As we did, brain readapts and reassembles too and its reorganisation is well investigated in the AS19 BRAIN REORGANISATION AND RECOVERY section of E-posters on ESOC 2021 platform (very user-friendly, as usual). Here you can find interesting results about brain network rearrangement after stroke and about physiological mechanisms that are possible future targets for stroke rehabilitation (read “Somatotopy of the interhemispheric interactions reflected in physiological mirror activity: preliminary results” by Nazarova et al.

Talking about rehabilitation, you might want to explore the AS04 CLINICAL TRIAL RESULTS – REHABILITATION & RECOVERY section. If you already know that dysphagia is the main culprit of stroke-related pneumonia, you might want to read about possible technology-based assessment and treatment of swallowing impairment, such as “Swallow safety, timings and clearance: do multiple measures detect treatment effects? Analysis from the swallowing treatment of electrical pharyngeal stimulation (STEPS) trial” by Benfield et al and “Randomised controlled feasibility trial of swallow strength and skill training with surface electromyographic biofeedback in acute stroke patients with dysphagia” by Everton et al. In the same section, interesting findings of the pilot trial “Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke: a pilot randomized controlled trial” by Thijs et al provide new insights into sitting balance therapy.

Although the future seems quite pale in these hard times, remember that new technologies, informatics and artificial intelligence are getting stronger and stronger and can provide new diagnostic and prognostic tools. You might want to discover with Cognard et al how “Electrical impedance spectroscopy can be used to differentiate clot analogs of different composition” or you might want to read “A personalised recurrence stroke predictor based on artificial intelligence” by Colangelo et al in the AS35 – TECHNOLOGY INNOVATIONS: VIRTUAL REALITY, ARTIFICIAL INTELLIGENCE AND MORE. Artificial intelligence is investigated in the pre-hospital setting too by Lallana et al in the “Evaluation of the use of artificial intelligence as a pre-hospital tool for acute stroke diagnosis” poster.

After this brisk, virtual walk among more than 700 original contributions, we can definitely say that the ESO aim to tackle the burden of stroke, although challenged, fiercely goes on. We all hope to see each other – live – in Lyon, next year. Because, after all, Jagger continued “if you try sometime you find, you get what you need.”

Several E-posters caught my eye in the rapidly expanding field of heart-brain research. Prolonged cardiac monitoring for the detection of atrial fibrillation is an essential part of etiological workup in ESUS patients. However, this may not be possible in all patients in all settings. The authors of FREQUENT PAROXYSMAL ATRIAL COMPLEXES AND SUPRAVENTRICULAR TACHYCARDIA COULD GUIDE THE DIAGNOSIS OF HIDDEN ATRIAL FIBRILLATION IN PATIENTS WITH ESUS (Sanchez Fernandez et al.) have shown that cardiac rhythm biomarkers such as frequent atrial paroxysmal complexes and paroxysmal supraventricular tachycardia may indicate a higher rate of occult atrial fibrillation in stroke patients and therefore may be useful in selecting patients for prolonged cardiac monitoring.

Cardiac CT has become a useful tool in the etiological workup of stroke.  In SEQUENTIAL CARDIAC CT TO DETERMINE CARDIAC THROMBI DISSOLUTION RATE IN ACUTE ISCHEMIC STROKE Beemsterboer et al. have evaluated the cardiac thrombi dissolution rate during the acute phase of stroke. They demonstrated that cardiac thrombi may resolve within days of stroke occurrence, thus cardiac thrombi might not be detected on later imaging.  Early cardiac imaging therefore may improve detection of cardioembolic source in stroke.

Treating patients with lacunar stroke can be challenging as they may show early neurological deterioration (END). The authors of EARLY NEUROLOGICAL DETERIORATION IN LACUNAR STROKE: CLINICAL AND IMAGING PREDICTORS AND ASSOCIATION WITH LONG-TERM OUTCOME (Vynckier et al.) showed that END is common, occurring in 1 in 6 lacunar stroke patients. They demonstrate radiological and clinical variables that are associated with END including lower NIHSS on admission, capsular warning syndrome, ventral pontine infarction and hypoperfusion on imaging. Importantly, acute dual antiplatelet therapy was associated with reduced risk of END in this study.

Recanalization therapy of stroke in the prolonged time window currently requires penumbral imaging. However, this is not feasible in all settings.  Several studies evaluated surrogate markers on native CT imaging for selecting patients eligible for treatment in the extended time window.  In CEREBRAL ATTENUATION CHANGES ON NON-ENHANCED CT: A SURROGATE FOR CT PERFUSION–BASED PENUMBRAL TISSUE AND INFARCT CORE IN ACUTE ISCHEMIC STROKE (Alzahrani et al.) the authors showed that specific brain attenuation ratios on native CT can differentiate penumbral and core lesions. Based on the findings in CURRENT ROLE OF ADVANCED NEUROIMAGING AND ITS CORRELATION WITH NON-CONTRAST COMPUTED TOMOGRAPHY IN THE LATE WINDOW TREATMENT SELECTION (Rodrigo-Gisbert et al.) the authors suggest that simplified imaging in stroke patients in the extended time window may be reasonable in patients with an ASPECTS score ≥6 on non-contrast CT imaging.

Enjoy the rest of the conference and make sure to also head to the E-poster Gallery to discover more research in areas of interest to you!

Many studies focused on pre-hospital stroke care. An interesting study that caught my eye was presented by Ramos Pachón et al. from Spain. MEDICAL COMPLICATIONS DURING TRANSFER IN DRIP-AND-SHIP VS MOTHER-SHIP CIRCUITS: SECONDARY ANALYSIS OF RACECAT TRIAL. These authors found that patients in the mothership protocol had an increased risk of transfer complications (e.g. vomiting, GCS declining, RACE score worsening) compared with the drip-and-ship protocol. Transfer complications resulted in a higher odds of mortality and a worse clinical outcome.

Earlier identification of large vessel occlusion (LVO) patients was addresses is several studies. TELESTROKE: REAL-TIME VIDEO ANALYSIS ALLOWS IDENTIFICATION OF LVO IN PATIENTS WITH SUSPECTED STROKE was presented by S. Thielmann from Switzerland. This feasibility study in 97 suspected stroke patients concluded that their telestroke concept is feasible and that early identification of LVO-patients could be possible. This could lead to reduced onset-to-treatment-time, preparing for endovascular treatment, and an improved clinical outcome. I am very excited to learn the results of the planned main study that will start in 2022.

Another study that focused on early detection of LVO patients was the study by van Meenen et al from the Netherlands, DETECTION OF LARGE VESSEL OCCLUSION STROKE WITH ELECTROENCEPHALOGRAPHY IN THE EMERGENCY ROOM: FIRST RESULTS OF THE ELECTRA-STROKE STUDY. The authors present the results of the first 100 patients who presented to the emergency department with suspected or confirmed stroke and underwent dry electrode EEG. Of the 65 patients with sufficient data quality to perform the analysis, 35 had acute ischemic stroke and 9 had LVO of the anterior circulation. The EEG feature with the highest diagnostic accuracy for LVO stroke was theta-alpha ratio. The authors concluded that dry electrode EEG seems a promising tool for detection of LVO, although the quality of the data needs to be further improved and evaluation in the prehospital setting is also needed.

Another interesting study that caught my attention was presented by Krebs et al from Austria. CT- VERSUS MRI-BASED IMAGING FOR INTRAVENOUS THROMBOLYSIS IN ISCHEMIC STROKE. This observational study focused on the choice of initial imaging modality. The authors found that this did not have an effect on safety nor functional outcome after stroke treatment, although the door to needle time was considerably longer in the MRI group.

I hope I have given you an impression of  interesting posters we have this year. The E-poster gallery can still be visited, so please go ahead and take a look and enjoy the remaining talks of the ESOC 2021.

Tell us something about yourself.

I’m a physician originally from Costa Rica in the final months of my PhD in stroke medicine.

Tell us something about yourself.

I obtained my degree in Medicine at the University of Genoa in Italy in 2016. During my university studies I also completed the prestigious Biomedical Excellence Programme at the Institute of Superior Studies of the University of Genoa (ISSUGE). Also, with the added experience received after a research stay at the Medizinische Hochschule Hannover (MHH), which focus their research on peripheral nerve regeneration under the guidance of Prof. Kirsten Haastert-Talini, I achieved the certification for my research training programme in Neurology at the University of Genoa in 2016 under the guidance of Prof. Angelo Schenone.

I commenced my specialist training in neurorehabilitation in Pavia, Italy and then moved to Switzerland where I am currently working as a clinical researcher at the CHUV University Hospital and University of Lausanne where I am completing my specialist training as a neurologist together with an MD-PhD degree in stroke neurology at the University of Lausanne (UNIL) under the guidance of Prof. Patrik Michel.

My aspiration is to become an academic clinical researcher, developing expertise in the fields of stroke neurology and of neuroimaging in stroke. Hence, my main interests are in these two fields, focusing especially on acute stroke management, perfusion neuroimaging and outcome prediction.