Background and Purpose— Hemispheric stroke studies associating lateropulsion (pusher syndrome) with the location of brain lesions have had mixed results from small, unmatched samples. This study was designed to determine whether lateropulsion localizes to specific brain regions across patients with stroke using a case-control design. Methods— Fifty patients with lateropulsion after stroke were matched with 50 stroke patients without lateropulsion using age, time since onset of stroke, admission motor Functional Independence Measure score, lesion side, and gender. The primary analysis included multivariate lesion symptom mapping using sparse canonical correlations to identify regions most associated with lateropulsion as assessed with the Burke Lateropulsion Scale. Secondary analyses included evaluating paired comparisons for lesion volume, degree of motor impairment, motor and cognitive Functional Independence Measure scores. Results— The lesion symptom mapping analysis of all lesions mapped onto a common hemisphere produced an overall significant model (P<5×10–5) with a regional peak at the inferior parietal lobe at the junction of the post-central gyrus (Brodmann Area 2) and Brodmann Area 40 as the lesion location most associated with lateropulsion. Lesion volume was larger for patients with lateropulsion. Despite adequate matching, motor performance and total Functional Independence Measure scores differed at a group level between patients with and without lateropulsion. Conclusions— This analysis implicated lesion involvement of the inferior parietal lobe as a key neuroanatomical determinant of developing lateropulsion. A better understanding of the anatomic underpinnings of lateropulsion may improve rehabilitation efforts, including the potential for informing noninvasive neuromodulation approaches.

Objective: To compare the effects of Transcranial Direct Current Stimulation (tDCS) versus Galvanic Vestibular Stimulation (GVS) on Lateropulsion following stroke. Methods: Patients with Stroke and Burke Lateropulsion Scale (BLS) scores greater than or equal to 2 gave informed consent to receive sinusoidal 1 Hz DC (0-2 mA) anodal stimulation over the affected parietal cortex versus similar GVS with ipsilesional mastoidal anode. Seated haptic center of pressure (COP-X) was measured using an AMTI analog-to-digital forceplate. An inclinometer (Biopac ) measured lateral thoracic tilt. COP-X Power Spectra were analyzed over 3 frequency intervals: 0-.3 Hz, .3-1 Hz, and 1-3 Hz. Results: Six males/4 females age 66 +/- 9.5 standard deviation with admission BLS scores of 5.4 +/- 3.7 within 8.6 +/- 8.1 days poststroke were enrolled. COP-X medial-lateral speed increased for both the tDCS and the GVS protocols compared to sham condition. Fourier Analysis of COP-X velocity for 0-.3 Hz responses showed a significant increase for tDCS stimulation. The 0.3-1 Hz responses for the tDCS condition were decreased from baseline. Lateral thoracic tilt showed significant improvement for tDCS compared to Sham stimulation at 10 minutes and for GVS versus Sham at 15 minutes. Discussion: Anodal tDCS over the ipsilesional PIVC increases low frequency postural responses usually attributed to visual control with down regulation of median frequency vestibular responses, biasing postural control toward more dependence on visual as opposed to vestibular control. Conclusions: 2 mA sinusoidal 1 Hz anodal tDCS over the ipsi-lesional PIVC or similar ipsi-lesional anodal GVS improve Lateropulsion following stroke.

Importance:Data from animal models show that the administration of dextroamphetamine combined with task-relevant training facilitates recovery after focal brain injury. Results of clinical trials in patients with stroke have been inconsistent. Objectives:To collect data important for future studies evaluating the effect of dextroamphetamine combined with physiotherapy for improving poststroke motor recovery and to test the efficacy of the approach. Design, Setting, Participants:This pilot, double-blind, block-randomized clinical trial included patients with cortical or subcortical ischemic stroke and moderate or severe motor deficits from 5 rehabilitation hospitals or units. Participants were screened and enrolled from March 2001 through March 2003. The primary outcome was assessed 3 months after stroke. Study analysis was completed December 31, 2015. A total of 1665 potential participants were screened and 64 were randomized. Participants had to begin treatment 10 to 30 days after ischemic stroke. Data analysis was based on intention to treat. Interventions:Participants were allocated to a regimen of 10 mg of dextroamphetamine (n = 32) or placebo (n = 32) combined with a 1-hour physical therapy session beginning 1 hour after drug or placebo administration every 4 days for 6 sessions in addition to standard rehabilitation. Main Outcomes and Measures:The primary outcome was the difference between groups in change in Fugl-Meyer motor scores from baseline to 3 months after stroke (intention to treat with dextroamphetamine). Secondary exploratory measures included the National Institutes of Health Stroke Scale, Canadian Neurological Scale, Action Research Arm Test, modified Rankin Scale score, Functional Independence Measure, Ambulation Speed and Distance, Mini-Mental State Examination, Beck Depression Inventory, and Stroke Impact Scale. Results:Among the 64 patients randomized to dextroamphetamine vs placebo (55% men; median age, 66 years; age range, 27-91 years), no overall treatment-associated difference in the mean (SEM) change in Fugl-Meyer motor scores from baseline to 3 months after stroke was noted (-18.65 [2.27] points with dextroamphetamine vs -20.83 [2.94] points with placebo; P = .58). No overall treatment-associated differences in any of the study's secondary measures and no differences in subgroups based on stroke location or baseline severity were found. No adverse events were attributed to study treatments. Conclusions and Relevance:Treatment with dextroamphetamine combined with physical therapy did not improve recovery of motor function compared with placebo combined with physical therapy as assessed 3 months after hemispheric ischemic stroke. The studied treatment regimen was safe. Trial Registration:ClinicalTrials.gov identifier: NCT01905371.

PURPOSE:The aim of the study was to describe the use of oral hydration protocols for dysphagic patients following stroke.DESIGN AND METHODS:We reviewed inpatient records for patients able to take food and liquids orally within 30 days of an ischemic stroke. Orders were hierarchically defined with three levels of liquid consistency modification (LCM) and six levels of augmented hydration orders (AHOs). Change from admission to discharge in hydration and functional independence measure (FIM) scores across LCM and AHO groups was assessed.FINDINGS:Length of stay, admission FIM, discharge FIM, and change in FIM scores were all significantly related to LCM and AHO group assignment. Need for supplemental intravenous hydration was low (6.9%) over the 2-year study period and was significantly related to both LCM and AHO group assignment.CONCLUSION AND CLINICAL RELEVANCE:The association of LCM and AHO interventions with functional outcomes and need for intravenous fluids helps to validate their clinical utility.

Objective: To assess the effects of 2mA transcranial Direct Current Stimulation (tDCS) over the affected Parietal-Insular-Vestibular Cortex (PIVC) on seated posture of patients with lateropulsion following stroke. We hypothesized that bilateral electrode placement over PIVC (vs active control) would produce a change in seated posture. Background: Lateropulsion following stroke (Pusher Syndrome) is characterized by lateral displacement of subjective postural vertical toward the weak side. It is caused by lesions affecting vestibular projections to the Ventral Lateral Thalamus (VLT) or projections from the VLT to the Parietal-Insular-Vestibular Cortex (PIVC). Methods: Seventeen subjects with Burke Lateropulsion Scale scores ≥ 2 within 30 days of an ischemic stroke signed an IRB-approved consent. They received 2mA tDCS delivered using 25cm 2 saline soaked sponge electrodes via one of two montages: Test (anode over the affected PIVC and cathode opposite PIVC) versus Active Control (anode over the affected PIVC and cathode over the opposite supra-orbital region). PIVC was defined using EEG 10/20 coordinates. Seated medial-lateral center of pressure (COP-X) was measured using a custom-designed chair mounted on an AMTI™ analog-to-digital forceplate. An inclinometer strapped to the chest and aligned with the sternum measured lateral trunk tilt. Data were collected prior to, then at 5, 10, and 15 minutes during tDCS and 5 min following tDCS. Results: Repeated Measures Analysis of Variance rejected the hypothesis of an interaction between Montage and Time for: mean COP-X displacement (in) (Wilks’ λ F = 0.647 df =(4, 13), P = 0.639); mean speed of COP-X (in/s) (Wilks’ λ F = 0.740 df =(4, 13), P =0.581); mean inclinometer tilt (degrees) (Wilks’ λ F = 0.740 df =(4, 13), P =0.581). Conclusion: Neither tDCS montage showed improvement in COP-X displacement, COP-X movement velocity or inclinometer readings. These negative results are important to encourage the development of alternative tDCS stimulation parameters or identification of alternative cortical or vestibular tDCS targets for the treatment of Lateropulsion Following Stroke.

Objective: To assess the effects of 2 mA tDCS on seated posture of patients with lateropulsion following stroke.

Introduction: It is a well described fact that elderly hospitalized patients lose weight, and this weight loss has been attributed to loss of muscle mass. On our acute Inpatient Stroke Rehabilitation Unit, patients with more severe deficits on admission appear to lose more weight than patients who are fairly functional. With this retrospective cohort study, we examined whether weight loss during stroke rehabilitation was associated with stroke severity as measured with the Functional Independence Measure (FIM) Score, and due to poor nutrition due to dysphagia or otherwise decreased food intake (estimated by Percent of Meal Consumed (PoMC)). Methods: 420 ischemic stroke patients, admitted to the Burke Rehabilitation Hospital Inpatient Stroke Unit between 12/14 and 12/15, were included in this retrospective cohort study. Weight change per admission day, as well as motor, cognitive and total FIM Scores was recorded. Patients who had mechanically altered diet orders or thickened liquid orders were judged to be dysphagic, and nutritional intake was estimated by PoMC. Results: Weight change per day during inpatient stroke rehabilitation was not correlated with gains in motor FIM (Pearson correlation 0.07, p=0.89) or cognitive FIM (Pearson Correlation -0.053, p=0.29) scores. Weight change per day was also not correlated with admission cognitive or motor FIM scores, indicating that stroke severity did not predict weight loss during admission. Of note, weight change per day was also not correlated with dysphagia, indicating that patient with swallowing difficulties were able to meet their nutritional needs through dietary modifications. Conclusion: Weight changes after stroke do not appear to be correlated to stroke severity and stroke outcomes, as measured by the FIM Score. In our cohort, dysphagia was not an independent risk factor for weight loss. Future prospective trials will be required in order to assess which patients are at risk for weight loss, and whether weight loss is correlated with other measures of impairment.

Pathologic tilt of subjective visual vertical (SVV) frequently has adverse functional consequences for patients with stroke and vestibular disorders. Repetitive transcranial magnetic stimulation (rTMS) of the supramarginal gyrus can produce a transitory tilt on SVV in healthy subjects. However, the effect of transcranial direct current stimulation (tDCS) on SVV has never been systematically studied. We investigated whether bilateral tDCS over the temporal-parietal region could result in both online and offline SVV misperception in healthy subjects. In a randomized, sham-controlled, single-blind crossover pilot study, thirteen healthy subjects performed tests of SVV before, during and after the tDCS applied over the temporal-parietal region in three conditions used on different days: right anode/left cathode; right cathode/left anode; and sham. Subjects were blind to the tDCS conditions. Montage-specific current flow patterns were investigated using computational models. SVV was significantly displaced towards the anode during both active stimulation conditions when compared to sham condition. Immediately after both active conditions, there were rebound effects. Longer lasting after-effects towards the anode occurred only in the right cathode/left anode condition. Current flow models predicted the stimulation of temporal-parietal regions under the electrodes and deep clusters in the posterior limb of the internal capsule. The present findings indicate that tDCS over the temporal-parietal region can significantly alter human SVV perception. This tDCS approach may be a potential clinical tool for the treatment of SVV misperception in neurological patients.

We offer this letter to spark discussion about potential transcranial methods to augment rehabilitation to ameliorate lateropulsion after stroke. Patients with lateropulsion after stroke, also known as 'pusher syndrome,' actively push themselves to the weak side and resist passive correction of the posture to the vertical upright [ [1] Davies P.M. Steps to follow: a guide to the treatment of adult hemiplegia. Springer, Berlin, Germany1985 Crossref Google Scholar ]. Various lesion sites along pathways which formulate subjective perceptions of verticality have been implicated in lateropulsion. Transcranial direct current stimulation (tDCS) or galvanic vestibular stimulation (GVS) over parts of the impaired pathways may change seated center of pressure for patients with lateropulsion and provide insight into the nature of the lesioned pathway. The parietal-insular vestibular cortex (PIVC) is a multi-modal cortical region that synthesizes sensory input from vestibular, somatosensory, and visual systems to allow dynamic regulation of postural orientation [ [2] Lopez C. Blanke O. The thalamocortical vestibular system in animals and humans. Brain Res Rev. 2011; 67: 119-146 Crossref PubMed Scopus (358) Google Scholar ]. In addition, trans-mastoidal galvanic vestibular stimulation (GVS) may provide a means of augmenting vestibular neural systems controlling posture and balance. Both tDCS and GVS could be used to impact posture before, during or after physical therapy sessions [ [3] Utz K.S. Dimova V. Oppenländer K. Kerkhoff G. Electrified minds: transcranial direct current stimulation (tDCS) and galvanic vestibular stimulation (GVS) as methods of non-invasive brain stimulation in neuropsychology – a review of current data and future implications. Neuropsychologia. 2010; 48: 2789-2810 Crossref PubMed Scopus (348) Google Scholar ] because they are portable, safe and well-tolerated. We tested the hypotheses that anodal upregulation on the lesion side via tDCS over the area of the PIVC or GVS might change tonic seated posture, as measured by the speed of the center of pressure, in the frontal plane.

BACKGROUND:Comparing cohorts with similar functional and motor status at admission to inpatient rehabilitation may delineate demographics or impairments associated with recovery from lateropulsion, also known as "pusher syndrome," after stroke based on lesion side. The aim of this case-control study was to determine how demographics and severity of stroke impairments at admission to inpatient rehabilitation distinguish patients who recover from lateropulsion from those who do not. METHODS:Patients with admission motor Functional Independence Measure (FIM) scores less than 31 and contralesional lower extremity Fugl-Meyer motor scores less than 19 out of 34 were included. Burke Lateropulsion Scales score of 2 or higher at the time of discharge from inpatient rehabilitation indicated persistent lateropulsion; a score of 0 or 1 indicated resolved lateropulsion. Logistic regression tests included age, gender, admission Motricity Index score, limb placement error, and cognitive FIM score. χ2 analyses compared groups for neglect. RESULTS:For patients with left brain lesion, older age and worse admission motor status distinguished those with persistent lateropulsion at discharge. For right brain lesion, related factors were older age, greater admission limb placement error, and lower cognitive FIM scores. Visuospatial neglect did not influence recovery from lateropulsion. CONCLUSIONS:Older age and severe impairments were associated with delayed recovery from lateropulsion in a manner specific to lesion side in a sample with motor and functional deficits. The study provides evidence that lesion side and admission characteristics are useful in early decision making for the duration of rehabilitation, selection of interventions, and discharge planning.

OBJECTIVE:To evaluate the safety and tolerability of dalfampridine extended release (D-ER) in participants with chronic post-ischemic stroke deficits, and to assess for potential drug activity on sensorimotor function. METHODS:Using a double-blind, placebo-controlled, cross-over design, participants were randomized to placebo/D-ER or D-ER/placebo sequences and given D-ER 10 mg or placebo twice daily. Key inclusion criteria were: ischemic stroke ≥ 6 months, Fugl-Meyer Assessment lower extremity motor score ≤ 28, ability to complete Timed 25-Foot Walk (T25FW). The primary outcome was safety and tolerability. The key exploratory measure was walking speed (T25FW). Other assessments were: Box and Block, and Grip and Pinch tests; Functional Independence Measure. Full-crossover data were analyzed using mixed-effects model. RESULTS:A total of 83 participants were randomized: 70 completed and 13 discontinued the study. Adverse events were consistent with previous D-ER trials; no new safety signals were observed. Four participants experienced serious adverse events: 3 seizures (1 placebo, 2 D-ER), 1 was secondary to intentional overdose. Most common treatment-emergent adverse events were: dizziness, nausea, arthralgia and fatigue. Mixed-effects analysis showed an effect for D-ER vs. placebo in improving walking speed (0.21 vs. 0.10 ft/s; p = 0.027). CONCLUSIONS:D-ER was generally well tolerated in participants with chronic stroke deficits. Potential drug activity on lower extremity sensorimotor function, with an improvement in walking speed, was seen.

Background. Lateropulsion, a postural control disorder, delays recovery following hemispheric stroke. The number of stroke impairments may lead to differential recovery rates, depending on the intact systems available for recovery from lateropulsion. Objective. To study the impact of key postural control deficits on lateropulsion rate of recovery following stroke. Methods. Through retrospective analysis: 169 patients with hemispheric stroke in an in-patient rehabilitation facility were divided into 3 groups: (1) motor deficits only; (2) motor and hemianopic or visual-spatial deficits or motor and proprioceptive deficits; and (3) motor, proprioceptive, and hemianopic or visual-spatial deficits. Kaplan-Meier survival analysis determined if time to recovery from lateropulsion (achieving a score of 0 or 1 on the Burke Lateropulsion Scale) differed by group. Results. Log rank tests showed that time to recovery from lateropulsion differed based on the number of deficits (group, P = .012). Post hoc analyses by lesion side showed that group differences only occurred in right brain lesion (P < .05) as compared with left brain lesions (P = .34). Patients recovered from lateropulsion during in-patient rehabilitation if they had only motor deficits; those with all 3 postural control deficits showed the most protracted recovery. Conclusions. Rate of recovery from lateropulsion after stroke is dependent on the side of lesion, and number of key motor, proprioceptive, and/or hemianopic or visual-spatial deficits. The more postural control systems affected, the slower the recovery. Our data identify patients likely to need protracted rehabilitation targeting key postural control deficits.

OBJECTIVE: The AESR trial was a multicenter, double-blind, pilot clinical trial designed to collect data to support the design of a Phase-3 clinical trial testing the efficacy of d-amphetamine combined with physical therapy to facilitate motor recovery following hemispheric ischemic stroke. BACKGROUND: Extensive data from a variety of animal models show that the administration of d-amphetamine combined with task relevant training facilitates recovery after focal sensorimotor cortex injury. The results of clinical trials have been inconsistent. The AESR trial was designed to evaluate two different treatment regimens, collect data to inform sample size calculations, determine safety, explore a variety of potential outcome measures, and identify logistic barriers important for future trials. DESIGN/METHODS: Using block randomization (cortical vs. subcortical; moderate vs. severe motor deficits based on the Fugl-Meyer scale) patients who could begin treatment 10-30 days after ischemic stroke were allocated to a regimen of 10mg of d-amphetamine or placebo combined with a 1-hour physical therapy session beginning 1-hour after drug/placebo administration every 4-days for 6-sessions in addition to standard rehabilitation (Regimen-1). Assessments were performed at baseline, end of treatment, and 3-months poststroke. A 12-point difference in Fugl-Meyer scores between groups was considered clinically significant. A sample size of 25 subjects per group was estimated to be necessary to detect this difference with 80% power. Assuming a 30% drop out rate, a total of 65-subjects were to be enrolled in each regimen. RESULTS: A total of 64-subjects were randomized (n=32 per group; d-amphetamine vs placebo mean age (±SD) 66±13 vs. 65±14 years; Caucasian 81% vs. 72%; men 50% vs. 59%). The mean (±SE) baseline Fugl-Meyer scores were similar (d-amphetamine 23.2±0.6 vs. placebo 24.5±0.6 points). The drop our rate was 9.5%; no subjects were withdrawn due to study-related adverse events. CONCLUSIONS: The studied treatment regimen was safe. Primary results will be presented. Study Supported by: NIH-NS39934

Objective: To evaluate the safety and tolerability of dalfampridine extended release tablets (D-ER; prolonged-release fampridine in Europe) 10 mg twice daily administered to patients with chronic post-ischemic stroke deficits, and to perform an exploratory assessment on sensorimotor function. Background: Ischemic stroke is a major cause of sensorimotor deficits that may lead to persistent disability, such as walking impairment. Methods: The study design included 2-wk screening, 2-wk treatment, 1-wk placebo (PBO) washout and crossover, 2-wk treatment, and 1-wk follow-up. Patients with a history of ischemic stroke ≥6 months prior to enrollment, with stable sensorimotor deficits and Fugl-Meyer Assessment lower extremity motor score ≤28, and who were able to complete the Timed 25-foot walk (T25FW) were eligible. Patients were randomized into 2 sequences: A (PBO/D-ER) or B (D-ER/PBO). Safety was the primary endpoint. Walking speed assessed by T25FW was the prespecified key efficacy exploratory outcome. Potential changes in community ambulation categories were based on walking speed. Results: Patient (N=83) demographics were comparable except for age, which varied significantly between sequences (mean [SE]: A=57.5 [1.31]; B=63.5 [1.68]; P =0.008). Seventy subjects (84.3%) completed the study with 6 withdrawals for adverse events (AEs). Treatment emergent AE rates were 55% for D-ER and 37% for PBO; most common were dizziness, nausea, and fatigue. Four subjects (2/treatment) had serious AEs including 3 seizures; 1 PBO and 2 D-ER one of which was secondary to an intentional overdose. The overall change in T25FW speed from baseline was greater with D-ER relative to PBO (0.21 vs 0.10 ft/sec; N=78; P =0.027). Based on walking speed, there was a near 2-fold increase in those who shifted from household to limited community ambulation and from limited to full community ambulation in the D-ER versus PBO groups (15.3% vs 7.7%, respectively). Conclusions: Results suggest that D-ER is well tolerated and may improve walking in patients with chronic post-ischemic stroke deficits. These data provide a foundation for larger efficacy and safety studies in this population.

OBJECTIVE: To test the effect of metformin as a potential neuroprotective agent following stroke.

ObjectivePoststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the Ecosystem Focused Therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the “psychosocial storm” of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy.DesignA total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks.ResultsEcosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability.ConclusionThese encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy. Copyright © 2012 John Wiley & Sons, Ltd.

Introduction: Brain natriuretic peptide (BNP) is a known predictor of cardiovascular morbidity in patients with heart failure, and can predict cardiovascular complications in patients without known cardiovascular disease. Recent studies have focused on the relationship between elevated BNP levels and ischemic stroke. Increased BNP levels were correlated with increased for risk of stroke or transient ischemic attack. Plasma BNP levels are elevated in patients with acute ischemic stroke and predict death in acute ischemic stroke patients with atrial fibrillation. Hypothesis: Admission BNP (aBNP) levels predict outcomes in an acute rehabilitation setting. Methods: 763 patients with ischemic stroke admitted to an acute inpatient rehabilitation unit were assessed. Admission BNP levels, admission and discharge Fugl-Meyer Motor Impairment (FMMI) scores and Functional Independence Measure (FIM) score were obtained for each patient. Odds ratios were calculated for aBNP quintile groups and need for transfer to acute care or death versus other discharge disposition (ACDvsO). Spearman Rank Order correlations were calculated for aBNP levels and cardiovascular comorbidities and complications, admission and discharge FMMI and FIM scores. Logistic Regression was used to assess interactions with age and the above co-variables. Results: aBNP quintile cut scores showed the following odds ratios and confidence intervals for ACDvsO discharge disposition: aBNP > 17.5 (O.R.=1.6; CI = 0.83-3.12 ; p=N.S); > 49.5 (1.83; 1.09-3.07; p= 0.02); > 104.9 (2.03; CI = 1.27-3.25; p=.003); >231.3 (2.03; CI = 1.22- 3.38; p= 0.006). aBNP was still a significant predictor of ACDvsO (X2 =6.84;p=.009) with age, admission FMMI and FIM scores entered as co-variables. aBNP was significantly correlated with admission FIM (r=-0.21; p=0.000); discharge FIM (r=-.245; p=0.000) but not with admission FMMI (0.001; p=0.98) or with discharge FMMI (0.019; p=0.70) Conclusion: Rehabilitation Hospital aBNP values can predict a two-fold increase in odds of death or need for transfer to acute care. They are also correlated with admission and discharge FIM scores perhaps indicating less cardiovascular reserve and poor endurance due to underlying cardiovascular disease. Previous studies have correlated BNP levels with stroke severity, however our analysis failed to find a correlation between BNP and FMMI as a measure of motor impairment. Patients with high aBNPs need to be closely monitored for adverse events and rehabilitation intensity needs to be tailored to their needs.

Background . Higher fasting blood glucose (FBG) concentrations in the hyperglycemic range are associated with more severe strokes. Whether this association also extends into patients with FBG in the normoglycemic range is unclear. We studied the association of stroke severity and FBG in normoglycemic patients with ischemic stroke in a median of 7 days after stroke when the initial glycemic stress response has resolved. Method and Material . Included were 361 nondiabetic ischemic stroke patients with admission fasting blood glucose within 70–130 mg/dL admitted into an acute stroke rehabilitation unit in a median of 7 days after stroke. Data including neuroimaging, vital signs, cardiovascular risk factors, and admission functional independence measure (AFIM) were recorded prospectively. Results . FBG correlated with stroke severity in the normoglycemic 70–130 mg/dL range (FBG-AFIM correlation coefficient −0.17; P = 0.003). Odds ratio for more severe injury (below average AFIM score) was 2.02 for patients with FBG 110–130 mg/dL compared to FBG 70–90 mg/dL (95% confidence interval 1.10–3.73, P = 0.022). Each mg/dL increase in FBG was associated with an average decrease of 0.25 FIM points. In a multiple linear regression model, FBG was associated with more severe stroke ( P = 0.002). Conclusion . One week after ischemic stroke, FBG within the normoglycemic range was associated with stroke severity.