Key worDS • cavernous malformation • cavernous angioma • incidental • natural history • asymptomatic • vascular disordersAbbreviations used in this paper: AVM = arteriovenous malformation; ICM = intracerebral cavernous malformation.

Objective: We aimed to study the long-term cognitive abilities of patients surviving out-of-hospital cardiac arrest who were treated with therapeutic hypothermia (TH). Methods:We prospectively identified and examined consecutive survivors of out-of-hospital cardiac arrest who underwent TH at our institution from June 2006 to May 2011. The results of brain imaging, serum neuron-specific enolase (NSE) measurements, and EEGs were recorded. We assessed cognitive domains using the modified Telephone Interview for Cognitive Status. An education-adjusted score of $32 was considered normal.Results: Of 133 total patients, 77 (58%) were alive at a median follow-up of 20 months (interquartile range 14-24 months). We interviewed 56 patients (73% of those alive). Median age was 67 years (range 24-88 years). Fifty-one patients (91%) were living independently. Modified Telephone Interview for Cognitive Status scores ranged from 16 to 41. Thirty-three (60%) were considered cognitively normal and 22 (40%) were cognitively impaired. The time to assessment did not differ among the cognitive outcomes (p 5 0.557). The median duration of coma was 2 days, possibly indicating that patients with severe anoxic injury were not included. Eighteen patients were not working at the time of their cardiac arrest (17 were retired and 1 was unemployed). Of the 38 patients who were working up to the time of the cardiac arrest, 30 (79%) returned to work. Cognitive outcome was not associated with age, time to return of spontaneous circulation, brain atrophy, or leukoaraiosis. Conclusions:The majority of surviving patients who underwent TH after cardiac arrest in this series had preserved cognitive function and were able to return to work.

Key PointsQuestionIs the recent use of non–vitamin K antagonist oral anticoagulants (NOACs) associated with increased risk of intracranial hemorrhage among patients with acute ischemic stroke treated with intravenous alteplase?FindingsThis US retrospective cohort study included 163 038 patients with acute ischemic stroke treated with alteplase. Among patients with use of NOACs within 7 days of hospital arrival vs patients with no use of anticoagulants, intracranial hemorrhage occurred in 3.7% vs 3.2%, respectively, a difference that was not statistically significant after multivariable adjustment.MeaningRecent use of NOACs was not significantly associated with increased risk of intracranial hemorrhage among patients with acute ischemic stroke treated with alteplase.

Background and Purpose-There is uncertainty whether warfarin-treated patients (despite international normalized ratio Ͻ1.7) have increased risks of symptomatic intracerebral hemorrhage after intravenous thrombolysis. Methods-Vascular risk factors, stroke subtype, and outcome measures were compared between warfarin-and nonwarfarin-treated patients undergoing acute thrombolysis within 3 hours of symptom onset. Results-From 212 patients (mean age, 74Ϯ14 years; 50% men) studied, 14 (6.5%) had prior warfarin use. After adjusting for age, baseline National Institutes of Health Stroke Scale, and stroke subtype, warfarin-treated patients had significantly increased risks of developing symptomatic intracerebral hemorrhage (adjusted OR, 14.7; 95% CI, 1.3 to 54.3). A trend for poorer stroke recovery and increased mortality was observed in warfarin-treated patients on univariate, but not on multivariable, analyses. Conclusions-Warfarin-treated patients with stroke have increased risks of symptomatic intracerebral hemorrhage after thrombolytic treatment. These data raise safety concerns of thrombolytic treatment in warfarin-treated patients with subtherapeutic international normalized ratio.