Neurology

Perfusion mismatch steers EVT benefit in large-core stroke, mainly within 6 hours

In this post hoc ANGEL-ASPECT analysis, EVT improved 90-day mRS 0–3 only in large-core patients with perfusion mismatch imaged ≤6 hours. In that early window, mismatch-positive patients had substantially higher good-outcome rates with EVT than medical management (48.9% vs 28.4%; OR 2.41). Early presenters without mismatch showed no functional benefit from EVT, and >6-hour patients gained no clear benefit regardless of mismatch. Absence of mismatch was more frequent among early large-core presenters and was associated with diminished EVT responsiveness. All interaction tests were nonsignificant, so these findings are hypothesis-generating but support routine mismatch assessment even in early arrivals. 1

Anticoagulation after hemorrhagic transformation in cardioembolic stroke improves outcomes

Among 763 cardioembolic stroke patients with hemorrhagic transformation, anticoagulation led to better 3‑month mRS distributions than antiplatelets or stopping antithrombotics. Anticoagulation increased radiologic HT exacerbation compared with antiplatelets but did not raise symptomatic intracerebral hemorrhage risk. Symptomatic ICH occurred most often when antithrombotic therapy was discontinued and least often in anticoagulated patients. Drug discontinuation versus anticoagulation was associated with higher odds of symptomatic ICH and worse functional outcomes. These retrospective data suggest that hemorrhagic transformation alone should not automatically preclude anticoagulation in cardioembolic stroke, pending prospective confirmation. 2

Modifiable early motor reserve predicts long-term outcomes in de novo Parkinson disease

Using PPMI data from 566 drug-naive PD patients, investigators quantified motor reserve as better-than-expected motor scores for a given putaminal DAT loss. Baseline regular physical activity correlated with higher motor reserve, and motor reserve largely mediated activity’s beneficial effect on motor symptoms. Adequate dopaminergic therapy and sustained physical activity were associated with slower early decline of motor reserve over several years. Average early-years motor reserve, not baseline value, best predicted long-term motor outcomes, including progression to Hoehn/Yahr stage 3 (HR 0.50). Propensity-matched analyses supported these associations, underscoring counseling on sustained activity and appropriate treatment intensity soon after diagnosis. 3