In preparation for a planned change of Emergency Medical Services triaging of suspected stroke dispatch in Alberta, we conducted a modeling exercise to predict the return on investment (ROI) of switching from the current endovascular thrombectomy (EVT) within a 6 h window to a 24 h window.

Using the Alberta Health Services administrative databases, we estimated the health service utilization (HSU) (including inpatient, outpatient, physician services and prescription drugs) cost of patients with stroke treated with EVT24h following the case-mix group plus methodology. The impact of EVT on HSU cost avoidance (B) and the cost (C) of EVT24h implementation were estimated, including costs for EVT procedure, diagnostic imaging and ambulance for all suspected strokes. Finally, ROI was calculated as the benefit divided by the cost (ROI = B/C). Threshold, deterministic and probabilistic sensitivity analyses were performed.

There were 288 patients treated with EVT24h between 2021/22 and 2023/24. The HSU cost per patient in the year following EVT treatment was estimated at $92,201. Given the impact of EVT was 30%, the benefit of EVT was estimated at $39,515. The cost of EVT24h implementation was $24,358 per EVT patient. Accordingly, ROI was estimated at 1.6 (ranged 0.7−2.0), and cost avoidance per patient was $15,157 (ranged − $8013 to $25,362). Given that there were 96 EVT24h per year, the cost avoidance for the health system would be $1.5 million annually. The probabilistic sensitivity analysis showed that the probability for EVT24h to be cost-avoidable (or ROI > 1) was 88.5%.

The expansion of EVT from 6 to 24 h is expected to result in a positive ROI.

Apolipoprotein E (APOE), particularly the ϵ4 allele, is a well-established susceptibility gene for dementias. However, its role in other neurological diseases and injuries remains unclear. This study aims to evaluate APOE as a risk factor for nervous system conditions beyond dementias.

A systematic review was conducted from inception to May 2025 across six databases: PubMed, Embase, CINAHL, APA PsycInfo, Web of Science and Cochrane. Studies were included if they employed clinical research methodologies, involved adult participants, completed APOE genotyping and examined APOE as a susceptibility gene in nervous system injuries other than dementias.

Thirty-three studies met inclusion criteria, encompassing stroke (n = 16), traumatic brain injury (n = 11), cranial or peripheral neuropathies (n = 4) and degenerative cervical myelopathy (n = 2). The ϵ4 allele was most consistently associated with increased susceptibility to intracerebral hemorrhage and chronic traumatic encephalopathy. In contrast, no relationship was observed between APOE and cerebral concussion risk. Findings across other conditions including ischemic and hemorrhagic stroke, subarachnoid hemorrhage, post-traumatic seizures, decompressive hemicraniectomy, degenerative cervical myelopathy and peripheral neuropathies were inconsistent or limited by small sample sizes.

While the APOE genotype may influence susceptibility in intracerebral hemorrhage and chronic traumatic encephalopathy, further research is needed to clarify its broader role and underlying mechanisms in non-dementia nervous system diseases and injuries.

This study aims to evaluate differences in healthcare utilization among patients with ischemic stroke in metropolitan versus non-metropolitan Manitoba.

This study is a population-level analysis using the Discharge Abstract Database from Manitoba. The database includes all patients who received care in a Manitoba facility for ischemic stroke between April 2019 and March 2023. Data were collected on patient demographics, comorbidities and geographical location of stroke presentation (metropolitan Winnipeg vs non-metropolitan). Outcomes included length of stay (LOS), treatment, discharge disposition and mortality. Regression analysis was performed to analyze outcomes, adjusting for age, sex and comorbidities.

3704 (71.6%) patients were admitted in Winnipeg, and 1471 (28.4%) patients were admitted in non-metropolitan Manitoba. Patients presenting to Winnipeg were younger (mean age 72.3 vs 74.3 years) and had higher rates of atrial fibrillation, hypertension, diabetes, chronic kidney disease and heart failure. Patients presenting to Winnipeg had a shorter LOS (16.1 days vs 18.4 days, coefficient 0.05, 95% CI −4.54 to −1.27), had higher rates of intravenous thrombolysis (adjOR 5.13, 95% CI 3.85–6.84), were less likely to be discharged home (39.8% vs 57.5%, adjOR 0.47, 95% CI 0.41–0.53) and were more likely to be transferred for inpatient stroke rehabilitation (adjOR 3.46, 95% CI 2.64–4.54). There were no differences in in-hospital mortality. There was a higher incidence of stroke in Winnipeg compared to non-metropolitan Manitoba (F-statistic 23.84, p = 0.0028).

This study illustrates differences in healthcare utilization outcomes between patients living in metropolitan Winnipeg versus non-metropolitan Manitoba presenting with ischemic stroke.

Sensory burden, a momentary experience of being bothered by sensory stimuli, is a frequent challenge following acquired brain injury (ABI). This study quantitatively tested a theoretical model conceptualizing sensory burden as a dynamic interaction between situational triggers and an individual’s biopsychosocial resources using an experience sampling method.

41 individuals with ABI (median age = 59 years, median time since injury = 6.3 years) provided real-time data at seven semi-random intervals per day over seven consecutive days. Multilevel regression modeling assessed the influence of situational triggers (setting, company, effort, activity dissatisfaction, and negative affect) and individual resources (processing speed, fatigue, and sleep quality) on sensory burden.

Momentary fluctuations in sensory burden varied in severity and variability across individuals. Sensory burden was associated with higher levels of negative affect (β = .58, p < .01), activity dissatisfaction (β = .07, p < .01), effort (β = .09, p < .01), and being in company (β = .39, p < .01). Moreover, sensory burden was related to slower processing speed (β = −0.04, p = .02) and higher fatigue (β = .19, p < .01). However, no interaction effects were found. Effort was the only positive, significant between-person predictor (β = .56, p < .01).

These findings underscore the dynamic and individualized nature of sensory burden after ABI, emphasizing the need for personalized interventions targeting sensory hypersensitivity. Future research should explore additional triggers, resources, and causal pathways to further elucidate the proposed mechanisms and inform treatment development.

Stroke remains a major public health issue globally. Tele-rehabilitation, incorporating internet-based interventions and wearable devices, offers an accessible strategy for post-discharge rehabilitation. This study evaluates their effectiveness in stroke patients.

A total of 160 subacute stroke patients hospitalized between November 2022 and September 2023 were enrolled and randomly allocated to four groups at discharge (n = 40 per group): a control group receiving conventional rehabilitation, an internet-based tele-rehabilitation (ITR) group, a wearable-device-assisted (WDA) group and a combined intervention (IWT) group, which received both ITR and WDA training. The primary outcome was assessed by the Modified Barthel Index (MBI) at discharge, 4 weeks and 12 weeks post-discharge, with the 12-week score prespecified as the primary endpoint. Secondary outcomes included Berg Balance Scale (BBS), simplified Fugl-Meyer Assessment (sFMA), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Mini-Mental State Examination (MMSE) and Zarit Burden Interview (ZBI), all assessed at discharge, 4 weeks and 12 weeks post-discharge.

At baseline, no significant differences were observed among groups (P > 0.05). Over 12 weeks, all intervention groups demonstrated significant improvements in MBI, BBS and sFMA compared to the control group (P < 0.05), with the IWT group achieving the greatest gains (P < 0.01). Anxiety, depression and caregiver burden significantly decreased across intervention groups, with the IWT group showing the most pronounced reductions (P < 0.01). Cognitive function also improved significantly, particularly in the IWT group (P < 0.01).

ITR and WDA training enhances functional and psychological recovery in stroke patients, highlighting its potential clinical significance in managing stroke recovery.

Spatial neglect is a heterogeneous post-stroke disorder with subtypes differing in reference frames, processing stages, and spatial domains. While egocentric peri-personal neglect recovery has been studied, recovery trajectories of allocentric peri-personal visuospatial and personal neglect remain unclear. This study investigated recovery time courses of egocentric and allocentric peri-personal visuospatial and personal neglect during the first 12 weeks post-stroke; whether initial severity predicts recovery and defines distinct patient clusters; and how subtypes interrelate over time.

Forty-one first-ever stroke patients were evaluated at weeks 3, 5, 8, and 12 post-stroke using the Broken Hearts Test, Line Bisection Test, Visuospatial Search Time Test, and Fluff Test. Recovery was analyzed using linear mixed models, clustering with Gaussian finite mixture models, and interrelationships using Spearman correlations.

Significant improvements occurred in egocentric and allocentric peri-personal visuospatial and personal neglect, primarily between weeks 3 and 5, followed by a plateau. The Line Bisection Test detected no changes. Higher initial severity predicted greater residual impairment. Cluster analysis identified near-normal, mild, and moderate-to-severe baseline subgroups with distinct recovery trajectories. Moderate-to-good correlations (ρ = 0.33 – 0.55) emerged between egocentric and allocentric neglect at week 3 and when timepoints were pooled.

Neglect improved mainly between weeks 3 and 5 after which recovery plateaued, mirroring motor and language recovery and suggesting a shared time-limited window. Initial severity was a determinant of recovery, highlighting the value of early severity stratification to monitor and support recovery potential after stroke. As subtypes are distinctive, assessment should include multiple neglect tests.

There is an increasing number of patients with cancer and acute ischemic stroke (AIS). We aim to compare outcomes in patients treated with thrombolysis for AIS with a history of cancer to those without.

This is a post hoc analysis of the Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT) trial, evaluating tenecteplase versus alteplase in patients with AIS within 4.5 h of onset. ICD-10 codes via administrative data linkage were used to identify a history of cancer. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Other outcomes included mRS 0–1 at 90 days, return to pre-stroke function, mortality and bleeding. Analysis was done using logistic regression for binary outcomes adjusted for age, stroke severity, presence of cancer history and time from onset to needle. A generalized linear regression model was used for numeric outcomes, with effect measures reported as adjusted risk ratios (aRR).

Of the 1577 patients enrolled, 37 (2.35%) had a prior diagnosis of cancer. At 90 days, cancer patients were less likely to achieve 90-day mRS 0–2 (aOR of 0.33 [95% CI 0.15–0.75]) and had higher mortality (aOR 3.75 [95% CI 1.76–7.75]) as compared to those without cancer. Length of stay was longer in patients with cancer than those without cancer (median 11.5 days [IQR 7–24.5] vs 5 days [IQR 3–11], respectively, aRR 2.76 [95% CI 2.58–2.94]).

Patients with AIS and a history of cancer had worse functional outcomes, prolonged length of stay and higher rates of mortality as compared to those with no diagnosis of cancer.

Social deprivation is associated with worse functional recovery and social participation after stroke. Home-based, individualized rehabilitation provided by Community Stroke Rehabilitation Teams (CSRTs) improves these outcomes. This study aimed to show that CSRTs offered an effective specific rehabilitation for socially deprived patients.

This was a retrospective study conducted in real-care conditions. Social deprivation was assessed by the Evaluation de la Précarité et des Inégalités de santé dans les Centres d’Examens de Santé score. The outcome questionnaires included the Frenchay Activity Index (FAI) and the EuroQol-5Dimension. We compared these outcomes between deprived and non-deprived (ND) populations. Rehabilitation of the deprived population was assessed by comparing interventions across both groups.

We included 198 deprived patients and 140 ND patients. Deprived patients were more often women (p = 0.027), more likely to live alone at home (p = 0.01), and were referred later to a CSRT, despite having greater activity limitations at baseline (p < 0.001). They also had a lower FAI at baseline (13.2 vs. 16.6; p = 0.007). Although their FAI improved over time (+2.4 ± 5.5; p < 0.001), the improvement was modest and insufficient to close the gap with the ND group (15.7 vs. 20.7; p < 0.001). Regarding program characteristics, the deprived population received input from a greater number of healthcare professionals (2.7 ± 1.2 vs 2.4 ± 1.3; p = 0.017) and more often from the intervention “Health professional relationship” (34.2% vs 15.6%; p = 0.005).

These findings highlight the intersectionality of stroke-related challenges and the critical need to design post-stroke rehabilitation strategies that are more equitable and responsive to gender and social determinants of health.

To investigate potential contributors to mental fatigue after aneurysmal subarachnoid hemorrhage (aSAH) and angiographically negative subarachnoid hemorrhage (anSAH), with a focus on information processing speed, attentional control, and psychological distress.

This observational study included 101 patients (70 aSAH, 31 anSAH) and 86 controls. Neuropsychological assessments and questionnaires were conducted five months post-SAH. Mental and physical fatigue were assessed with the Dutch Multifactor Fatigue Scale, information processing speed and attentional control with the Trail Making Test and Vienna Test System Reaction Time and Determination Test, and psychological distress with the Hospital Anxiety and Depression Scale.

Patients reported significantly higher mental and physical fatigue than controls (p < .001) and information processing speed and attentional control were significantly lower (p < .05), with no differences between aSAH and anSAH groups. Severe mental fatigue was present in 55.7% of patients with aSAH and 61.3% of patients with anSAH, significantly exceeding the prevalence of severe physical fatigue (p < .05). Higher mental fatigue correlated with worse attentional control in aSAH and with lower information processing speed in anSAH. Both mental and physical fatigue correlated with psychological distress, particularly after anSAH.

The factors related to mental fatigue appear to differ based on the type of SAH, potentially involving problems in information processing speed and attentional control, psychological distress, or both. This study emphasizes the need for individualized rehabilitation strategies addressing both cognitive and psychological factors in managing mental fatigue after SAH.