Ching-Huang Lin

Background: Post-stroke autonomic dysfunction is a critical determinant of long-term prognosis. Reduced baroreceptor sensitivity (BRS), a marker of this dysfunction, has been linked to adverse outcomes, but its independent predictive value for functional recovery requires clarification. Aim: To evaluate the independent prognostic value of BRS measured in the acute phase of a first-ever ischemic stroke for predicting 12-month functional outcomes. Design: A prospective, single-center, observational cohort study. Methods: We enrolled 292 patients with a first-ever acute ischemic stroke. BRS was measured within 7 days of onset, typically between days 4 and 7, using the sequence method under standardized conditions. Patients were dichotomized into low-BRS (≤11 ms/mmHg) and high-BRS groups. The primary endpoint was 12-month functional outcome, assessed by the modified Rankin scale (mRS) and Barthel index (BI). We used inverse probability of treatment weighting (IPTW) and multiple logistic regression to assess the independent association between BRS and outcomes. Results: After adjustment, low BRS remained a significant independent predictor of poor 12-month outcomes. Patients in the low-BRS group had more than double the adjusted odds of an unfavorable outcome (mRS 3–6; adjusted OR 2.06, 95% CI 1.12–3.78) and more than triple the adjusted odds of moderate-to-severe dependency (BI ≤ 90; adjusted OR 3.13, 95% CI 1.63–6.00) compared with the high-BRS group. Conclusions: Reduced BRS in the acute phase of ischemic stroke was independently associated with poor 12-month functional outcomes. If confirmed in external cohorts and implemented with standardized protocols, BRS assessment may help early risk stratification after stroke.

The role of IV thrombolysis before endovascular thrombectomy (bridging thrombectomy, BT) in posterior circulation large-vessel occlusion stroke remains uncertain. This study evaluated the effectiveness and safety of BT compared with direct thrombectomy (DT) using data from 2 nationwide registries and an updated meta-analysis. Patients from collaborative registries in Taiwan and South Korea who underwent thrombectomy for vertebral, basilar, and posterior cerebral artery occlusions were included. This observational study included hospital-based registry data with standardized collection of treatments and outcomes. Propensity score matching was applied to adjust for baseline differences between BT and DT groups. Outcomes included 90-day modified Rankin Scale (mRS) score, mortality, successful reperfusion, and symptomatic intracranial hemorrhage (sICH). We also performed a systematic review and meta-analysis of observational studies comparing BT vs DT in posterior circulation large-vessel occlusion stroke. Among the combined 9,942 patients, 873 (median age 71, 32% female) who underwent thrombectomy for posterior circulation stroke were analyzed. Of them, 281 received BT and 592 received DT. BT was associated with a lower 90-day mRS score (median 3 vs 4; adjusted odds ratio [OR] 1.44 per 1-point improvement, 95% CI 1.09-1.91) and lower mortality (17.4% vs 26.9%; adjusted OR 0.51, 95% CI 0.33-0.81). The proportions of successful reperfusion (79.3% vs 81.1%) and sICH (2.5% vs 2.9%) were comparable. In propensity score-matched cohorts (n = 205 each), BT remained associated with better functional outcomes (OR 1.44, 95% CI 1.00-2.07) and reduced mortality (matched OR 0.45, 95% CI 0.26-0.78). The meta-analysis, which included 39 studies and 7,288 patients, confirmed that BT was associated with higher odds of achieving 90-day mRS score 0-2 (OR 1.57, 95% CI 1.28-1.94), 90-day mRS score 0-3 (OR 1.33, 95% CI 1.05-1.68), and lower mortality (OR 0.77, 95% CI 0.61-0.97), without an increased risk of sICH (OR 1.01, 95% CI 0.71-1.44). BT was associated with better 90-day functional outcomes and lower mortality, without increasing hemorrhagic risk in posterior circulation large-vessel occlusion stroke. These findings support the use of BT in eligible patients, pending further validation from randomized trials. This study provides Class III evidence that in patients with posterior circulation stroke undergoing thrombectomy, previous IV thrombolysis is associated with better 90-day functional outcomes and lower mortality without increasing hemorrhagic risk.

Stroke remains a leading cause of acquired physical disability globally, with upper limb motor impairment significantly affecting independence and quality of life. Currently, objective neurophysiological biomarkers are not routinely incorporated into stroke care. This study aimed to investigate the predictive value of MEPs for upper limb outcomes in acute ischemic stroke. This prospective cohort study included 133 adults experiencing their first acute ischemic stroke. Within 10 days of onset, participants underwent Motor-evoked potential (MEP) testing via transcranial magnetic stimulation (TMS) and were categorized as MEP+ (with preserved responses) or MEP- (with absent responses). Outcome measures included the Fugl-Meyer Assessment (FMA), Barthel Index, and modified Rankin Scale (mRS), assessed at baseline and 90 days. Logistic regression models adjusted for age and baseline stroke severity were used to determine the independent predictive value of MEP status. Among 133 patients (mean age 63.6 ± 12.2 years; 57.9% male), those with preserved MEPs (57.1%) demonstrated significantly better motor and functional outcomes at 90 days. MEP+ patients had higher FMA scores (61.0 ± 9.5 vs. 33.5 ± 25.5), Barthel Index scores (80.3 ± 25.0 vs. 57.7 ± 30.0), and greater odds of achieving minimal disability (mRS ≤ 1: 52.6% vs. 17.5%; all p < 0.001). Proportional recovery was also significantly higher in the MEP+ group for both the FMA and the Barthel Index (both p < 0.001). Early MEP assessment is a valuable prognostic tool for upper-limb stroke recovery, supporting its routine incorporation into clinical practice.

This case report discusses a 62-year-old male with treatment-resistant bipolar II depression and hypertension. After poor responses to multiple treatments, an add-on esketamine nasal spray (ESK-NS) was introduced in October 2022. Improvement was seen, and the patient’s depressive episode was nearly remitted during the maintenance phase. However, recurrence was noted when ESK-NS frequency was reduced to once every 2 months, indicating that the dosing frequency should be adjusted cautiously. The patient experienced common side effects, including dissociation, dizziness, and transient hypertension. Nifedipine was offered when his systolic blood pressure exceeded 160 mm Hg, accompanied by headache or dizziness. Blood pressure monitoring was essential throughout ESK-NS treatment. This report highlights esketamine’s potential for bipolar depression treatment and calls for further studies on its cardiovascular effects and proper management.

BACKGROUND: As populations age, there is an increasing need to optimize endovascular treatment (EVT) and to understand country-specific differences in East Asia. We harmonized stroke registries from Korea and Taiwan to enable comparisons of patient characteristics and outcomes, with a particular focus on the impact of age. METHODS: Multicenter prospective stroke registries in Korea (CRCS-K [Clinical Research Collaboration for Stroke in Korea]) and Taiwan (TREAT-AIS [Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke]) were harmonized to form a unified data set of patients undergoing EVT. Outcomes included 3-month modified Rankin Scale, symptomatic intracranial hemorrhage, and successful recanalization. We assessed the association between age and outcomes in the overall population and those who were aged ≥80 years using logistic regression models, adjusting for relevant covariates. RESULTS: A total of 9934 EVT cases (7835 from Korea and 2099 from Taiwan) were included from 2011 to 2023. Patients had a mean age of 70.1±12.9 years (57.6% male; median National Institutes of Health Stroke Scale score, 14 [interquartile range, 9–19]). Compared with Korean patients, Taiwanese patients had a higher prevalence of risk factors and more severe strokes, contributing to lower rates of favorable 3-month outcomes. Increasing age was associated with poorer EVT results; among patients ≥80 years, 18% achieved a modified Rankin Scale score of 0 to 2, compared with 46% of younger patients. However, the risk of symptomatic intracranial hemorrhage did not significantly increase with age (adjusted odds ratio per year, 1.01 [0.99–1.02]; adjusted odds ratio of ≥80 years, 0.98 [0.75–1.29]). Prestroke functional independence, baseline hemoglobin, and bridging thrombolysis were identified as significant modifiers of outcomes in the oldest patients. CONCLUSIONS: Taiwanese EVT patients had more risk factors and worse outcomes than Korean patients. Advanced age is associated with poorer functional recovery, yet selected older patients, particularly those who were functionally independent before the stroke or received bridging thrombolysis, demonstrated meaningful benefit. These results underscore the importance of individualized treatment strategies and careful patient selection, especially as populations continue to age.

Background and Purpose: As populations age, there is an increasing need to optimize endovascular treatment (EVT) for acute ischemic stroke. We harmonized prospective stroke registries from Korea and Taiwan to enable direct comparisons of patient characteristics and clinical outcomes, with a particular focus on the impact of advanced age. Methods: Prospective stroke registries in South Korea (CRCS-K) and Taiwan (TREAT-AIS) were harmonized to form a unified dataset of patients treated with EVT. EVT outcomes included 3-month modified Rankin Scale (mRS), symptomatic intracranial hemorrhage (SICH), and successful recanalization. We assessed the association between age and outcomes in the overall population and in those aged ≥80 years, adjusting for relevant covariates. Results: A total of 9941 EVT cases (7835 from Korea and 2106 from Taiwan) were included. Patients had a mean age of 70.1 ± 12.9 years (57.6% male, median NIHSS: 14 [IQR: 9–19]). Compared to Korean patients, Taiwanese patients had a higher prevalence of vascular risk factors and more severe strokes, contributing to lower rates of favorable 3-month outcomes. Increasing age was associated with poorer EVT results; among patients ≥80 years, only 18% achieved mRS 0–2, compared to 47% of younger patients. However, the risk of SICH did not significantly increase with age (adjusted OR per year: 1.00 [0.99–1.01]; adjusted OR ≥80 years: 1.05 [0.85–1.29]). Pre-stroke functional independence and bridging thrombolysis were identified as key modifiers of better outcomes even in the oldest patients. Conclusion: Taiwanese EVT patients had more risk factors and worse outcomes than Korean patients. Advanced age is associated with poorer functional recovery, yet selected older patients—particularly those who were functionally independent before the stroke or received bridging thrombolysis—demonstrated meaningful benefit. These results underscore the importance of individualized treatment strategies and careful patient selection, especially as populations continue to age.

BACKGROUND: Stroke-associated pneumonia (SAP) is a common poststroke complication but the influence of early neurological deterioration (END) on SAP risk remains unclear. We aimed to develop an easy-to-access model to predict SAP and evaluate the SAP–END relationship using the Glasgow Coma Scale (GCS). METHODS: This retrospective study enrolled consecutive patients aged ≥20 years with first-ever acute ischemic stroke at Kaohsiung Veterans General Hospital between January 1, 2010, and November 30, 2020. SAP was defined according to modified Centers for Disease Control and Prevention criteria. Patients’ baseline characteristics, laboratory data within 24 h, neurological findings, and serial GCS scores within 48 h were collected. Regression analysis was used to identify independent risk factors for SAP. RESULTS: Among 1009 enrolled patients, SAP occurred in 85 (8.4%) patients. Using multivariate analysis, END after admission (adjusted odds ratio [aOR] 2.94, 95% confidence interval [CI] 1.74–4.95, P<0.001) remained significant after adjusting for confounders. Initial GCS score <10 (aOR 2.30, 95% CI 1.30–4.06, P=0.004), National Institutes of Health Stroke Scale (NIHSS) score 5–15 (aOR 2.02, 95% CI 1.09–3.73, P=0.026) or ≥16 (aOR 3.45, 95% CI 1.72–6.89, P2.5 (aOR 2.10, 95% CI 1.28–3.46, P=0.004) were also significant. The area under the curve (AUC) of combined GCS score, END, NIHSS score, cardioembolism, stroke with undetermined type, and NLR was 0.83 (95% CI 0.78–0.87, P<0.001), which was superior to that of PANTHERIS scores (0.62, 95% CI 0.55–0.68, P<0.001). CONCLUSIONS: This study developed a simple predictive model for SAP using easily accessible and generally available parameters. GCS-based END was an independent risk factor for SAP. Early identification of SAP risk factors and reversible END causes may lower SAP incidence.

Motor recovery following a stroke is related to the initial stroke severity and corticospinal tract integrity. One of the outcomes representing corticospinal tract integrity is the motor evoked potential (MEP). This study aimed to investigate the predictive value of MEP for motor recovery in patients with acute ischemic stroke. Patients with hemiparesis secondary to initial acute ischemic stroke were enrolled. MEPs of the upper limb were assessed as preserved (MEP+) or absent (MEP-) response ≤10 days post-stroke. Fugl-Meyer assessment (FMA) was performed at baseline and post-stroke at 30 and 90 days. A modified Rankin scale (mRS) was conducted at 90 days post-stroke. Patients were divided into two groups according to the highest FMA score of MEP- patients. Generalized estimating equations and logistic regression were used for our study analysis. Sixty-one participants were included in this study. The highest FMA score of MEP- patients ≤10 days after stroke was 38. Among patients with an initial FMA score ≤38, FMA scores at 30 and 90 days post-stroke were significantly higher in MEP + patients than in MEP- patients. Proportional recovery at 30 and 90 days post-stroke was significantly higher in MEP + patients than in MEP- patients. MEP + patients had a higher percentage of good functional outcomes than MEP- patients, without statistical difference. Among patients with initial FMA score >38, FMA scores were 60.4 ± 4.8 and 63.9 ± 2.9 and proportional recovery was 65.2 ± 27.0% and 83.7 ± 24.6% at 30 and 90 days post-stroke, respectively. Among patients with moderate-to-severe ischemic stroke, MEP + patients had better motor recoveries (approximately 70%) than MEP- patients at 90 days post-stroke. MEP + patients had better functional outcomes than MEP- patients.