Previous studies have addressed the differences in risk factors and stroke mechanisms between ICAS and ECAS, 2,3 but the results are inconsistent. Whereas some reported that hypertension, diabetes mellitus, and metabolic syndrome (MetS) are more closely associated with ICAS, 4-8 this was not confirmed by others. 9-11 It also remains unclear whether the risk factors and stroke mechanisms differ between anterior and posterior circulation atherosclerosis. 12Previous studies examined a small number of patients at single hospitals. 6,7,11 Most importantly, prospective studies that used detailed examinations, including advanced brain and vascular imaging, are scarce. The purpose of this study was to elucidate the differences in the risk factors and mechanisms of stroke between ICAS and ECAS, and between anterior and posterior circulation atherosclerosis. We developed a Background and Purpose-The aim of this study was to investigate differences in risk factors and stroke mechanisms between intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) and between anterior and posterior circulation atherosclerosis. Methods-A multicenter, prospective, Web-based registry was performed on atherosclerotic strokes using diffusionweighted magnetic resonance imaging and magnetic resonance angiography. Stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombo-occlusion, local branch occlusion, or hemodynamic impairment. Results-One-thousand patients were enrolled from 9 university hospitals. Age (odds ratio [OR]

Background and Purpose-Single small subcortical infarctions (SSSIs), so-called lacunae, are typically caused by lipohyalinosis of a perforator artery. However, SSSIs can be caused by underlying large parent arterial disease or microatheroma of the proximal portion of a perforator artery. We sought to investigate whether indicators for small vessel disease (SVD) and atherosclerosis in patients with SSSI differ according to lesion location and the presence of parent artery disease. Methods-We assessed 449 patients who had an SSSI (lesion diameter Յ20 mm) in the perforator territory of middle cerebral artery (nϭ244), basilar artery (nϭ141), and vertebral artery (nϭ64) on diffusion-weighted imaging performed within 48 hours of stroke onset. We divided SSSI into 3 groups according to lesion location and the presence of parent artery disease: (1) SSSI with parent artery disease (SSSIϩPAD); (2) proximal SSSI without PAD (pSSSI-PAD); and (3) distal SSSI without PAD (dSSSI-PAD). The prevalence of SVD indicators (leukoaraiosis and microbleeds) and atherosclerosis indicators (cerebral atherosclerosis and coronary heart disease) were compared among the groups. Results-SSSIϩPAD had the highest prevalence of atherosclerosis indicators and the lowest prevalence of SVD indicators, whereas dSSSI-PAD had the lowest prevalence of atherosclerosis indicators and the highest prevalence of SVD indicators. pSSSI-PAD showed intermediate features. Atherosclerosis indicators significantly increased and SVD indicators significantly decreased as the vascular territory became lower (from middle cerebral artery, basilar artery to vertebral artery). Conclusion-Differences in SVD and atherosclerosis indicators suggest that SSSI has a heterogeneous pathogenesis according to lesion location and the presence of PAD.

Diverse factors such as neurologic dysfunction, lesion location, microbleeds, genetic traits, and social support are differently related to acute and subacute emotional disturbances. Strategies to prevent or manage these problems should consider these differences.

No abstract

ISC-active, but not ISC-inactive, is distinct in terms of risk factors, stroke mechanisms, and lesion patterns. Chronic inflammation and an activated coagulation system may contribute to the pathogenic mechanism of strokes, the extent of each depending on the activity and severity of cancer.

Background and Purpose— There is a paucity of information about the role of resting heart rate in the prediction of outcome events in patients with ischemic stroke with atrial fibrillation. We aimed to investigate the relationships between the level and variability of heart rate in the acute stroke period and stroke recurrence and mortality after acute ischemic stroke in patients with atrial fibrillation. Methods— Acute patients with ischemic stroke who had atrial fibrillation and were hospitalized within 48 hours of stroke onset were identified from a multicenter prospective stroke registry database. The acute stroke period was divided into early (within 24 hours of hospitalization) and late (72 hours to 7 days from onset) stages, and data on heart rate in both stages were collected. Moreover, the level and variability of heart rate were assessed using mean values and coefficients of variation. Outcome events were prospectively monitored up to 1 year after the index stroke. Results— Among 2046 patients eligible for the early acute stage analysis, 102 (5.0%) had a stroke recurrence, and 440 (21.5%) died during the first year after stroke. A statistically significant nonlinear J-shaped association was observed between mean heart rate and mortality ( P <0.04 for quadratic and overall effect) but not between mean heart rate and stroke recurrence ( P >0.1 for quadratic and overall effect). The nonlinear and overall effects of the coefficients of variation of heart rate were not significant for all outcome variables. The same results were observed in the late acute stage analysis (n=1576). Conclusions— In patients with atrial fibrillation hospitalized for acute ischemic stroke, the mean heart rate during the acute stroke period was not associated with stroke recurrence but was associated with mortality (nonlinear, J-shaped association). The relationships between heart rate and outcomes were not observed with respect to heart rate variability.

Digital therapeutics is an evidence-based intervention using high-quality software, with the sole purpose of treatment. As many healthcare systems are encountering high demands of quality outcomes, the need for digital therapeutics is gradually increasing in the clinical field. We conducted review of the implications of digital therapeutics in the treatment of neurological deficits for stroke patients. The implications of digital therapeutics have been discussed in four domains: cognition, speech and aphasia, motor, and vision. It was evident that different forms of digital therapeutics such as online platforms, virtual reality trainings, and iPad applications have been investigated in many trials to test its feasibility in clinical use. Although digital therapeutics may deliver high-quality solutions to healthcare services, the medicalization of digital therapeutics is accompanied with many limitations. Clinically validated digital therapeutics should be developed to prove its efficacy in stroke rehabilitation.

Our results show that PSAP is relatively prevalent and that previous stroke, neurological dysfunction and the MAO-A gene are involved in the development of PSAP.