185 (25.31 • NCCT features identified ICH patients at a high risk of IVH growth with subtype-specific differences. • The effect of NCCT features was not moderated by time and location or indirectly mediated by hematoma expansion. • Our findings may assist in the risk stratification of IVH growth with baseline NCCT and might inform ongoing and future studies.

Vitamin D receptors are located in neurons and glial cells of the brain. Vitamin D protects the nervous system by stimulating the synthesis of neurotrophin and neuromodulators, maintaining intracellular calcium homeostasis, and preventing oxidative brain damage. Vitamin D deficiency/insufficiency affects around 50% of the population, with rates varying according to race and ethnic origin. Vitamin D deficiency/insufficiency is a major public health concern because of its association with cognitive impairment and dementia. We aim to do a follow-up review of the literature on the association between vitamin D insufficiency and cognitive impairment, including dementia. We reviewed vitamin D insufficiency and cognitive function studies published between 2010 and 2021. Except for animal models and research on human subjects with dementia, stroke, or brain malignancies, we reviewed clinical trials, case-control, cohort, cross-sectional, systematic reviews, and meta-analyses. Adults worldwide were the target demographic. There were no limits on vitamin D levels or intake. PubMed, Cochrane, Clinicaltrials.gov, and Google Scholar were all accessed databases using keyword combinations such as “Vitamin D AND Alzheimer’s,” “Vitamin D AND cognitive,” “Vitamin D AND Geriatric,” and “Vitamin D AND Dementia”. All team members reviewed and verified the studies. Nine studies matched our inclusion criteria, involving 69,643 people with an average age of 53.6 years old. Vitamin D deficiency/insufficiency has been linked to impaired executive function, processing speed, visuoperceptual ability, and dementia in five studies. Two investigations established a direct proportional association between the degree of vitamin D insufficiency and the severity of memory and cognitive impairment. Vitamin D supplementation, according to one study, increases cognitive and memory functions. Adults with vitamin D deficiency have reduced cognitive function and an increased risk of dementia. A significant limitation is that Africans, Hispanics, and Asians are underrepresented in the studies. Additionally, larger randomized controlled trials are needed to examine the many effects of vitamin D deficiency/insufficiency, supplementation, and its relationship to cognition in the aging brain.

BACKGROUND:The effect of thrombectomy in patients presenting with extensive ischemic stroke at baseline is currently being investigated; it remains uncertain to what extent brain tissue may be saved by reperfusion in such patients. Penumbra salvage volume (PSV) has been described as a tool to measure the volume of rescued penumbra.OBJECTIVE:To assess whether the effect of recanalization on PSV is dependent on the extent of early ischemic changes.METHODS:Observational study of patients with anterior circulation ischemic stroke triaged by multimodal-CT undergoing thrombectomy. PSV was defined as the difference between baseline penumbra volume and net infarct growth to follow-up. The effect of vessel recanalization on PSV depending on the extent of early ischemic changes (defined using Alberta Stroke Program Early CT Score (ASPECTS) and core volumes based on relative cerebral blood flow) was determined using multivariable linear regression analysis, and the association with functional outcome at day 90 was tested using multivariable logistic regression.RESULTS:384 patients were included, of whom 292 (76%) achieved successful recanalization (modified Thrombolysis in Cerebral Infarction ≥2b). Successful recanalization was independently associated with 59 mL PSV (95% CI 29.8 to 88.8 mL) and was linked to increased penumbra salvage up to an ASPECTS of 3 and core volume up to 110 mL. Recanalization was associated with a higher probability of a modified Rankin Scale score of ≤2 up to a core volume of 100 mL.CONCLUSIONS:Recanalization was associated with significant penumbra salvage up to a lower ASPECTS margin of 3 and upper core volume margin of 110 mL. The clinical benefit of recanalization for patients with very large ischemic regions of >100 mL or ASPECTS <3 remains uncertain and requires prospective investigation.

Recent studies examining the impact of music on long- and short-term memory, as well as cognitive function, have emerged with contradictory findings. This study investigates the positive impact of music on memory and the auditory cortex in people of all ages. In the PubMed database, we searched for studies that have examined the impact of music on memory and auditory function. From January 2011 to June 2021, we searched for studies on the adult population that were “clinical trials, case control cohort and cross-sectional studies, systematic reviews and meta analyses” in English. In our search, we used a combination of the keywords “Music, Aging, Memory, Auditory Cortex.” Four reviewers independently extracted and assessed the studies based on predetermined criteria. To eliminate bias, the results were double-checked by six people (fellows, researchers, etc.). We chose eight studies from a total of 108. Two studies linked music exposure to improved executive function in the aging brain, four studies examined the correlation between music exposure and improved auditory memory, one study compared the aging brains of musicians and non-musicians, and two studies pointed at music in dementia and Alzheimer’s patients. The total number of participants in the study was 409, with an average age of 54 years and a range of 17 to 91 years. The duration of exposure to music varies between less than five and eleven years, with an average of eight and a half years. The primary finding is that music has a positive influence on aging brains' auditory cortex, memory, and executive skills. The impact of music on specific parts of the aging brain is a secondary outcome. Music has a positive influence on the auditory cortex, memory, and several brain executive functions, according to our findings. Adults should participate in music-related activities to promote a healthy auditory cortex and memory aging. The absence of prior research on this topic was one of the study’s limitations. More research is needed to better understand the impact of music on the aging brain.

Dementia is a disorder distinguished by progressive and irreversible global cognitive impairment. About 45 million live with dementia globally, with an estimated increase to 75 million by 2030. Early recognition and diagnosis of dementia could enhance the efficiency of health care and quality of life. Hence, Medicare implemented a covered visit for assessing cognitive function for eligible patients as of January 2021. Previous studies described many tests and screening tools that clinicians can use to diagnose dementia. However, choosing a suitable test is solely left for clinicians to decide. We conducted a systematic review to provide an evidence‐based screening tool guide to facilitate dementia diagnosis.

Introduction: Measurement of left ventricular end diastolic pressure (LVEDP) is an established diagnostic method to evaluate all types of heart failure (HF). Invasive measurement of LVEDP requires an in-hospital procedure which limits accessibility. A noninvasive technique for detecting elevated LVEDP would significantly improve the diagnosis of HF, particularly in the outpatient setting. Herein we present the results of a multicenter study to validate a noninvasive system to detect elevated LVEDP. Methods: The Vivio System includes a modified blood pressure cuff and single lead ECG to capture brachial artery waveforms to assess preload, afterload and contractility. A model was created to identify patients with elevated LVEDP (> 18mmHg). 728 patients were enrolled from 7 medical centers in the USA. All patients were referred for coronary angiography and left heart catheterization for clinical indications. A group of 321 patients with no known significant health problems were enrolled as a control group. Invasive LVEDP measurements were conducted using Millar catheters. The control group was assumed to have a LVEDP = 10 mmHg. The training dataset (n = 262, mean age 45 ± 19 yrs; 54% male) contained 101 patients with LVEDP measurements (n = 44 with LVEDP > 18 mmHg) and 161 controls. The validation dataset (n = 155, mean age 46 ± 21 yrs; 62% male) contained 75 patients with LVEDP measurements (n = 40 with LVEDP > 18 mmHg) and 80 controls. Results: Leave-one-out cross-validation on the training dataset yielded a sensitivity of 0.84 (95% confidence interval (CI): 0.70 - 0.93) and a specificity of 0.84 (95% CI: 0.79 - 0.89). The validation dataset showed a sensitivity of 0.80 (95% CI: 0.64 - 0.91) and a specificity of 0.83 (95% CI: 0.75 - 0.90). Figure 1 shows the overall classification performance. Conclusion: The Vivio System can accurately detect elevated LVEDP and has the potential to significantly improve early detection of HF in the outpatient setting.

We have isolated and characterized the cDNA and genomic DNA encoding fibroblast growth factor receptor-4 of Xenopus laevis (XFGFR-4). The gene encompassing the total coding sequence spans about 10 kb, consists of 17 exons, and has an organization very similar to those of mammalian genes encoding FGFR-1 and -2, except that the XFGFR-4 gene does not contain an alternative exon for the third immunoglobulin-like domain nor an internal poly(A)-addition site. Thus, XFGFR-4 appears not to generate multiple forms of mRNA, as are identified for the mammalian FGFR-1, -2 and -3 genes. The amino-acid sequence of XFGFR-4 shows high homology to other vertebrate FGFR-4 species, but the similarity was significantly lower than in the cases of FGFR-1 and -2. Northern blot analysis showed the XFGFR-4 mRNA to occur throughout X. laevis early embryogenesis in a profile different from those of X. laevis FGFR-1 and -2.

In ischemic posterior circulation stroke, the utilization of standardized image scores is not established in daily clinical practice. We aimed to test a novel imaging score that combines the collateral status with the rating of the posterior circulation Acute Stroke Prognosis Early CT score (pcASPECTS). We hypothesized that this score (pcASCO) predicts functional outcome and malignant cerebellar edema (MCE). Ischemic stroke patients with acute BAO who received multimodal-CT and underwent thrombectomy on admission at two comprehensive stroke centers were analyzed. The posterior circulation collateral score by van der Hoeven et al was added to the pcASPECTS to define pcASCO as a 20-point score. Multivariable logistic regression analyses were performed to predict functional independence at day 90, assessed using modified Rankin Scale scores, and occurrence of MCE in follow-up CT using the established Jauss scale score as endpoints. A total of 118 patients were included, of which 84 (71%) underwent successful thrombectomy. Based on receiver operating characteristic curve analysis, pcASCO ≥ 14 classified functional independence with higher discriminative power (AUC: 0.83, 95%CI: 0.71–0.91) than pcASPECTS (AUC: 0.74). In multivariable logistic regression analysis, pcASCO was significantly and independently associated with functional independence (aOR: 1.91, 95%CI: 1.25–2.92, p = 0.003), and MCE (aOR: 0.71, 95%CI: 0.53–0.95, p = 0.02). The pcASCO could serve as a simple and feasible imaging tool to assess BAO stroke patients on admission and might be tested as a complementary tool to select patients for thrombectomy in uncertain situations, or to predict clinical outcome. • The neurological assessment of basilar artery occlusion stroke patients can be challenging and there are yet no validated imaging scores established in daily clinical practice. • The pcASCO combines the rating of early ischemic changes with the status of the intracranial posterior circulation collaterals. • The pcASCO showed high diagnostic accuracy to predict functional outcome and malignant cerebellar edema and could serve as a simple and feasible imaging tool to support treatment selection in uncertain situations, or to predict clinical outcome.

Background: Mass immunization campaigns have been initiated to contain the ongoing COVID-19 pandemic. COVID-19 mRNA vaccines (BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)) have been given emergency use authorization. Recently the lay press has reported concerns for vaccine-associated myocarditis. The aim of this study is to present a systematic review of the Cardiac Magnetic Resonance (CMR) findings of myocarditis following the second dose of Covid-19 mRNA vaccination. Methods: PRISMA search strategy was used in the database search of studies that discussed the Cardiac Magnetic Resonance findings in patients following the second dose of Covid-19 mRNA vaccination. We had no restrictions on study design, population, or language. Results: 28 studies were included in this study, 113 out of 136 patients developed myocarditis after the second dose of covid19 mRNA vaccination. Cardiac magnetic resonance (CMR) findings were suggestive of myocarditis in all subjects. Results were similar in most subjects and included non-ischemic early or late glandium enhancement in a patchy or diffuse or nodular pattern that involved epicardial or myocardial layer or both of cardiac walls, myocardial edema, and fibrosis, hypokinesis of ventricular walls. Some subjects showed normal ventricular prone develop myocarditis after the second dose of COVID19 mRNA vaccination. Moderna vaccine risk after vaccination.

Background: Noncontrast Computed Tomography (NCCT) features are promising markers for acute hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH). It remains unclear whether accurate identification of these markers is also reliable in raters with different levels of experience. Methods: Patients with acute spontaneous ICH admitted at four tertiary centers in Germany and Italy were retrospectively included from January 2017 to June 2020. In total, nine NCCT markers were rated by one radiology resident, one radiology fellow, and one neuroradiology fellow with different levels experience in ICH imaging. Interrater reliabilities of the resident and radiology fellow were evaluated by calculated Cohen’s kappa (κ) statistics in reference to the neuroradiology fellow who was referred as the gold standard. Gold-standard ratings were evaluated by calculated interrater κ statistics. Global interrater reliabilities were evaluated by calculated Fleiss kappa statistics across all three readers. A comparison of receiver operating characteristics (ROCs) was used to evaluate differences in the diagnostic accuracy for predicting acute hematoma expansion (HE) among the raters. Results: Substantial-to-almost-perfect interrater concordance was found for the resident with interrater Cohen’s kappa from 0.70 (95% CI 0.65–0.81) to 0.96 (95% CI 0.94–0.98). The interrater Cohen’s kappa for the radiology fellow was moderate to almost perfect and ranged from 0.58 (95% CI 0.52–0.65) to 94 (95% CI 92–0.97). The intrarater gold-standard Cohen’s kappa was almost perfect and ranged from 0.79 (95% CI 0.78–0.90) to 0.98 (95% CI 0.78–0.90). The global interrater Fleiss kappa ranged from 0.62 (95%CI 0.57–0.66) to 0.93 (95%CI 0.89–0.97). The diagnostic accuracy for the prediction of acute hematoma expansion (HE) was different for the island sign and fluid sign, with p-values < 0.05. Conclusion: The NCCT markers had a substantial-to-almost-perfect interrater agreement among raters with different levels of experience. Differences in the diagnostic accuracy for the prediction of acute HE were found in two out of nine NCCT markers. The study highlights the promising utility of NCCT markers for acute HE prediction.

Evidence regarding the effect of mechanical thrombectomy (MT) of basilar artery occlusion (BAO) stroke is yet sparse. As successful recanalization has been suggested as major determinant of outcome, the early identification of modifiable factors associated with successful recanalization could be of importance to improve functional outcome. Hyperglycemia has been associated with enhanced thrombin generation and unfavorably altered clot features. We hypothesized that serum baseline glucose is associated with likelihood of vessel recanalization mediated by collateral quality and clot burden in BAO stroke. BAO stroke patients who received multimodal CT on admission were analyzed. The association of vessel recanalization defined using modified Thrombolysis in cerebral infarction scale (mTICI) scores 2b-3, and baseline imaging and clinical parameters were tested in logistic regression analyses. Collateral quality and clot burden were evaluated using the Basilar Artery on CT-Angiography (BATMAN) score. Out of 117 BAO patients, 91 patients (78%) underwent MT. In 70 patients (77%), successful recanalization could be achieved (mTICI 2b/3). In multivariable logistic regression analysis, only a higher BGL (aOR 0.97, 95% CI 0.96–0.99, p = 0.03) and higher BATMAN score (aOR 1.77, 95% CI 1.11–2.82, p = 0.02) were independently associated with vessel recanalization. Application of alteplase, or time from symptom onset-imaging revealed no independent association with recanalization status. Higher BGL was significantly associated with reduced likelihood for recanalization success besides BATMAN score as a measure of collateral quality and clot burden. BGL could be tested as a modifiable parameter to increase likelihood for recanalization in BAO stroke, aiming to improve functional outcome.

Computed tomography perfusion (CTP) is used as a tool to select ischemic stroke patients for endovascular treatment (EVT) and is currently investigated in the setting of extensive stroke with low Alberta Stroke Program Early CT scores (ASPECTS). The purpose of this study was to perform a comprehensive quantitative analysis of cerebral blood flow within the ischemic lesion compared to threshold-derived core lesion volumes. We hypothesized that the degree of cerebral blood volume (CBV) reduction within the ischemic lesion is predictive of irreversible tissue injury and functional outcome in patients with low ASPECTS. Ischemic stroke patients with an ASPECTS ≤ 5 who received multimodal CT on admission and underwent thrombectomy were analyzed. The ischemic lesion on CTP was identified, and CTP-derived parameters were measured as absolute means within the lesion and relative to the physiological perfusion measured in a contralateral region of interest. The degree of irreversible tissue injury was assessed using quantitative net water uptake (NWU). Functional endpoint was good outcome defined as modified Rankin Scale (mRS) scores 0–3 at day 90. One hundred eleven patients were included. The median core lesion volume was 71 ml (IQR: 25–107), and the median quantitative NWU was 9.5

Key Points Question Does providing clinical decision support during an acute care hospitalization improve deprescribing of potentially inappropriate medications and 30-day postdischarge adverse drug events (ADEs) in older adults? Findings This cluster randomized multicenter trial of 5698 hospitalized participants found that providing electronically generated deprescribing reports did not have a significant impact on ADEs within 30 days despite increased deprescribing at discharge. Meaning The findings of this randomized clinical trial indicate that clinical decision support during hospitalization improves deprescribing but has little impact on medication harms in the short term.

Background In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied. Aim This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion. Methods In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0-2 at day 90). Results A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25-16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9-5.8). Conclusion PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.